The SAGE Encyclopedia of LGBTQ Studies 1483371301, 9781483371306

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The SAGE Encyclopedia of

LGBTQ Studies

Editorial Board Editor Abbie E. Goldberg Clark University

Editorial Board Katherine R. Allen Virginia Tech Meg John Barker The Open University José A. Bauermeister University of Michigan Lisa Diamond University of Utah Nancy J. Knauer Temple University Ramona Faith Oswald University of Illinois at Urbana-Champaign

The SAGE Encyclopedia of

LGBTQ Studies 1

Edited by Abbie E. Goldberg Clark University

Copyright © 2016 by SAGE Publications, Inc. FOR INFORMATION: SAGE Publications, Inc. 2455 Teller Road Thousand Oaks, California 91320 E-mail: [email protected] SAGE Publications Ltd. 1 Oliver’s Yard 55 City Road London, EC1Y 1SP United Kingdom SAGE Publications India Pvt. Ltd. B 1/I 1 Mohan Cooperative Industrial Area Mathura Road, New Delhi 110 044 India SAGE Publications Asia-Pacific Pte. Ltd. 3 Church Street #10-04 Samsung Hub Singapore 049483

All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

Printed in the United States of America.

Library of Congress Cataloging-in-Publication Data Names: Goldberg, Abbie E., editor. Title: The SAGE encyclopedia of LGBTQ studies / edited by Abbie E. Goldberg. Description: Thousand Oaks, California : SAGE, [2016] | Includes bibliographical references and index. Identifiers: LCCN 2015038930 | ISBN 9781483371306 (hardcover: alk. paper) Subjects: LCSH: Gay and lesbian studies–Encyclopedias. | Gays–Encyclopedias. | Sexual minorities–Encyclopedias. Classification: LCC HQ75.15 .S24 2016 | DDC 306.7603– dc23 LC record available at http://lccn.loc.gov/2015038930

Acquisitions Editor: Maureen Adams Editorial Assistant: Jordan Enobakhare Developmental Editor: Sanford J. Robinson Production Editor: Tracy Buyan Reference Systems Manager: Leticia Gutierrez Copy Editors: Taryn Bigelow, Teresa Herlinger, Megan Markanich Typesetter: Hurix Systems Pvt. Ltd. Proofreaders: Lawrence W. Baker, Sarah Duffy, Scott Oney Indexer: Wendy Allex Cover Designer: Candice Harman Marketing Manager: Kay Stefanski

16 17 18 19 20 10 9 8 7 6 5 4 3 2 1

Contents Volume 1 List of Entries vii Reader’s Guide xiii About the Editor xxi Contributors xxii Introduction xxxiii Entries A B C D

1 103 179 279

E F G

349 391 425

Volume 2 List of Entries vii Reader’s Guide xiii Entries H I J K L

467 575 627 637 639

M N O P Q

729 807 829 833 895

Volume 3 List of Entries vii Reader’s Guide xiii Entries R S T

921 977 1167

V W Y

1279 1295 1317

Appendix: Organizations and Publications Providing Resources on LGBTQ Studies 1321 Index 1331

List of Entries Abstinence Only Until Marriage Access to Health Care. See Health Care System Activists in College Adolescent Pregnancy Adoption, Choices About Adoption, International Adoption, Legal Considerations in Adoption, Openness in Adoption and Foster Care Discrimination Adoption Type Adoption via the Child Welfare System Adults With LGBQ Parents Advance Health Care Planning Affirmative Therapy African American Sexualities Age of Consent Ageisms in LGBTQ Cultures Aging, Sex, and Sexuality Aging, Social Relationships, and Support Aging and Bisexuality Aging and Gay Men Aging and Lesbian Women Aging and Transgender People Ally Development and Programming Ally Experience American Indian Sexualities. See Native American/First Nation Sexualities Antigay Ballot Initiatives (and LGBTQ Activism) Anxiety Asexuality Asian American/Pacific Islander Sexualities Assisted Reproductive Technologies (ARTs) Athletes. See College Athletes; Sports, SexualMinority Men in; Sports, Sexual-Minority Women in

Bereavement. See Dying, Death, and Bereavement Bias in the Criminal Justice System “Big Data” Bias in LGBTQ Research Binational Same-Sex Couples and Families Biphobia Bisexual Inclusion in the LGBTQ Rights Movement Bisexual People and Community Bisexualities Bisexuality, Female Bisexuality, Male Black Colleges. See Historically Black Colleges and Universities, LGBTQ Students at Body Image Disturbance and Eating Disorders in LGBTQ People Body Modification Body Size and Weight Bondage, Dominance/Submission, Sadism/ Masochism (BDSM) Bondage and Discipline/Domination and Submission (BDSM). See Bondage, Dominance/ Submission, Sadism/Masochism (BDSM) Breast Care for Transgender People Bullying, Legal Protections Against Bullying, Rates and Effects of Bullying, School-Based Interventions for Business Butch–Femme Campus Climate Cancer and Social Support Cancer in the LGBTQ Community Career Development and Trajectories Caregiving Catholic LGBTQ People Causes of Sexual Orientation. See Essentialist– Constructionist Debate on the Origins of Sexual Orientation Child Support After LGBQ Divorce/Separation

Ballroom Scene, The Bear Community vii

viii

List of Entries

Children With LGBQ Parents, Academic Outcomes Children With LGBQ Parents, Female/Male Role Models Children With LGBQ Parents, Gender Development and Identity Children With LGBQ Parents, Psychosocial Outcomes Children With LGBQ Parents, Sexual Identity Children With LGBQ Parents, Stigmatization Children With Transgender Parents, Psychosocial Outcomes Christian LGBTQ People Chronic Illness Cisgenderism Closet, The COLAGE College Athletes College Students Colorado Designated Beneficiary Coming Out, Disclosure, and Passing Commitment Ceremonies Community Climate Coparenting Corrective Rape Couples Therapy Criminal Legal System and LGBTQ People Cross-Category Friendships Cultural Dissemblance (of African Americans) Custody and Litigation, LGBQ Parents Custody Issues in Transgender Parenting DADT. See Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell Dating, Sexual-Minority Men Dating, Sexual-Minority Women Deciding Whether to Parent Defense of Marriage Act (DOMA) Dementia Demographics and the LGBTQ Population Depression Developmental Aspects of Sexuality Developmental Disabilities. See Intellectual Disabilities Disabilities Among LGBTQ Elders Disciplinary Tensions in Studying LGBTQ Populations Discrimination Against LGBTQ Elders

Discrimination Against LGBTQ People, Cost of Discrimination Against LGBTQ People by Law Enforcement Discrimination Against LGBTQ People in the Public Sector Discrimination on the Basis of HIV/AIDS in Health Care Division of Labor in LGBTQ-Parent Families Divorce, Legal Issues in Divorce and Relationship Dissolution, Psychological Experience of Divorce and Separation, Historical Perspective on DOMA. See Defense of Marriage Act Domestic Partnership Domestic Violence, Female. See Intimate Partner Violence, Female Domestic Violence, Male. See Intimate Partner Violence, Male Don’t Ask, Don’t Tell and Public Opinion Down Low Drag Dying, Death, and Bereavement East Asian Sexualities Education Effeminacy Elder Abuse Embodiment Employment Non-Discrimination Act (ENDA) Essentialist–Constructionist Debate on the Origins of Sexual Orientation Ethical Debates About Surrogacy Ethical Research With Sexual and Gender Minorities Evolutionary Theory Ex-Gay Movement Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation Families of Choice Families of Origin, Relationships With Fertility Tourism. See International Surrogacy/ Reproductive Outsourcing Film Focus Groups Foster Care Foster Parenting Foster Parenting, Legal Considerations in

List of Entries

Fraternities and Sororities Freedom to Marry (and Other Marriage Equality Organizations) Friendships Gaming Gangs Gay, Lesbian & Straight Education Network (GLSEN) Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell Gay Gentrification Gay Sperm Donors Gayborhoods Gaydar Gay–Straight Alliances (GSAs) Gender Binaries Gender Clinics Gender Identity and Pregnancy. See Masculinity and Pregnancy Gender Identity Discrimination as Sex Discrimination Gender Nonconformity, Youth Gender Spectrum Gender Transition at Work Genderqueer GLAAD GSAs. See Gay–Straight Alliances (GSAs) Hate Crimes Health Care Plans Health Care Providers, Disclosure of Sexual Identity to Health Care System Health Disparities Health Disparities, Transgender People Health Insurance Coverage for Transgender People, Access to Heteronormativity Heterosexism Heterosexist Bias in Research Historically Black Colleges and Universities, LBGTQ Students at History of Transgender Medicine in the United States HIV and Treatment HIV/AIDS and Aging HIV/AIDS and Gay Masculinity

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HIV/AIDS and Racial/Ethnic Disparities HIV/AIDS and Social Support HIV/AIDS in Prison HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to Homelessness Home–School Partnerships in LGBTQ-Parent Families Homonormativity Homophobia Homophobic Language in the Peer Group Homosexuality, Female Homosexuality, Male Hormones and Surgery During Gender Transition Hospital Visitation Housing, Protection Against Discrimination in HRC. See Human Rights Campaign (HRC) Human Rights Campaign (HRC) Hypermasculinity Immigration Incarceration Infertility and Reproductive Loss Intellectual Disabilities Intentions and Motivations to Parent Internalized Homophobia International Surrogacy/Reproductive Outsourcing Interracial Relationships Intersections Between Sex, Gender, and Sexual Identity Intersex Society of North America Intersexuality Intimate Partner Violence, Female Intimate Partner Violence, Male It Gets Better Jewish LGBTQ People Joint Adoption Juvenile Justice System Kink Lambda Legal Latina/o Sexualities Laws Banning Homosexuality and Sodomy Leadership

x

List of Entries

Leather Culture Legal Consciousness Legal Recognition of Nonmarital Same-Sex Relationships Legal Rights of Nonbiological Parents Leisure Lesbian “Bed Death” LGB Parenting Styles and Values LGBQ Parents, Coming Out to Children LGBQ Parents and the Health Care System LGBT Consumer Market, The LGBTQ Grandparenting LGBTQ Health in Non-Western Contexts LGBTQ (In)Visibility Within College Contexts LGBTQ Issues in K–12 Education Across Global Contexts LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook LGBTQ People of Color LGBTQ Social Movements (Assimilation vs. Liberation) LGBTQ Umbrella LGBTQ-Parent Families With More Than Two Parents LGBTQ-Parent Involvement and Advocacy in Schools LGBT/Queer Studies Programs Living Arrangements of Children After LGBQ Divorce/Separation Long-Term Same-Sex Couples Marriage, Reasons for and Against Marriage Equality, Effects on Well-Being and Relationships Marriage Equality, Landmark Court Decisions Masculinities Masculinity and Pregnancy Masculinity Stereotypes Media Representations of LGBTQ People Men Who Have Sex With Men (MSM) Mentoring Methodological Decisions by Researchers of LGBTQ Populations Microaggressions Military and LGBTQ People Military and Transgender People

Minority Stress Mixed-Orientation Marriages Monogamy and Non-Monogamy Monosexism Morality and Respectability MSM. See Men Who Have Sex With Men (MSM) Multiracial LGBTQ-Parent Families Muslim LGB People Naming Practices National Center for Lesbian Rights (NCLR) Native American/First Nations Sexualities New Family Structures Survey. See Methodological Decisions by Researchers of LGBTQ Populations No Promo Homo Policies Nonbinary Genders Nonbiological, Nongestational Mother Nondiscrimination Protections, State and Local Nonheterosexual Children of LGBTQ Parents Online Communications. See LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook Online Surveys Origins of Heterosexuality and Nonheterosexuality. See EssentialistConstructionist Debate on the Origins of Sexual Orientation Pansexuality Parent Gender Transition and Intimate Relationship Changes Parent Relationship Quality Parental Well-Being Parent–Child Relationships Parents and Friends of Lesbians and Gays. See PFLAG Partners in (Gender) Transition Passing. See Strategic Disclosure PFLAG Physical Disabilities Physicians Police Officers/Law Enforcement Officials Policing Masculinities and Femininities Polyamorous Parenting

List of Entries

Polyamory Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity Pornography Posttraumatic Stress Poverty Powers of Attorney Prison Rape Professional Athletes Psychological Approaches to Studying LGBTQ People Qualitative Research Quantitative Research Queer Queer Anticapitalism Queer Ethnographies/Autoethnographies Queer Politics Queer Theory Queering Heteromasculinities Racialized Masculinity Relationships With Families Who Share the Same Donor Relationships With Former Spouses Relationships With Parents, Youth Relationships With Siblings, Youth Religion and Spirituality, Youth Religion/Spirituality and LGBTQ People Religious Freedoms and LGBTQ Rights Religious Identity and Sexuality, Reconciliation of Religious LGBTQ Youth Reproductive Outsourcing. See International Surrogacy/Reproductive Outsourcing Research, Use of Large Datasets in Resilience and Protective Factors, Youth Retirement Romantic Friendships Rural and Urban Communities Same-Sex Weddings Sampling School Choice in LGBTQ-Parent Families School Climate School Professionals’ Responses to LGBTQ Training

xi

School Selection. See School Choice in LGBTQ-Parent Families Schools as Heteronormative Spaces School-to-Prison Pipeline Scientific Integrity, Debates About Second-Parent Adoption Self-Insemination Senior Living Programs and Policies Sense of Belonging/School Climate in LGBTQ-Parent Families Services and Advocacy for GLBT Elders (SAGE) Sex Positive Movement Sex Reassignment Surgery. See Vaginoplasty for Transgender Women Sex Therapy Sex Work and Criminalization Sex Work and Prostitution, Female Sex Work and Prostitution, Male Sexology Sexual Addiction and Compulsions Sexual Agreements and Arrangements Sexual Attraction, Behavior, and Identity Sexual Compulsivity, Treatment of Sexual Consent Sexual Desire and Relationship Quality Sexual Education Mandates for Inclusion Sexual Fluidity Sexual Minorities and Violence Sexual Norms and Practices Sexual Orientation Among Transgender People Sexual Orientation Conversion Therapy Sexual Orientation Discrimination as Sex Discrimination Sexual Risk-Taking Sexual-Identity Labels Sexualities at School Sibling Relationships Single-Parent Adoption Sissyboy Experience Smoking Social Class Social Class and Sexuality, Intersections Between Social Media, Use for Recruitment Sororities and Fraternities. See Fraternities and Sororities Spatial/Social Location of LGBT Persons Sperm Donor, Choosing a

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List of Entries

Sperm Donor Selection and Race/Ethnicity Sperm Donors, Known Sperm Donors, Unknown Sperm Donors’ Involvement in Children’s Lives Sports, Sexual-Minority Men in Sports, Sexual-Minority Women in Stealth (Transgender Passing) Stepfamily Division of Labor and Money Management Stepfamily Family Functioning and Relationship Stability Stonewall Strategic Disclosure Substance Abuse and LGBTQ People Substance Abuse Treatment and Recovery Substance Abuse/Dependence and Transgender People Substance Use, Youth Suicide, Effects on Family and Friends Suicide, Risk Factors for and Prevention of Support Groups and Resources Surrogacy Surrogacy, Legal Considerations of Theories of Sexual Orientation Therapists, Training of Therapists’ Biases Regarding LGBTQ People Therapy With Children of LGBQ Parents Therapy With Families During and After Parental Gender Transition Therapy With LGBTQ Parents Therapy With LGBTQ Youth Therapy With Transgender, Transsexual, and Gender-Nonconforming People Therapy With Transgender Individuals: Mental Health Considerations Tomboy Experience Training of Teachers in LGBQ Sensitivity and Competence Transgender and Gender-Nonconforming Individuals and Bathrooms Transgender and Gender-Nonconforming Youth and the Legal System Transgender and Gender-Nonconforming Youth of Color Transgender Ethnographies

Transgender Geographies Transgender Health Care Transgender Identities Transgender Inclusion in the LGBTQ Rights Movement Transgender Inclusion on College Campuses Transgender Inmates Transgender Medicine. See History of Transgender Medicine in the United States Transgender Parents and Well-Being Transgender People and Binding, Tucking, and Packing Transgender People and Division of Labor Transgender People and Religion/Spirituality Transgender People and Violence Transgender Sexualities Transgender Students: Access to Sex-Segregated Facilities and Programs Transgender Youth and Cross-Sex Hormones Transgender Youth and Family Relationships Transgender Youth and Puberty Suppression Transgender Youth and Well-Being Transition to Parenthood and Parental Roles Transition to Parenthood for LGBTQ People Transphobia Transracial Versus Inracial Adoption Trevor Project, The Vaginoplasty for Transgender Women Veterans Violence and Victimization of Youth Visual Arts Wills and Trusts Work Environments Work–Family Interface, LGBQ Parents Workplace Discrimination Workplace Friendships Workplace Policies Workplace Relationships World Professional Association for Transgender Health WPATH. See World Professional Association for Transgender Health Youth and Dating

Reader’s Guide The Reader’s Guide is provided to aid readers in identifying entries on related topics. It classifies entries into 15 general topical categories: (1) Activism and Advocacy; (2) Family, Kin, and Friendship Networks; (3) Intersectionalities; (4) LGBTQ Identity and Politics; (5) LGBTQ People and Aging; (6) LGBTQ People, Health, and Well-Being; (7) LGBTQ Youth; (8) LGBTQ College Students/Young Adults; (9) Marriage and Divorce; (10) Parenting; (11) Research Methods; (12) Routes to Parenthood; (13) Sexuality and Intimate Relationships; (14) Societal Institutions and LGBTQ Issues; and (15) Work. Entries may appear in multiple categories, and often do. Activism and Advocacy

Family, Kin, and Friendship Networks

Activists in College Ally Development and Programming Ally Experience Antigay Ballot Initiatives (and LGBTQ Activism) Employment Non-Discrimination Act (ENDA) Freedom to Marry (and Other Marriage Equality Organizations) Gay, Lesbian & Straight Education Network (GLSEN) Gay–Straight Alliances (GSAs) Gender Spectrum GLAAD Human Rights Campaign Intersex Society of North America It Gets Better Lambda Legal National Center for Lesbian Rights (NCLR) No Promo Homo Policies PFLAG School Professionals’ Responses to LGBTQ Training Stonewall Trevor Project, The World Professional Association for Transgender Health

Aging, Social Relationships, and Support Ballroom Scene, The Bisexual People and Community Cancer and Social Support Caregiving Cross-Category Friendships Families of Choice Families of Origin, Relationships With Friendships HIV/AIDS and Social Support LGBTQ Grandparenting LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook Mentoring PFLAG Relationships With Families Who Share the Same Donor Relationships With Parents, Youth Relationships With Siblings, Youth Romantic Friendships Services and Advocacy for GLBT Elders (SAGE) Sibling Relationships Suicide, Effects on Family and Friends Support Groups and Resources Transgender Youth and Family Relationships Workplace Relationships xiii

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Reader’s Guide

Intersectionalities

African American Sexualities Asian American/Pacific Islander Sexualities Binational Same-Sex Couples and Families Catholic LGBTQ People Christian LGBTQ People Cultural Dissemblance (of African Americans) East Asian Sexualities HIV/AIDS and Gay Masculinity HIV/AIDS and Racial/Ethnic Disparities Intellectual Disabilities Interracial Relationships Intersections Between Sex, Gender, and Sexual Identity Intersexuality Jewish LGBTQ People Latina/o Sexualities LGBTQ People of Color Multiracial LGBTQ-Parent Families Muslim LGB People Native American/First Nations Sexualities Physical Disabilities Racialized Masculinity Religion/Spirituality and LGBTQ People Religious Identity and Sexuality, Reconciliation of Religious LGBTQ Youth Rural and Urban Communities Social Class Social Class and Sexuality, Intersections Between Sperm Donor Selection and Race/Ethnicity Transgender and Gender-Nonconforming Youth of Color Transgender People and Religion/Spirituality Transgender Sexualities LGBTQ Identity and Politics

Asexuality Ballroom Scene, The Bear Community Bisexual Inclusion in the LGBTQ Rights Movement Bisexual People and Community Bisexualities Bisexuality, Female

Bisexuality, Male Bondage, Dominance/Submission, Sadism/ Masochism (BDSM) Butch–Femme Cisgenderism Closet, The Coming Out, Disclosure, and Passing Community Climate Demographics and the LGBTQ Population Down Low Drag Effeminacy Embodiment Essentialist–Constructionist Debate on the Origins of Sexual Orientation Evolutionary Theory Ex-Gay Movement Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation Gay Gentrification Gayborhoods Gaydar Gender Binaries Gender Spectrum Genderqueer Homosexuality, Female Homosexuality, Male Hypermasculinity Internalized Homophobia Intersexuality Kink LGBTQ Social Movements (Assimilation vs. Liberation) LGBTQ Umbrella Masculinities Masculinity Stereotypes Morality and Respectability Nonbinary Genders Pansexuality Psychological Approaches to Studying LGBTQ People Queer Queer Anticapitalism Queer Ethnographies/Autoethnographies Queer Politics Queer Theory

Reader’s Guide

Queering Heteromasculinities Religious Identity and Sexuality, Reconciliation of Sexual Fluidity Sexual Identity Labels Sexual Orientation Among Transgender People Sissyboy Experience Stealth (Transgender Passing) Strategic Disclosure Theories of Sexual Orientation Tomboy Experience Transgender Ethnographies Transgender Identities Transgender Inclusion in the LGBTQ Rights Movement LGBTQ People and Aging

Advance Health Care Planning Ageisms in LGBTQ Cultures Aging, Sex, and Sexuality Aging, Social Relationships, and Support Aging and Bisexuality Aging and Gay Men Aging and Lesbian Women Aging and Transgender People Caregiving Dementia Disabilities Among LGBTQ Elders Discrimination Against LGBTQ Elders Dying, Death, and Bereavement Elder Abuse HIV/AIDS and Aging Powers of Attorney Retirement Senior Living Programs and Policies Services and Advocacy for GLBT Elders (SAGE) Wills and Trusts LGBTQ People, Health, and Well-Being

Advance Health Care Planning Affirmative Therapy Anxiety Biphobia Body Image Disturbance and Eating Disorders in LGBTQ People

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Body Modification Body Size and Weight Breast Care for Transgender People Cancer and Social Support Cancer in the LGBTQ Community Chronic Illness Couples Therapy Dementia Depression Disabilities Among LGBTQ Elders Discrimination on the Basis of HIV/AIDS in Health Care Dying, Death, and Bereavement Ex-Gay Movement Health Care Plans Health Care Providers, Disclosure of Sexual Identity to Health Care System Health Disparities Health Disparities, Transgender People Health Insurance Coverage for Transgender People, Access to History of Transgender Medicine in the United States HIV and Treatment HIV/AIDS and Aging HIV/AIDS and Gay Masculinity HIV/AIDS and Racial/Ethnic Disparities HIV/AIDS and Social Support HIV/AIDS in Prison HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to Hormones and Surgery During Gender Transition Hospital Visitation Intellectual Disabilities LGBTQ Health in Non-Western Contexts LGBTQ Parents and the Health Care System Marriage Equality, Effects on Well-Being and Relationships Men Who Have Sex With Men (MSM) Parental Well-Being Physical Disabilities Physicians Posttraumatic Stress Powers of Attorney

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Reader’s Guide

Sex Therapy Sexology Sexual Addiction and Compulsions Sexual Agreements and Arrangements Sexual Compulsivity, Treatment of Sexual Orientation Conversion Therapy Sexual Risk-Taking Smoking Substance Abuse and LGBTQ People Substance Abuse Treatment and Recovery Substance Abuse/Dependence and Transgender People Substance Use, Youth Suicide, Effects on Family and Friends Suicide, Risk Factors for and Prevention of Support Groups and Resources Therapists, Training of Therapists’ Biases Regarding LGBTQ People Therapy With Children of LGBTQ Parents Therapy With Families During and After Parental Gender Transition Therapy With LGBTQ Parents Therapy With LGBTQ Youth Therapy With Transgender, Transsexual, and Gender-Nonconforming People Therapy With Transgender Individuals: Mental Health Considerations Transgender Health Care Transgender Parents and Well-Being Transgender People and Binding, Tucking, and Packing Transgender Youth and Cross-Sex Hormones Transgender Youth and Puberty Suppression Transgender Youth and Well-Being Trevor Project, The Vaginoplasty for Transgender Women LGBTQ Youth

Abstinence Only Until Marriage Adolescent Pregnancy Age of Consent Bullying, Legal Protections Against Bullying, Rates and Effects of Bullying, School-Based Interventions for Developmental Aspects of Sexuality Foster Care

Gaming Gangs Gay, Lesbian & Straight Education Network (GLSEN) Gay–Straight Alliances (GSAs) Gender Clinics Gender Nonconformity, Youth Homophobic Language in the Peer Group It Gets Better LGBTQ Issues in K–12 Education Across Global Contexts LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook No Promo Homo Policies Nonheterosexual Children of LGBTQ Parents Relationships With Parents, Youth Relationships With Siblings, Youth Religion and Spirituality, Youth Religious LGBTQ Youth Resilience and Protective Factors, Youth School Climate School Professionals’ Responses to LGBTQ Training Schools as Heteronormative Spaces School-to-Prison Pipeline Sexual Education Mandates for Inclusion Sexualities at School Substance Use, Youth Therapy With LGBTQ Youth Therapy With Transgender, Transsexual, and Gender-Nonconforming People Tomboy Experience Training of Teachers in LGBQ Sensitivity and Competence Transgender and Gender-Nonconforming Individuals and Bathrooms Transgender and Gender-Nonconforming Youth and the Legal System Transgender and Gender-Nonconforming Youth of Color Transgender Students: Access to Sex-Segregated Facilities and Programs Transgender Youth and Cross-Sex Hormones Transgender Youth and Family Relationships Transgender Youth and Puberty Suppression Transgender Youth and Well-Being

Reader’s Guide

Trevor Project, The Violence and Victimization of Youth Youth and Dating

xvii

Powers of Attorney Relationships With Former Spouses Same-Sex Weddings Wills and Trusts

LGBTQ College Students/Young Adults

Abstinence Only Until Marriage Activists in College Ally Development and Programming Ally Experience Campus Climate Career Development and Trajectories College Athletes College Students Fraternities and Sororities Historically Black Colleges and Universities, LGBTQ Students at LGBTQ (In)Visibility Within College Contexts LGBT/Queer Studies Programs Transgender Inclusion on College Campuses Transgender Students: Access to Sex-Segregated Facilitates and Programs Marriage and Divorce

Child Support After LGBQ Divorce/Separation Colorado Designated Beneficiary Commitment Ceremonies Defense of Marriage Act (DOMA) Divorce, Legal Issues in Divorce and Relationship Dissolution, Psychological Experience of Divorce and Separation, Historical Perspective on Freedom to Marry (and Other Marriage Equality Organizations) Legal Consciousness Legal Recognition of Nonmarital Same-Sex Relationships Living Arrangements of Children After LGBQ Divorce/Separation Long-Term Same-Sex Couples Marriage, Reasons for and Against Marriage Equality, Effects on Well-Being and Relationships Marriage Equality, Landmark Court Decisions Mixed-Orientation Marriages Naming Practices Partners in (Gender) Transition

Parenting

Adoption, Legal Considerations in Adoption, Openness in Adults with LGBQ Parents Caregiving Child Support After LGBQ Divorce/Separation Children With LGBQ Parents, Academic Outcomes Children With LGBQ Parents, Female/Male Role Models Children With LGBQ Parents, Gender Development and Identity Children With LGBQ Parents, Psychosocial Outcomes Children With LGBQ Parents, Sexual Identity Children With LGBQ Parents, Stigmatization Children With Transgender Parents, Psychosocial Outcomes Coparenting Custody and Litigation, LGBQ Parents Custody Issues in Transgender Parenting Division of Labor in LGBTQ-Parent Families Foster Care Foster Parenting Foster Parenting, Legal Considerations in Home–School Partnerships in LGBTQ-Parent Families Joint Adoption Legal Rights of Nonbiological Parents LGB Parenting Styles and Values LGBQ Parents, Coming Out to Children LGBQ Parents and the Health Care System LGBTQ Grandparenting LGBTQ-Parent Families With More Than Two Parents LGBTQ-Parent Involvement and Advocacy in Schools Living Arrangements of Children After LGBQ Divorce/Separation Multiracial LGBTQ-Parent Families Naming Practices

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Reader’s Guide

Nonbiological, Nongestational Mother Nonheterosexual Children of LGBTQ Parents Parent Gender Transition and Intimate Relationship Changes Parental Well-Being Parent–Child Relationships Polyamorous Parenting Relationships With Families Who Share the Same Donor Second-Parent Adoption Sense of Belonging/School Climate in LGBTQ-Parent Families Single-Parent Adoption Sperm Donors’ Involvement in Children’s Lives Stepfamily Division of Labor and Money Management Stepfamily Family Functioning and Relationship Stability Surrogacy, Legal Considerations of Therapy With Children of LGBTQ Parents Therapy With Families During and After Parental Gender Transition Therapy With LGBTQ Parents Transgender Parents and Well-Being Transition to Parenthood and Parental Roles Transition to Parenthood for LGBTQ People Work–Family Interface, LGBQ Parents Research Methods

“Big Data” Bias in LGBTQ Research Disciplinary Tensions in Studying LGBTQ Populations Ethical Research With Sexual and Gender Minorities Focus Groups Heterosexist Bias in Research Methodological Decisions by Researchers of LGBTQ Populations Online Surveys Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity Qualitative Research Quantitative Research Research, Use of Large Datasets in Sampling Scientific Integrity, Debates About Social Media, Use for Recruitment

Routes to Parenthood

Adoption, Choices About Adoption, International Adoption, Legal Considerations in Adoption and Foster Care Discrimination Adoption Type Adoption via the Child Welfare System Assisted Reproductive Technologies (ARTs) Deciding Whether to Parent Ethical Debates About Surrogacy Foster Care Foster Parenting Foster Parenting, Legal Considerations in Gay Sperm Donors Infertility and Reproductive Loss Intentions and Motivations to Parent International Surrogacy/Reproductive Outsourcing Joint Adoption Masculinity and Pregnancy Nonbiological, Nongestational Mother Second-Parent Adoption Self-Insemination Single-Parent Adoption Sperm Donor, Choosing a Sperm Donor Selection and Race/Ethnicity Sperm Donors, Known Sperm Donors, Unknown Surrogacy Surrogacy, Legal Considerations of Transracial Versus Inracial Adoption Sexuality and Intimate Relationships

Adolescent Pregnancy Age of Consent Aging, Sex, and Sexuality Bear Community Bondage, Dominance/Submission, Sadism/ Masochism (BDSM) Butch–Femme Dating, Sexual-Minority Men Dating, Sexual-Minority Women Developmental Aspects of Sexuality Down Low Interracial Relationships

Reader’s Guide

Intersections Between Sex, Gender, and Sexual Identity Intersexuality Intimate Partner Violence, Female Intimate Partner Violence, Male Kink Leather Culture Lesbian “Bed Death” Long-Term Same-Sex Couples Men Who Have Sex With Men (MSM) Mixed-Orientation Marriages Monogamy and Non-Monogamy Monosexism Pansexuality Parent Gender Transition and Intimate Relationship Changes Polyamorous Parenting Polyamory Pornography Prison Rape Romantic Friendships Sex Therapy Sex Work and Criminalization Sex Work and Prostitution, Female Sex Work and Prostitution, Male Sexology Sexual Addiction and Compulsions Sexual Agreements and Arrangements Sexual Attraction, Behavior, and Identity Sexual Compulsivity, Treatment of Sexual Consent Sexual Desire and Relationship Quality Sexual Education Mandates for Inclusion Sexual Fluidity Sexual Norms and Practices Sexual Risk-Taking Transgender People and Division of Labor Transgender Sexualities Youth and Dating Societal Institutions and LGBTQ Issues

Adoption, Legal Considerations in Adoption and Foster Care Discrimination Bias in the Criminal Justice System Binational Same-Sex Couples and Families Biphobia Bullying, Legal Protections Against

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Bullying, School-Based Interventions for Business Community Climate Corrective Rape Criminal Legal System and LGBTQ People Custody and Litigation, LGBQ Parents Custody Issues in Transgender Parenting DADT. See Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell Defense of Marriage Act (DOMA) Discrimination Against LGBTQ Elders Discrimination Against LGBTQ People, Cost of Discrimination Against LGBTQ People by Law Enforcement Discrimination Against LGBTQ People in the Public Sector Discrimination on the Basis of HIV/AIDS in Health Care Don’t Ask, Don’t Tell and Public Opinion Education Employment Non-Discrimination Act (ENDA) Foster Care Foster Parenting, Legal Considerations in Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell Gender Identity Discrimination as Sex Discrimination Hate Crimes Health Care System Health Insurance Coverage for Transgender People, Access to Heteronormativity Heterosexism HIV/AIDS in Prison Homelessness Homonormativity Homophobia Housing, Protection Against Discrimination in Immigration Incarceration Juvenile Justice System Laws Banning Homosexuality and Sodomy Legal Consciousness Microaggressions Military and LGBTQ People Military and Transgender People Minority Stress

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Reader’s Guide

Monosexism No Promo Homo Policies Nondiscrimination Protections, State and Local Police Officers/Law Enforcement Officials Policing Masculinities and Femininities Pornography Poverty Prison Rape Religion/Spirituality and LGBTQ People Religious Freedoms and LGBTQ Rights Rural and Urban Communities School Climate Schools as Heteronormative Spaces School-to-Prison Pipeline Sex Work and Criminalization Sexual Minorities and Violence Sexual Orientation Discrimination as Sex Discrimination Social Class Spatial/Social Location of LGBT Persons Sports, Sexual-Minority Men in Sports, Sexual-Minority Women in Transgender and Gender-Nonconforming Individuals and Bathrooms Transgender and Gender-Nonconforming Youth and the Legal System Transgender Geographies Transgender Inmates Transgender People and Violence Transphobia

Violence and Victimization of Youth Workplace Discrimination Work

Business Career Development and Trajectories Employment Non-Discrimination Act (ENDA) Education Gender Transition at Work Health Care Plans Leadership Leisure LGBT Consumer Market, The Mentoring Physicians Police Officers/Law Enforcement Officials Professional Athletes Sports, Sexual-Minority Men in Sports, Sexual-Minority Women in Strategic Disclosure Transgender and Gender-Nonconforming Individuals and Bathrooms Veterans Visual Arts Work Environments Work-Family Interface, LGBQ Parents Workplace Discrimination Workplace Friendships Workplace Policies Workplace Relationships

About the Editor is the author of two books: Lesbian and Gay Parents and Their Children: Research on the Family Life Cycle (2010, APA), and Gay Dads: Transitions to Adoptive Fatherhood (2012, NYU Press). She is also the editor, with Katherine R. Allen, of LGBT-Parent Families: Innovations in Research and Implications for Practice (2013, Springer). She has received funding from the National Institutes of Health, the American Psychological Association, the Alfred P. Sloan Foundation, the Williams Institute, the Spencer Foundation, the Gay and Lesbian Medical Association, and the Society for the Psychological Study of Social Issues.

Abbie E. Goldberg is an Associate Professor in the Department of Psychology at Clark University in Worcester, Massachusetts. She received her PhD in clinical psychology from the University of Massachusetts Amherst and completed her clinical psychology internship at Yale Medical School. She has published over 70 peer-reviewed articles on lesbian/gay parenting, children of lesbian and gay parents, families formed through adoption, families formed via reproductive technologies, and other related topics. She is currently on the editorial boards of eight journals, including the Journal of Marriage and Family, the Journal of Family Psychology, and Adoption Quarterly. She

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Contributors Jon Arcelus  Nottingham Centre for Gender Dysphoria 

Kira Abelsohn  University of Calgary Roberto L. Abreu  University of Kentucky 

Mikaila Mariel Lemonik Arthur  Rhode Island College 

Katie L. Acosta  Georgia State University

Paige Averett  East Carolina University 

Tony E. Adams  Northeastern Illinois University

Kimberly F. Balsam  Palo Alto University 

Madelaine Adelman  Arizona State University 

Meg John Barker  The Open University

Alex Ajayi  University of Minnesota 

Katie M. Barrow  Louisiana Tech University 

John D. Allen  Rainbow Support Group 

Clare Bartholomaeus  Flinders University 

Katherine R. Allen  Virginia Tech 

Robin Bauer  Baden-Wuerttemberg Cooperative State University Stuttgart University of Hamburg

Leslie C. Allen  Temple University Louisa Allen  University of Auckland 

José A. Bauermeister  University of Michigan 

Kathryn Almack  University of Nottingham 

Joel Baum  Gender Spectrum 

Ellen Ann Andersen  University of Vermont 

Amanda K. Baumle  University of Houston 

Eric Anderson  University of Winchester 

Genny Beemyn  University of Massachusetts Amherst

Simon Andrade  New York City Department of Health and Mental Hygiene 

Daryl J. Bem  Cornell University  Diana C. Bennett  University of Utah 

Y. Gavriel Ansara  University of Surrey  xxii

Contributors

Kristen E. Benson  North Dakota State University  Israel Berger  University of Sydney  Dana Berkowitz  Louisiana State University CJ Bishop  University of Saskatchewan  Kaitlin A. Black  Clark University  Karen L. Blair  University of Utah  Lucy Blake  Centre for Family Research  Bernadette Blanchfield  University of Virginia 

Taylor N. T. Brown  University of California, Los Angeles, School of Law  Kath Browne  University of Brighton  Michael D. Brubaker  University of Cincinnati  Douglas Bruce  DePaul University Stephanie Budge  University of Wisconsin–Madison  Joan M. Burda  Lawyer, Lakewood, Ohio Case Western Reserve University School of Law Carol M. Burns-Wortham  Oakland University 

Madelyn J. Boesen  GLSEN (Gay, Lesbian & Straight Education Network) 

Catherine Butler  University of Bath

Derek M. Bolen  Angelo State University 

Thomas Stone Carlson  North Dakota State University

Alexander A. Boni-Saenz  IIT Chicago-Kent College of Law 

Mark Carrigan  University of Warwick

Amy Brainer  University of Michigan–Dearborn 

Sheila L. Cavanagh York University

Ana Maria Brandão  University of Minho 

Peter J. D. Ceglarek  University of Michigan 

Mark Brennan-Ing  ACRIA 

Michael P. Chaney  Oakland University

Barbara G. Brents  University of Nevada, Las Vegas 

Shannon D. Chaplo  University of Utah

Melanie E. Brewster  Teachers College, Columbia University 

Lisa Chauveron  Montclair State University 

Tristan Bridges  College at Brockport, State University of New York 

John L. Christensen  University of Connecticut 

David Brodzinsky  National Center on Adoption and Permanency 

Bryan N. Cochran  University of Montana  Christopher C. Collins  Angelo State University 

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Contributors

Devin B. Collins  Angelo State University 

Michael P. Dentato  Loyola University Chicago 

D’Lane R. Compton  University of New Orleans 

Lisa Diamond  University of Utah 

Ingrid Arnet Connidis  University of Western Ontario 

Lore M. Dickey  Louisiana Tech University 

Loree Cook-Daniels  FORGE 

Brian Dodge  Indiana University–Bloomington 

Jacqueline E. Coppock  Our Lady of the Lake University 

Daniela G. Domínguez  Our Lady of the Lake University 

Caroline Mala Corbin  University of Miami

Jordan B. Downing  Tewksbury Hospital 

Robert W. S. Coulter  University of Pittsburgh 

Harley Dutcher  University of Michigan 

Betsy Crane  Widener University 

Rebecca Eaker  University of Georgia 

Christa Craven  College of Wooster Sara L. Crawley  University of South Florida  Jason Lee Crockett  Kutztown University of Pennsylvania  John Marc Cuellar  Angelo State University  John G. Culhane  Widener University School of Law  Elizabeth Currans  Eastern Michigan University 

Jennifer Earles  University of South Florida Shiri Eisner  Tel Aviv University  John P. Elia  San Francisco State University Michele J. Eliason  San Francisco State University  Autumn Elizabeth  Otto-Friedrich Universität/Université Paris 7  Kate Ellis-Davies  University of Cambridge 

Nicola Curtin  Clark University 

Rachel Epstein  LGBTQ Parenting Network, Sherbourne Health Centre 

Roshan das Nair  University of Nottingham 

Chana Etengoff  Barnard College, Columbia University 

Jack K. Day  University of Texas at Austin 

Breanne Fahs  Arizona State University 

Karin De Angelis  U.S. Air Force Academy 

Rachel H. Farr  University of Massachusetts Amherst 

Deborah Dempsey  Swinburne University 

Ruth E. Fassinger  University of Maryland, College Park 

Contributors

Alicia L. Fedewa  University of Kentucky 

David Godfrey  American Bar Association 

Brian A. Feinstein  Stony Brook University 

Abbie E. Goldberg  Clark University 

Matthew B. Feldman  New York City Department of Health and Mental Hygiene 

Susan Golombok  University of Cambridge 

Leigh E. Fine  Kansas State University  Joseph Fischel  Yale University Jessica N. Fish  University of Arizona 

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Andrew Gorman-Murray  University of Western Sydney  Erika L. Grafsky  Virginia Tech  Jamison Green  California Institute of Integral Studies 

Corey Flanders  Centre for Addiction and Mental Health 

Emily A. Greytak  GLSEN (Gay, Lesbian & Straight Education Network) 

Sarah C. Fogel  Vanderbilt University 

Pat Griffin  University of Massachusetts Amherst 

Karen I. Fredriksen-Goldsen  University of Washington 

Beth A. Haines  Lawrence University 

M. Reuel Friedman  University of Pittsburgh 

Douglas C. Haldeman  John F. Kennedy University 

Megan Fulcher  Washington & Lee University 

Corie Jo Hammers  Macalester College 

Jacqui Gabb  The Open University

Sela Harcey  Iowa State University 

Leslie J. Gabel-Brett  Lambda Legal 

Debra A. Harley  University of Kentucky 

M. Paz Galupo  Towson University 

Gary W. Harper  University of Michigan School of Public Health 

Gary J. Gates  University of California, Los Angeles, School of Law 

Angelique Harris  Marquette University 

Trevor G. Gates  College at Brockport, State University of New York 

Amira Hasenbush  Williams Institute  Kristina M. Hash  West Virginia University

Rod Patrick Githens  University of the Pacific 

Nikki Hayfield  University of the West of England 

Hillary A. Gleason  University of Montana 

Brian Heaphy  University of Manchester 

xxvi

Contributors

Robert B. Heasley  Indiana University of Pennsylvania 

Kipp Jarecke-Cheng  Nurun

Anna Heller  Anna Heller Psychotherapy 

Rusi Jaspal  De Montfort University

Shane B. Henise  Towson University 

Sandra Jeppesen  Lakehead University 

Alyssa J. Henry  Independent Practice

Michelle Marie Johns  CDC Foundation

Cara Herbitter  University of Massachusetts Boston 

Lon B. Johnston  Texas A&M University–Commerce 

Jody L. Herman  Williams Institute 

Tim R. Johnston  SAGE (Services and Advocacy for GLBT Elders) 

Amy L. Herrick  University of Pittsburgh  Darryl B. Hill  College of Staten Island Jennifer Hillman  Penn State University, Berks College  Laura Hills  Brunel University London Lisa Hollis-Sawyer  Northeastern Illinois University  Elizabeth G. Holman  University of Illinois at Urbana-Champaign  Stacy Holman Jones California State University, Northridge M. Morgan Holmes  Wilfrid Laurier University  Warwick Hosking  Victoria University  David M. Huebner  University of Utah 

Marjorie Jolles  Roosevelt University  Rebecca L. Jones  The Open University Courtney G. Joslin  University of California, Davis  Adam Jowett  Coventry University  Christine Elizabeth Kaestle  Virginia Tech  David M. Kaplan  Saint Louis University  Emily Kazyak  University of Nebraska–Lincoln Kristin Kelley  Indiana University  Janna Kellinger  University of Massachusetts Boston 

Kim Hughes  University of Georgia 

Joshua G. Kellison  U.S. Department of Veterans Affairs 

Áine M. Humble  Mount Saint Vincent University 

Brian L. Kelly  Loyola University Chicago 

Marcus Anthony Hunter  Yale University 

Suzanne A. Kim  Rutgers University 

Caroline J. Huxley  University of Warwick 

Shawn D. King  West Virginia University 

Contributors

Lori Kinkler  Hampshire College

Nicholas A. Livingston  University of Montana 

Christian Klesse  Manchester Metropolitan University

Catherine A. Lugg  Rutgers University 

Nancy J. Knauer  Temple University

Jason Lydon  Black and Pink 

Emily Knox  Texas A&M University 

Anthony Lyons  La Trobe University

Joseph Kosciw  GLSEN (Gay, Lesbian & Straight Education Network) 

Phillip M. Lyons  Sam Houston State University 

Katrina Kubicek  Children’s Hospital Los Angeles  Kiersten Kummerow  Georgia State University  Katherine A. Kuvalanka  Miami University  Samantha Kwan  University of Houston  Pamela Lannutti  La Salle University  Erin S. Lavender-Stott  Virginia Tech Marianne LeBreton  McGill University  Stephen Lee  Santa Clara University  Kari Lerum  University of Washington, Bothell  Arlene Istar Lev  University at Albany, State University of New York 

Megan C. Lytle  University of Rochester Medical Center  Tiffany G. Maglasang  University of Oklahoma  Gerald Mallon  Hunter College Christy Mallory  Williams Institute  Marianne Mankowski  West Virginia University  Emily S. Mann  University of South Carolina  Jimmie Manning  Northern Illinois University  Liz Margolies  National LGBT Cancer Network  Robin Maril  Human Resource Campaign Robin Marquis  COLAGE  Laura Maycock  Pioneer Women’s Health 

Jennifer Levi  Western New England University

Sara I. McClelland  University of Michigan 

Heidi M. Levitt  University of Massachusetts Boston 

Emily McCormick  University of California 

Michele K. Lewis  Winston-Salem State University 

Jeffrey Q. McCune Jr.  Washington University in St. Louis

Rachel Lewis  George Mason University 

Elizabeth McDermott  Lancaster University 

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Contributors

Christi R. McGeorge  North Dakota State University 

Frank Muscarella  Barry University 

Dianah McGreehan  Angelo State University 

Omar Mushtaq  University of California, San Francisco 

Jenifer K. McGuire  University of Minnesota 

Kevin L. Nadal  John Jay College 

Sarah M. Merrill  Cornell University 

Joel T. Nadler  Southern Illinois University Edwardsville 

Mallory Merryman  Smith College 

Margaret Nichols  Institute for Personal Growth 

Nancy J. Mezey  Monmouth University

Elly-Jean Nielsen  University of Saskatchewan 

Shannon Minter  National Center for Lesbian Rights 

Nkiru Nnawulezi  Michigan State University 

Renae C. Mitchell  Towson University 

Petra Nordqvist  University of Manchester 

Ayako Miyashita  Williams Institute  Lauren Mizock  Worcester State University  Joey L. Mogul  People’s Law Office  Lyndsey Moon  Roehampton University  Mignon R. Moore  Barnard College–Columbia University  Todd G. Morrison  University of Saskatchewan  Alison Rose Moss  University of Illinois at Chicago Indiana University South Bend 

Isabelle Notter  Brown University  Gillian Oakenfull  Miami University  Kathryn M. Oost  University of Montana  Nancy A. Orel  Bowling Green State University  Jason Orne  University of Wisconsin–Madison  Ramona Faith Oswald  University of Illinois at Urbana-Champaign  Sara B. Oswalt  University of Texas at San Antonio 

Lauren Moss  Kutztown University 

James E. Parco  Colorado College 

Sarah Mountz  California State University, Northridge 

C. J. Pascoe  University of Oregon

April M. Moyer  Clark University 

Kenneth M. Pass  University of Michigan School of Public Health 

Jason P. Murphy  Rutgers, The State University of New Jersey 

Charlotte J. Patterson  University of Virginia 

Contributors

xxix

Crystal Paul  Louisiana State University 

Jennifer J. Reed  University of Nevada, Las Vegas 

Elizabethe Payne  QuERI 

Sari L. Reisner  Harvard School of Public Health/Fenway Health 

Rodney Pennamon  Webster University 

Kristen A. Renn  Michigan State University 

Carla A. Pfeffer  University of South Carolina 

Ryan T. Ricarte  University of Pittsburgh 

Erich N. Pitcher  Michigan State University 

Christina Richards  Nottinghamshire Healthcare NHS Trust 

Charles Joseph Polihronakis  Columbia University–Teachers College 

Hannah B. Richardson  Cambridge Health Alliance/Harvard Medical School 

Nancy D. Polikoff  American University Washington College of Law  Amanda M. Pollitt  University of Arizona  V. Paul Poteat  Boston College  Daniel Potter  American Institutes for Research  Emma C. Potter  Virginia Tech  Brian Powell  Indiana University  Jennifer Power  La Trobe University Australian Research Centre in Sex, Health and Society  Sharon E. Preves  Hamline University  Elizabeth Price  University of Hull  Anastasia Prokos  Iowa State University 

Niall Richardson  University of Sussex  Damien W. Riggs  Flinders University  Christina Rincon  Palo Alto University  Rachel G. Riskind  Guilford College  Ian Rivers  Brunel University London  Karen A. Roberto  Virginia Tech  Tonette S. Rocco  Florida International University  Eric M. Rodriguez  New York City College of Technology  Carlos Rodríguez-Díaz  University of Puerto Rico  Katrina Roen  University of Oslo 

Victoria Rawlings  Lancaster University 

Adam P. Romero  Williams Institute, University of California, Los Angeles, School of Law 

Victor J. Raymond  Madison College 

Margaret Rosario  City University of New York 

xxx

Contributors

Suzanna M. Rose  Florida International University 

Elisabeth Sheff  Sheff Consulting Group 

Dana Rosenfeld  Keele University 

David L. Shmerler  Kings County Hospital Center 

Emily Rothman  Boston University School of Public Health 

Ray Siebenkittel  Louisiana State University 

Alice Ruby  Sperm Bank of California 

Tony James Silva  Southern Illinois University–Carbondale 

Nick Rumens  Middlesex University

Erin Silver  University of Southern California

Maya Rupert  National Center for Lesbian Rights

Paul Simpson  University of Manchester 

Glenda M. Russell  University of Colorado 

Anneliese Singh  University of Georgia 

Stephen T. Russell  University of Texas at Austin 

Susan E. Smalling  St. Olaf College 

Sage E. Russo  San Francisco State University  Maura Ryan  Georgia State University  Elizabeth M. Saewyc  University of British Columbia  Ritch C. Savin-Williams  Cornell University  Joanna E. Scheib  University of California, Davis  Vanessa Schick  University of Texas  Mimi Schippers  Tulane University  Leighton Seal  West London Mental Health NHS Trust  Brad Sears  Williams Institute, University of California, Los Angeles, School of Law 

David G. Smith  U.S. Naval Academy  Melissa J. Smith  QuERI  Shannon Snapp  California State University, Monterey Bay  Jorge Soler  University of Michigan  Sarah M. Steelman  Virginia Tech  Amy C. Steinbugler  Dickinson College Lauren Charles Stewart  University of Oregon  Matthew C. Stief  Cornell University  Mindy Stombler  Georgia State University 

Lori Sexton  University of Missouri–Kansas City 

Amy L. Stone  Trinity University 

Julie Shapiro  Seattle University 

Rebecca L. Stotzer  University of Hawaii 

Contributors

xxxi

Jennifer Sumner  California State University, Dominguez Hills 

Pamela Valera  Columbia University Medical Center

Jason Sumontha  University of Virginia 

Brad van Eeden-Moorefield  Montclair State University

Francisco I. Surace  University of Massachusetts Boston 

Reid Vanderburgh  Author and Retired Therapist

Elizabeth A. Suter  University of Denver

Amanda Veldorale-Griffin  The Family Alliance

Eric Swank  Arizona State University 

Muriel Vernon  University of California, Los Angeles

Ariella Tabaac  Virginia Commonwealth University 

Jay C. Wade  Fordham University

Joshua A. Tabak  Cornell University 

Ryan M. Wade  University of Michigan School of Public Health 

Fiona Tasker  Birkbeck University of London

Sarah Warbelow  Human Rights Campaign 

Yvette Taylor  Weeks Centre for Social and Policy Research at London South Bank University

Sue Westwood  University of Surrey

Cynthia J. Telingator  Harvard Medical School  Brian C. Thoma  University of Utah  Charee M. Thompson  Ohio University 

Chassitty N. Whitman  John Jay College of Criminal Justice  Chris Wienke  Southern Illinois University–Carbondale  Tarynn M. Witten  Virginia Commonwealth University 

Russell B. Toomey  University of Arizona 

Carolyn Wolf-Gould  A.O. Fox Memorial Hospital, Bassett Health Care 

Samantha L. Tornello  Pennsylvania State University–Altoona 

Evan Wolfson  Freedom to Marry 

Mark Totten  Humber College 

Gust A. Yep  San Francisco State University 

Noah Tsika  Queens College, City University of New York 

Adam F. Yerke  Chicago School of Professional Psychology 

Debra Umberson  University of Texas at Austin 

Sheila York  York University

Introduction Fifty years ago, or even 10 years ago, many of the entries in this encyclopedia could not have been produced. Although interest in—and research on—issues related to LGBTQ lives and concerns in the United States and beyond have been proliferating in recent years, both have seen particularly rapid growth in the past decade or so. Today, a careful reading of the New York Times or other national media outlets reveals almost daily coverage of some aspect of LGBTQ life or politics. Further, in the past 5 years in particular, major legislative shifts have occurred (e.g., the repeal of Don’t Ask, Don’t Tell in 2011; nationwide recognition of same-sex marriage in 2015), reflecting and marking the ways in which societal attitudes toward LGBTQ people have shifted. Of course, as journalist Michelangelo Signorile warns in his 2015 book, It’s Not Over: Getting Beyond Tolerance, Defeating Homophobia, and Winning True Equality, there are many areas in which LGBTQ people, and particularly transgender and genderqueer people, face continued discrimination and associated challenges. Signorile highlights the high rates of violent crimes against LGBTQ people— and, in particular, trans women of color—as an example of evidence that the fight for equality for LGBTQ people is far from over. He also points out the continued difficulties surrounding fair housing and employment opportunities that LGBTQ people continue to face, given the absence of national laws prohibiting discrimination in these areas on the basis of sexual orientation or gender identity. But regardless of whether one views the past decade or so as a time of considerable achievement with regard to LGBTQ rights issues, or as a time of advancement in some areas and stalled progress

in others, it is certain that issues related to LGBTQ lives—including those related to school experiences, violence, suicide, activism, resilience, family formation, and aging—have increasingly moved away from the distant margins of societal awareness, thus demanding attention from legislators, policy makers, and researchers. Researchers from numerous disciplines have turned to, or intensified their focus on, LGBTQ issues; this research, in turn, has been used to inform key political and legislative decisions, such as the recent U.S. marriage equality decision. Indeed, once regarded by some as a relatively small minority with little public influence or voice, the LGBTQ community, and its allies, has established itself as a visible, diverse, and influential presence in society—one worthy of an encyclopedia on topics as diverse as homelessness, military involvement, and reproductive experiences. The disciplines represented in the encyclopedia are diverse. Some of the more central disciplines represented are psychology, sociology, family studies, legal studies, and social work; however, the work of scholars in other disciplines, such as anthropology and marketing, are also represented. The wide range of topics in this encyclopedia required an interdisciplinary team of top scholars. In turn, the resulting entries complement and enrich each other, such that a scholar or student interested in LGBTQ aging, for example, could deepen his or her understanding of this topic by reading entries on aging from multiple disciplines and vantage points (e.g., there are separate entries on lesbian, gay, bisexual, and trans aging; there are also entries on advance health care plans, health care discrimination, retiring, and dying and bereavement).

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Introduction

Why an Encyclopedia on LGBTQ Studies? General interest in and research on LGBTQ studies have proliferated. One place where interest in this area is particularly high is in the university setting. As undergraduate and graduate courses increasingly acknowledge LGBTQ-related issues and topics, even offering opportunities to do papers and projects related to LGBTQ studies, students increasingly look for resources and reference materials to assist them in learning and writing about such issues. Librarians and professors alike are often uncertain where to turn for a comprehensive and diverse set of articles or chapters that are introductory enough for a student to gain a basic understanding of the topic, but also sufficiently nuanced and well-referenced for graduate students and faculty to gain something from them as well. Knowledge of student and faculty concerns, combined with an innate interest in and excitement about the explosion of societal interest in and research on LGBTQ-related topics, led me (Abbie E. Goldberg) to develop the initial concept for this project with Maureen Adams, acquisitions editor at SAGE. Initial conversations with colleagues—some of whom were ultimately invited to join the editorial board—enabled us to further develop and refine this initial vision. Careful selection of the editorial team resulted in an interdisciplinary team of top scholars with complementary expertise. Namely, the editorial team consisted of Katherine Allen (human development and family studies), Meg Barker (psychology), José Bauermeister (psychology), Lisa Diamond (psychology), Nancy Knauer (law), and Ramona Oswald (human development and family studies). Upon assembling a top-notch editorial team, we then reached out to a diverse and interdisciplinary group of potential authors.

The Process The editorial team began by selecting potential topics for the encyclopedia, conducting online searches of books, journals, and textbooks on various topics related to LGBTQ studies. Effort was made to emphasize sources in the social sciences, but also to consider topics that appeared central to other disciplines. We sought to put together a list of potential topics that was both representative of the field—that

is, popular and important—but also cutting-edge and timely. In this way, there are topics that are both broad, and about which much has been written (e.g., LGBTQ adoption, depression in sexual minorities) as well as topics that are specific or understudied (e.g., breast care for transgender people, pregnancy in LGBTQ youth). In determining what ground we would cover, we also sought to emphasize (a) LGBTQ experiences across the life cycle (youth, parenthood, aging), (b) intersections among sexual orientation and other key identities (race, ability, gender), (c) key contexts and systems that impact LGBTQ lives (schools, workplaces, neighborhoods, the military), and (d) theories and methods that have been used in research on LGBTQ people. A particularly distinctive feature of the encyclopedia, about which we are especially proud, is the large number of entries related to trans/transgender issues and lives (there are entries on trans inmates, health care issues, and violence, to name just a few). There are also a number of entries on major LGBTQ organizations, such as Gay, Lesbian & Straight Education Network (GLSEN) and Parents & Friends of Lesbians and Gays (PFLAG), and a number of entries on therapeutic interventions with LGBTQ people, couples, and families. These distinctive features of the encyclopedia make it an essential and broad reference book for a wide range of individuals and organizations. Upon establishing a near-complete list that had been reviewed and re-reviewed by all members of the editorial team, we began the process of identifying authors for entries. We sought out accomplished researchers and scholars with established expertise on the given topic to write the entries. The majority accepted, and some offered to write multiple entries. Some chose to enlist the help of coauthors, such as advanced—and promising—doctoral students. Invitations to contribute were sent out beginning in May of 2014. The majority of authors were asked to revise their entries at least once. By June 2015, we had successfully received all revised and final entries. The editorial team worked quickly and carefully, delivering feedback in remarkably little time—especially at the tail end of the project, when we had only a few remaining entries to review and re-review. We are all amazed at what has been accomplished—by authors and the editorial team—in just over a year.

Introduction

xxxv

The Audience

Acknowledgments

As noted earlier, we want college students to access and read the entries in these volumes. We also want graduate students and scholars of LGBTQ sexualities and lives to read and learn from this encyclopedia. But, we are also hopeful that scholars in law, psychology, anthropology, history, family studies, social work, counseling, and other diverse fields—who may know little or nothing about many of the topics represented here—will read and incorporate the information in this collection into their thinking, writing, and teaching. We are hopeful, too, that librarians and other university staff and administrators may find this collection to be a useful and interesting tool for advancing their own understanding of these issues, in order to inform the work that they do. Finally, this book is for individuals who identify as LGBTQ themselves, and who are seeking a resource in which they are at the center of thinking, theorizing, and research, instead of at the margins.

This project reflects the contributions of many. Maureen Adams, the acquisitions editor, worked with me to develop the initial idea for the encyclopedia. Her insight and enthusiasm during this initial stage helped launch the project into reality. Sanford Robinson, our developmental editor, was patient, available, and careful, and his attention to detail—as well as the big picture—was instrumental to the successful and timely completion of the project. Leticia Gutierrez helped ensure that SAGE’s versatile Reference Tracking system was working for both editors and authors, and she frequently came to the aid of the editorial board members when we had a question we could not solve on our own. I am deeply grateful to the committed editorial team. They all gave of themselves in ways that deepened and nuanced the resulting product. They provided invaluable suggestions regarding authors; provided astute and remarkably fast feedback to authors; served as sounding boards when I needed them; and maintained a cheerful enthusiasm for the project, even when entries were coming in faster than we could keep up. I am very grateful to the LGBTQ activists, researchers, and pioneers—both living and dead—whose tireless work on behalf of the LGBTQ community ensured that a volume like this would be both relevant and eagerly consumed. I’m also indebted to my dear LGBTQ friends, colleagues, and family members, of whom there are many, for maintaining—or feigning— interest in the varied topics in this volume as it came to fruition. In some cases, too, informal questions or suggestions about potential topics (“What about ___?”) led me to pursue potential topics for inclusion in the encyclopedia. Finally, I’m grateful to the support and patience of my own family, who has endured yet another book project with me—this one bigger and longer than any of those that preceded it. I am proud of the final product and grateful to the many contributors whose hard work ensured that it would become a reality.

The Structure Topics are in alphabetical order, from A (Abstinence Only Until Marriage) to Y (Youth and Dating); no suitable Z topics appeared. Some topics are multifaceted, well-researched, and complex, and thus receive attention in multiple entries. Long entries (i.e., those that are about 3,000 words in length) represent the most significant and welldeveloped topics in the field. These are typically the entries about which the most research has been done. Medium-length entries (about 2,000 words) address core topics in the field, but topics that are perhaps less central (or about which less research has been done). Short entries (1,000 words) describe less central or newer topics to the field. In addition, we provide a thematic Reader’s Guide that groups related entries by topic (15 in total). Many individual entries cut across more than one topical area and appear under several headings. Furthermore, suggestions for further readings are provided with each entry so that the interested reader can pursue avenues for deeper topical exploration. Finally, an appendix presents a list of organizations, journals, and websites related to various topics within the larger field of LGBTQ studies.

Abbie E. Goldberg Clark University

SAGE was founded in 1965 by Sara Miller McCune to support the dissemination of usable knowledge by publishing innovative and high-quality research and teaching content. Today, we publish over 900 journals, including those of more than 400 learned societies, more than 800 new books per year, and a growing range of library products including archives, data, case studies, reports, and video. SAGE remains majority-owned by our founder, and after Sara’s lifetime will become owned by a charitable trust that secures our continued independence. Los Angeles | London | New Delhi | Singapore | Washington DC | Melbourne

A activities to those between two individuals within the context of a monogamous marriage. Historically, abstinence only until marriage has been sanctioned by organized religion. Both Judaism and Christianity, for instance, have traditionally promoted an abstinence-only approach. A term common in the 20th century was “premarital sex,” which referred to violation of the abstinence-only-until-marriage societal expectation. Although both young men and young women were expected to be sexually abstinent before marriage, there was a higher expectation that young women in particular would adhere to being sexually abstemious or else run the risk of being stigmatized as “whores” or “sluts.” This was clearly a double standard as young men were in many ways societally encouraged to engage in sexual contact with females even to the extent that their masculinity and manhood was tied to, and defined by, sexual experiences. The concept of abstinence only until marriage found its way into the sexuality education arena first in the late 19th and early 20th centuries, when the social hygiene movement began to reinforce the notion that sexual contact was dangerous in terms of spreading sexually transmitted diseases (then referred to as venereal or social diseases) and sexual morality was inculcated into the minds of the young. Abstinence only until marriage was a key concept of schooling efforts as well as in the Boy Scouts of America, Girl Scouts, and other social organizations.

ABSTINENCE ONLY UNTIL MARRIAGE Abstinence only until marriage is a term used most recently to describe a deeply contested approach to sexuality education, which exists predominantly in the United States. The main tenets of this form of sexuality education include, but are not limited to, teaching youth that (1) to enjoy good overall health, abstaining from sexual activities with others is necessary; (2) abstaining from sexual contact outside of marriage is not only an expected societal norm, but also the only way to fully protect against contracting sexually transmitted conditions and prevent teenage pregnancies; (3) marriage and monogamy within marriage are socially expected; and (4) engaging in sexual contact with others outside of marriage is likely to result in a number of harmful mental and physical health problems. This entry provides a broad overview of the topic and then offers a concise historical sketch of abstinence only until marriage. Next, the main arguments of the proponents and opponents of abstinenceonly-until-marriage sexuality education are provided. Finally, the implications abstinence only until marriage has for lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals and communities are explored. Abstinence only until marriage, as a concept, has had a long history in the Western world. Specifically, it refers to individuals abstaining from sexual contact until married and confining sexual 1

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Activists in College

Sexuality education has promoted abstinence only for more than a century. The United States federal government became involved in officially promoting it in the 20th century. Specifically, in 1981, with the Adolescent Family Life Act in the United States, abstinence only until marriage became a stronger and more pronounced (even centrally featured) part of the educational mandate. Perhaps the most significant moment when abstinence only until marriage was featured in school-based sexuality education was in 1996, when the U.S. federal government allocated millions of dollars of federal funding to both school-based and community-based sexuality education. There were strict stipulations that the schools and community-based organizations were required to follow to receive and maintain such funding, such as focusing solely on the virtues of sexual abstinence. Those who support abstinence-only sexuality education tend to hold conservative views about sexuality in general. Often they espouse the abstinence-only-until-marriage approach because they believe that it is an effective way of preventing HIV/AIDS, other sexually transmitted conditions, and unintended teenage pregnancies. What frequently undergirds the staunch commitment to this form of sexuality education is the view that sexual contact should be reserved for married individuals for the express purpose of reproduction. Despite such support for abstinence-only-untilmarriage sexuality education, there are virtually no data that support the efficacy of this approach. In fact, the results of the evaluation studies show that abstinence-only-until-marriage sexuality education does not prevent sexually transmitted conditions or reduce the number of teenage pregnancies. The opponents of abstinence-only-until-marriage sexuality education invariably claim that this is neither a responsible nor an effective mode of education and that it is an oppressively restrictive form of sexuality education that focuses on abstaining from sexual activity and neglects to cover comprehensive aspects of sexuality education such as the sociocultural, ethical, biological, and psychological aspects of sexuality. In addition, those opposed to abstinenceonly-until-marriage approaches argue that it is important to teach school-aged individuals about contraception, safer sexual expression, various

sexual and gender expressions, and a number of aspects about reproductive health in general in an effort to promote sexual health. The premise upon which abstinence-onlyuntil-marriage sexuality education is based is fundamentally heterosexist and sex-negative. The discourse has centered exclusively on heterosexuality and heterosexual marriage and has silenced LGBTQ individuals and sexualities. Given the pervasiveness of this form of sexuality education in schools in the United States until very recently, countless LGBTQ youth have experienced alienation, silencing, and invisibility in school settings. LGBTQ individuals are often seen as illegitimate sexual citizens, and abstinence-only-until-marriage sexuality education has reinforced this notion. John P. Elia See also Education; Heteronormativity; Heterosexism; LGBTQ Issues in K–12 Education Across Global Contexts; School Climate; Schools as Heteronormative Spaces; Sexualities at School

Further Readings Elia, J. P., & Tokunaga, J. (2015). Sexuality education: Implications for health, equity, and social justice in the United States. Health Education, 115(1), 105–120. Fisher, C. M. (2009). Queer youth experiences with abstinence-only-until-marriage sexuality education: “I can’t get married so where does that leave me?” Journal of LGBT Youth, 6(1), 61–79. Santelli, J., Ott, M. A., Lyon, M., Rogers, J., Summers, D., & Schleifer, R. (2006). Abstinence and abstinence-only education: A review of U.S. policies and programs. Journal of Adolescent Health, 38(1), 72–81.

ACCESS

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HEALTH CARE

See Health Care System

ACTIVISTS

IN

COLLEGE

LGBTQ activists in college are postsecondary students who engage in individual or organized

Activists in College

behaviors, activities, and strategies designed to improve conditions on campus for LGBTQ individuals. The purpose of the activism may be to create visibility for the existence of LGBTQ people; to draw attention to discrimination or violence against them; to change policies, improve programs, or implement curriculum; or to make other demands on behalf of LGBTQ people on campus. Activism may be a solitary activity, or it may involve other LGBTQ and allied participants. Some activists identify themselves as student leaders, while others prefer not to see themselves in those terms. LGBTQ activists may have any sexual orientation and gender identity, and not every college student engaged in LGBTQ activism identifies as lesbian, gay, bisexual, transgender, or queer. This entry addresses (a) forms of campus activism, (b) the influence of activism on colleges and universities, (c) the influence of activism on those students who participate in it, and (d) connections between LGBTQ campus and community activists.

Forms of Campus Activism LGBTQ activism in higher education takes on many forms. Some forms of activism involve physical actions common among campus social justice activists: marches, protests, demonstrations, pickets, sitins, vigils, or even building takeovers. Particular to the LGBTQ community are the “kiss-in,” during which pairs of same-sex couples kiss in public, to bring visibility to same-sex affection, and “die-ins,” a form of AIDS activism during which participants lie on the ground as though dead, typically in a place that will disrupt usual activities taking place there, to represent deaths from HIV/AIDS. Compatriots may spray paint or chalk around the bodies in the manner of a police crime scene, to portray these deaths as homicides at the hands of an uncaring public or civic authority. The Day of Silence (www .dayofsilence.org) is an annual action in which LGBTQ students and allies remain silent for a day, handing out information about how this action symbolizes the silencing of LGBTQ people. Many campuses hold a vigil for the Trans Day of Remembrance to honor those who have lost their lives due to antitrans hatred and violence. LGBTQ college graduates

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may engage in philanthropic activism, through donations targeted toward particular programs and services; or they may make substantial gifts to the institution as a whole, with the stipulation that the institution adopt particular policies (e.g., sexual orientation and gender-identity nondiscrimination). Other LGBTQ campus activist strategies involve communication through letter writing or e-mail campaigns, traditional (print) media opinions and editorials, or digital and social media. On a single campus, in alliance with activists at other institutions, or with off-campus allies, communication strategies can be effective in bringing internal and external awareness to activists’ targeted concerns (e.g., the need for improved policy, programs, campus climate). Popular grassroots campaigns that address youth and college students include the It Gets Better videos aimed at preventing suicide among LGBTQ youth by providing encouragement designed to counter anti-LGBTQ bullying in schools, and the You Can Play videos, many of which were made by college athletic teams and departments, with the message that talented LGBTQ athletes are welcome on their teams. LGBTQ activists and their allies use Facebook, YouTube, Tumblr, Instagram, and other social media platforms to implement media campaigns and to organize online and in-person actions. The No H8 (No Hate) Campaign (http://www .noh8campaign.com), described as a photographic silent protest, has also been a prominent activist strategy on campus. In this action, college students paint their faces with the campaign logo and take photos with duct tape over their mouths, demonstrating the silencing that LGBTQ individuals often experience. The campaign is a multimedia action that has spread through social media and attracts celebrities, family and community members, and students from elementary and secondary education. There have also been significant activist efforts to increase inclusion at religiously affiliated institutions. For example, LGBTQ alumni of Gordon College, a leading Christian institution, formed a group called OneGordon (http://www.onegordon .com) to support current students and alumni of the institution. LGBTQ activists within a campus religious context sometimes wear a rainbow button,

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Activists in College

emblem, or sash to worship services in order to disrupt the notion that LGBTQ people are not also people of faith.

Influence of Activism on Colleges and Universities Since the mid-1980s, LGBTQ activism has transformed postsecondary institutions. Campus activism—mainly by students, but also by some faculty and staff—has been responsible for (a)  causing or contributing to the formation of committees (sometimes called commissions) that conduct campus climate studies and/or address homophobic/transphobic incidents on campus; (b) the implementation of nondiscrimination policies for sexual orientation and, increasingly, gender identity in hiring and educational practices; (c) the provision of domestic partner benefits for employees; (d) the establishment of LGBTQ campus resource centers; (e) the introduction of gender-inclusive (sometimes called gender-neutral) restrooms and housing; (f) the development of LGBTQ/queer studies curricula; (g) the increase in genderconfirming medical care; and (h) the increased visibility of LGBTQ people on campus. Some of these changes to policy and programs might have occurred without the pressure and visibility brought about by campus activism, but the consensus among scholars of LGBTQ issues in higher education is that activism has been an essential element in the timing and progression of these changes. As the visibility of trans issues increases and attitudes toward them become more positive, trans-student activism related to issues of housing, safety, and restroom access is increasingly common. This phenomenon illuminates the larger one of LGBTQ activism: The more visible the community is, the more attitudes change toward the positive, which promotes more activism, in a cycle of visibility and activism. LGBTQ campus activism shares a history with LGBTQ community activism. The student homophile movement emerged in a few campuses in the late 1960s, alongside gay and lesbian movements in some cities. The Student Homophile League was founded at Columbia University in 1967 and had gay and straight members. Early activist organizations

emerged at a few other institutions, with names like the Gay Liberation Front, Homosexuals Intransigent!, Lambda Union, and even a Queer Student Cultural Center (at the University of Minnesota in 1969). Gay student unions, gay and lesbian student organizations, and eventually lesbian, gay, bisexual, transgender, and queer alliances took on activist roles at hundreds of postsecondary institutions. Campus activists remained in loose connection with community activists throughout the 1980s and 1990s, coming together to protest against public and government responses to the AIDS crisis and when local communities faced particular threats through harassment, discrimination, or violence. Among the first orders of business for student organizations in the 1970s was to seek legal permission to organize and hold events on campuses where they were banned, lawsuits being a form of activism. Nascent student groups at public institutions faced the most stringent restrictions on organizing. Gay and lesbian students at Virginia Commonwealth University and the Universities of Kansas, New Hampshire, Missouri, and Oklahoma sued their institutions for the right to meet and sponsor activities on campus.

Influence of Participating in Campus Activism on LGBTQ Students Campus activism influences the identities and experiences of LGBTQ students who participate in it. Abundant evidence supports the claim that students who are more involved in their college experience learn more, graduate at higher rates than less involved peers, and further their development of a number of desirable characteristics such as civic engagement, volunteerism, and intercultural competence. On the whole, LGBTQ student activists make gains in these areas, regardless of sexual orientation or gender identity. They report becoming more connected to institutional administrators and faculty, as well as developing leadership skills that they use in other contexts on campus as well as in their post-college careers. Not all LGBTQ activists identify themselves as such. They may consider themselves leaders, not activists, or they may not view themselves through

Activists in College

either of those lenses. Some students who engage in LGBTQ activism are cisgender and/or heterosexual; some are hesitant to consider themselves as agitators for change. They may connect their activism to long-held commitments to social justice, with LGBTQ issues being their current focus. They may also see their LGBTQ activism as preparation for a career in social change work. Some subpopulations of LGBTQ students may have less access to activist outlets than others. International students from conservative nations, for example, may be concerned that engaging in LGBTQ activism will lead to negative consequences, either in visa status or in life back in the home country. Domestic students on financial aid may worry that an arrest record could hinder future scholarship opportunities. Any number of other students may not want to carry an activist engagement through to the point of arrest for civil disobedience, for fear of consequences on and off campus. Students in any of these groups might find less risky or public ways to participate in LGBTQ activism, such as online activism and behind-thescenes contributions to public actions.

Connections Between Campus and Community Activists National LGBTQ advocacy organizations mobilize college students as activists. The National Gay and Lesbian Task Force (NGLTF); Human Rights Campaign; National Black Justice Coalition; Trans Student Equality Resources; Gay, Lesbian and Straight Educators Network (GLSEN); Gay and Lesbian Alliance Against Defamation (GLAAD); and Campus Pride are prominent supporters of LGBTQ campus activism, sponsoring media sites and training opportunities for activists and student leaders. The Point Foundation provides scholarships for LGBTQ students “to achieve their full academic and leadership potential— despite the obstacles often put before them—to make a significant impact on society” (https:// www.pointfoundation.org). These organizations recognize the potential of college student activists to create change in society beyond campus. A number of LGBTQ community and national organizers got their start as campus activists. For

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example, Derek Charles Livingston, a co-chair of the 1993 National March on Washington for Lesbian, Gay, and Bi Equal Rights and Liberation, was an undergraduate student activist at Brown University. Urvashi Vaid was an activist at Vassar College before beginning a career that took her into leadership of the National Gay and Lesbian Task Force (NGLTF) and Arcus Foundation, both of which are committed to multiracial LGBTQ social justice activism. T. J. Jourian, trans activist and community organizer, led student actions at Michigan State University while an undergraduate and graduate student there. Being a campus activist—or going to college at all—is not a prerequisite for community activism, but the viability of colleges and universities as training grounds for community organizers is undeniable. While LGBTQ campus and community activists share some history, LGBTQ campus activists have a complicated history of collaboration with other social justice activists. Depending on the specifics of campus racial, gender, religious, and social climate— and depending on the awareness, interests, and abilities of the leaders of LGBTQ activist movements at a given time—LGBTQ activists may seek coalitions and participate in collective actions for social justice. Alternately, they may retain a closer focus on LGBTQ activism. The trend appears to be toward greater collaboration and coalition building, though progress in this direction is uneven. Racism in the LGBTQ community and homophobia and transphobia in some communities of color, for example, impede efforts to build multiracial movements for social justice related to sexual orientation and gender identity. Kristen A. Renn and Erich N. Pitcher See also College Students; Education; Leadership

Further Readings Beemyn, B. (2003). The silence is broken: A history of the first lesbian, gay, and bisexual college student groups. Journal of the History of Sexuality, 12(2), 205–223. Marine, S. B. (2011). Stonewall’s legacy—bisexual, gay, lesbian, and transgender students in higher education. ASHE Higher Education Report, 37(4). San Francisco, CA: Jossey-Bass.

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Adolescent Pregnancy

McEntarfer, H. K. (2011). “Not going away”: Strategies used by students, faculty, and staff members to create gay-straight alliances at three religiously affiliated universities. Journal of LGBT Youth, 8(4), 309–331. Renn, K. A. (2007). LGBT student leaders and queer activists: Identities of lesbian, gay, bisexual, transgender, and queer identified college student leaders and activists. Journal of College Student Development, 48(3), 311–330.

ADOLESCENT PREGNANCY Although it may seem counterintuitive, nearly two decades of population research have documented that lesbian, gay, and bisexual adolescents have a higher risk for pregnancy involvement (either becoming pregnant or causing a pregnancy) than their heterosexual peers. This entry describes the extent of the risk for adolescent pregnancy among LGBTQ youth, outlines the various hypotheses about why they might be at higher risk, and describes some of the evidence that supports these possible reasons for higher rates of pregnancy among LGBTQ adolescents. A growing number of population-based adolescent health surveys administered in schools include a question assessing sexual orientation. Such surveys also often ask about sexual health issues, including whether an adolescent has ever had sexual intercourse, number of sexual partners they have had, whether contraception was used the last time they had sex, and whether they have been pregnant, or (for boys) whether they have ever caused a pregnancy. Although most of the sexual health questions on these surveys focus on penile-vaginal intercourse between male and female sexual partners as the sexual activity in question, and are not necessarily inclusive of the variety of sexual behaviors that LGBTQ youth might engage in, some of the surveys do ask about gender of sexual partners, and about oral or anal sex. These surveys provide some of the strongest population evidence concerning adolescent pregnancy among LGBTQ youth. The research evidence to date is primarily from North America, but on regional and national

surveys from Canada, New Zealand, and the United States, LGBTQ youth report 1.5 to 4 times the prevalence of pregnancy involvement than do their heterosexual peers. In adolescent health surveys that are large enough to analyze sexualminority groups separately, lesbian and gay adolescents as well as bisexual males and females report higher rates of ever being pregnant or causing a pregnancy. Unfortunately, only one population-based adolescent survey to date, from New Zealand, reported including a measure of transgender identity, but did not report pregnancy comparisons, so it is unknown whether transgender youth also have higher risk for pregnancy involvement. Why might LGBTQ youth have a higher risk for pregnancy involvement? One approach to answering this question is to first focus on those common contributors to pregnancy involvement in the general population—that is, both risk and protective factors linked to higher or lower odds of adolescent pregnancy. If LGBTQ youth have higher rates of common risk factors, and lower levels of protective factors, these together might explain their higher risk for pregnancy. Another approach is to focus on risk factors unique to LGBTQ youth, as well as interventions to prevent unwanted pregnancy for them. Getting pregnant (or causing a pregnancy) typically requires unprotected penile-vaginal intercourse between sexually fertile people. A single episode of unprotected intercourse sometimes (but rarely) results in pregnancy. The sooner adolescents start having sex, and the more often they have sex, especially without contraception, the greater their chance of pregnancy during the teen years. Other factors that increase these risks are also important to consider: for example, a history of sexual abuse during childhood or adolescence, or having sex while intoxicated. In nearly all population-based studies of LGBTQ youth, LGBTQ youth are more than twice as likely to report a history of sexual abuse or sexual assault as are heterosexual students. In most surveys, LGBTQ youth are also more likely to report ever having sexual intercourse, an earlier age at first sex, sex

Adoption, Choices About

under the influence of alcohol or drugs, and more sexual partners than heterosexual students. Assumptions that LGBTQ youth only have sex with same-gender partners are inaccurate; most LGBTQ youth don’t have sex at all, but many bisexual youth, and those who identify as gay or lesbian, also report sex with people of other genders. Condom or contraceptive use, however, shows inconsistent results across studies; in some studies, LGBTQ youth are just as likely to use condoms or birth control the last time they had sex as heterosexual students, while other studies report they are less likely to use contraception. LGBTQ youth are also more likely to run away or be kicked out, and to engage in survival sex while homeless or street-involved, which are also contributors to adolescent pregnancy involvement. They also report lower levels of protective factors, such as positive family relationships or school connectedness, than do their peers. Their higher exposure to risk factors and lower levels of protective factors may explain the higher risk of pregnancy. In addition to factors that contribute to adolescent pregnancy in the general population, some studies have identified possible factors specific to LGBTQ youth. Some studies have suggested that pregnancy might serve as “camouflage”—that is, to appear to be heterosexual, in order to avoid further stigma and discrimination. Qualitative studies have documented this phenomenon, and at least one population study noted that many LGBTQ youth who reported adolescent pregnancy involvement also reported higher levels of sexualorientation-related discrimination and violence. It has also been suggested that LGBTQ youth may get pregnant because sex education at school does not include LGBTQ-relevant content, or because programs targeted toward sexual health among LGBTQ youth do not include pregnancy prevention information, but no studies have tested these hypotheses so far. There is almost no research about the outcomes of LGBTQ youth’s adolescent pregnancies—that is, whether they miscarry, terminate the pregnancy, or give birth, and whether they become LGBTQ teen parents, or place the baby for adoption. There is also limited research on

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interventions to prevent unintended pregnancy among LGBTQ youth, whether focused on reducing contributing factors such as abuse, or reducing sexual risk behaviors, or addressing other contributing factors, such as homelessness. Such approaches, as well as interventions to foster protective factors, may help reduce unintended adolescent pregnancy among LGBTQ youth, but such evidence is still needed. Elizabeth M. Saewyc See also Developmental Aspects of Sexuality; Resilience and Protective Factors, Youth; Sexual Education Mandates for Inclusion; Sexual Risk-Taking

Further Readings Reed, S., Miller, R. L., & Timm, T. (2011). Identity and agency: The meaning and value of pregnancy for young Black lesbians. Psychology of Women, 35, 571–581. Saewyc, E. (2014). Adolescent pregnancy among lesbian, gay and bisexual teens. In A. Cherry & M. E. Dillon (Eds.), International handbook on adolescent pregnancy (pp. 159–169). New York, NY: Springer. Saewyc, E. M., Poon, C., Homma, Y., & Skay, C. L. (2008). Stigma management? The links between enacted stigma and teen pregnancy trends among gay, lesbian and bisexual students in British Columbia. Canadian Journal of Human Sexuality, 17, 123–131. Travers, R., Newton, H., & Munro, L. (2011). “Because it was expected”: Heterosexism as a determinant of adolescent pregnancy among sexually diverse youth. Canadian Journal of Community Mental Health, 30, 65–79.

ADOPTION, CHOICES ABOUT Adoption is the legal securement of a parent’s relationship with a child not biologically related to the parent. Approximately 1 million children in the United States live with adoptive parents and 2.5% of families include an adopted child. Estimates suggest that around 4% of adopted children are living with LGBTQ parents. People may choose to adopt

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Adoption, Choices About

a child rather than have a biological child for a variety of reasons. These may include the inability to conceive one’s own children, preference for providing a home to a child in need, or to secure parental rights for a nonbiologically related parent (e.g., a partner choosing to adopt the biological children of their partner/spouse). This entry describes the issues related to adoption choices for LGBTQ potential parents. It discusses the practical and emotional decisions related to adoption for LGBTQ parents. It explains the key factors related to LGBTQ parents adopting and the pathways for adoption. Relevant research related to these choices is discussed, although there is no research base regarding transgender parents’ adoption experiences specifically; the research is largely focused on issues related to gay and lesbian parents.

Overview of LGBTQ Adoption In general, like their heterosexual and cisgender (i.e., not transgender) counterparts, many members of the LGBTQ community express a desire to become parents. For some, this need may include a desire to have a biologically related child. However, unlike their heterosexual and cisgender counterparts, typically only one parent is biologically related to the child in LGBTQ partnerships. Though some LGBTQ people opt for a parenthood route that allows for a biological relationship for at least one parent (namely, via donor insemination or surrogacy), studies suggest lesbian and gay parents have lower expressed need for a biological child and still need to secure the rights of the second parent when they do. Therefore, adoption is often the first choice to achieve parenthood for both potential parents in LGBTQ partnerships. For many decades, LGBTQ individuals and couples have been adopting children, though with varying levels of openness about their gender and/ or sexuality in the process. In many cases, parents hid their sexuality or gender identity throughout the adoption process in order to avoid potential discrimination or legal bans on their adopting. However, doing so often left one parent in the

partnership without legal rights to their child and/ or resulted in psychological distress during the adoption process for both adopting parents. LGBTQ parents have also faced vastly varied legal and systemic facilitators and barriers to adoptions depending on their geographic location and people involved in the adoption process. Today, legal changes, including the legalization of same-sex marriage and successful challenges to adoption bans as well as shifting societal attitudes toward LGBTQ couples generally and LGBTQ adoption in particular, decrease the need to hide sexual and gender identity during the adoption process. However, it is still challenging for LGBTQ individuals or couples to openly adopt in many states in the United States and in many countries around the world. In some areas, such adoptions are illegal, while in others, they are encumbered by individuals involved in the adoption process (e.g., social workers, judges, birth parents) who are opposed to or biased against such adoptions.

Issues Affecting the Decision to Adopt and the Process of Adoption Multiple factors may ease or inhibit the process of adoption for LGBTQ potential parents. For example, family of origin support, overall social support, the political and social climate of communities, and general political issues such as the presence or absence of marriage equality may all affect an LGBTQ individual or couple’s decision to adopt. For example, parents with greater support and community resources specific to LGBTQ parents (e.g., support groups) may be more likely to pursue adoption than parents with less support in communities with no specific resources. Another factor affecting the decision to adopt may be the confidence LGBTQ potential parents have in their future parenting. Despite all research evidence to the contrary, some may also question their ability on the basis of their gender or sexual identity to meet the needs of an adopted child. Deciding to adopt may be fraught with emotional struggle and hardship both for individual LGBTQ parents and for couples as a unit. The

Adoption, Choices About

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arduous nature of the process may strain relationships due to the invasive nature of the pre-adoption process or the disappointment of adoptions falling through. Parents may also struggle with agreeing on the parameters of their adoption including the age, cultural background, and origin of potential adoptees. LGBTQ parents may face a double layer of stigma because of their choosing to adopt: that is, they face stigma due to their sexual orientation/ gender identity as well as the adoptive/nonbiological status of their families.

For all potential parents, financial resources largely influence these decisions, as each can be quite expensive. For all people, higher income is linked to an increased likelihood to adopt in general. Economists suggest the cost of children is even higher for lesbian and gay parents who choose to adopt, because they have to extend not only monetary resources but additional work and time to overcome barriers related to overt and covert discrimination based on their sexual or gender identity.

Choosing a Path to Parenthood

The Adoption Process

Potential parents with the biological ability to do so must first choose whether they want to have a biologically related child. In the case of LGBTQ parents wanting a biological child, they may try artificial insemination (of a biological woman) or use of a surrogate implanted with the sperm or egg of a parent or from another donor. When one parent is biologically related to the child, the second parent may need to go through an additional legal process to secure their rights as a parent to the child, referred to as second-parent adoption. The second-parent adoption process adds an additional layer of psychological stress and financial investment for same-sex couples. If potential parents choose to adopt a child, they must decide whether to adopt domestically or internationally. If adopting internationally, one member of the couple might need to adopt as a single person, as some countries do not allow same-sex parents to adopt but will allow singleparent adoption. In these cases, parents can pursue second-parent adoption once the child is in the United States. If adopting domestically, parents have to choose between a public or private adoption. Public adoptions tend to involve children who have been removed from their biological parents’ care due to abuse or neglect and are facilitated by public child welfare agencies. Private adoptions typically include children voluntarily given up by their biological parents and may be facilitated through an agency or independently with the help of a lawyer.

Adoption is not a single event; rather, it is a multistage process that unfolds over time. Prior to adoption, potential parents face a myriad of decisions, as described above, while also considering the impact a child or children will have on their lives. In the actual adoption process, potential parents must contend with multiple interviews and home visits to determine their eligibility. Once this process is complete, the waiting often begins, especially for those attempting to adopt an infant. Following adoption, parents face all the challenges of newly adoptive parents in addition to potential additional issues related to their sexual or gender identities, such as discrimination on the part of the health care system or their children’s schools. Complications of the adoption process are further compounded by LGBTQ parents having to consider the unique legal issues related to their gender and/or sexual identity and potential stigma their children and family may face during and after the adoption process. The little available research suggests LGBTQ potential parents do face both overt and covert discrimination in legal settings (e.g., judges refusing to approve adoptions for same-sex parents) as well as organizational settings (e.g., adoption agencies refusing to complete adoptions with same-sex parents), even in cases where legal or policy protections do exist. For example, the organizational policy of an adoption agency may indicate that LGBTQ parents have all the same rights to adopt as heterosexual parents.

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Adoption, Choices About

However, an individual adoption worker may show preference to heterosexual parents in actual practice.

Matching the Needs of Children and Parents Potential adoptive parents must make several decisions about the types of children they feel prepared to adopt. Parents must choose the age range of children, determine whether they have preferences regarding the child’s cultural background, and if they are willing to adopt a child with special needs (and, if so, what type and how severe). Many parents prefer an infant, although the waiting period tends to be longer for infants and longer still if the parents wish the child to match their cultural or ethnic backgrounds. Parents willing to adopt older children may find the process quicker and cheaper as they are more able to adopt domestically and through the child welfare system rather than paying a private agency. However, adopting older children may create its own set of challenges as older children may struggle more with attachment (being able to form stable and healthy bonds with their parent or parents) and adjustment to their new families. Some parents may prefer to adopt within their own racial and/or ethnic group(s) for a variety of reasons, including wanting the child to look more like them or feeling better prepared to meet the child’s cultural needs, while others will feel comfortable with a child from different or multiple races/ethnicities. Similarly, LGBTQ potential parents may prefer to adopt a child of their own gender due to doubts about being able to meet the gender-specific needs of their child in a same-sex parent household. Studies suggest, however, that outcomes for children show little difference in relation to the gender identifications of their parent or parents. Some parents may choose to adopt children with any of a variety of special needs. When doing so, it is important that they make informed decisions about what type of issues they feel competent managing for a child or children. Special needs for

children may include issues with attachment, fetal alcohol syndrome (a cluster of symptoms related to prenatal exposure to alcohol, which may include behavioral or learning problems), or a variety of behavioral (e.g., lack of impulse control) and mental health issues (e.g., attention issues, anxiety).

Conclusion LGBTQ prospective parents face multiple decisions when considering adoption, including what process to use and the type of child they are best suited to parent. These decisions are further complicated by the social and political contexts in which they are making their choices. Notwithstanding, increasing numbers of LGBTQ parents are successfully engaging in the adoption process to start and expand their families. Susan E. Smalling See also Adoption, International; Adoption, Legal Considerations in; Adoption, Openness in; Adoption and Foster Care Discrimination; Adoption Type; Adoption via the Child Welfare System

Further Readings Farr, R. H., & Patterson, C. J. (2013). Lesbian and gay adoptive parents and their children. In A. E. Goldberg & K. R. Allen (Eds.), LGBT parent families: Innovations in research and implications for practice (pp. 39–55). New York, NY: Springer. Gianino, M. (2008). Adaptation and transformation: The transition to adoptive parenthood for gay male couples. Journal of GLBT Family Studies, 4(2), 205–243. Goldberg, A. E., Downing, J. B., & Sauck, C. C. (2007). Choices, challenges, and tensions: Perspectives of lesbian prospective adoptive parents. Adoption Quarterly, 10(2), 33–64. Javier, R. A., Baden, A. L., Biafora, F. A., & CamachoGingerich, A. (2007). Handbook of adoption: Implications for researchers, practitioners and families. Thousand Oaks, CA: Sage. National Adoption Information Clearinghouse. (2000). Gay and lesbian adoptive parents: Resources for

Adoption, International professionals and parents. Retrieved from https:// www.childwelfare.gov/pubs/f_gay/f_gay.pdf Ryan, S., & Whitlock, C. (2007). Becoming parents: Lesbian mothers’ adoption experience. Journal of Gay and Lesbian Social Services, 19(2), 1–23.

ADOPTION, INTERNATIONAL Adoption by lesbians and gay men is becoming increasingly common, not only in most areas of the United States but in many other countries around the world including Canada, the United Kingdom, Germany, Denmark, the Netherlands, Belgium, Norway, Sweden, Iceland, Israel, Spain, Argentina, Brazil, South Africa, New Zealand, and parts of Australia. In each of these countries, laws have been passed supporting adoption by nonheterosexual individuals and/or couples. Most children adopted by sexual-minority families are born and placed for adoption domestically, either by their birth parents during infancy, or by the country’s child welfare system, after the children have been removed from their birth families because of adverse living conditions. In other cases, lesbians and gay men have become parents through international adoption (i.e., they adopt from other countries). This pathway to parenthood, however, more often entails significant barriers and complications for sexual-minority couples.1

Barriers to International Adoption by Sexual-Minority People International adoption involves the legal placement of an orphaned child from one country— often referred to as the “country of origin” or “sending country”—into a family living in a different, or “receiving,” country. Standards for international adoption were established by the United Nations Convention on the Rights of the Child in 1989 and by the Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption in 1993. These standards prioritize the rights of sending countries to establish laws and practices that define adoptive parent

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suitability and the best interests of the child; in other words, the authorities in sending countries set the eligibility criteria for prospective adoptive parents for the children being placed from their country. Receiving countries are expected to respect and follow the guidelines established by legal and child welfare authorities in the country of origin. Unlike the growing number of receiving countries that support adoption by sexual-minority families, no sending countries around the world— with the exception of the United States and South Africa, which are both sending and receiving countries—have adoption laws or policies that support the placement of children with nonheterosexual people. In fact, in many sending countries, homosexual behavior is still criminalized, thereby making it impossible for the authorities to consider placing children with sexual minorities. Even in countries where homosexuality is not criminalized, discrimination against these individuals based upon cultural mores, religious beliefs, stereotypes, and misconceptions often result in LGBTQ people being labeled as deviant, ill, sinful, and dangerous to children. China and Russia, for example, expressly prohibit the adoption of children by lesbians and gay men. Other countries require that prospective adoptive parents be married, but only recognize marriages between a man and a woman. In short, legal, cultural, religious, and discriminatory barriers make it extremely difficult, and, in many cases, impossible for openly, self-identified sexual-minority women and men to become parents through international adoption. And yet, many have been successful in adopting children from other countries.

Current Trends and Agency Practices The number of international adoption placements has declined around the world for a variety of political, legal, ethical, and economic reasons. In the United States, for example, the number of placements peaked at nearly 23,000 children in 2004; by 2013, the figure had been reduced to slightly more than 7,000.

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Adoption, International

A 2003 survey by the Donaldson Adoption Institute, of U.S. adoption agency policies and practices related to adoption by lesbians and gay men in 1999 and 2000, indicated that over two thirds of private agencies involved in international adoption were willing to accept adoption applications from sexual-minority individuals and couples. Moreover, 51% of these agencies reported having made at least one adoption placement with lesbian or gay clients. On the other hand, slightly less than 20% of agencies reported actively recruiting sexual-minority individuals or couples as prospective applicants for their international adoption program. In some cases, nonpartnered LGBTQ people apply to adopt from other countries as single parents, often without revealing their sexual orientation to the adoption worker; at other times, their sexual orientation is known by the adoption agency but is not revealed as part of the home study or documentation sent to the authorities in the child’s birth country. When coupled LGBTQ people seek to adopt internationally, including those who are married or in domestic partnerships, one of the partners is identified as the preadoptive parent in the adoption paperwork and the other partner is either not included in the description of the family composition or is identified as a family friend or support person. Although the couple’s sexual orientation is almost always known by the adoption agency in these cases, it is often not discussed with the clients and is unlikely to be included in the home study and adoption paperwork. Depending upon the state in which the couple resides, once the child is living with them and has been legally adopted by one parent, the other parent often seeks a second-parent adoption. Don’t Ask, Don’t Tell has been the predominant strategy used by agencies in dealing with clients’ sexual orientation for international adoption placements. Although this practice often leads to a successful adoption, it poses a significant ethical dilemma for agencies involving the choice between adhering to the laws, cultural values, and religious beliefs of the child’s birth country—which in virtually all cases would preclude placement of a child

with LGBTQ applicants—and the desire to find a stable, safe, and nurturing home for a child in need, regardless of the parents’ sexual orientation, as well as the desire to support their clients’ goal of becoming adoptive parents. It also poses a conflict for sexual-minority applicants regarding their deep desire to become parents to a child from another country and their commitment to leading an open, proud, and self-confident life as a sexual-minority group member. To achieve the former goal, they often have to “return to the closet” regarding their sexual orientation when working with the adoption social worker or when meeting adoption authorities in the child’s birth country. The policy of Don’t Ask, Don’t Tell poses other problems for adoption agencies and their clients. If the agency does not know their clients’ sexual orientation, or if they choose not to discuss the matter with their single or partnered clients during the application process, there is a risk that effective adoption preparation and support for these nonheterosexual adoptive families will be compromised. Guidelines for working with LGBTQ adoptive applicants emphasize the importance of addressing a number of issues related to sexual orientation, including how the clients’ sexual orientation will be represented in the home study; the extent to which clients are “out” and with whom; the support of extended family, neighbors, coworkers, and the community in general, related to sexual-minority issues; how to talk with children about parental sexual orientation; how to help children cope with prejudice, homophobic comments, and discriminatory behavior; protecting the parent-child relationship when state law precludes a second-parent adoption; and referral to LGBTQaffirmative community resources. In addition, the failure to address sexual orientation issues in the adoption process makes it impossible for professionals to prepare older children and explore their understanding and comfort level in being placed in a home headed by LGBTQ parents. Research and social casework practice also suggest that sexual-minority individuals often experience heightened minority stress when they are forced to keep secret their sexual orientation, not only from adoption agency personnel but also

Adoption, International

when meeting the child’s current caregivers and the adoption authorities in the child’s birth country. International adoption often requires parents to travel great distances to meet their child and complete the adoption process in the country of origin. Sometimes more than one trip is necessary, and it is not uncommon for the parents to be required to spend a number of weeks in the birth country while the adoption is being finalized. Deciding which one of the couple will be identified as the adoptive parent to the U.S. adoption agency and the authorities in the country of origin, and whether only one or both of them will travel to the child’s birth country, can put pressure on the couple, complicating their transition to adoptive parenthood. So, too, does having to manage this process alone, when only one parent makes the trip. Furthermore, when both travel to the birth country to finalize the adoption, managing the secret about the nature of their relationship when meeting local child-care providers and adoption authorities adds additional stress for the couple. International adoption is predicated on the assumption that adoptive parents will support their child’s connection with his or her birth culture. In support of this goal, a growing number of families are engaging in heritage travel as their children get older, returning to the birth country, exploring the culture, visiting the orphanage or foster home where the child previously lived, and sometimes even making contact with birth family members. In situations where birth countries have strict legal or cultural prohibitions against homosexuality, such trips could increase the stress on all family members, who may feel the need to maintain the secret of the parents’ sexual orientation from the people they encounter. It could also increase the risk of the child experiencing another form of rejection in response to homophobic attitudes and reactions, including those from birth family members.

Looking to the Future As the number of international adoption placements has dramatically declined over the past decade, opportunities to adopt orphaned children

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from other countries have been reduced for citizens of all receiving countries, including LGBTQ people. The fact that almost all sending countries prohibit placement of their children with sexualminority individuals and couples makes the current prospects of international adoption for this group increasingly challenging. Adoption agencies need to be open and frank with LGBTQ applicants about the difficulties they will encounter in trying to adopt from another country, and when appropriate, help their clients to examine other adoption options. They also need to confront their own policies and practices related to the ethical and adoption preparation dilemmas they face in working with sexual-minority clients who seek to adopt internationally. As more and more societies become accepting of same-sex relationships, and are better informed about the sizable body of research showing that sexual-minority adults have the same parenting sensitivities and skills as heterosexual adults, and that children are not disadvantaged when raised by lesbians or gay men, perhaps in the future there will be fewer barriers and less stress for sexual-minority couples in their efforts to adopt from other countries. Continued work to overcome the misconceptions and stereotypes among legal and adoption authorities in sending countries through education, advocacy, and respectful dialogue will hopefully pave the way for these professionals to understand and accept that families headed by sexual-minority parents offer orphaned, and often traumatized, children opportunities for lifelong family stability, safety, nurturance, and healing. David Brodzinsky See also Adoption and Foster Care Discrimination; Adoption Type; Families of Origin, Relationships With; Minority Stress; Second-Parent Adoption; Single-Parent Adoption; Transition to Parenthood for LGBTQ People

Note 1. Virtually no information exists on the experiences of transgender people who seek to adopt children, either in the United States or elsewhere. Moreover, research on

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Adoption, Legal Considerations in

parenting by sexual-minority people has focused almost exclusively on lesbians and gay men.

policies and second-parent adoptions, and covers interactions with the legal system, including judges and attorneys.

Further Readings Brodzinsky, D. (2011). Expanding resources for children III: Research-based best practices in adoption by gays and lesbians. New York, NY: Donaldson Adoption Institute. Retrieved from http://www.adoptioninstitute.org Brodzinsky, D. (2012). Adoption by lesbians and gay men: A nationwide survey of adoption agency policies and practices. In D. Brodzinsky & A. Pertman (Eds.), Adoption by lesbians and gay men: A new dimension in family diversity (pp. 62–84). New York, NY: Oxford University Press. Brodzinsky, D. M., & Pertman, A. (Eds.). (2012). Adoption by lesbians and gay men: A new dimension in family diversity. New York, NY: Oxford University Press. Dambach, M. (2011). The international legal context governing intercountry adoptions by gay men and lesbians. Adoption & Fostering, 35, 65–77. Goldberg, A. E., & Allen, K. R. (Eds.). (2013). LGBTparent families: Innovations in research and implications for practice. New York, NY: Springer. Goldberg, A. E., Downing, J. B., & Sauck, C. (2007). Choices, challenges, and tensions: Perspectives of lesbian prospective adoptive parents. Adoption Quarterly, 10, 33–64. Mallon, G. P. (2011). The home study assessment process for lesbian, gay, bisexual, and transgender prospective foster and adoptive families. Journal of GLBT Family Studies, 7, 9–29.

ADOPTION, LEGAL CONSIDERATIONS IN Despite increasing rates of adoption by LGBTQ individuals and couples, there are legal barriers that continue to make this route to parenthood challenging for members of the LGBTQ community. This entry addresses the legal considerations faced by LGBTQ individuals as they pursue adoption. It presents the types of adoption available to LGBTQ individuals and couples, discusses legal

Adoption Options LGBTQ individuals and couples have options when they decide to pursue parenthood. One of the most common paths to parenthood that samesex couples choose is adoption. The number of same-sex couples who become parents through adoption has increased over the past few decades. In fact, same-sex couples are more likely than heterosexual couples to be raising a child whom they adopted. Upon choosing the path of adoption, couples or individuals (i.e., single parents by choice) are faced with the decision to choose the type of adoption they wish to pursue. Most commonly, couples adopt via either public domestic adoption (i.e., through the U.S. child welfare, also known as foster care, system), or private domestic adoption (e.g., the parent hires a lawyer or uses a private adoption agency to facilitate the adoption of an infant in the United States). Private domestic adoptions can be “open” or “closed.” An open adoption is one that allows birth parents and adoptive parents to have information about each other (e.g., names, contact information). In a closed adoption, birth parents and adoptive parents are not provided identifying information about each other and there is no contact between them. International adoptions have historically been an option, but are increasingly difficult for LGBTQ individuals and couples. This is because the countries most commonly accessed for international adoption (e.g., China, Russia, Guatemala) are becoming more rigid in their requirements for adoptive parents; many will not consider applicants who are single/not married or are “out” as sexual minorities.

Legal Policies LGBTQ individuals and couples encounter numerous barriers in achieving the legal status of

Adoption, Legal Considerations in

“parent.” Some states do not allow openly LGBTQ individuals or couples to co-adopt (i.e., to adopt their child together), for example. In some of these jurisdictions, same-sex couples have had success adopting serially. That is, one partner initially adopts the child as a single parent and then the other partner petitions for a second-parent adoption, allowing both partners to be legally recognized as the child’s parents. Second-parent adoptions are employed by female same-sex couples in which one partner has given birth to the child; in this case, the nonbiological mother does not have automatic legal rights to the child (although in some states, the nonbiological mother may have legal status as a parent, if the women are married). Similarly, male samesex couples that pursue surrogacy may also seek second-parent adoptions for the nonbiological father. Notably, second-parent adoptions by same-sex partners are not universally available. Some states explicitly permit them, some states explicitly prohibit them, and in some states, whether or not they are granted depends upon where the couple lives, and/or which judge hears their case. Thus, in the absence of a second-parent adoption, the child has two social parents but only one legal parent—the partner who adopted the child. In the cases where only one member of an LGBTQ couple is a legal parent and the other is not, the legal parent has a nearly insurmountable advantage in any dispute with a nonparent, including a nonparent partner (or, more likely, former partner). And this difference in parental legal rights within couples may contribute to feelings of anxiety and stress, particularly for the legally invisible parent. Thus, legal inequities between same-sex partners create a substantial power imbalance even in intact families. Further, it also disadvantages the child to have only one legal parent in terms of inheritance and benefits. Options that families have pursued in order to increase the legal rights of the “second” parent when second-parent adoption is not permitted include legal documentation of the parents’ relationship (e.g., in wills, via shared finances and

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property) and hiring an attorney to establish de  facto parentage (i.e., legal recognition to a person who has acted like a parent for a substantial period of time).

Interactions With the Legal System The legal landscape concerning LGBTQ adoption is complex, shifts constantly, and varies by state and sometimes by county within the same state. Depending on where they live, some same-sex couples must face the reality that they will need to closet their relationship if they pursue adoption (both domestic and international adoption). That is, one parent is acknowledged by the agency or country issuing the adoption and the other parent is not. This situation can create intrapersonal and interpersonal stress, in that one partner is virtually invisible in the adoption process, having little or no direct contact with the agency, birthparent(s), and/or the child prior to the finalization of the adoption. Little research has examined lesbian and gay adoptive and prospective adoptive parents’ experiences with attorneys, judges, and adoption agencies, which may reflect and perpetuate societal heterosexist values. Out of awareness of such values, and the potential for discrimination, LGBTQ parents often seek professionals who are familiar with family law and the specifics of handling second-parent adoptions. In addition, they seek attorneys, judges, and agencies that are known to be “friendly” to the LGBTQ community. Some view these professionals as advocates who help them to navigate a potentially discriminatory legal system. Many parents search for these professionals by talking with other parents who have successfully adopted children; some communicate with each other in online forums and create a support network of LGBTQ parents seeking to adopt. In addition, research has shown that some potential adoptive parents travel to different counties or states to ensure that their adoptions are overseen by gay-friendly judges. Although there is little research that has examined the legal considerations faced by lesbian and

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Adoption, Openness in

gay individuals and couples who have adopted children, there is an even larger gap in the literature concerning bisexual individuals as well as transgender individuals. Little is known about how they navigate legal challenges as they pursue adoption. Members of the bisexual and transgender communities likely face similar barriers (e.g., discriminatory legislation, heterosexist policies, prejudice from agencies) but may also face unique challenges stemming from societal lack of acknowledgement and understanding of their sexuality and/or gender. April M. Moyer and Abbie E. Goldberg See also Adoption, Choices About; Adoption, Openness in; Adoption and Foster Care Discrimination; Adoption Type; Foster Parenting, Legal Considerations in

Further Readings Downing, J. B., Richardson, H. B., Kinkler, L. A., & Goldberg, A. E. (2009). Making the decision: Factors influencing gay men’s choice of an adoption path [Special issue: Lesbian and gay adoptive parents: Issues and outcomes]. Adoption Quarterly, 12, 247–271. Goldberg, A. E., Moyer, A. M., Weber, E. R., & Shapiro, J. (2013). What changed when the gay adoption ban was lifted? Perspectives of lesbian and gay parents in Florida. Sexuality Research and Social Policy, 10, 110–124. Goldberg, A. E., Weber, E. R., Moyer, A. M., & Shapiro, J. (2014). Seeking to adopt in Florida: Lesbian and gay parents navigate the legal process. Journal of Gay & Lesbian Social Services, 26, 37–69. Shapiro, J. (2013). The law governing LGBT-parent families. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 291–304). New York, NY: Springer.

ADOPTION, OPENNESS

IN

Openness arrangements describe possibilities for contact and information sharing between birth and adoptive families. Contact can involve

different members of the adoptive kinship network, which includes the adoptee, birth family, and adoptive family members; and contact can vary in frequency and type (e.g., in-person visits, phone calls, letters, e-mails, texts, social media contacts, and/or gifts). There have been growing trends toward greater openness in adoption over the past several decades in the United States, particularly with domestic adoptions. While sparse research has examined this topic among nonheterosexual adoptive parents, broader literature about adoption has demonstrated that options for openness between birth and adoptive families are generally linked with positive outcomes for adoptees, birth parents, and adoptive parents. Specifically, among lesbian and gay adoptive parents, there have been several recent studies that are aligned with the overall knowledge base about openness arrangements. This entry focuses on the openness arrangements among sexualminority parents and their adopted children’s birth family members. It addresses questions about the prevalence, perceptions, and dynamics of openness arrangements among sexual-minority adoptiveparent families. The discussion is particularly attentive to the perspective of adoptive parents, as no existing research has examined these topics from the viewpoint of birth family members or adopted children.

Motivations for Openness in Adoption Longitudinal interview-based research with lesbian, gay, and heterosexual couples who have adopted children has yielded important information about adoptive parents’ motivations for open adoption, how adoptive parents are navigating relationships with their child’s birth family, and how adoptive parents expand their notions of family to include birth parents. Some couples, regardless of sexual orientation, feel that open adoption is “the healthier approach,” given the lack of secrecy and full disclosure that they believe to positively influence their children’s psychological development (as well as benefiting everyone involved). A small number of parents want to pursue open

Adoption, Openness in

adoption specifically because of the greater likelihood of access to detailed medical information and health history regarding their child. Some sexualminority parents note that one of the most desirable features of open adoption is the possibility of gaining a male or female role model through the process. These parents express the belief that having a male or female role model would benefit their child’s gender development. Gay adoptive fathers in particular appear to be likely to express a desire for a “mother figure” for their child, which is aligned with societal discourse about the necessity of women in children’s lives. Most lesbian mothers, however, do not appear to highlight the role of birth father as important in providing this “male” role. Interestingly, same-sex couples do not seem to feel “pushed” toward open adoption by their adoption agency, whereas some heterosexual couples report feeling that they had little choice about openness if they hoped to complete an adoption in a reasonable amount of time. To the contrary, sexual-minority parents often specifically want to pursue open adoption because they can be “out” about their sexual orientation during the whole adoption process.

Pathways to Adoption and the Possibility of Openness Motivations for greater openness in adoption have been identified among lesbian and gay parents in research about how participants became parents. For example, factors that push gay fathers toward or away from various adoption paths—namely international, public, and private domestic open adoption—have been examined. Interviews with gay male couples pursuing domestic open adoption reveal that a desire for an infant is common, as they want to be there for their child from the start to be able to play a strong role in their development and develop a healthy bond and attachment. Some gay fathers feel having an infant is the closest they can come to having a biological child, and a few report the role of racial preferences. Gay men who adopt via domestic open adoption also note insecurity about adopting through the public child

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welfare system and no desire (or choice) to adopt internationally due to legal barriers and/or having to “hide” their relationship (as international “sending countries” typically prefer or require married heterosexual couples). As noted earlier, some gay fathers find domestic open adoption appealing because of the inherent honesty and openness involved, and some appreciate the practical reasons involved (e.g., perceived convenience). Similarly, many lesbian couples note that their desire to be “out” fits well within the larger philosophy about open adoption, and they feel a sense of integrity around representing themselves truthfully to birth mothers. Yet, at the same time, lesbian preadoptive parents express sadness, powerlessness, and a sense of injustice about the likelihood of experiencing rejection by birth parents based on their sexual orientation. Other gay male couples note that they want to adopt via the public child welfare system for financial reasons (e.g., perceived lower costs), or as a result of not being able to pursue another type of adoption due to legal barriers (e.g., international adoption), and/or not wanting birth parent contact. Likewise, lesbian and gay parents who pursue international adoption perceive it as the fastest and most secure pathway to parenthood. Some express not wanting direct birth parent involvement (or fears about their child being “taken back”), and some report discomfort about having to be “chosen” by a birth mother.

“Chosen” by Birth Parents Among lesbian and gay parents who adopt via different pathways, it appears that at least some parents (around one-third in one survey) are directly chosen by the birth parents to be the adoptive parents, have met one or both birth parents prior to adoption, have ongoing contact with the birth parents or other birth family members after adoption, and report that birth parents know of their sexual orientation. All four of these factors (being directly chosen, meeting birth parents prior to adopting, having birth family contact after adopting, and disclosure of sexual orientation) are more common among lesbian and gay parents who

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Adoption, Openness in

adopt privately or with an attorney as compared with other routes to adoption.

Perceptions of Birth Family Contact Indeed, lesbian, gay, and heterosexual adoptive couples who have completed private or public domestic adoptions appear likely to have some contact with their child’s birth mother—consistent with overall trends toward greater openness in adoption in the United States. Regardless of family type, most adoptive parents report positive feelings toward birth mothers and are satisfied with their level of birth family contact (whatever it is). Lesbian and gay adoptive parents, however, more so than heterosexual parents, tend to describe their child’s birth parents (typically the birth mother) as family, reflecting inclusiveness and expanded notions of family. This notion runs parallel to Kath Weston’s concept of “families of choice” that describes the extended communities of support (not defined by biological ties) that sexual-minority individuals often draw from in the absence of support from families of origin.

Trends in Openness Arrangements Among Lesbian and Gay Adopters Consistent with previous research, studies that include lesbian and gay adoptive parents indicate that earlier contact predicts greater contact later on, and satisfaction with contact is likely to be higher among families with ongoing birth family contact. In addition, lesbian and gay adoptive parents’ feelings toward the birth mother and satisfaction with contact do not appear to be related to the actual levels of birth family contact. In the same way, other demographic variables, such as the child’s race, do not seem to influence the level of birth family contact among lesbian, gay, and heterosexual adoptive parent families. Similar to broader research about openness in adoption, the degree to which contact increases, decreases, or is maintained over time across the pre- and postadoption periods varies among adoptive lesbian, gay, and heterosexual parent families.

Some couples describe becoming increasingly invested, while others become less open over time. Several parents across family types mention hesitation or concerns about open adoption before being placed with their child, and they describe few changes in their attitudes following placement. Others, despite a high level of investment in contact initially, experience a decline in expectations for contact due to a lack of response from birth parents. One factor that is associated with less birth mother contact among all adoptive families, including those with lesbian and gay parents, is substance use by the birth mother during pregnancy.

Tensions Between Birth and Adoptive Parents For those families with ongoing contact, a minority of adoptive parents describe feeling as though the birth mother is overstepping her boundaries in some way. Interestingly, gay men appear to be the most tolerant of these types of behaviors, and at least some evidence has suggested that gay fathers may be most likely to maintain postplacement contact. While other data from several studies indicate that all families are equally likely to have some form of ongoing or planned contact, gay fathers may be likely to have the most contact in particular formats—such as by phone—perhaps as a result of fewer perceived barriers to open communication among birth mothers and gay fathers. Similarly, gay fathers may be particularly likely to be chosen by birth mothers, as men may be perceived by birth parents to be less challenging to work with than women. Perhaps birth mothers are seeking to minimize competition or jealousy in selecting gay fathers, as compared with selecting additional “mothers” in lesbian couples.

Foster Parenting Lesbian, gay, and heterosexual parents whose children joined the family specifically via foster-toadoption placements report a number of challenges with birth family contact. Parents describe their

Adoption, Openness in

own anxiety and stress related to their children’s visits with birth parents, and that their children sometimes become upset and agitated following visits. Even with a commitment to keep a positive attitude toward birth parents, some adoptive parents also note distress around having an increased level of conflict with their partners related to differences of opinion about how to navigate birth family contact. Lesbian and gay couples who foster-to-adopt report that not all birth parents are accepting of same-sex couples, and some contend with direct homophobia from birth families. In these cases, it appears that social workers may be withholding information from the birth family about the foster/adoptive parents’ sexuality. LGB foster parents with birth family contact also frequently report hiding their sexual orientation because they often feel it makes the birth family uncomfortable (and this may be more common among sexual-minority men than women). Some adoptive parents are disheartened by a lack of birth family contact when they had hoped for a greater degree of openness postplacement, and many foster parents also report a lack of contact with their foster youth’s birth family. In contrast, a smaller percentage of parents also do explicitly identify positive aspects of contact with their child’s birth family and/or feel their relationships with their foster child’s birth family are close. (Among foster parents, these dynamics appear to be more common among lesbian and bisexual women rather than gay men.)

Legal Adoption Finalization With regard to legal finalization of adoption, available data indicate that contact with birth families is in no way a hindrance to the legal adoption process moving forward. In contrast, contact may be facilitative in some ways—challenging some adoptive parents’ “worst fears” that birth family contact will somehow derail or compromise the stability of the placement. This idea has also been disconfirmed by other studies indicating that birth family contact does not interfere with adoptive couples’ sense of entitlement, nor does it

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exacerbate fears that birth parents might attempt to reclaim their child.

Withholding Adoption Information From Children A final area of interest about open adoption within adoptive families is the extent to which parents share openly with their child about adoption and birth family. While it seems common that adoptive parents (sexual-minority and heterosexual) do not purposefully withhold adoption information from their children, those who have plans to withhold have strong rationales for doing so, such as considering the developmental appropriateness of sharing difficult information with their children. Thus, in the same spirit of honesty and openness regarding contact with birth families, lesbian and gay adoptive parents also tend to be committed to openness of communication about adoption with their children.

Conclusion Given that this growing body of research comparing openness dynamics among lesbian, gay, and heterosexual adoptive parent families reflects few differences in birth family contact, this may suggest that all adoptive parents, regardless of sexual orientation, navigate dynamics of openness in adoption in similar ways. This is in contrast to notions that sexual-minority adoptive parents are subject to different influences than are heterosexual parents in making decisions about birth family contact. While lesbian and gay adoptive parents may have different experiences than do heterosexual adoptive parents throughout the adoption process (e.g., encountering legal barriers and/or discrimination based on sexual orientation), it does not appear that these differences are linked with distinct and consistent discrepancies in the level of contact or dynamics surrounding relationships with birth family members. Policy and practice surrounding adoption by lesbian and gay parents have largely outpaced the research on this topic, and greater information about the dynamics of postadoption birth family

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Adoption, Openness in

contact is beneficial to those working to navigate these complex relationships—including adoptive kinship network members and those adoption professionals who work with them. Results from empirical research may also provide valuable information to prospective adoptive parents who are curious about how openness between birth and adoptive families can be managed postplacement. Decisions about openness arrangements should be carefully considered, as the factors involved are unique to each individual adoption placement, and there is no “one-size-fits-all” approach with regard to successfully navigating open adoptions. Future research could provide insight into the “best practices” for helping prospective and current adoptive parents (and birth family members) making decisions about contact and information sharing. With specific regard to the prejudice experienced by adoptive parents from birth parents on the basis of sexual orientation, as well as related decisions about parents’ disclosure about sexual orientation to birth parents, intervention with birth family members might be particularly useful. Perhaps research could investigate the impact of education and training about families led by lesbian and gay parents on birth parents’ attitudes toward placing children with sexual-minority parents, and also on subsequent relationship dynamics among birth and adoptive family members. Future longitudinal work would also help to address the role of satisfaction with contact and feelings toward birth mothers (and other birth relatives) in influencing birth family contact. Particularly among lesbian and gay adoptive parents, exploring the role of the adoption agency in encouraging (or discouraging) contact, as well as legal parenting status issues, would be informative. Further research would benefit from larger and more diverse samples and longitudinal examinations to decipher what factors related to openness arrangements are linked with positive and healthy outcomes for all involved over time. Rachel H. Farr See also Adoption, Choices About; Adoption, International; Adoption, Legal Considerations in;

Adoption and Foster Care Discrimination; Adoption Type; Adoption via the Child Welfare System; Deciding Whether to Parent; Families of Choice; Foster Care; Foster Parenting

Further Readings Brodzinsky, D. M. (2011). Expanding resources for children III: Research-based best practices in adoption by gays and lesbians. New York, NY: Donaldson Adoption Institute. Retrieved from http://www .adoptioninstitute.org Brodzinsky, D. M., Green, R. J., & Katuzny, K. (2011). Adoption by lesbians and gay men: What we know, need to know, and ought to do. In D. Brodzinsky & A. Pertman (Eds.), Adoption by lesbians and gay men: A new dimension in family diversity (pp. 233–254). New York, NY: Oxford University Press. Downing, J., Richardson, H., Kinkler, L., & Goldberg, A. (2009). Making the decision: Factors influencing gay men’s choice of an adoption path. Adoption Quarterly, 12(3–4), 247–271. Downs, A., & James, S. E. (2006). Gay, lesbian, and bisexual foster parents: Strengths and challenges for the child welfare system. Child Welfare, 85(2), 281–298. Farr, R. H., & Goldberg, A. E. (2015). Contact between birth and adoptive families during the first year postplacement: Perspectives of lesbian, gay, and heterosexual parents. Adoption Quarterly, 18(1), 1–24. Goldberg, A. E., Downing, J. B., & Sauck, C. C. (2007). Choices, challenges, and tensions: Perspectives of prospective lesbian adoptive parents. Adoption Quarterly, 10(2), 33–64. Goldberg, A. E., & Gianino, M. (2011). Lesbian and gay adoptive parent families: Assessment, clinical issues, and intervention. In D. Brodzinsky & A. Pertman (Eds.), Adoption by lesbians and gay men: A new dimension in family diversity (pp. 204–232). New York, NY: Oxford University Press. Goldberg, A. E., Kinkler, L. A., Richardson, H. B., & Downing, J. B. (2011). Lesbian, gay, and heterosexual couples in open adoption arrangements: A qualitative study. Journal of Marriage and Family, 73(2), 502–518. Goldberg, A. E., Moyer, A. M., Kinkler, L. A., & Richardson, H. B. (2012). “When you’re sitting on the

Adoption and Foster Care Discrimination fence, hope’s the hardest part”: Challenges and experiences of heterosexual and same-sex couples adopting through the child welfare system. Adoption Quarterly, 15(4), 288–315. Grotevant, H. D. (2012). What works in open adoption. In P. A. Curtis & G. Alexander (Eds.), What works in child welfare (pp. 309–328). Washington, DC: Child Welfare League of America.

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specifically upon LGBTQ adoptive and foster parents by agencies in regard to their sexual orientation and/or gender identity. The entry focuses primarily on adoptive and foster care where longterm placements are provided to children removed from their birth parents, rather than short-term or temporary placements.

Effects of Social Norms

ADOPTION AND FOSTER CARE DISCRIMINATION Historically, formal adoption and foster care were restricted to heterosexual married couples. Over the past two decades such restrictions have been lifted in many countries to allow single people and/ or people who do not identify as heterosexual and cisgender (i.e., people whose gender identity normatively accords with that expected of their assigned sex) to become adoptive or foster parents. In some countries, however, restrictions upon who is eligible to adopt or foster remain, and indeed this is differentiated within countries by state or province. Yet despite the gradual lifting of restrictions, and as is the case with many such legislative and policy changes, practices within adoption and foster care agencies often lag behind the laws and policies that guide them. As such, some lesbians, gay men, and bisexual and transgender people may continue to experience a range of discriminatory practices from adoption and foster care agencies. This entry addresses the contemporary experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people seeking to foster or adopt. In focusing on locales where formal restrictions have been lifted, this entry highlights how discrimination continues, despite the changing of legislation and policies. Specifically, the entry focuses on the effects of social norms upon LGBTQ applicants (in the form of heteronormativity and cisnormativity), instances of explicit discrimination in the context of adoption and foster care assessment and practice (in the form of homophobia, biphobia, and transphobia), and the injunctions placed

As tools for understanding the effects of social norms, the concepts of heteronormativity and cisnormativity offer much leverage in gaining insight into some of the subtle ways in which lesbian, gay, bisexual, and transgender foster care and adoption applicants experience discrimination. Perhaps the most common effect of social norms upon lesbian, gay, bisexual, and transgender applicants is the presumption that all people are heterosexual (i.e., heteronormativity) and that all people are cisgendered (i.e., cisnormativity). These presumptions can mean that when a potential applicant initially calls an agency and talks about a partner, the person on the phone presumes that the partner is of a different gender than the applicant. It can mean that promotional and training materials only feature heterosexual people. It can mean that when issues related to transgender people are addressed in assessment procedures and training, they take cisgender people as the norm or enforce normative gender binaries upon transgender people. Another common experience reported by LGBTQ foster care and adoption applicants is the expectation that they will disclose and explain their sexual orientation and/or gender identity to the agency worker undertaking their assessment. In other words, rather than agency workers who assess LGBTQ applicants being knowledgeable about these populations, applicants often report that they have to educate agency workers in order to receive a fair assessment. For lesbian or gay applicants who apply as couples, this can result in having to provide information about the dynamics of same-sex relationships. For transgender applicants, agency workers may often hold little or no knowledge about the lives of transgender people, or conversely may hold a range of normative

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Adoption and Foster Care Discrimination

presumptions about what it means to be transgender (i.e., that all transgender people will take hormones and/or have gender-affirming surgery). For bisexual applicants, a lack of knowledge among agency workers can result in having to dispel myths about bisexual people. Research in the field also suggests that assessment processes can contribute to the invisibility of bisexual people. For example, if two bisexual women in a relationship apply to foster or adopt, research suggests that they are often treated as lesbians, even if they explicitly state that this is not the case. Similarly, when a male and female couple present for assessment, research suggests that they are normatively presumed to be heterosexual, even if they explicitly state that one or both identify as bisexual. Indeed, it can often be the case that agency workers willfully ignore statements about bisexuality and refuse to include it in assessment reports, instead labeling applicants as either heterosexual, lesbian, or gay. A final example of the effects of social norms upon LGBTQ applicants is a lack of supports and resources. This may include training materials, case examples, and assessment documents not being inclusive of LGBTQ people. Agencies may not collect or release information about applicants who identify as members of these populations, making it more difficult for peer support groups to be developed. Heteronormativity and cisnormativity can also lead to agencies conceptualizing lesbians, gay men, bisexuals, and transgender people as “just like” heterosexual and/or cisgender people, under rhetoric of liberal inclusivity. This can mean that opportunities to target the specific needs of these populations are missed.

Explicit Discrimination Despite legislative and policy changes in many locales removing restrictions upon who is eligible to foster and adopt, this does not mean that LGBTQ people are always welcomed by agencies. In many locales, agencies with religious affiliations continue to discriminate, and often this is protected by legislation that allows organizations to

exercise religious freedom. Of course, even if such active discrimination is not the case, the views and beliefs of agency workers can mean that applicants who do not identify as heterosexual and/or cisgender are vetted out early in the assessment process, or ultimately not approved. Research suggests that some lesbians and gay men in particular attempt to circumvent this by presenting as single people and by not mentioning their lesbian or gay identity. Being approved to foster or adopt does not mean that LGBTQ people are free from experiencing discrimination. Research suggests that in some instances agency workers can be explicitly homophobic, biphobic, and/or transphobic. This can include refusing to place children; refusing to support applications for permanent placements (in the context of conversions from foster care to adoption); seeing LGBTQ foster and adoptive parents as “second class parents” deserving of “second class children” (i.e., placing these parents with children with extremely challenging behaviors, significant mental and physical health problems and/or disabilities); making discriminatory remarks in the presence of foster and adoptive parents; and terminating placements. Another specific form of discrimination reported in the literature relates to the refusal to place LGBTQ young people with LGBTQ foster or adoptive parents. Though it would seem appropriate and productive for such placements to occur (i.e., so that it is more likely the young person will be supported and accepted), research suggests that some agencies view such placements as endorsing non-normative sexual orientations and gender identities among young people, that there may be the potential for abuse, and that young people are better placed within heterosexual, cisgender-parent households. These types of views are reflective of homophobia, biphobia, and transphobia. Finally, it has been suggested that some agencies allow birth parents to vet the placement of their child with LGBTQ people. While in many instances it is important that birth parents are actively involved in placement decisions, the existence of homophobia, biphobia, and transphobia can mean that placement decisions are made that are not in

Adoption and Foster Care Discrimination

the best interests of the child, and are instead made in accordance with the discriminatory views of some birth parents, which are then endorsed or supported by the agency.

Injunctions Placed Upon LGBTQ Adoptive and Foster Parents Echoed repeatedly across research on LGBTQ foster and adoptive parents is the reported expectation that they be “perfect parents.” Applicants report that they feel an injunction to present a “perfect” home, to be in a normative relationship (i.e., monogamous, long-term, completely conflict free), and to have a past free from any forms of non-normative behaviors (i.e., for public and prominent expression of their sexual orientation and/or gender identity). Research suggests that this injunction can stymie accessing support once approved, under the tacit understanding that LGBTQ foster and adoptive parents should have exceptional parenting and coping skills, and that to present as otherwise may result in the placement being terminated. Another injunction that is widely reported across the literature on lesbian, gay, bisexual, and transgender parenting is the expectation of providing appropriate “role models” to children. For lesbian and gay foster and adoptive parents, for example, this can involve the expectation that they will involve adults of different genders in the raising of children (i.e., so that children are exposed to both cisgender men and women). For transgender foster and adoptive parents, the expectation can be that they ensure children interact with cisgender adults. In addition to this injunction to expose children to “difference,” there can be an accompanying injunction for LGBTQ foster and adoptive parents not to expose children to too much difference (i.e., to shield them from LGBTQ communities). A final injunction placed upon LGBTQ foster and adoptive parents is not to cause trouble: to be thankful for the forms of inclusion they are offered, and to refrain from challenging any exclusion they experience. This can be explicit (in terms of parents

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being advised not to challenge discrimination for fear of placement termination), or implicit (in terms of the sense that support is lacking within agencies). Research suggests that many LGBTQ foster and adoptive parents, when they experience a supportive agency worker, are fearful of what may happen if their case is reassigned and they are allocated a less supportive worker. This can result in a sense of having to be thankful for conditional support, rather than experiencing support as something that is guaranteed and ongoing. In sum, while in many locales restrictions have been lifted in terms of who is eligible to become a foster or adoptive parent, this does not necessarily mean that LGBTQ applicants are welcomed, nor that they are fully included and supported if their application is accepted. Research suggests that both mundane and hostile forms of discrimination continue, and that this leaves LGBTQ foster and adoptive parents with the sense that the support they experience is contingent and limited. Damien W. Riggs and Clare Bartholomaeus See also Adoption via the Child Welfare System; Discrimination Against LGBTQ People, Cost of; Discrimination Against LGBTQ People in the Public Sector; Foster Parenting; Heterosexism

Further Readings Brown, S., Smalling, S., Groza, V., & Ryan, S. (2009). The experiences of gay men and lesbians in becoming and being adoptive parents. Adoption Quarterly, 12(3–4), 229–246. Downs, A. C., & James, S. E. (2006). Gay, lesbian, and bisexual foster parents: Strengths and challenges for the child welfare system. Child Welfare: Journal of Policy, Practice, and Program, 85(2), 281–298. Eady, A., Ross, L. E., Epstein, R., & Anderson, S. (2009). To bi or not to bi: Bisexuality and disclosure in the adoption system. In R. Epstein (Ed.), Who’s your daddy? And other writings on queer parenting (pp. 124–132). Toronto, Ontario, Canada: Sumach Press. Goldberg, A. E., Downing, J. B., & Sauck, C. C. (2008). Choices, challenges, and tensions: Perspectives of lesbian prospective adoptive parents. Adoption Quarterly, 10(2), 33–64.

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Adoption Type

Hicks, S. (2000). “Good lesbian, bad lesbian . . .”: Regulating heterosexuality in fostering and adoption assessments. Child and Family Social Work, 5(2), 157–168. Riggs, D. W. (2011). Australian lesbian and gay foster carers negotiating the child protection system: Strengths and challenges. Sexuality Research and Social Policy, 8(3), 215–226. Ross, L., Epstein, R., Goldfinger, C., Steele, L., Anderson, S., & Strike, C. (2008). Lesbian and queer mothers navigating the adoption system: The impacts on mental health. Health Sociology Review, 17(3), 254–266.

ADOPTION TYPE LGBTQ people are increasingly becoming adoptive parents within the context of same-sex relationships. Rates of adoption by same-sex couples have doubled over the last decade, and approximately 2 million lesbian, gay, and bisexual people report being interested in adopting. In realizing their desires to parent, prospective adoptive parents must choose between three central adoption types: international adoption, private domestic adoption, and public domestic adoption. The process of choosing an adoption route entails complex intersections of personal desires, social norms and expectations, financial constraints, and legal regulations. All prospective adoptive parents negotiate the perceived benefits and challenges of various adoption routes, and same-sex couples must additionally navigate societal discrimination and legal challenges in pursuing adoption. This entry provides an overview of the central benefits and challenges associated with each type of adoption for same-sex couples.

International Adoption International adoption has become increasingly difficult for sexual minorities as a result of intercountry laws that prohibit lesbians and gay men from adopting. Same-sex couples have historically pursued international adoption by hiding their sexual orientation and adopting as single parents.

Perceived Benefits of International Adoption

Despite barriers to adopting internationally, there are numerous reasons why some same-sex couples may choose this type of adoption. Like heterosexual couples, same-sex couples may choose to adopt internationally because of a strong connection to another country. Prospective parents may also conceptualize international adoption as a way to actualize their strong desire to help a child in need. Some prospective parents choose international adoption because they can adopt a child of a specific racial or ethnic heritage to which they have a connection (e.g., one that matches their own). Additionally, in contrast to domestic adoptions, prospective parents may feel more comfortable choosing a type of adoption where they do not have to directly navigate birth family relationships. Finally, some couples perceive international adoption as entailing a clearer wait time before a child is placed with them compared with domestic adoptions. For instance, same-sex couples may be concerned about waiting indefinitely for birth parents to choose to place their child with a same-sex couple if they adopt domestically. Barriers to International Adoption

International adoption has become increasingly difficult for same-sex couples to pursue as a result of discriminatory intercountry laws prohibiting same-sex couples from adopting. Same-sex couples have historically found ways to adopt internationally by having one partner hide their sexual orientation and adopt as a single parent. For many same-sex couples this requirement is considered antithetical to their values of openness and honesty, and they are unwilling to compromise their values and risk the legal uncertainties in order to adopt internationally. International adoption has become especially prohibitive for gay men as a result of some intercountry laws that also prohibit single men from adopting. Same-sex couples that decide to have one partner legally adopt their child often choose to complete a second-parent adoption after the first parent’s adoption is finalized. Second-parent

Adoption Type

adoptions protect children’s rights and provide both parents the legal rights of guardians. However, not all states allow second-parent adoptions, which leaves same-sex couples without basic legal protections. For instance, the noncustodial parent’s rights may be called into question if the couple separates or the legal primary parent dies. Finally, in addition to the legal uncertainties and discriminatory laws associated with international adoption, the financial cost of adopting internationally is a significant barrier for many prospective adoptive parents.

Private Domestic Adoption Private domestic adoption entails the adoption of children, typically infants, through an arrangement with an agency or lawyer that helps “match” a birth mother or birth family with adoptive parents. This is an increasingly common type of adoption within the United States, and one that many samesex couples find appealing. There are nevertheless barriers that can make pursuing a private domestic adoption challenging. Perceived Benefits of Private Domestic Adoption

Adoptive parents often cite the desire for an infant as a primary motivating factor for choosing private domestic adoption. Unlike international and public adoption, domestic adoption allows parents to raise their child from birth and thereby limit early risk factors related to possible maltreatment, neglect, or abuse. Private domestic adoptions typically entail some form of contact between adoptive parents and birth family members, typically the birth mother. Over the last 20 years, openness between adoptive and birth family members has increasingly become the norm. Research suggests that in contrast to some heterosexual couples who may feel threatened by the presence of birth parents or the birth mother, gay male couples may feel less threatened by birth mothers and may be drawn to open adoptions precisely because it allows them to provide their child with a mother figure. Furthermore, same-sex couples may choose to pursue private

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domestic adoptions because they can adopt without hiding their sexual orientation. Finally, many parents pursue private domestic adoptions for practical reasons, such as perceiving this type as the most common type of adoption and because it is considered convenient, local, and financially feasible. Challenges of Private Domestic Adoption

Although same-sex couples may appreciate the philosophy of private domestic adoptions in allowing couples to openly adopt, same-sex couples may nevertheless have to confront discriminatory practices and legal regulations at the agency and state level. Although there is increasing recognition of best practices for adoption agencies working with same-sex couples, many same-sex couples continue to face discrimination by adoption professionals, social workers, and adoption agencies. Agency professionals may be blatantly discriminatory or may lack knowledge regarding issues relevant to LGBTQ adoptive parents. Furthermore, even if adoption agencies openly work with same-sex couples, many couples experience discriminatory state laws that make it difficult to co-adopt or to secure second-parent adoptions. Numerous states do not allow same-sex couples to co-adopt, and thus one partner must initially adopt the child and the other parent must petition for a second-parent adoption—an option that, again, may not be available in the couple’s state or jurisdiction. Research suggests that as state laws change to further protect the rights of LGBTQ adoptive parents, there are significant practical and symbolic benefits to increased sociolegal security, such as decreased anxiety during the adoption process, greater security and legitimacy for adoptive children, and increased ability to bond with the adoptive child. Although open adoption arrangements may be desirable for many adoptive parents, navigating birth parent relationships can pose numerous uncertainties and challenges. For instance, samesex couples may have to endure longer wait times for birth parents to choose them than heterosexual couples. Finally, similar to international adoptions,

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Adoption Type

private domestic adoptions may be considered prohibitively expensive for some couples.

Public Domestic Adoption Public domestic adoption entails the adoption of foster care children through child welfare. Prospective adoptive parents are often required to initially foster children prior to legally adopting them, and are referred to as foster-to-adopt parents. Perceived Benefits of Public Domestic Adoption

Many heterosexual and same-sex couples view adopting children as a moral imperative in which adopting is an avenue for helping children in need. Foster-to-adopt parents are typically open to adopting older children and less tied to the idea that adopting an infant is the only viable way to start a family. Additionally, public domestic adoption is inexpensive and entails a number of financial and legal supports and services to help with the costs of parenting children from the child welfare system. For instance, foster-to-adopt parents may be eligible for child care subsidies, health insurance benefits, and other types of state-provided benefits. Transracial adoptions are common in public adoptions, in that there is a disproportionate number of White adopters and a disproportionate number of racial-minority children in foster care. Research suggests that same-sex couples are more likely to adopt transracially than heterosexual couples. Same-sex couples may therefore be drawn to public adoption given that they can meet the needs of foster-to-adopt children through their openness to adopting transracially. Challenges of Public Domestic Adoptions

Foster-to-adopt parents confront unique challenges in adopting. Children in child welfare are often older and have experienced numerous risk factors, including prenatal substance abuse exposure, prematurity, parental neglect or abuse, poverty, and parental mental illness. Compared with children adopted as infants through private adoptions, these children are more likely to demonstrate behavioral, emotional, and attachment issues. These challenges

can lead to increased adoption disruptions and lower parenting satisfaction. Research suggests that samesex adoptive parents may be more inclined than heterosexual couples to consider adopting children with serious emotional, physical, and behavioral problems. Despite the possible stress and uncertainty related to adopting children from child welfare, the majority of gay, lesbian, and heterosexual parents are very satisfied with the adoption overall, particularly two years after the placement of the child. Within the child welfare system, same-sex couples may confront a lack of support, continued legal challenges, and increased scrutiny. Prospective adoptive parents often face the reality that they do not have legal custody of their foster children until the adoption process is finalized. Legal uncertainties and delays in the legal finalization of the adoption can add increased stress and uncertainty. Similar to challenges experienced adopting internationally or privately, same-sex couples adopting through child welfare also face discriminatory state laws that impact whether both partners can jointly adopt their child. Positive relationships between foster parents and agency staff are particularly important given that positive relationships are associated with placement success whereas negative relationships with agency staff are linked to placement disruption and parental dissatisfaction. Inadequate support services, insufficient information about the child, and poor communication are some of the central challenges that some foster-to-adopt parents face. These challenges may be compounded for same-sex parents who may encounter heterosexist beliefs by agency workers and may feel inappropriately scrutinized by social workers. Foster-to-adopt parents often desire positive relationships with birth parents, but this can be challenging if the biological parent or parents are actively seeking to secure legal custody of the child. Thus, adoptive parents may feel frustrated or angry with birth parents who are actively seeking to disrupt the adoption process. Such relationships may be particularly difficult for same-sex parents in contexts in which birth families are actively uncomfortable, dismissive, or disapproving of the foster parents’ sexual orientation.

Adoption via the Child Welfare System

Conclusion Same-sex couples are increasingly becoming parents through adoption, and in choosing how to become adoptive parents, same-sex couples must consider the various positives and challenges associated with each type of adoption. Although same-sex couples consider many of the same factors as heterosexual couples in choosing an adoption path, same-sex couples must also navigate prevailing social norms, legal regulations, discriminatory practices, and the specific sociolegal context in which they are adopting. Future research is needed that addresses the unique issues relevant to transgender adoptive parents. There is currently a lack of legal precedent for transgender parents, and transgender people may be discriminated against and denied parental rights despite research and professional advice indicating that gender identity is not a determinant of parenting ability. Jordan B. Downing See also Adoption, Choices About; Adoption, Legal Considerations in; Adoption, Openness in; Adoption and Foster Care Discrimination; Adoption via the Child Welfare System

Further Readings Brown, S., Smalling, S., Groza, V., & Ryan, S. (2009). The experiences of gay men and lesbians in becoming and being adoptive parents. Adoption Quarterly, 12, 229–246. Downing, J., Richardson, H., Kinkler, L., & Goldberg, A. (2009). Making the decision: Factors influencing gay men’s choice of an adoption path. Adoption Quarterly, 12, 247–271. Farr, R. H., & Patterson, C. J. (2009). Transracial adoption by lesbian, gay, and heterosexual couples: Who completes transracial adoptions and with what results? Adoption Quarterly, 12, 187–204. Goldberg, A. E., Moyer, A. M., Kinkler, L. A., & Richardson, H. B. (2012). “When you’re sitting on the fence, hope’s the hardest part”: Challenges and experiences of heterosexual and same-sex couples adopting through the child welfare system. Adoption Quarterly, 15, 288–315.

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Goldberg, A. E., Moyer, A. M., Weber, E. R., & Shapiro, J. (2013). What changed when the gay adoption ban was lifted? Perspectives of lesbian and gay parents in Florida. Sexuality Research and Social Policy, 10, 110–124. Jennings, S., Mellish, L., Tasker, F., Lamb, M., & Golobok, S. (2014). Why adoption? Gay, lesbian, and heterosexual adoptive parents’ reproductive experiences and reasons for adoption. Adoption Quarterly, 17(3), 205–226. Lavner, J. A., Waterman, J., & Peplau, L. A. (2014). Parent adjustment over time in gay, lesbian, and heterosexual parent families adopting from foster care. American Journal of Orthopsychiatry, 84(1), 46–53.

ADOPTION VIA THE CHILD WELFARE SYSTEM This entry describes the general phenomenon of adoption from the child welfare system and specifically by LGBTQ people. It explains the basis for those relationships in terms of adoption practice and highlights the emerging changes in policies and practices that have impacted LGBTQ people’s experiences in adoption. The entry identifies the important qualities of adoption and highlights some of the key variables of adoption. Adoption is defined as a process whereby a person assumes the  parenting  of another, usually a child or youth, from that person’s biological or legal parent or parents, and, in so doing, permanently transfers all the rights and responsibilities, along with filiations, from the biological parent or parents. Unlike legal guardianship or other systems designed for the care of the young, adoption is intended to effect a permanent change in status, and as such requires societal recognition, through either legal or religious sanction. Modern systems of adoption, arising in the 20th century, are governed by federal and state-based comprehensive statutes and regulations. Each state has an obligation to protect the health and welfare of children. There are many ways to adopt, but this entry focuses on adoption from the child welfare system.

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Adoption via the Child Welfare System

Although adoption is an age-old tradition in most societies, it has changed considerably over the centuries, with its focus shifting from closed infant adoptions to a greater openness about adoption and the issues of adoption. Adoption, as defined by law, terminates the rights and responsibilities of birth parents and vests them in an adoptive parent or parents. Adoptions are officially sanctioned through public or state-licensed private agencies or via private placement arrangements. Courts, guided by the child’s best interest, must review all adoption petitions; in addition, the agency’s consent is required for agency adoptions, and in most states, judges hearing private adoption petitions must consider agency or social worker recommendations.

LGBTQ People and Adoption In recent years, data has focused increasingly on LGBTQ people and their desire to adopt. According to a 2011 Williams Institute study that used multiple data sources, an estimated 37% of LGBTQ-identified adults have had a child at some time in their lives. An estimated 3 million LGBTQ Americans have had a child and as many as 6 million American children and adults have an LGBTQ parent. More than 111,000 same-sex couples are raising an estimated 170,000 biological, step-, or adopted children. Additionally, these same-sex couples who consider themselves to be spouses are more than twice as likely as heterosexual couples to be raising biological, step-, or adopted children. Same-sex couples raising children are 4 times more likely than their different-sex counterparts to be raising an adopted child. Specifically, an estimated 16,000 same-sex couples are raising more than 22,000 adopted children in the United States. Further, same-sex couples are 6 times more likely than their heterosexual counterparts to be raising foster children. Approximately 2,600 same-sex couples are raising an estimated 3,400 foster children in the United States.

LGBTQ Adoption Policies Utah and Mississippi were the two states with the most restrictive adoption policies for LGBTQ

people at the time of this writing. In Utah, where gay marriage was not allowed before 2015, the law banned all unmarried individuals in cohabiting relationships from being adoptive or fostercare parents, while Mississippi only banned same-gender couples from those roles. In response to the growing need to find permanent parents for children and youth in need of permanent homes, many states have moved toward safeguarding the interests of the children of LGBTQ people by strengthening their legal relationships with their families. States sometimes discriminate against LGBTQ couples that want to adopt as a couple (that is, they do not allow both partners to jointly adopt a child), but will allow single LGBTQ persons to adopt. Usually, if a couple wants to coparent an adopted child, one partner adopts the child first, and then the other partner asks a court to grant a secondparent or co-parent adoption. At the time of this writing, at least 14 states have granted second-parent adoptions to LGBTQ parents, ensuring that their children can enjoy the benefits of having two legal parents; in seven other states, parents can make the request with some restrictions. In states that do not permit second-parent adoption for LGBTQ families, adopted children are denied equal protection under the law and its benefits. Discrimination against lesbian, gay, bisexual, and trans people may continue to exist on many levels of society, but the marriage issue for LGBTQ people was resolved in 2015 with the U.S. Supreme Court decision outlawing state bans on same-sex marriage. The benefits bestowed on couples by virtue of entering into a legal bond of marriage are economic, legal, and emotional. These benefits are meant to support not only both partners but also their children.

Research Findings: LGBTQ People Make Good Adoptive Parents As ethical debates may continue over the appropriateness of LGBTQ people parenting children and youth, are we losing track of the point? The real issue is that children and youth need responsible, loving parents. We must keep in mind two vital points in this debate: First, research findings

Adoption via the Child Welfare System

indicate that gender-identity expression and sexual orientation are unrelated to whether or not someone is a good parent. Second, research findings show that children in LGBTQ-parented families are as well-adjusted, happy, and successful as their counterparts raised in heterosexual-parented families. It is time that child welfare providers recognize and embrace the fact that some LGBTQ people would be wonderful parents to children and youth who are in desperate need of permanent homes. Although the majority of states no longer officially deem LGBTQ people as unfit to rear a child, each state decides independently who can adopt, and legislators continue to introduce bills barring adoptions by LGBTQ people into state legislatures every year. Restrictions on the ability of LGBTQ people to provide foster or adoptive homes for needy children run counter to the welfare of children needing such homes. States’ and agencies’ refusal to place children with sexual minorities is also sometimes based on the perceived potential harm to children (i.e., fear of molestation, fear that the child will be stigmatized, and fear that the child will become homosexual/bisexual). Refusals to permit LGBTQ people to adopt stem in part from a fear of appearing to accept LGBTQ people and same-gendered relationships to any degree.

Assessment of LGBTQ Foster and Adoptive Parents Deciding to adopt from the child welfare system is a huge decision and commitment. All potential parents are understandably apprehensive about what the process entails, and—given the apparent misperceptions held by some about LGBTQ people choosing to parent—these potential parents may have even greater reasons for concern. Overall, large numbers of LGBTQ people have successfully fostered or adopted, but the view that LGBTQ people will simply be rejected as foster or adoptive parents is still a commonly held perception. It is well established that most professionals who provide health and social services to adopted children and their families are heterosexual.

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During the past decade, child welfare agencies have made various efforts to enhance the ability of such professionals to respond effectively to the needs of people who are not heterosexual. These efforts have been largely sporadic, with an emphasis on raising awareness and sensitivity. Additional efforts have sought to increase knowledge and understanding about the history and culture of specific groups of lesbian, gay, bisexual, and trans people. These attempts, however, have not fully addressed the issue of effective practice in a way that builds capacity in a comprehensive, sustained manner; though these efforts represent a good beginning, they are less than adequate.

The Challenge for Professionals States have a clear imperative to provide effective services for prospective lesbian, gay, bisexual, and trans adoptive parents. This shift requires organizational, cultural, and systemic shifts to be implemented throughout an organization. Social work educators, as well as practitioners, often assume that competence with LGBTQ groups can be achieved through short-term, and often “oneshot,” workshops or LGBTQ guest speakers in lectures or in panels. These assumptions reflect a short-sighted, simplistic view of a complex process. Restructuring one’s views and developing a sound base of organizational, cultural, and systemic knowledge and skills should be long-term professional endeavors. Thus, any serious initiative to work effectively with LGBTQ populations begins with these premises: to review and revise all policies, assuring that procedures are LGBTQ-affirming for all children, youth, and families; to develop practices that are supported by these policies; to utilize competencybased training for all levels of staff in child welfare agencies and capacity-building technical assistance, especially for program supervisors who will supervise these changes; and, finally, to integrate and promote an LGBTQ-affirming approach into all aspects of the child welfare system. Child welfare agencies must pursue preparation for serving LGBTQ populations effectively on a multidimensional front. A unimodal focus on raising awareness or sensitivity is required, but is

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Adoption via the Child Welfare System

inadequate by itself. It is unacceptable to believe that increasing one’s level of understanding of LGBTQ people is all one needs to do. Nowhere is this issue more relevant than during the adoption assessment process.

The Assessment Process The assessment processes for lesbian, gay, bisexual, and trans adoptive parents can become skewed if the assessing worker is either overfocusing on sexuality or totally ignoring it. Workers cannot ignore gender-identity expression and sexual orientation in the assessment process, because an individual’s sexuality is an aspect of who they are as a total person and will affect their life as a parent. Although it may not always be an issue for the applicant, the worker should be able to assess the applicant’s ability to constructively manage bi/trans/homophobia in his or her own life. The child welfare field has moved from the model that has treated LGBTQ applicants as being the same as their heterosexual counterparts to acknowledging the different experiences that being an LGBTQ parent brings to fostering and adoption. As LGBTQ parents have demonstrated their unique strengths as foster/adoptive parents, they have had less need to argue that they are “just as good” as heterosexual parents, challenging the underlying presumption that the heterosexual model of family life is best. Adoption agencies are required by law to carry out a full assessment of applicants before approving them as foster or adoptive parents. The information to be collected and required safety and reference checks are detailed in the relevant state regulations and standards. Although this process may vary from state to state, agencies should make prospective parents aware of the flow of this process at the start of their initial engagement with the agency. All applicants should understand the process so that no individual group thinks they are being asked to  do something that other groups are not. The Human Rights Campaign’s (HRC) website identifies eight questions to consider before starting the adoption process (see http://www.hrc.org/resources/

entry/8-questions-to-ask-before-starting-theadoption-process): 1. Should potential parents adopt via a public or private agency? 2. What child is right for me/us? 3. Do you have the necessary investments childrearing requires? 4. Do you have the patience to wait for your child to show you love? 5. Do you have the social and community resources around you that will help you and them along the way? 6. Are you patient enough to successfully complete pre- and postadoption placement counseling? 7. Are you ready to be 100% honest and transparent with the agency worker? 8. Have you had a major life event in the past 12 months?

The Adoption Process The process of adopting through the child welfare system typically proceeds in several discrete steps. These steps are outlined below, in a format that is geared toward the prospective adoptive parent. Step 1: Contact Your Local Adoption Agency. Prospective adoptive parents should contact the Parent Recruitment Hotline to receive an information packet by mail. They can pick up the information packet, as well. Step 2: Attend an Orientation. After the prospective adoptive parent(s) receive their packet of information, they should call one of the recruitment agencies and make an appointment to attend an orientation or register online. At the orientation, adoption professionals will give prospective adoptive parent(s) an overview of the adoption process, guide them through every step of the process, and answer their questions.  Step 3: Complete the Adoption Application. At the end of the orientation, prospective adoptive

Adoption via the Child Welfare System

parent(s) will be given an application to fill out. Prospective adoptive parent(s) must return the completed application to their adoption recruitment agency. Once social workers have reviewed it and are satisfied that the basic elements are in place, they will contact the prospective adoptive parent(s) to begin a home study.  Step 4:  Have a Home Study Prepared. The home study provides the child welfare agency and the courts with comprehensive information needed to place a child in the care of the prospective adoptive parent(s). Parents and their social worker will meet several times during the process. Parents will submit various documents including copies of birth certificate(s), a marriage license (if applicable), income tax returns, and medical reports completed by a physician. All adults in the prospective adoptive parent’s home must be fingerprinted and cleared through the State Central Registry for Abuse and Neglect. Depending on the particular circumstances, a home study can take up to several months.  Step 5:  Complete a Training Series. While the home study is under way, prospective adoptive parent(s) will attend an 8- to 10-week Model Approach to Parenting Preparation (MAPP) or Parent Resource for Information, Development, Education (PRIDE) training course, where they will learn parenting skills, assess their own strengths as a parent, and better understand the particular needs of adoptive children.  Step 6: Be Matched With a Child. Once the training series has been completed, the prospective adoptive parent(s) are ready to begin the matching process. Prospective adoptive parent(s) will have the opportunity to look at Web-based catalogues of children waiting for adoption. The local child welfare agency will assist both the prospective adoptive parent(s) and the child to make the right match. Visiting will begin at this point. Step 7: Get to Know Each Other. After visiting, the child(ren) will move into the adoptive family’s home. During this preadoptive phase, the family and the child will get to know each other. The

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family will learn about the child’s medical and family history. The family will also learn about adoption subsidies and reimbursements. The family will sign an Adoptive Placement  Agreement. The agreement says that the family will take care of the child and intend to adopt.  Step 8: A Child Is Placed in the Family’s Care. After the children move into their new home with the family, it will take approximately 6 to 8 months—and in some cases longer—before the adoption can be finalized. The agency will remain involved with both the family and the child during this time. Step 9: Choose an Attorney to File the Adoption Petition. When the family is ready to finalize the adoption, they will hire an attorney and work with the agency to file the adoption petition in family court. Fees for an adoption attorney will, in most cases, be reimbursed by the local agency.  Step 10: Finalize the Adoption. The adoption petition will be reviewed in family court. When the judge approves the match, the family and the child can go to court to sign the final adoption papers.

Conclusion Social work—and more specifically, child welfare’s response to lesbian, gay, bisexual, and trans adoption applicants—has been varied and sometimes unpredictable. Although not all social workers are biased against LGBTQ families, and though there have been many changes in policy during the past decade, a major issue continues to be the lack of federal law to guide social work practice. Going out on a limb to approve or work with an LGBTQ parent, or quietly implementing a home study, have been common themes in child welfare. It is important that agencies and social workers are prepared for issues that will arise, both professionally and individually, in working with LGBTQ prospective adoptive parents. Professionals need to be aware of assumptions and stereotypes that previously may have shaped policy and legislation and may have informed practice that was less than

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Adults With LGBQ Parents

competent. Social workers also need to examine their own personal attitudes about LGBTQ people. They need to be careful not to assume automatic parenting skills in heterosexual applicants, just as they need to be careful not to assume unsuitability for parenting in LGBTQ applicants. The genderidentity expression and sexual orientation of a potential parent does not, of itself, indicate anything about that person’s ability to care for children who may have had difficult experiences. Social workers need to explore openly with each individual or couple their experience and skills in relation to caring for and parenting a child or adolescent though adoption from the public child welfare system. Gerald Mallon See also Adoption, Choices About; Adoption, International; Adoption, Openness in; Adoption and Foster Care Discrimination; Joint Adoption; SecondParent Adoption; Single-Parent Adoption

Further Readings Brown, S., Smalling, S., Groza, V., & Ryan, S. (2009). The experiences of gay men and lesbians in becoming and being adoptive parents. Adoption Quarterly, 12, 229–246. Gates, G. J. (2011). How many people are lesbian, gay, bisexual, or transgender? Retrieved August 24, 2013, from http://williamsinstitute.law.ucla.edu/wp-content/ uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf Mallon, G. P. (2014). Issues in adoption practice. In G. P. Mallon & P. Hess (Eds.), Child welfare for the 21st century: A handbook of practices, policies, and programs (2nd ed., pp. 219–231). New York, NY: Columbia University Press. Mallon, G. P. (2014). Lesbian, gay, bisexual and trans foster and adoptive parents: Recruiting, assessing, and supporting an untapped resource for children and youth (2nd ed.). Washington, DC: Child Welfare League of America. Patterson, C. J. (1996). Lesbian mothers and their children: Findings from the Bay Area families study. In J. Laird & R.-J. Green (Eds.), Lesbians and gays in couples and families: A handbook for therapists (pp. 420–438). San Francisco, CA: Jossey-Bass.

ADULTS WITH LGBQ PARENTS Adults with lesbian, gay, bisexual, and queer (LGBQ) parents are a diverse group. Many of these adults had LGBQ parents who came out in the context of a heterosexual relationship, while others were born to or adopted by one or more “already-out” LGBQ parents. Adults with LGBQ parents vary in regard to their social and demographic backgrounds such as their races and ethnicities and their sexual and gender identities, which may be the same as or different from their parents’. Early research on this population primarily grew out of the need for social science research to investigate the effects of parental sexual orientation on children’s well-being to aid in family court custody decisions. As was typical in the 1970s and 1980s, when LGBQ parents came out in the context of heterosexual marriages, LGBQ parents’ parental rights could be, and often were, challenged based solely on their sexual orientations. Groundbreaking research, published in the mid1990s by United Kingdom psychologists Fiona Tasker and Susan Golombok, longitudinally examined the experiences of adults with lesbian parents. In regard to psychological well-being outcomes, their sample of 25 young adults with lesbian mothers was indistinguishable from the comparison group of 21 young adults with heterosexual parents. The groups did not differ in regard to their likelihood of having been teased while growing up; however, the young adults with lesbian mothers, especially boys, were more likely to recall being teased in regard to their sexuality. Most studies on the offspring of LGBQ parents that followed were conducted with children; however, in 2000, freelance writer Noelle Howey and poet Ellen Samuels coedited an important anthology of essays written by grown children of lesbian, gay, and transgender parents. This represented one of the first efforts to collect and share the experiences of adults with sexual and gender minority parents; further, these accounts were uniquely written from these adults’ own perspectives. Soon

Adults With LGBQ Parents

after, in 2004, writer and journalist Abigail Garner published her own groundbreaking book, Families Like Mine: Children of Lesbian and Gay Parents Tell It Like It Is, for which she interviewed more than 50 adults (in their 20s and 30s) with lesbian, gay, bisexual, and transgender parents. In an LGBTQ-affirming way, Garner explicitly steered away from the notion that kids with LGBTQ parents are “no different” from kids with heterosexual parents. For example, she highlighted the “pressure to be perfect” that many youth with LGBTQ parents feel as a result of their families being under scrutiny. She also discussed the notion of heterosexual offspring of LGBTQ parents being “culturally queer, erotically straight”—a concept of bicultural identity first used by Stefan Lynch, executive director of COLAGE (see the COLAGE entry in this volume), to describe how adults with LGBQ parents, even if heterosexual, can be linked to queer culture via their heritage. Academic works since then have followed this lead and have aimed to describe the varied and rich experiences of adults with LGBQ parents— primarily in the United States—as they have navigated a heteronormative society. Psychologist Abbie Goldberg published two papers in the mid2000s to explain how adults with lesbian, gay, and bisexual (LGB) parents handled disclosure of their familial identities to friends, significant others, and coworkers, and how these adults perceived their familial backgrounds as having influenced their adult lives. Many of them felt that growing up with LGB parents allowed them to be more openminded and to develop more flexible notions of gender and sexuality than they might have otherwise. Although these adults felt proud or ashamed of their families at various points in their lives and had various reasons for and degrees of disclosure to others, all faced the challenge of, as Goldberg stated, “negotiating the pressures of heteronormativity (and a desire to protect oneself from marginalization and derision) with one’s lived experience in a particular (often invisible, often marginalized) family structure.” In 2009, extending Garner’s writing on the “second generation,” family researchers Katherine

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Kuvalanka and Goldberg published the first study of LGBTQ individuals with LGBQ parents in the social science literature (see the Children With LGBQ Parents, Sexual Identity entry in this volume). They found that, for some second-generation individuals, having lesbian and bisexual parents made their own coming out easier; however, others felt that their own coming out was hindered due to social pressures, such as to counteract the notion that “gay parents make gay kids.” From 2011 to 2013, Goldberg first-authored four more papers from another dataset of qualitative interviews with individuals with LGBQ parents. To begin, Goldberg and her colleagues conducted an in-depth examination into the connection of adults with LGBQ parents to the LGBTQ community, revealing different strengths of connection, as well as changes in connection over time. In 2012, as marriage equality debates raged on in the United States, Goldberg and Kuvalanka reported how a sample of (mostly) adults with LGB parents felt about their parents having access to, or being denied the right to enter into, civil marriage. Although the vast majority of these participants favored marriage equality and pointed out both the tangible and symbolic benefits of marriage that their parents and families had been denied, others echoed critiques of marriage as heteronormative and emphasized how their families had not needed marriage to make their families “whole.” In 2013, Goldberg reported on how some of these same adults felt about marriage for themselves in light of a lack of marriage equality for their parents; findings revealed great diversity in responses in that many participants held romantic hopes and ideals for themselves in regard to marriage, while others held more pragmatic or conflicted views. Also that year, Goldberg and family researcher Katherine Allen shared their investigations of subsets of these same adults with LGBQ parents, exploring the topics of LGB stepfamilies and relationships with donor dads. For the vast majority of these participants, LGB stepfamily formation happened outside of legal influence, posing both advantages and disadvantages, while participants with known donors had relationship ties

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Advance Health Care Planning

with their donor “fathers” that ranged from minimal to parental. Since the early works of Tasker and Golombok in the mid-1990s, studies involving adults with LGBQ parents (most of which have studied adults with lesbian parents specifically) have shed additional light on the experiences of these individuals and their families. Some researchers have utilized a minority stress perspective to understand how interpersonal homophobia and institutionalized heterosexism have continued to influence these individuals’ lives beyond their childhoods. In 2013, psychologist David Lick and colleagues surveyed more than 90 adults with LGB parents with the aim of identifying how individual differences in childhood and adolescent experiences of social stigma had later impact on adults’ psychological adjustment. Participants experienced varied degrees of stigma during childhood and adolescence, yet there were no differences in participants’ later psychological adjustment; indeed, these participants generally reported that their social experiences relating to their families grew significantly more positive over time. Meanwhile, in 2014, Kuvalanka and colleagues provided an in-depth examination into the various types of sexual stigma that adults (both heterosexual and LGBTQ) with lesbian parents faced during their adolescence and how they coped. In response to the interpersonal and institutional stigma that participants experienced, participants generally reacted in fearful, defiant, or distancing ways to that stigma. Those who were fearful often tried to “blend in,” while those who were defiant usually confronted the source of the stigma or got involved in political activism, and, finally, those who distanced themselves from stigma simply ignored the heteronormativity that they encountered. Findings from all of these studies reveal the complex interplay among individual, familial, and social influences resulting in vastly varied—and still, as of yet, unexplored— experiences of adults with LGBQ parents. Katherine A. Kuvalanka See also Children With LGBQ Parents, Gender Development and Identity; Children With LGBQ Parents, Psychosocial Outcomes; Children With LGBQ

Parents, Sexual Identity; Children With LGBQ Parents, Stigmatization; COLAGE

Further Readings Goldberg, A. E. (2007). (How) does it make a difference? Perspectives of adults with lesbian, gay, and bisexual parents. American Journal of Orthopsychiatry, 77, 550–562. Goldberg, A. E., & Kuvalanka, K. A. (2012). Marriage (in)equality: The experiences and perspectives of young adults with lesbian, gay, and bisexual parents. Journal of Marriage and Family, 74, 34–52. doi:10.1111/j.1741-3737.2011.00876.x Kuvalanka, K. A., Leslie, L. A., & Radina, R. (2014). Coping with sexual stigma: Emerging adults with lesbian parents reflect on the impact of heterosexism and homophobia during their adolescence. Journal of Adolescent Research, 29, 241–270. doi:10.1177/0743558413484354 Lick, D. J., Patterson, C. J., & Schmidt, K. M. (2013). Recalled social experiences and current psychological adjustment among adults reared by gay and lesbian parents. Journal of GLBT Family Studies, 9, 230–253. doi:10.1080/1550428X.2013.781907 Tasker, F. L., & Golombok, S. (1997). Growing up in a lesbian family: Effects on child development. London, England: Guilford Press.

ADVANCE HEALTH CARE PLANNING The goal of advance health care planning is to assure that when a person lacks capacity, the health care decisions that are made reflect the decisions that the person would have made if he or she had been capable of doing so. This entry explores why advance health care planning is important for LGBTQ adults, the basis of the right to make health care decisions, and the advance health care planning process.

Advance Health Care Planning for LGBTQ Adults Advance health care planning for LGBTQ adults made headlines in 2007 with reports of the ordeal

Advance Health Care Planning

of Lisa Pond and Janice Longbehn. Lisa suffered a brain aneurysm in Miami, Florida, shortly before she, Janice, and their four children were to depart on a cruise. Despite Janice’s offer to have Lisa’s living will faxed, hospital staff denied Janice and the children visitation and participation in health care decisions, until Lisa’s biological family arrived shortly before her death. Hospital staff told Janice that she was “in an antigay city and state.” In the aftermath, the hospital agreed to change policies and training, and President Obama directed the Department of Health and Human Services to assure that advance directives are honored and that LGBTQ families are assured visitation.

Complicating Factors Several factors complicate advance health care planning for LGBTQ adults. Standard medical protocols look to the spouse and biological family or for documentation for the health care decision maker. The “chosen family” of LGBTQ adults is not widely recognized in law or protocols. The expansion of same-sex marriage will minimize the health care–related complexities that arise inasmuch as more LGBTQ adults will be able to document their spouse. Strained relationships between LGBTQ adults and biological family can lead to conflict. Homophobia on the part of family or health care providers can interfere with health care decision making. When an LGBTQ person has a health crisis, these factors can be stacked on top of one another, with an LGBTQ family not fitting into the standard health care provider protocol, the biological family under stress asserting their legal right as “family” to make health care decisions, and homophobic care providers being uncomfortable or hostile to LGBTQ families.

The Right to Make Health Care Decisions Every adult has a fundamental right to make health care decisions. This right is based on informed consent. Informed consent categorizes any unauthorized touching, including treatment by a doctor, as a battery. Although the U.S.

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Constitution does not make explicit mention of the right to make health care decisions, courts have consistently inferred the right to make such decisions as a constitutionally protected privacy or liberty interest. End-of-life health care decisions came before the United States Supreme Court in Cruzan v. Director of the Missouri Department of Health in 1990. Everyone agreed that Nancy Cruzan was permanently and irreversibly unconscious, kept alive with a feeding tube. Her family sought to have the feeding tube removed, and others disagreed. The Court confirmed that adults have a constitutional right to make health care decisions, including the decision to refuse care, and the authority to make advance health care directives and appoint a health care surrogate, but struggled with the level of evidence necessary to withhold or withdraw life support. The Court ruled that the state could require “clear and convincing” proof of the patient’s wishes for withholding or withdrawing a feeding tube. This issue was revisited in 2005, when the family of a patient, Terri Schiavo, who had been hospitalized in an irreversible vegetative state since 1990, disagreed about removing her feeding tube. In both of these cases there was no formal advance health care planning, no appointment of a health surrogate; the patient’s wishes were unwritten, subject to varying interpretation, and there was disagreement as to what to do. These cases highlight the importance of advance health care planning.

First Steps The first step in advance health care planning is for individuals to consider the kind of health care they want to receive or not receive, and whom they trust to make health care decisions for them. Factors to consider include health care goals, personal values, and beliefs. There are some excellent tools to guide a person through the planning process, such as “Five Wishes” from the organization Aging with Dignity, “Your Conversation Starter Kit” from the Conversation Project, and the American Bar Association’s “Consumer’s Tool Kit for Health Care Advance Planning.”

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Advance Health Care Planning

Who Will Make Health Care Decisions When an adult lacks the capacity to make health care decisions, the authority to make decisions transfers to a person known as a health care surrogate. The transfer happens when a health care provider decides that a patient lacks the capacity to make health care decisions. In most situations the determination is made by the treating physician; some circumstances require the concurrence of two doctors. The exact standards for the transfer of health care decision making to a surrogate vary from state to state. If an adult has not named a health care surrogate in writing, most states have laws that name a default health care surrogate. The remaining states use medical protocol to allow marital or biological family to make health care decisions. The laws and protocols turn first to a spouse or biological family. Most commonly they ask the spouse of the patient first. If there is no spouse, they ask the adult children. If there are no children, they ask the parents. If the parents are unavailable, they ask siblings and so on through the family tree. This strategy does not fit well with the family situation of many LGBTQ adults. Domestic partners are included on the statutory lists in 5 states, and best friends are included in 23 states—but generally only if there is no spouse or biological family higher up in the statutory list. The default provisions are overcome by appointment of a health care surrogate named in a power of attorney for health care, or other document.

Putting It in Writing For LGBTQ adults, it is critical that the appointment of a health care surrogate be recorded in writing. This avoids the default of the spouse or biological family. Some states have standard forms for appointing a health care surrogate or include the appointment of a health care surrogate in a statutory living-will form. The process for appointing a surrogate is state-specific, and it is essential that the formalities be followed precisely; simple mistakes can invalidate the document. A good place to look for statutory or standard forms is the

website of the state attorney general or state department of health. A form that works in approximately 40 states was developed by the American Bar Association Commission on Law and Aging.

Guidance for the Surrogate Tools such as “Five Wishes,” “Your Conversation Starter Kit,” and the “ABA Consumer’s Tool Kit for Health Care Advance Planning” can be used to document health care goals, values, and specific directions on the use of feeding tubes and other forms of life-prolonging care. It is important to be specific regarding withholding or withdrawal of a feeding tube in the event of permanent unconsciousness. In the event of disagreement, the courts look for “clear and convincing” evidence of wishes concerning the use of a feeding tube. While oral testimony may be used to establish the desire not to be kept alive with a feeding tube, written evidence is very helpful. The most common advance health care directives are “living wills” and Do Not Resuscitate (DNR) orders. A “living will” leaves directions for life-prolonging care and artificially provided nutrition and hydration, when a person’s condition is terminal or when death is imminent. DNRs are specific medical orders that affirm if a person stops breathing or the person’s heart stops beating, no artificial measures should be taken to restore respiration or heartbeat. DNRs are only appropriate when death is expected. Many states require a health care provider to sign off on a DNR order. The latest kind of directive is known as Physician Orders for Life Sustaining Treatment (POLST). POLST covers DNR, pain control, life-prolonging care, and artificially provided nutrition and hydration. POLST is incorporated into medical orders when serious illness or frailty makes death likely. POLST orders are more likely to reflect the current wishes of the patient. If the patient lacks the capacity to make health care decisions, the health care surrogate can generally consent to POLST. Not all states recognize POLST; the protocol is still in development in many states.

Advance Health Care Planning

How to Create Advance Directives You can do it yourself (DIY) or use a lawyer to create advance health care directives. The advantage of DIY is cost. There are many standard and statutory forms that can be used. But there are risks inherent in DIY planning. Many forms are not clearly written and do not have clear instructions. A person needs help from a lawyer to make any changes in the form without invalidating the form. The formalities for signing the documents vary from state to state and must be followed precisely. For LGBTQ adults who might have a challenge to the validity of advance directives, the assistance of a lawyer adds a layer of assurance. Receiving assistance from a nonmarital partner or person named in the documents opens the door for challenges based on undue influence and should be avoided.

The Conversation All too often, advance health care planning occurs in a vacuum. The person completes the paperwork, files it away with estate planning documents, and never mentions it to anyone. When a health crisis occurs, no one knows who the health care surrogate is or what guidance was provided. It is essential that chosen family, marital family, and biological family know that advance health care planning has been done, who the surrogate is, and what the health care goals and values are. For LGBTQ families this is especially important because of the mixture of chosen, marital, and biological family and the potential for conflict among them. Advance care planning conversations are the most effective way to make sure everyone knows the plan. This can be done as one conversation or a series of conversations. Each conversation should discuss who the health care surrogate is, and what the health care goals and values are. Advance directives should be shared among all. The Conversation Project publishes a guide for getting ready for this conversation. Health care providers need to be included in the conversation. Health care providers need to know who the surrogate is, and the person’s health care goals and personal values. Health care providers can provide essential understanding of health care

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status, treatment options, disease progressions, and possible outcomes. For an LGBTQ adult, talking with health care providers about being LGBTQ and about chosen family needs to take place early. There needs to be a level of comfort, understanding, and trust. If there is not, the time to look for another health care provider is now, not when a health crisis has occurred. The Conversation Project publishes a guide with tips for starting the conversation with health care providers.

Conclusion The default provisions for health care decision making when an adult is unable to make those decisions are not a good fit for many LGBTQ adults; thus, advance health care planning is essential. Naming a health care surrogate, documenting health care goals, and having meaningful conversations with loved ones and health care providers increase the odds that the person one prefers to make one’s health care decisions ultimately does so, and that those decisions most closely reflect the decisions the person would make if he or she could. David Godfrey See also Families of Choice; Families of Origin, Relationships With; Health Care Providers, Disclosure of Sexual Identity to; Homophobia; Hospital Visitation; Mixed-Orientation Marriages; Powers of Attorney; Wills and Trusts

Further Readings Aging with Dignity. (2015). Five wishes. Retrieved from http://www.agingwithdignity.org/five-wishes.php American Bar Association Commission on Law and Aging. (2005). Consumer’s tool kit for health care advance planning. Washington, DC: American Bar Association. Retrieved from http://apps.americanbar .org/aging/publications/docs/consumer_tool_kit_bk.pdf American Bar Association Commission on Law and Aging. (2011). Giving someone your durable power of attorney for health care. Washington, DC: American Bar Association. Retrieved from http://www .americanbar.org/content/dam/aba/administrative/law_ aging/2011/2011_aging_hcdec_univhcpaform_4_2012_ v2.authcheckdam.pdf

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Affirmative Therapy

American Bar Association Commission on Law and Aging. (2014). Default surrogate consent statutes as of June 2014. Washington, DC: American Bar Association. Retrieved from http://www.americanbar .org/content/dam/aba/administrative/law_aging/2014_ default_surrogate_consent_statutes.authcheckdam.pdf Conversation Project. (2015). Your conversation starter kit. Retrieved from www.theconversationproject.org National POLST. (2015). Physician orders on lifesustaining care. Retrieved from http://www.polst.org

AFFIRMATIVE THERAPY LGBTQ affirmative therapy is defined as a set of skills and clinical practices that are informed by a positive view of LGBTQ individuals and relationships and an awareness of the negative influences of heterosexism and homophobia on the wellbeing of LGBTQ individuals and relationships. Based on this definition, in order to provide competent and affirmative services with LGBTQ clients, therapists have a responsibility to engage in self-of-the-therapist work to explore their own beliefs and biases related to LGBTQ identities and relationships. An entry on LGBTQ affirmative therapy is particularly relevant to examining and understanding the lives and experiences of LGBTQ individuals given that research has shown that LGBTQ persons seek therapy services at more than twice the rate of heterosexual individuals and the therapeutic community has a history of using harmful and misinformed approaches when working with LGBTQ clients. This entry provides a discussion of the need for LGBTQ affirmative therapy as well as an overview of the three essential components of LGBTQ affirmative therapy, namely, (1) conceptual knowledge, (2) clinical skills, and (3) self-exploration.

The Need for LGBTQ Affirmative Therapy One possible rationale for the development of LGBTQ affirmative therapy is that LGBTQ persons seek therapy services at a higher rate compared with heterosexual individuals, which

increases the likelihood that all therapists, regardless of specialization, will work with LGBTQ clients. Given that therapists are likely to work with LGBTQ clients, there needs to be an approach to therapy that both affirms LGBTQ clients and ensures that therapy results in positive outcomes for this population. Additionally, the development of LGBTQ affirmative therapy grew out of the documented harm caused by the therapeutic community as a result of certain therapeutic practices, such as conversion therapy (also known as reparative or reorientation therapy). Conversion therapy is an approach to therapy that seeks to change the sexual orientation of LGBTQ persons to a heterosexual sexual orientation. This approach is based on the belief that any sexual orientation other than heterosexual is deviant, pathological, and/or sinful. Existing research has documented a number of harmful effects of conversion therapy, including increased rates of suicidal ideation and attempts, drug and alcohol use, depression, and anxiety. Due to the documented harmful effects of conversion therapy, many professional mental health organizations (e.g., American Association for Marriage and Family Therapy, American Counselor Association, American Psychological Association, and National Association of Social Workers) have cautioned their members against any approach to therapy that seeks to alter clients’ sexual orientation. Conversion therapy is just one example of the ways the therapeutic community has pathologized LGBTQ identities and relationships.

Conceptual Knowledge of Key Constructs Related to Working With LGBTQ Clients The first essential component to the practice of LGBTQ affirmative therapy is the development of conceptual knowledge about key constructs related to working with LGBTQ clients. In particular, therapists need to be knowledgeable about homophobia, heterosexism, heterosexual privilege, and minority stress. Homophobia is commonly defined as unsupported negative beliefs about LGBTQ individuals that are based on stereotypes

Affirmative Therapy

and unfounded fears. Homophobia can negatively influence the therapy process for both therapists and clients alike. For example, therapists may consciously or unconsciously hold homophobic beliefs such as the belief in the inability of LGBTQ couples to develop long-term monogamous relationships, which limits their ability to provide effective couples therapy to LGBTQ clients. This highlights the need for therapists to explore the ways in which homophobia has influenced their conscious and unconscious beliefs. LGBTQ clients may also struggle with internalizing homophobic messages, which negatively impact their sense of self-worth and well-being. By being knowledgeable about homophobia, therapists can assist LGBTQ clients in challenging the internalization of homophobia and the negative effects that internalized homophobia has on their lives. Heterosexism is another key construct that therapists need to be knowledgeable about in order to provide LGBTQ affirmative therapy. Heterosexism is defined as a societal belief system that is based on the assumption of the superiority of heterosexual identities and relationships and the inferiority of LGBTQ identities and relationships. Examples of heterosexism include laws that explicitly deny marital rights to LGBTQ couples, regulations that only grant health insurance access to married heterosexual couples, and the decision of the Federal Drug Administration (FDA) to restrict gay men from donating blood. It is important for therapists to be knowledgeable about the concept of heterosexism in order to begin to understand the unequal treatment and marginalization that LGBTQ clients experience and the impact this has on their lives and relationships. The third construct that therapists need to understand in order to provide LGBTQ affirmative therapy is heterosexual privilege. Heterosexual privilege refers to the unearned civil rights and societal advantages granted to heterosexual persons based solely on their sexual orientation. Examples of heterosexual privilege include having one’s sexual orientation affirmed at any mental health or medical center, being able to freely discuss one’s relationship without fear of negative

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reprisal, and easily finding positive portrayals of one’s sexual orientation in textbooks and in the media. The cumulative effect of these privileges for heterosexual persons is the increased sense of belonging and self-worth that is associated with being a member of the dominant socially sanctioned group. This increased sense of belonging and self-worth serves as a protective factor from negative effects of daily stress. For heterosexualidentified therapists, an awareness of heterosexual privilege is particularly important to the practice of LGBTQ affirmative therapy in order to avoid the problematic assumption that all people are treated in the same way that they are and have the same access to social support and civil rights. Additionally, this construct is important for all therapists, regardless of sexual orientation, so they are aware of the negative effects that the absence of such privileges has on the mental and relationship health of LGBTQ individuals. Another important construct related to the practice of LGBTQ affirmative therapy is minority stress. Minority stress refers to the added stress that LGBTQ persons experience due to living in a homophobic and heterosexist society, which is above and beyond the normal stressors of everyday life. Some of the effects of minority stress on the LGBTQ community include increased rates of depression, anxiety, suicidal ideation and attempts, and alcohol and drug misuse. Knowledge of minority stress is important for therapists as it helps them interpret these increased rates as resulting from living as marginalized persons in a homophobic and heterosexist society and not as a sign of pathology within the LGBTQ community itself.

LGBTQ Affirmative Therapy Clinical Skills The second essential component to the practice of LGBTQ affirmative therapy is the development of a specific set of clinical skills. In particular, therapists need to be able to communicate an LGBTQ affirmative stance, use nonheteronormative language, and directly explore the influence of heterosexism on the lives of their LGBTQ clients. An important initial step in the practice of LGBTQ

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Affirmative Therapy

affirmative therapy involves communicating an affirmative stance to all clients. Some of the ways that therapists can communicate an LGBTQ affirmative stance include adding a statement of their commitment to provide affirmative therapy services to the LGBTQ community in their marketing materials (e.g., website, brochures, etc.) and intake paperwork, verbally sharing this commitment with all clients during the first session, and displaying books and magazines relevant to the lives of LGBTQ individuals in their therapy offices or waiting rooms. Communicating an LGBTQ affirmative stance before a therapist knows the sexual orientation of a client is important as it creates an opening for LGBTQ individuals to disclose their sexual orientation and provides a needed measure of safety. Another important clinical skill associated with LGBTQ affirmative therapy is the intentional use of nonheteronormative language, which involves the use of gender neutral or inclusive terms to describe committed relationships. An example of this practice would involve the use of the term “partner” instead of “husband” or “wife.” The use of nonheteronormative language communicates to clients that therapists are not assuming that all clients have an opposite-sex partner and are open to the possibility that their clients may be in an LGBTQ relationship. Another example of the use of nonheteronormative language is replacing the typical binary options for gender (i.e., woman or man) with an open-ended question, such as “How would you describe your gender?” on client paperwork. In order to provide LGBTQ affirmative therapy, therapists also need to explore the potential negative influence that heterosexism has on the lives of LGBTQ clients. While it is important that therapists avoid the assumption that LGBTQ clients only seek therapy on account of their sexual orientation or gender identity, it is essential for therapists to consider the ways that heterosexism may be influencing clients’ experience of the presenting problem (i.e., the reason clients sought therapy). One way that therapists can explore the influence of heterosexism is by asking clients such questions as • What effect does living in a homophobic and heterosexist society have on your sense of self and your relationships?

• What influence do the negative societal messages you receive as an LGBTQ person have on the struggles you are experiencing in your life and relationships?

Questions that explore the influence of heterosexism help LGBTQ clients situate their struggles and challenges within a larger societal context that acknowledges the ways that LGBTQ persons are marginalized in society and removes some of the unfair blame that is placed upon LGBTQ individuals for their problems.

Therapist Self-Exploration The final and perhaps most important component of LGBTQ affirmative therapy is for therapists to engage in a critical self-exploration process that explores their heteronormative assumptions, biases, and privileges. Heteronormative assumptions are automatic, and often unconscious, beliefs based on the notion that all people are heterosexual or in a heterosexual relationship. The exploration of conscious and unconscious heteronormative assumptions and biases is important for all therapists, regardless of sexual orientation, given that heteronormative assumptions are the cultural norm. In order to lessen the influence of heteronormative assumptions and biases on clinical work, therapists need to engage in a process of self-exploration related to their beliefs about healthy coupling practices, family formation and composition, and human sexuality, and how those beliefs might be informed by heteronormative assumptions. In addition to exploring heteronormative assumptions and biases, heterosexual therapists need to engage in a critical self-exploration process about the ways in which they are privileged by society and how they came to develop a heterosexual sexual orientation. In particular, it may be helpful for heterosexual therapists to develop a list of privileges they experience due to their sexual orientation in order to enhance their sensitivity to how heterosexism operates to both privilege heterosexual persons and discriminate against LGBTQ individuals. One important heterosexual privilege that is often overlooked is the fact that heterosexual individuals are not required to explore how

African American Sexualities

they developed their sexual orientation identity, which is something that LGBTQ persons are required to do by society in the coming-out process. Therefore, an important aspect of LGBTQ affirmative therapy for heterosexual therapists involves a willingness to explore how they came to develop a heterosexual sexual orientation. By increasing the knowledge that heterosexual therapists have about their sexual identities, they can decrease the extent to which heteronormative assumptions and heterosexual privilege influence the therapy process. Thomas Stone Carlson and Christi R. McGeorge See also Couples Therapy; Therapists’ Biases Regarding LGBTQ People; Therapy With Children of LGBQ Parents; Therapy With LGBTQ Parents; Therapy With LGBTQ Youth

Further Readings Bigner, J. J., & Wetchler, J. L. (Eds.). (2012). Handbook of LGBT-affirmative couple and family therapy. New York, NY: Routledge. Matthews, C. R. (2007). Affirmative lesbian, gay, and bisexual counseling with all clients. In K. J. Bieschke, R. M. Perex, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 201–219). Washington, DC: American Psychological Association. McGeorge, C. R., & Carlson, T. S. (2011). Deconstructing heterosexism: Becoming an LGB affirmative heterosexual couple and family therapist. Journal of Marital and Family Therapy, 37(1), 14–26. doi:10.1111/j.1752-0606.2009.00149.x

AFRICAN AMERICAN SEXUALITIES This entry addresses the important themes and ideas that constitute the scholarship and research in and about African American sexualities with a special focus on African American LGBTQ people. It begins by showing how the roles of theory, family, identity politics, and urban life have helped provide key insights into the sexual attitudes and practices of African American people.

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This entry concludes by highlighting the broader and continued significance of scholarship and research on African American sexualities generally, and African American LGBTQ sexualities more specifically. The study of the sexual practices, perspectives, and experiences of African Americans is a broad and varied area of research and scholarship. Research addressing how sexuality shapes the experiences of African Americans has produced key information about the role of race and sexual orientation in social institutions and everyday life. To address and convey the key facets of this broad area of inquiry and scholarship, this entry focuses on four primary themes central to the literature: theory, family, identity politics, and urban life. As will be shown, each offers an important window into the key ideas and scholarship on African American LGBTQ sexualities. To be sure, these themes are not meant to be exhaustive but instead help to distill many of the key features and contributions of research and scholarship on and about the sexual behaviors and perspectives of African Americans.

Theory The study of African American sexualities has produced numerous theories and models for analyzing the broader social world. For example, the popular idea of intersectionality, which emphasizes the multiple and overlapping identities of people, builds from the lives and experiences of African Americans across sexual orientation. The idea of intersectionality holds that individuals are marked by multiple identities. These identities include race, gender, class, and sexual orientation, among others. Further, intersectionality suggests that these identity categories influence an individual’s worldview and interactions with others; it also seeks to help the researcher identify how systems of oppression and marginalization impact the livelihoods of individuals, especially African Americans. Other prominent theories illustrate the inequities and discrimination among African Americans on the grounds of sexual orientation. For instance, heteronormativity has been used to convey the systematic privilege bestowed upon heterosexuals

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African American Sexualities

even among African Americans and other minorities. Focused on heterosexual privilege, scholars have shown that sexual orientation has a clear impact on the ability of African American LGBTQ people to get gainful employment, enjoy positive familial support, and access resources that their heterosexual counterparts readily access. Moreover, the concept of heteronormativity seeks to show that sexual orientation is a source and site of inequality. Whereas LGBTQ people of all races had been previously considered primarily through the lens of deviance, heteronormativity illustrates that normative notions of morality and sexuality are subjective and have been used to subjugate a large subsection of the American population. These two aforementioned theories reveal the complexity of African American sexuality and the prejudices and oppressions that African American sexual minorities face. Theories derived from the sexual lives and experiences of African Americans, such as intersectionality and heteronormativity, challenge the idea that African American sexualities are inherently pathological. Rather, scholars using intersectionality and heteronormativity as analytical themes and lenses show that African Americans have a diverse range of sexualities and sexual practices influenced by their many different classed and gendered identities. Emphasis is often placed on the standpoint of African Americans as related to gender, sex, sexual orientation, and family to bring attention to evolving sex practices and perceptions of Black people. Here, ideas of masculinity and femininity have also helped to illustrate the various gender roles and perceptions of African Americans. Ultimately these theories reveal that people of African descent, before, during, and after the era of enslavement in the United States, have developed important and instructive practices and understandings about sex and sexuality.

Family The study of African American sexualities has also often focused on the role and influence of family, especially the changing patterns of family formation in the United States over time. African American families tend to have and make less money

than their White counterparts. This tendency is especially true for African American families with same-sex partners as heads of household. Further, even among African Americans, LGBTQ-headed families have lower household incomes and educational outcomes. These tendencies point to enduring patterns of inequality and discrimination acutely experienced by African American LGBTQ people. African American sexualities are a valuable source of insights for understanding and investigating trends in marriage in the United States. With the decline of traditional marriage post-1950 and recent progress toward marriage equality in the United States, family and marital arrangements have varied greatly among African Americans. The sexual decisions of African Americans across sexualities have major implications for family arrangements ranging from the traditional nuclear family model, to cohabitating unmarried co-parents, to same-sex married households with adopted and biological children. African American gay men, for example, have historically created fictive kin networks to establish familial ties among community members to enable them to survive and thrive even if shunned by loved ones who are biologically related. African American lesbians’ familial arrangements have been shown to have gender roles and divisions of labor that can be comparable to those in heterosexual families. Taken together, the theme and role of family for understanding sexual patterns and practices of African Americans highlights the important links between sexual orientation and African American familial arrangements.

Identity Politics Researchers have investigated the impact of sexuality and sexual orientation on the identity and politics of African Americans. The focus on identity politics has helped to explain the perspectives and experiences of the African American lesbians, gays, bisexuals, and transgendered and queer citizens encompassed in the LGBTQ category. While some African Americans may likely identify more strongly with their race than their sexual

African American Sexualities

orientation, others find more powerful links with being LGBTQ despite their racial identity. For example, it has been shown that African American women prefer to self-identify as “gay” rather than lesbian, due to the perceived White racial origins of the term lesbian. Here, then, scholars have shown that the identity politics of African Americans is not easily predicted. Instead, the identity politics, especially relative to feelings of membership and belonging, varies greatly among African Americans especially when accounting for the role of sexuality. For instance, a variety of scholars have found that being African American and LGBTQ does not predict gender performances, roles, or preferences. Indeed, investigations of African American lesbians’ experiences have shown that gender performance and roles can vary greatly, breaking away from traditional categories of butch and femme. Identity politics has also been a helpful lens for understanding and uncovering the process of transitioning one’s gender and/or sexual orientation. Indeed, some African Americans have transitioned from one gender to another and/or from heterosexual to gay, lesbian, or bisexual. As scholars have shown, the transition of one’s sexuality and/or gender involves experiences of prejudices and oppression within and outside of African American communities. In recent decades, the term queer has also become a common, though not universal, means of identification within African American sexualities. The category of queer is meant to affirm the fact that for most people sexuality is more fluid than the binary categories of heterosexual and homosexual allow. Further, queer has also become a viable way to connect and develop a broader LGBTQ politics that seeks to ensure that citizens are not discriminated against or relegated to second-class citizen status because of their sexual orientation. This point is especially instructive for understanding the distinctions among African American LGBTQs. It should be noted that being transgendered is not primarily a sexual identity as is the case for lesbian, gay, and bisexual, as there are many African American transgendered citizens who identify as heterosexual. Rather, queer is

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meant to bring together these different modes of sexual and gender expression that differ from normative and conventional standards and binaries. Researchers have also spent a lot of time detailing the continued role of pervasive homophobia and how it has influenced the identity politics of both heterosexual and LGBTQ African Americans. Though it has been conventional wisdom that homophobia is especially acute among African Americans, recent surveys indicate this link to be a spurious one. While homophobia is present, other factors such as class, region, and age are also key in shaping African American perspectives on sexual orientation. Further, though religion has often been the source of homophobic rhetoric and claims, in recent decades many within religious communities have looked to more inclusive theologies to broaden their appeal and welcome African American LGBTQs.

Urban Life That place matters is not lost on scholars of African American sexualities. Indeed, census reports indicate that the vast majority of African Americans live in cities. As a result, the city and urban life more generally have played a key role in ascertaining insights into and about the sexual attitudes and practices of African Americans. The Great Migration (1910–1970) reshaped the landscape of urban America. Moving individually and in large groups, African Americans traveled throughout the urban landscape to find new neighborhoods, homes, and refuges from the discrimination they endured in much of the rural South. In many cases romantic interests were instrumental in drawing African American men and women from rural to urban America. Following lovers, husbands, and wives, African Americans sought to establish new lives in some of America’s most vibrant cities. Across the nation, this movement led to the establishment of Black urban neighborhoods and a range of nightlife practices and venues that provided a space to express sexual desires. Researchers have focused on this link between cities and African American sexualities. For example, urban African Americans tend to live in predominantly

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Age of Consent

Black neighborhoods and choose their sexual partners within a network of urban Black communities. Studies on urban inequality have especially focused on the sexuality of African Americans. Investigating the prevalence of single African American mothers in urban America, research has shown that racial residential segregation, poverty, and mass incarceration have influenced African American sexual outcomes. From delayed marriage to single motherhood to absentee fatherhood, the link between place and African American sexuality has been used by researchers to show the continued impact of enduring White–Black health and economic disparities over time. African American sexualities shape cities just as cities are shaping African American sexual practices and beliefs.

Conclusion The role of sex and sexual orientation in organizing human life is clearly significant, and critically important for explaining and apprehending the social world. African American sexualities are varied in their expression and have been a key subject for study by researchers. How African Americans think about themselves and their bodies has been shown to have a real impact on their actions and attitudes toward other Black people, sexual partners, and familial arrangements. Research confirms that there is a vibrant African American LGBTQ population, and scholars have shown that many African Americans across sexual orientation hold positive perspectives about sex and sexuality, creating a variety of family and romantic practices as a result. Marcus Anthony Hunter See also Cultural Dissemblance (of African Americans); Racialized Masculinity

Further Readings Battle, J., & Barnes, S. (Eds.). (2010). Black sexualities. New Brunswick, NJ: Rutgers University Press. Cohen, C. J. (1997). Punks, bulldaggers, and welfare queens: The radical potential of queer politics. GLQ, 3, 437–465. Collins, P. H. (2004). Black sexual politics. New York, NY: Routledge.

Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299. Ferguson, R. (2004). Aberrations in Black. Minneapolis: University of Minnesota Press. Guy-Sheftall, B. (Ed.). (1995). Words of fire. New York, NY: New Press. Hawkeswood, W. G. (1997). One of the children: Gay Black men in Harlem. Chicago, IL: University of Chicago Press. Hemphill, E. (Ed.). (1991). Brother to brother: New writings by Black gay men. Boston, MA: Alyson Publications. Hunter, M. A. (2010). All the gays are White, All the Blacks are straight: Black gay men, identity and community. Sexuality Research & Social Policy, 7(2), 81–92. Johnson, E. P. (2008). Sweet tea. Chapel Hill: University of North Carolina Press. Johnson, E. P., & Henderson, M. G. (Eds.). (2005). Black queer studies: A critical anthology. Durham, NC: Duke University Press. Moore, M. R. (2010). Invisible families. Berkeley: University of California Press. Smith, B. (Ed.). (1983). Home girls: A Black feminist anthology. New Brunswick, NJ: Rutgers University Press.

AGE

OF

CONSENT

Age of consent commonly refers to the minimum age at which a governing body permits persons to engage in sexual conduct. However, the question “What is the age of consent in location x?” elides an often varied array of statutes regulating the sexual conduct of young people. In the very same jurisdiction there are often multiple “ages of consent,” depending on the type of sexual contact, the genital sex of the participants, and/or the marital status of the participants. For example, in India, although the age of consent is 18 (if unmarried), there is no “age of consent” for same-sex sex, since same-sex sex, across all ages, was recriminalized in 2013. And while most states in the United States set the age of consent at 16, marriage generally provides an exemption. Most states also specify age-span exemptions. Sexual conduct with

Age of Consent

someone between the ages of 13 and 16 is usually a felony, but if the other partner is within four or five years of the younger partner, the conduct may be a misdemeanor, or fully permitted. The term age of consent is somewhat misleading. Sexual assault laws cannot nor could not locate the exact age where someone transforms from a dependent subject incapable of making decisions for herself to an independent, rational actor. It might be more apt to understand such laws as reflecting and reinforcing an age of sexual citizenship. The remainder of this entry thus uses the term age of consent reservedly.

Overview (United States) Until the 1890s, U.S. states adopted British common law and set the age of consent at 10 or 12. Age-of-consent laws have historically served the purpose of securing fathers’ proprietary rights over their daughters. Nonvirgin girls were less marketable for marriage, and so age-of-consent laws were designed to protect girls’ value (their virginity). At the turn of the 20th century, temperance, suffragist, and social purity reformers successfully lobbied legislators to raise the age of consent from 10 or 12 to 16 or 18. These campaigns shifted what was understood as the governing principle of age-ofconsent laws—no longer only about protecting virginity, these statutes were now also intended to protect (usually White) girls from sexual aggressors. As a result of postwar liberalization and second-wave feminist activism, all states in the United States overhauled their age-of-consent statutes beginning in the 1970s. First, states genderneutralized the laws. Whereas historically only (White) girls could be victims of sexual assault and only men could be perpetrators, revisions to the criminal codes unspecified the gender of both victim and perpetrator. Second, states instituted aforementioned age-span provisions, intended to target abuse and manipulation. A third round of age-of-consent reform in the United States occurred in the mid-1990s, with legislative and prosecutorial emphasis on stricter enforcement and enhanced criminal sentencing.

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Conservative and some liberal politicians argued that adolescent pregnancy was a leading cause of urban poverty, and that such poverty and consequent state spending could both be reduced if the men fathering teenage girls’ children were more vigorously prosecuted for violating age-of-consent laws.

Criticisms From the Progressive Era onward, feminists and libertarians have voiced concern that age-ofconsent statutes criminalize young female sexuality. These laws, such critics argue, disqualify and devalue young girls’ expressed desires. From the 1970s onward, some gay rights activists have argued that age-of-consent laws have been enforced disproportionately and homophobically against gay men, criminalizing consensual, cross-generational sexual activity (in 2000, after a decade of gay rights activism around the issue, the United Kingdom equalized its age of consent to 16; the age was formerly 16 for “heterosexual” sex and 18 for “homosexual” sex). And from the 1990s onward, liberal and feminist legal scholars have protested that the most recent changes in enforcement and sentencing were motivated by two racist and inaccurate assumptions: first, that teenage girls of color having children were the primary cause of urban poverty, and second, that sexually aggressive, older men of color were responsible for such pregnancies.

Countercriticism On the other hand, age-of-consent statutes, like sodomy and seduction laws, have been used by prosecutors and legislators to reach forms of sexual violence that may not meet the force or nonconsent thresholds of rape law. Because age-of-consent statutes are usually strict liability offenses, violations are sometimes easier to prove than rape. Likewise, age-of-consent prosecutions bypass the other well-known problem associated with rape prosecutions: judge and jury bias regarding determinations of force and nonconsent. So while reform campaigns to raise the age of

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Ageisms in LGBTQ Cultures

consent—at the turn of the 20th century and beyond—have been waged in the name of childhood innocence, such campaigns have also sought to protect young people from sexual violence. Age-of-consent laws are complicated and historically contentious. The rationales for these laws—property transfer, the upholding of gender norms, the upending of gender norms, the protection of young people’s innocence, the protection of young people’s sexual autonomy, the reduction of state spending—quite often directly conflict with one another. Contemporary codifications of ageof-consent law reflect these differing moral principles and political investments. Joseph Fischel See also Adolescent Pregnancy; Heteronormativity; Laws Banning Homosexuality and Sodomy; Youth and Dating

Further Readings Califia, P. (2000). No minor issues: Age of consent, child pornography, and cross-generational relationships. In P. Califia (Ed.), Public sex: The culture of radical sex (pp. 54–93). San Francisco, CA: Cleis Press. Cocca, C. E. (2004). Jailbait: The politics of statutory rape laws in the United States. Albany: State University of New York Press. Freedman, E. B. (2013). Redefining rape: Sexual violence in the era of suffrage and segregation. Cambridge, MA: Harvard University Press. Oberman, M. (2000). Regulating consensual sex with minors: Defining a role for statutory rape. Buffalo Law Review, 48, 703–784. Waites, M. (2005). The age of consent: Young people, sexuality, and citizenship. Basingstoke, England: Palgrave Macmillan.

AGEISMS

IN

LGBTQ CULTURES

LGBTQ individuals experience aging and ageism differently from heterosexuals and from each other. LGBTQ individuals can experience ageism, which excludes them from their own “kind” and from

general forms of social participation. While increasing attention has been given since the 1990s to how ageism affects gay men’s experiences of aging, this work has overshadowed the ageisms experienced by lesbian, bisexual, trans, and queer persons. To address the above-identified knowledge gaps, this entry examines ideas within the literatures on LGBTQ experiences of aging and ageism.

Definitions Aging and Ageisms

Aging is viewed as a natural, biological process, but aging and ageism are not reducible to physical experience; they are social constructs. Aging is defined as material and symbolic—consisting of changes to our bodies and our ideas about the passing of time (e.g., the symbolism of being ages 5, 18, 40, 65, 100) and occurring within social relations where differently aged selves are accorded different meanings and values. Aging is commonly constructed as a phased experience as reflected in “life stage” models of aging that involve the progression from birth, nursery, school, further/higher education, work, marriage/children, and retirement to death. Such models pivot around the changing socioeconomic fortunes of individuals who at different life stages experience greater or lesser involvement in waged work and child care. This model is heteronormative (i.e., takes heterosexuality as the norm) and cannot serve LGBTQ people well. This is one reason why the more contingent, pluralized, and fluid concept of “life course” has gained currency in studies of aging. Ageism, too, is less the inevitable result of natural age differences than historically and culturally constructed. It is constituted through power relations and expressed in how individuals and groups stereotype each other. Ageism is believed to result from societal discourses (i.e., ways of thinking) that emphasize an age hierarchy wherein youth is overassociated with vigor and older people become overassociated with decline. Even theories of “successful aging” and “aging well” contain the ageist assumption that old(er) people are valuable when they emulate or invoke qualities associated with

Ageisms in LGBTQ Cultures

youth or a younger self considered trapped within an older body. But, while ageism weighs more heavily on old(er) people, young people can experience ageism that relies on stereotypes of them as immature, irresponsible, and insubstantial. The meanings of aging are never fully fixed and have been understood differently across time and various cultures. Unlike consumer societies, the Kaliai society of Papua New Guinea regards old women as sexual citizens. Increasing longevity across Europe since the mid-20th century has encouraged expectations of a prolonged, healthy, and active midlife that would not have been possible during Victorian times characterized by high levels of mortality when individuals might be considered old at 40.

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female that privileges the former in most social realms. While individuals are sorted at birth into male and female, this rigid binary has been challenged more recently by queer academics and activists arguing that gender is much more fluid and, as indicated, includes a range of expressions. Similarly, the simple binary of straight/gay excludes diverse forms of sexual expression. Individuals can identify queerly as ambiguous, bisexual, heteroflexible/homoflexible, or pan/polysexual. Sexuality is defined as a product of socialization processes, which shape sexual experience. It is based on a hierarchy of sexual expression that privileges opposite-sex attraction between individuals who are cisgendered—that is, content with the gender into which they were assigned at birth and into which they have become socialized/accustomed.

Genders and Sexualities

Whereas lesbian and gay identity rests on erotic attraction to people of the same sex, bisexuality, like queer, could involve being attracted to various expressions of gender not included in the male/ female binary. The category trans is also diverse and fluid. Indeed, through their actions, selfpresentations, and self-definitions, trans individuals “queer” or challenge the binary of male/female and conventional notions of masculinity and femininity. Note that not every trans individual transitions from male to female or female to male. The extent of medical intervention has little bearing on how individuals self-identify, in that gender is distinct from the physical body. Gender and sex are cultural/social constructions, not biological facts. Also, trans can involve identifying as male (e.g., gay, straight, or neither), female (e.g., lesbian, straight, or neither), or gender-neutral (i.e., defining oneself outside of and presenting a challenge to conventional gender binaries). How people present or define themselves can vary according to context (e.g., where/whether they disclose their trans status, how they identify in a given situation, and the spectrum of identification that they might pass through). Gender is defined as resulting from the socialization of human beings on the basis of bodily/ genital features and into a hierarchy of male or

LGBTQ Individuals’ Experiences of Generic Ageism LGBTQ individuals can experience ageism just like cisgendered heterosexuals. Older people can be stereotyped as less productive or less flexible. This is reflected in the proverb “You can’t teach an old dog new tricks.” Regardless of how individuals identify, they can be seen as no longer sexually active, though compared with heterosexual men, ageism might occur earlier for and impact more heavily on women, gay men, and transmen identifying as gay. Influences of social class can trump influences of gender/sexuality in shaping whether individuals experience growing older and being old in more or less positive ways. This appears less applicable to privileged individuals for whom age is reworked into an asset, such as male executives, broadcasters, and politicians. Ideas about “aging well” might empower those with the right economic and cultural resources but contribute to the stigmatization of individuals who are blamed for “aging badly” because of their poorer life chances. Life chances are affected by social class in ways that intersect with influences of gender. Women’s career breaks for child-rearing affect the ability to build up a pension or develop skills and knowledge necessary for career advancement. However,

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Ageisms in LGBTQ Cultures

older LGBTQ individuals can experience ageism made worse by prejudice and discrimination concerning their sexual/gender difference.

Gay Men’s Experiences of Aging: Accelerated Aging The topic of older gay men, aging, and ageism is addressed first because there is more literature devoted to this topic. Ageism combines with homophobia (i.e., fear of gayness that combines hostility and discrimination) to construct the desperate “old queen” as predatory on younger men who are enticed into an unnatural or less eligible sexuality. This stereotypic old gay man is also assumed to be devoted to selfish promiscuity and thus held responsible for having chosen to exist outside of legitimate kinship—that is, the heterosexual family. There are signs that ageist thinking becomes modified within gay culture. Indeed, the dominant motif within the specific literature on gay aging is that gay men’s obsession with youth leads to a distorted view of what constitutes legitimate sexual citizenship (i.e., the quality of being sexual and having one’s sexual preferences recognized) and automatically excludes those who bear the signs of age. Aging is seen as “accelerated,” meaning that, in contrast to heterosexuals, gay men are considered old before their time. While this explains why older gay men can report feeling their age and excluded mostly when on the (commercial) gay scene of bars/clubs, saunas, and gay websites, this concept is too limited to explain the variety of older gay men’s responses to ageism. Research conducted in Manchester, Britain, recognizes how gay men develop resources of aging to question gay ageism and construct their own legitimate older gay identity. This is accomplished largely through the notion of an “authentic” aging self that exceeds concerns with the body and where outward appearance should reflect a more real inner self consisting of personality and values. However, this authentic older self can also work in contradictory ways. It can be used to distinguish older selves from younger gay men and reproduces an ageism that

stereotypes the latter as the selfish and “superficial” dupes of consumer and gay cultures. Middleaged gay men can also distinguish and distance themselves from old gay men who are associated with morbidity (i.e., ill health) and mortality. Looking at gay male aging in more nuanced ways that recognize men’s experiences of exclusion, opportunities for agency, and ambivalence toward ageism provides insight into the power relations in gay male culture where ageism works in multidirectional ways.

Lesbian Experiences of Aging/Ageism: Communities of Understanding? The United States–dominated literature on lesbian aging indicates that ageism is much less a problem within lesbian cultures. Indeed, females are socialized in ways that encourage them to be more compassionate and other-directed than males. The bonds that develop from common experiences of socialization might be intensified considering that lesbian-identified women have united to challenge “lesbophobia” (i.e., the fear of lesbianism that leads to prejudice, discrimination, and hostility), heteronormativity, and sexism. These factors are expressed in assumptions about woman’s natural dependence on men that wonder how women manage without a man. Researchers of lesbian experience have drawn attention to how the exacting aesthetic standards required of gay men and heterosexual women barely apply to lesbian-identified women. Shaped by feminist thought since the 1960s, older women are more accepted if not positively valued in lesbian social networks where attractiveness is generally thought to exceed bodily surface. Indeed, experiences of social exclusion on the grounds of ageism are more likely to come from outside lesbian society and to be linked to their identities as older women per se. While this thinking is widely accepted in lesbian cultures, there is little evidence to support these claims. Although lesbian cultures provide many opportunities for support and can function as communities of understanding able to hear

Ageisms in LGBTQ Cultures

concerns relating to growing older, this idea is overly romanticized and is based on the assumption of a harmonious lesbian community untainted by ageism in a society where ageism is pervasive. Ageism might operate less acutely within lesbian cultures compared with heterosexual and gay male social networks, but these cultures cannot be completely immune from ageism. The situation is likely to be more complicated, contradictory, and diverse than the above account acknowledges. In a U.S. context, researchers have indicated that ageism encourages lesbian-identified women to distance themselves from growing older and take pride in looking younger than their actual years. Lesbian subjects who are committed to challenging gender norms concerning the body may find themselves restricted by these same norms in relation to maintaining a youthful appearance through weight management and the like. Researchers have also noted how some older lesbian subjects are avoiding contact with their same-aged peers to seek out the company of younger women. While this is plausible, different generations of women have developed conflicting ideas in relation to feminism and women’s status. Some older lesbians who remember the women’s and gay liberation movements in the 1960s and 1970s may feel divided from younger postfeminist lesbians whom they regard as nonpolitical.

Bisexual, Trans, and Queer Experiences of Aging and Ageism: Challenges to Fixity Bisexual, trans, and queer experiences of aging are not identical but are covered here under a single heading because BTQ individuals and scholars have been particularly active in challenging binaries of gender and sexuality as natural and inevitable. Those self-defining as queer understand gender, sexuality, and aging as ambiguous, shifting, unstable, and thus socially constructed. However, ageism often works below the radar of consciousness and can be expressed in queer spaces. Although less is known about aging and ageism in relation to bisexuality, aging as bisexual can involve double invisibility on the grounds of age

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and sexual difference and exclusion from both gay and straight cultural spaces. Older bisexual individuals might experience ageism in gay/lesbian, straight, and hybrid spaces/cultures, that is, various combinations. Older bisexual people can find themselves excluded from social relations on account of common stereotypes expressed by gay and straight people that demonize them as unreliable, immature, or promiscuous for their failure to commit to one gender. Challenging this stereotypical view, researchers have observed how non-normative futures are envisioned in the lives of bisexual people. Being defined as bisexual can prompt critical questioning and encourage the imagination of positive futures involving ethical polyamory (i.e., emotional and sexual involvement by consent with more than one partner). This idea simultaneously registers the problems related to aging and ageism faced by bisexual individuals and challenges the idea of bisexual aging as characterized by misery and exclusion. Moreover, older transwomen could encounter ageism, sexism, and transphobia whereby individuals are assumed to have breached the most fundamental human divide and are viewed as a subspecies of female or male and therefore not “real,” acceptable expressions of these gender categories. People tend to become trans later in life having developed the political, cognitive, and emotional resources to make the necessary changes. It is possible, however, that transwomen can “pass” in their chosen gender less easily than transmen, who could benefit from the value attached to being seen as an older male. There is very little scholarship on trans aging, though this process appears subject to a range of cultural, psychological, material, legal, and health-related constraints and disadvantages. Tina Donovan has provided a first-person account that shows how as a transwoman she found difficulty securing health care and employment to help her prepare for later life. Louis Bailey has examined the idea and consequences of a “second puberty.” People who have transitioned are thrust into a second puberty as their bodies develop the secondary sex characteristics associated with their new gender identity as enabled through hormonal

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Ageisms in LGBTQ Cultures

therapy and as they undergo new social experiences navigating the world in their new gender roles. Louis Bailey’s writings consider how trans people can rework meanings of aging that disrupt conventional understandings of aging. Such experiences challenge the solidity of age categories and the workings of ageism itself.

Conclusion Although older LGBTQ individuals experience certain forms of oppression in common with heterosexuals and with each other, there are clear differences between their experiences of aging and ageism. The main experience of ageism in gay male cultures is that men are encouraged to see themselves as old(er) before their time and are more likely to be rejected as possible sex partners and friends than younger men. It has been noted, however, that older gay men develop resources of aging to challenge gay ageism and reclaim value on their own terms, though sometimes by expressing ageism toward younger gay men. For lesbian-identified women, especially in a U.S. context, being old(er) is considered to be less of a barrier to being valued. However, this romanticized assumption of lesbian communities as largely untainted by ageism is questionable in societies where age-negativity is endemic. Further, older bisexual individuals can find themselves excluded by gay and straight people as unreliable closet cases who are immature or indecisive for not having settled for one gender. Older trans and queer-identified individuals’ challenge to sexual/ gender fixity can result in their rejection by gay and straight-identified, cisgendered people. However, it has been noted that older bisexual and trans individuals too can develop the knowledge that enables them to envision polyamorous futures and challenge the rigidities of monosexuality (i.e., being attracted to only one gender), as well as gender and age categories. In order to develop a fuller understanding of aging and ageism, there needs to be more research particularly on lesbian, bisexual, trans, and queer experiences of these complex social processes. Paul Simpson

See also Aging and Bisexuality; Aging and Gay Men; Aging and Lesbian Women; Aging and Transgender People; Discrimination Against LGBTQ Elders; Intersections Between Sex, Gender, and Sexual Identity; Transgender Identities

Further Readings Bailey, L. (2012). Trans aging and later life. In R. Ward, I. Rivers, & M. Sutherland (Eds.), Lesbian, gay, bisexual and transgender aging: Biographical approaches for inclusive care and support (pp. 51–66). London, England: Jessica Kingsley. Barker, J. (2004). Lesbian aging: An agenda for research. In G. Herdt & B. de Vries (Eds.), Gay and lesbian aging: Research and future directions (pp. 29–72). New York, NY: Springer. Bennett, K., & Thompson, N. (1991). Accelerated aging and male homosexuality: Australian evidence in a continuing debate. Journal of Homosexuality, 20(3–4), 65–75. Cook-Daniels, L. (2006). Trans aging. In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual and transgender aging: Research and clinical perspectives. New York, NY: Columbia University Press. Donovan, T. (2002). Being transgender and older: A first person account. Journal of Gay & Lesbian Social Services, 13(4), 19–22. Jones, R. (2011). Imagining bisexual futures: Positive, non-normative later life. Journal of Bisexuality, 11(2–3), 245–270. Kehoe, M. (1986). A portrait of the older lesbian. In M. Kehoe (Ed.), History, culture and erotic aspects of lesbianism. Binghamton, NY: Haworth Press. Simpson, P. (2013). Alienation, ambivalence, agency: Middle-aged gay men and ageism in Manchester’s gay village. Sexualities, 16(3–4), 283–299. Slevin, K. (2006). The embodied experiences of old lesbians. In T. Calasanti & K. Slevin (Eds.), Age matters: Realigning feminist thinking (pp. 247–268). New York, NY: Routledge. Slevin, K., King, N., & Calasanti, T. (2006). Ageism and feminism: From “et cetera” to center. National Women’s Studies Association Journal, 18(1), 13–30. Slevin, K., & Mowery, C. (2012). Exploring embodied aging and ageism among old lesbians and gay men. In L. Carpenter & J. DeLamater (Eds.), Sex for the life

Aging, Sex, and Sexuality course: From virginity to Viagra, how sexuality changes throughout our lives (pp. 260–277). New York, NY: New York University Press.

AGING, SEX,

AND

SEXUALITY

Sexuality within the context of aging can be defined broadly as sexual activity (e.g., kissing; petting; anal, oral, and vaginal intercourse; masturbation), sensual activity (e.g., holding hands, hugging, dancing, wearing body lotion), and emotional intimacy experienced by middle-aged (aged 50–64) and older adults (aged 65 and older). Although research suggests that many adults engage in sexual activity well into their 80s, aging LGBTQ adults often face significant challenges to the expression of their sexuality. This entry will discuss what is known about the sexuality of middle-aged and older LGBTQ adults, and how it is influenced by ecological factors such as age cohort, stigma, discrimination, sexual dysfunction, health disparities, socioeconomic status, ethnicity, and institutional factors.

Sexual Activity and Satisfaction Unfortunately, few large-scale research findings are available regarding the sexuality of lesbian and gay elders, and most of those studies feature convenience samples of primarily White, middle-class participants. Significantly less is known about the sexuality of aging bisexual and transgender adults, as well as ethnic-minority and rural LGBTQ elders. Findings from a national MetLife survey suggest that both heterosexual and LGBTQ adults maintain moderate to high levels of interest in sexual activity (consistent with their previous levels of interest as young adults), and continue to engage in sexual activity, well into their advanced age. Although aging lesbian, gay, bisexual, and transgender adults must be regarded as distinct populations, overarching factors that reduce participation in sexual activity include health problems and the lack of an available partner. Studies of middle-aged and older lesbians report consistently that lesbian couples engage in sexual

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activity less frequently than both gay male and heterosexual couples, sometimes referred to as “lesbian bed death.” However, older lesbians report placing more emphasis upon commitment, compatibility, and affection than upon sex, and those who have had sex with both male and female partners have described their lesbian relationships as more sexually and emotionally satisfying. Unlike their heterosexual counterparts, aging lesbians appear less likely to suffer from body image dissatisfaction, as lesbians are influenced less by mainstream cultural values in which standards of female beauty are narrowly defined and youthful. Celibacy among aging lesbians has been attributed primarily to a lack of opportunity rather than choice. The myth of the older gay man in the 1970s as lonely, single, and desperately seeking sexual encounters with younger men in bars or bath houses has been dispelled in a series of research studies. One study revealed that older gay men tended to have fewer partners as they aged, and that 75% were happy with their sex lives. Older gay men also tend to have sex with men close to their own age, and continue to have meaningful long-term sexual and platonic relationships. No large-scale studies are available to provide information regarding the frequency of sexual activity among aging bisexual and transgender adults. An online survey of middle-aged and older transgender adults revealed that more than 75% reported having sex with a partner within the last year. Challenges reported by some transgender elders included the need to make negotiations about sex, such as whether certain body parts would be “on” or “off limits.” Because such limited empirical data is available regarding the frequency and types of sexual activity among older bisexual and transgender adults, it remains essential to avoid making generalizations about these often invisible elders.

Ecological Factors Ecological factors including age, age cohort, ethnicity, and health disparities can play a major role in the expression of sexuality. LGBTQ adults over the age of 65 are continually in fear of being

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actively persecuted for their sexual orientation or identity. In contrast, LGBTQ baby boomers witnessed the 1969 Stonewall riots and the beginning of gay activism in the 1970s as young adults. Although homosexuality was no longer considered pathological by the American Psychiatric Association as of 1973, transgender and bisexual elders have never experienced a time when their sexual identity was not considered pathological or problematic. LGBTQ minority group elders face at least “double jeopardy” (i.e., the additional stigma faced by members of multiply disadvantaged or minority groups) through heterosexism and ageism, and they may face additional challenges of sexism or racism. According to the Centers for Disease Control (CDC) and the Institutes of Medicine, LGBTQ adults experience significant physical and mental health disparities. For example, more than 40% of middle-aged and older LGBTQ adults suffer from at least one disability or chronic illness, and they are significantly more likely to smoke and engage in binge drinking than their heterosexual peers. LGBTQ elders also are 2 times more likely to live alone, to be at risk for elder abuse and neglect, and to delay treatment-seeking behaviors. Nearly 1 in 3 LGBTQ elders report being depressed, and more than half report feeling socially isolated and lonely. These health disparities (e.g., binge drinking, feeling lonely) can also lead to participation in highrisk sexual behaviors. LGBTQ elders are also 80% less likely than their heterosexual peers to seek needed health and social services, and less than 25% of LGBTQ baby boomers are willing to disclose their sexual orientation when they do. Physicians receive less than five hours of education in LGBTQ-related health care, and many care providers report feeling “uncomfortable” when treating lesbian or gay patients. Discrimination reported by LGBTQ patients includes condescending remarks, refusal to provide treatment, breaches of confidentiality, and excessive curiosity. Such discrimination is reported by 1 in 3 older transgender adults. Unfortunately, concealing one’s sexual orientation or identity can lead to ineffective or deleterious health care screening and treatment, particularly in relation to sexual health.

Erectile Dysfunction (ED) and Prostate Cancer Data from the Urban Men’s Health Study indicate that nearly 40% of gay and bisexual men reported some degree of sexual dysfunction such as erectile dysfunction (ED). Health problems including cardiovascular disease and diabetes, medication side effects, and psychological matters were identified as contributing factors. Because gay men may place significant value upon their ability to have an erection and to ejaculate, ED may be particularly distressing. Virtually no population studies are available regarding the prevalence or etiology of sexual dysfunction among bisexual or transgender elders. The risk of prostate cancer increases with age, and more than 20,000 older gay men annually are diagnosed with prostate cancer. Research suggests that older gay men, like their heterosexual peers, maintain limited or incorrect knowledge about prostate health. A common myth among gay men is that participating in rough sex or using a dildo can increase their risk of prostate cancer. Older gay men with limited income and education, and those who are African American, typically have the lowest level of accurate knowledge. Virtually all studies of older gay and bisexual men show, however, that these men are concerned and fearful about prostate cancer, including potential treatment side effects such as ED. Aging transgender women, who retain their prostate even after reconstructive surgery, face additional health disparities including a lack of routine care and screening for prostate cancer. Transgender elders also may be at increased risk for breast, ovarian, and uterine cancer as a result of hormone therapy.

Sexually Transmitted Diseases, Including HIV/AIDS Although many aging lesbians and their health care providers subscribe to the myth that lesbians are immune from sexually transmitted diseases (STDs) including HIV, nearly half of middle-aged and older lesbians report that they engaged in heterosexual intercourse at least once in their lives. Although rare, female-to-female transmission of the HIV virus has been documented. Research also shows that approximately 20% of women who

Aging, Sex, and Sexuality

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report that they never had heterosexual contact are infected with the human papilloma virus (HPV), the primary cause of cervical cancer. Accordingly, aging lesbians and bisexual women should receive routine screenings and appropriate preventive care messages. As of 2015 it is estimated that more than half of all adults living with HIV are over the age of 50. This population includes both long-time survivors and newly infected middle-aged and older adults. Reports from the CDC also reveal that gay and bisexual men are 44 times more likely to contract HIV than other men, and African Americans and Latinos are 12 and 5 times, respectively, more likely to be HIV positive than their White peers. Transgender elders also are at high risk for HIV. The most likely forms of viral transmission include unprotected sex with men and the sharing of HIVinfected needles. Despite the rapid increase in older adults affected by HIV/AIDS, no national prevention programs are targeted at older adults, much less older LGBTQ adults. The CDC’s current recommendations only call for routine HIV testing for patients up to 64 years old. Older adults, including older LGBTQ adults, are less likely to be tested for HIV than both their younger LGBTQ counterparts and younger adults in general, because health care providers typically believe they are unlikely to engage in high-risk behaviors. In fact, less than half of health care providers even broach the topic of sex with their older patients. Older adults also tend to receive their HIV diagnosis within the context of a hospital visit versus routine care, are more likely to be diagnosed with AIDS versus HIV, and are more likely to die sooner than those diagnosed at younger ages. As noted, LGBTQ elders often delay seeking medical care due to fear of discrimination.

lives, many staff subscribe to the myth that older adults are asexual and express more negative and restrictive attitudes toward sexual activity among gay and lesbian versus heterosexual residents. Although the federal Nursing Home Reform Law of 1987, which includes a robust section on nursing home residents’ rights, dictates that residents have the right to dignity and privacy, the right to espouse an LGBTQ identity or to engage in an LGBTQ relationship is not protected. The limited empirical research available regarding the sexuality of older LGBTQ nursing home residents suggests that many who were previously open about their sexual orientation feel compelled to “go back in the closet.” Examples of this process can include changes in the way an LGBTQ resident dresses or acts, and hiding photos of their partner. Out of fear of discrimination from staff and other residents, some LGBTQ residents even identify a same-sex partner as a cousin or other relative. Some facilities do cater to LGBTQ populations, but they represent the exception rather than the rule. Options for low-cost, LGBTQ-friendly, public elder housing are virtually nonexistent. By 2030, nearly 40% of all U.S. prisoners will be considered elderly, yet little is known about older LGBTQ inmates. Research suggests that LGBTQ prisoners face significant sexual abuse and related, increased risk for HIV infection. Specifically, male bisexual and gay inmates are 10 times, and female bisexual and lesbian inmates are 2 times, more likely to be raped than their heterosexual counterparts. Additional concerns for aging transgender prisoners include a lack of privacy, and their needs for personal care, which may inadvertently reveal their sexual identity. Unfortunately, no nationwide programs exist for required HIV prevention or testing among older LGBTQ inmates.

Sexuality in Institutional Settings

Conclusion

The issues surrounding the authentic expression of sexuality for the more than 3 million older adults living in institutional settings, including nursing homes and prisons, are particularly complex for older LGBTQ adults. Although research suggests that the majority of nursing home residents regard sexuality as at least moderately important in their

Like their heterosexual peers, LGBTQ elders typically sustain interest in sexual activity well into advanced age. Factors that limit LGBTQ elders’ participation in sexual activity, however, include the availability of a partner, health status, sexual dysfunction, health disparities, stigma, and fear of discrimination and lack of privacy in institutional

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Aging, Social Relationships, and Support

settings. Additional research is needed to better understand the issues related to sexuality among bisexual and transgender elders. Advocacy and education is needed for both LGBTQ elders and their health care providers. Jennifer Hillman See also Discrimination Against LGBTQ Elders; Health Disparities; HIV/AIDS and Aging; Lesbian “Bed Death”; Senior Living Programs and Policies; Services and Advocacy for GLBT Elders (SAGE); Sexual Norms and Practices; Sexual Risk-Taking

Further Readings Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., … Petry, H. (2011). The aging and health report: Resilience and disparities among lesbian, gay, bisexual and transgender older adults. Seattle, WA: Institute for Multigenerational Health. Grant, J. M. (2010). Outing age 2010: Public policy issues affecting lesbian, gay, bisexual, and transgender elders. Washington, DC: National Gay and Lesbian Task Force Policy Institute. Retrieved from http:// www.lgbtagingcenter.org/resources/resource.cfm?r=30 Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: Institute of Medicine of the National Academies. Kimmel, D., Rose, T., & David, S. (Eds.). (2006). Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives. New York, NY: Columbia University Press. MetLife. (2010). Still out, still aging: The MetLife study of lesbian, gay, bisexual and transgender baby boomers. Westport, CT: MetLife Mature Market Institute. Perlman, G., & Drescher, J. (Eds.). (2005). A gay man’s guide to prostate cancer. Binghamton, NY: Haworth Press.

AGING, SOCIAL RELATIONSHIPS, AND SUPPORT Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are emerging from the margins, creating an increasingly diverse older adult

population. Approximately 2.4% of American adults ages 50 and older self-identity as LGBTQ, representing more than 2.4 million people; this number more than doubles when taking into account same-sex sexual behavior and romantic relationships. In addition, the number of LGBTQ older adults is increasing dramatically, due to the aging of the baby boom generation, and is expected to double over the next 15 years.

LGBTQ Aging, Health, and Well-Being To date, LGBTQ older adults are rarely considered in aging or health research. Yet, they remain an underserved and at-risk population. Health disparities are gaps in quality of health, resulting from disadvantages and differences in group status such as race, ethnicity, income, educational level, and sexual and gender identity. Such gaps exist for LGBTQ older adults because of environmental, economic, and social disadvantage. Lesbian, gay, and bisexual adults, age 50 and older, compared with heterosexuals of similar age, have been found to be at increased risk of health disparities, including elevated rates of disability and psychological distress. In addition, older lesbian and bisexual women have higher rates of cardiovascular disease and obesity compared with older heterosexual women; gay and bisexual older adult men, compared with heterosexual men, are at greater risk of poor health, living alone, and HIV/AIDS. There are also important differences in health among LGBTQ older adults by socioeconomic status, geographic location, and race/ethnicity. Promoting health equity, within a life course perspective, is critical for understanding LGBTQ aging because it takes into account how both risks and resources influence aging over time as well as identifies ways in which LGBTQ older adults can achieve their full health potential.

Social Relationships and Support Although there are health disparities among LGBTQ older adults, most experience good health; their social relationships and other resources offset many of the challenges they have faced during their lifetime. Social relationships are multidimensional,

Aging, Social Relationships, and Support

existing within historical, social, political, and geographical environments. Given the shifting sociohistorical context, the configurations of social relations are unique and changing in many important ways for LGBTQ older adults. Like older adults in the general population, LGBTQ older adults have a variety of important relational ties, including spouses and partners, children, intimate friends, and others, such as neighbors. The term family of choice refers to alternative LGBTQ relational networks that include relationships with partners, friends, and others in their communities who provide support, in addition to, or instead of, biological and legal family. Partners and spouses provide a broad range of physical, emotional, and economic benefits, and evidence suggests that these benefits extend to sexualminority couples, especially when they are supported by important others, such as biological and other family members. Having a partner is associated with better physical and mental health; however, legal marriage, as compared with other types of partnerships, seems to have a more protective effect on health and well-being. Ex-partners can also play a critical role in providing emotional and practical forms of support and assistance to older LGBTQ adults. While today’s lesbian and gay midlife and older adults are less likely to have children than their heterosexual counterparts, the rates of same-sex parenting are on the rise, suggesting that future cohorts of older lesbian/gay elders will be increasingly likely to have, and to possibly receive support from, adult children. Information from the American Community Survey indicates that the proportion of samesex couples reporting having children rose from 12% to 17% from 1990 to 2009. According to data from the 2011 American Community Survey, there were more than 600,000 same-sex couple households in the United States, and 16% of those households included one or more children. By sex, 10% of male-male households included children and 22% of female-female households did. These families often face bias and discrimination on account of stigma as it relates to sexuality and same-sex relationships in the United States. Most LGBTQ older adults receive their primary support from partners or spouses, friends, and

55

others in LGBTQ communities as opposed to biological or legal family members. Connectedness to LGBTQ communities provides important social resources such as protection against social isolation and having others to turn to when one experiences an unfair or hostile environment. Like older adults in the general population, LGBTQ older adults with strong social ties enjoy better health and quality of life. When needed, kin in LGBTQ communities often provide instrumental and emotional support through informal caregiving, which benefits both caregivers and those receiving care. As was evident during the HIV/AIDS crisis, caregiving is often extensive in these communities, and the dynamics of caregiving can alter and challenge personal relationships in new ways. Social networks reflect the structure of social relationships and the characteristics of relational ties, including size, contact frequency, geographic proximity, composition, and density. Diversity of social networks is related to social bridging, in which an individual’s position in a social network creates connections between other individuals. Among sexual and gender minority groups, women and transgender older adults have the largest and most diverse social networks; bisexual older women and men report smaller social networks than lesbians and gay men of similar age. Among LGBTQ midlife and older adults, social support is strongly associated with health and well-being. The availability of social support is likely influenced by the broader social context. For example, living in states with legal same-sex marriage and higher concentrations of same-sex couples is protective in terms of health. The quality of relationships may vary by type of relationship as well. Among LGBTQ older adults, support from friends is associated with higher quality of life and lower incidence of stress and depression. However, support from biological family is often not associated with better health, suggesting that LGBTQ individuals may rely more heavily on their friends and family of choice for positive social support. Among LGBTQ older adults, like those in the general population, there are many benefits associated with intimate and close relationships and support, although much less is known about the differing types and functions, structures, and quality of

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Aging and Bisexuality

these relationships, and the mechanisms by which they influence change in aging and quality of life over time in these communities.

Conclusion Social relationships are a key resource for LGBTQ people of all ages and critically important to aging, health, and well-being over the life course. While the study of social relations among LGBTQ people is growing, there remain critical gaps in existing knowledge. To date, most research examining the social relations of LGBTQ people are relatively homogeneous, with limited representation of older adults, racial and ethnic minorities, and bisexual and transgender people. Future research work needs to better investigate the full range and complexity of sexual and gender identities, and the role of social relations in the lives of demographically diverse LGBTQ people and their families. Understanding the social relationships of LGBTQ midlife and older adults, as a resilient yet at-risk population, will offer important insights into the increasing diversity and strengths of our aging society. Karen I. Fredriksen-Goldsen See also Ageisms in LGBTQ Cultures; Aging, Sex, and Sexuality; Aging and Bisexuality; Aging and Gay Men; Aging and Lesbian Women; Aging and Transgender People; Caregiving; Families of Choice

Further Readings Barker, J. C., Herdt, G., & de Vries, B. (2006). Social support in the lives of lesbians and gay men at midlife and later. Sexuality Research & Social Policy, 3(2), 1–23. de Vries, B. (2007). LGBT couples in later life: A study in diversity. Generations, 31(3), 18–23. Emlet, C. A., Fredriksen-Goldsen, K. I., & Kim, H.-J. (2013). Risk and protective factors associated with health-related quality of life among older gay and bisexual men living with HIV disease. Gerontologist, 53, 963–972. Fredriksen-Goldsen, K. I., & Kim, H.-J. (2015). Count me in: Response to sexual orientation measures among older adults. Research on Aging, 37(5), 464–480. doi:10.1177/0164027514542109

Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103, 1802–1809. Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., … Petry, H. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health. Gates, G. J. (2011). Family formation and raising children among same-sex couples. National Council on Family Relations (NCFR) Report (Issue FF51). Los Angeles, CA: Williams Institute. Grossman, A. H., D’Augelli, A. R., & Hershberger, S. L. (2000). Social support networks of lesbian, gay, and bisexual older adults 60 years of age and older. Journal of Gerontology Psychological Sciences, 55B, 171–179. Kim, H.-J., & Fredriksen-Goldsen, K. I. (2013). Nonresponse to a question on self-identified sexual orientation in a public health survey and its relationship to race and ethnicity. American Journal of Public Health, 103, 67–69. Muraco, A., & Fredriksen-Goldsen, K. I. (2011). “That’s what friends do”: Informal caregiving for chronically ill midlife and older lesbian, gay and bisexual adults. Journal of Social and Personal Relationships, 28, 1073–1092. Weston, K. (1991). Families we choose: Lesbians, gays, kinship. New York, NY: Columbia University Press. Williams, M. E., & Fredriksen-Goldsen, K. I. (2014). Same-sex partnerships and the health of older adults. Journal of Community Psychology, 42, 558–570.

AGING

AND

BISEXUALITY

Aging is a lifelong process, not just something that affects people in the last decades of life. Many experiences in later life can most helpfully be thought of as on a continuum with experiences earlier in the life course. Experiences of aging differ hugely between individuals and depending on the context and historical period in which someone

Aging and Bisexuality

lives. These general points about aging are as true for bisexual people as for any other group. Research and work with sexual and gender minorities around aging usually takes age 50 or 55 as the starting point of being “older” or an “elder.” This entry follows that convention although it is important to recognize that it represents an arbitrary starting point and also that this very broad definition of aging may obscure differences between very wide age ranges (e.g., someone aged 50 and someone aged 100 or older). This entry also defines bisexuality broadly, as romantic or sexual attraction to more than one gender. This definition differs from the more common one of “attraction to both genders” by allowing for the possibility of more than two genders. This definition also intentionally includes those who identify as bisexual, those who behave bisexually but do not identify as bisexual, and those who experience bisexual attraction but do not behave or identify as bisexual. Many issues that affect bisexual people as they grow older are also common to most people as they grow older. These issues include adjusting to bodily change; changes to lifestyle and income, especially around any retirement from paid work; changes to generational position and status within families; increased prevalence of disease and disability; and, for older people in many parts of the world, coping with living in societies that systematically devalue and stigmatize aging. Other issues affecting bisexual people as they grow older are common to many LGBTQ people, such as the expectation that all older people are heterosexual and cisgendered (that the sex they were assigned at birth matches their experience of gender), and often increased pressure to stay silent about some aspects of life and experiences, such as same-sex partners or a relatively large number of former partners in cultures that privilege longlasting couple relationships. Issues affecting bisexual people earlier in life also continue to affect them in later life, such as the invisibility or erasure of bisexuality as a legitimate sexual identity, and encounters with biphobia (discrimination and prejudice against bisexual people). However, there are also distinctive features of

57

being bisexual and growing older, and it is on these that this entry focuses. Following a brief overview of varieties of bisexuality across age categories, the entry presents a discussion of the components of bisexuality and the stability of bisexual identity in later life. Next, the underrepresentation of older bisexual people in the research literature is considered, particularly with respect to those who identify not only as bisexual but also as belonging to an ethnic minority. Issues associated with coming out as bisexual in later life are then addressed, followed by an examination of the role of generational and historical cohorts in the formation and expression of bisexual identity. The entry concludes with a look at the nature and duration of relationships among older bisexual individuals, and considerations affecting bisexual people who are approaching the end of life.

Identity, Behavior, and Attraction As with bisexual people of all ages, it is important to distinguish between those who identify as bisexual, those who behave bisexually, and those who experience bisexual attractions. People who identify as bisexual make up a much smaller group than those who have sexual and romantic relationships with people of more than one gender or those who experience attraction to more than one gender. This pattern continues into later life with relatively few older LGBTQ people identifying as bisexual. Older people who do identify as bisexual are more likely to be able to access services and groups designed for older LGBTQ people than those who identify as heterosexual but behave bisexually. However, generic LGBTQ services and groups are often experienced as not fully welcoming or inclusive of bisexual people, due to biphobia within LGBTQ communities, and these experiences may impact older bisexual people’s willingness to use generic LGBTQ services and groups. Older people who identify as homosexual and behave bisexually may feel able to access services and groups for older LGBTQ people but often at the price of minimizing or remaining silent about their bisexual behavior or attractions.

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The Continuing Significance of Bisexuality in Later Life Sexual identity, behavior, and attraction are all commonly assumed to become less significant as people grow older. Research among heterosexual, gay, and lesbian populations shows that sexual behavior and attraction may lessen for some people as they grow older (although not for all) but that sexual identity generally remains relatively constant (the exception being people who “come out” in later life, as discussed later in this entry). Since bisexuality is often thought of as a fluid or transient identity, it might be anticipated that this finding would not hold true for bisexual people. However, research is building that bisexual identities, especially long-established ones, also remain stable in later life. A study of a group of midlife (ages 35–67, average age 50) bisexually identified people living in San Francisco in the 1980s and 1990s, undertaken by Martin Weinberg and his colleagues, found that most participants’ sexual practices had changed as they grew older. They were having less sex with fewer partners, which participants attributed partly to the effects and responsibilities of being older, including life-stage effects such as being very busy with work and children. Participants were more likely to be having sex with only one gender than when they were younger—about a third were having sex only with people of a different gender and about a fifth were only having sex with people of the same gender. Participants were also more likely to be monogamous than when they were younger. They were less involved in organized bisexual communities and politics, especially since the local bisexual resource center had closed. However, many participants in this study reported that their identity as bisexual had remained constant and indeed was more stable than when they were younger. The researchers argued that, in contrast to earlier in their lives, most had now “obtained closure” on their identity. They based their identity as bisexual on their attractions rather than on their behaviors. The stability of their identity as bisexual as they grew older came from recognizing the

long-standing nature of those attractions. A different, more recent study, by Rebecca Jones, which examined how bisexually identified adults predominantly from the United Kingdom and the United States imagined their own aging and later life, also found that most people imagined and experienced long-standing bisexual identities that continued throughout the life course. These studies, taken together, suggest that bisexual identities in later life may be as stable as any other sexual identity. They also counter the common assumption that bisexuality is primarily about sexual behavior. Rather, they suggest that bisexuality, like other sexual identities, is made up of many components, which include those of behavior, identity, and attraction.

Underresearched Groups Older bisexual people as a whole constitute an underresearched group—there is hardly any empirical research looking specifically at the experiences of older bisexual people, apart from the two studies already discussed. Empirical studies of LGBTQ aging as a whole usually include very small numbers of bisexual respondents and usually analyze their findings by gender, not by sexuality. Thus, “gay and bisexual men” are treated as one group and “lesbian and bisexual women” are treated as another. This analytic practice makes it impossible to identify what, if anything, is distinctive about bisexual experiences of aging. We know very little about the experiences of people who behave bisexually but do not identify as such. This is a common limitation of all work with sexual minorities, whether academic or not, since making contact with people who do not identify as members of a sexual minority is extremely challenging. It is a particular issue for research and services targeting older bisexual people since they constitute a minority within a minority. We know very little about older bisexual people who have not been activists around bisexual issues and those who are not connected to wider bisexual communities. Someone who has been an activist or has had strong connections to a bisexual

Aging and Bisexuality

community may be more likely to have a stable identity as bisexual than someone who has not. We also know very little about the experience of bisexual people in their seventies, eighties, nineties, or older. This means that we have very little information about what it means to be bisexual at the stage of life where disabilities and ill health become more likely and when the end of life may come into view.

Intersections With Bisexuality and Aging The literature on bisexual aging has focused on predominantly middle-class, White, and relatively highly educated people living in Western nations. This means that we know very little about how socioeconomic situation, ethnicity, culture, religion, educational background, disability, and geographical location intersect with bisexuality in later life. It is important not to generalize from the participants in the limited empirical literature to older bisexual people who may be living very different lives. Understandings and experiences of bisexuality, including use or not of the self-description bisexual, vary across cultures and parts of the world, across social and economic classes, between genders, and according to age cohorts. Some people reject use of the term bisexuality (and the rest of LGBTQ referents) as inherently middle-class, metropolitan, White, and Western. Empirical research focusing on bisexuality and non-White ethnicity at any stage of the life course is rare, but what there is reports recurrent difficulties for Black and minority ethnic (BME) bisexuals in accessing organized bisexual communities, which are predominantly White. BME bisexual people often experience racism within bisexual and LGBTQ communities as well as outside them. Racism compounded with biphobia can lead to very painful experiences of exclusion and denial of identity. In later life, such exclusion can be further compounded with ageism. Another underresearched area is how gender differences affect aging as a bisexual person. Although research about LGBTQ aging in general

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does suggest some differences between male and female experiences of nonheterosexual aging, it is not clear that these findings hold true for bisexual older people. Gender may be experienced and affect bisexual people differently from lesbians and gay men, because their own gender and the gender of people to whom they are attracted are not synonymous for bisexual people. There is also evidence that genderqueer and nongendered identities are more common in some bisexual communities than elsewhere, which is a further reason that it is not possible to extrapolate from studies that categorize responses only by male or female gender.

Coming Out as Bisexual in Later Life Although “coming out” is often thought of as something that younger people do, in fact many people come out as L, G, B, T, or Q later in life. Midlife, retirement, or when any adult children leave home are all common points at which people come out later in life. It seems likely that this extends to bisexual people too. Some people who come out as bisexual in later life may be describing themselves as bisexual in order to signal their continuing commitment to an existing long-standing relationship, while pursuing new relationships only with people of a different gender from their existing partner. Others may be seeking relationships with any gender or transitioning to a heterosexual or homosexual relationship. Stigma and misunderstanding as to what a bisexual identity implies may mean that older bisexual people who come out later in life lose contact with grandchildren. This loss is especially the case for older bisexual men because of the combination of two prejudices, first that bisexual men are predatory and second that older men’s sexuality is disgusting or dirty. Older bisexual men thus can suffer from a double stigma.

Historical and Cohort Effects on Bisexual Aging Individuals’ experiences of aging are affected by the historical period in which they live and the

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generational cohort to which they belong, but they are not determined by them. Examining differences between historical cohorts can be helpful in determining whether something is due to aging per se or just to aging in one particular time and place. A bisexual person who is aged 80 in 2015 will have been born in 1935, so will have grown  to adulthood before the first gay rights movements and before the decriminalization of homosexual sex in many jurisdictions. A bisexual person who is aged 50 in 2015 will have been born in 1965, so will have grown into adulthood after the first gay rights movements arose, and is likely to have encountered the AIDS crisis in early adulthood. These kinds of generational differences are significant in the aging experiences of older lesbians and gay men; it seems likely that this is also the case for bisexual older people. For example, older people who have been out about their sexual identity for most of their lives may be more likely to remain out if they start receiving care services. The visibility of older bisexual people may therefore increase in the next few decades. Experiences of aging are always historically and culturally contingent, so different cohorts and generations of bisexual people may age very differently.

Relationships Older bisexual people, like younger ones, are found in a variety of different relationship types, ranging from monogamy to polyamory and swinging. Being older means that it is possible that a bisexual person’s relationship(s) may have been of very long duration. But longevity also means that someone has had a longer opportunity for forming and breaking relationships, so they may have had a large number of relationships over the years. Older age status is not predictive of the types or numbers of relationships that bisexual people may have. Older bisexual people may be married to different-sex partners or to same-sex partners in jurisdictions where same-sex marriage or civil partnership exists. In the future, when same-sex marriages will have been available longer and on a

broader scale, it seems likely that the numbers of older bisexual people in same-sex marriages will increase just as the numbers are likely to increase for lesbian and gay older people, because same-sex marriage will have been a possibility for a greater proportion of someone’s life. A study of bisexual men in monogamous marriages to women, 40% of whom were aged 46 or older, found that these marriages were successful and sexually happy, with good communication and acceptance of the men’s bisexual attractions being seen as key to their success. Older bisexual people who are not in statesanctioned relationships, and especially those who are in polyamorous relationships, may experience difficulties in their relationships being recognized socially and legally. These difficulties can be a particular issue later in life and in end-of-life care, when health and care services may not recognize the significance of family-of-choice and may privilege family-of-birth or family-by-marriage inappropriately. This extends to funeral and other after-death arrangements, when someone’s wishes may not be observed and surviving partners may not be acknowledged or provided for. Making legal provision and discussing end-of-life arrangements and wishes can be extremely beneficial for older bisexual people, as indeed for all LGBTQ people. Thus, the experiences of bisexual people as they grow older are both similar to and distinctive from the aging experiences of other LGBTQ people. Older bisexual people’s experiences are also both similar to and distinctive from the experiences of younger bisexual people. It is clear that more empirical work is needed to explore all aspects of bisexual aging, including the diversity of bisexual people’s experiences of aging. The distinctions between identity, attraction, and behaviors that are so significant in the study of bisexuality in later life also carry potential benefits for work with other sexual and gender minorities. Rebecca L. Jones See also Ageisms in LGBTQ Cultures; Aging, Sex, and Sexuality; Aging and Gay Men; Aging and Lesbian

Aging and Gay Men Women; Aging and Transgender People; Biphobia; Bisexual Inclusion in the LGBTQ Rights Movement; Bisexualities

Further Readings Barker, M., Richards, C., Jones, R., Bowes-Catton, H., Plowman, T., Yockney, J., & Morgan, M. (2012). The bisexuality report: Bisexual inclusion in LGBT equality and diversity. Milton Keynes, England: Open University, Center for Citizenship, Identity and Governance/Health and Social Care. Dworkin, S. H. (2006). Aging bisexual: The invisible of the invisible minority. In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual and transgender aging: Research and clinical perspectives (pp. 36–52). New York, NY: Columbia University Press. Edser, S. J., & Shea, J. D. (2002). An exploratory investigation of bisexual men in monogamous, heterosexual marriages. Journal of Bisexuality, 2(4), 5–43. Firestein, B. (Ed.). (2007). Becoming visible: Counseling bisexuals across the lifespan. New York, NY: Columbia University Press. Jones, R. L. (2011). Imagining bisexual futures: Positive, non-normative later life. Journal of Bisexuality, 11(2–3), 245–270. Jones, R. L. (2012). Imagining the unimaginable: Bisexual roadmaps for ageing. In R. Ward, I. Rivers, & M. Sutherland (Eds.), Lesbian, gay, bisexual and transgender ageing: Biographical approaches for inclusive care and support (pp. 21–38). London, England: Jessica Kingsley. Keppel, B. (2006). Affirmative psychotherapy with older bisexual women and men. Journal of Bisexuality, 6(1/2), 85–104. Keppel, B., & Firestein, B. (2007). Bisexual inclusion in addressing issues of GLBT aging: Therapy with older bisexual women and men. In B. Firestein (Ed.), Becoming visible: Counselling bisexuals across the lifespan (pp. 164–185). New York, NY: Columbia University Press. Rosenfeld, D. (2003). The changing of the guard: Lesbian and gay elders, identity and social change. Philadelphia, PA: Temple University Press. Weinberg, M. S., Williams, C. J., & Pryor, D. W. (2001). Bisexuals at midlife: Commitment, salience and identity. Journal of Contemporary Ethnography, 30(2), 180–208.

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Yuen Thompson, B. (2012). The price of “community” from bisexual/biracial women’s perspectives. Journal of Bisexuality, 12(3), 417–428.

AGING

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GAY MEN

As the human population ages, so do gay men, and research into this aging population has been steadily growing since the 1970s, when scholars began to document the distinctive social factors affecting gay men’s later years. Determining the number of older gay men is difficult because same-sex erotic encounters and romantic relationships do not necessarily result in identification as gay, and those who do adopt a gay identity do not necessarily disclose these identities to others. But the fact that estimates of the gay male population at any given time range from 2% to 10% of the population, and the fact that the average life expectancy in the West has virtually doubled over the past century, make the older gay male population a group whose experiences, circumstances, and needs are worthy of investigation, as does their distinctive placement in a context of rapid social change implicating sexual identity, sexual and other relationships, political ideology, and personal and community health that has unfolded across their own lifetimes. This entry begins by reviewing the range of approaches applied in aging research. Then, it considers the challenges to representative sampling of older gay men. It then summarizes research findings that highlight the significance of historical/generational context and social support for older gay men’s lives, circumstances, and health. The entry concludes with a review of research into older gay men living with and/or affected by HIV/AIDS.

Aging Studies: Competing Approaches Aging can be defined and approached in several ways. From a biomedical perspective, it is typically approached as a biological process of, for example, the slowing of cell regeneration, with the body becoming slower, weaker, frailer, and more prone

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to such illnesses as coronary heart disease, stroke, cancer, and Alzheimer’s disease. A more psychological approach tends to view aging as driven by internal mental processes, and focuses on mental or cognitive functioning and health. Social gerontologists (social scientists specializing in human aging) variously focus on social structures, processes, practices, roles, relationships, networks, experiences, and identities related to aging. For example, some social gerontologists approach aging as a social role, structured by social institutions and cultural assumptions, which people adopt in later life. Other social gerontologists consider aging to be a lifelong process of moving not only through the physical process of aging, but also through sequential stages of life that have been culturally and institutionally constructed (for example, formal education, work and career, marriage and parenthood, and finally retirement and grandparenthood). These life stages are connected to specific chronological ages, so that people are deemed to be “on” or “off” time (for example, teenaged mothers are now viewed as “off time”). Social gerontologists interested in policy and social justice are generally concerned with the fair distribution of social resources and human rights across age-groups, working to ensure that older people are not discriminated against in the workplace, education, health and social care, and law, and that their needs are met within these and other fields. These approaches are similar in that they tend to focus on the lives, needs, and circumstances of people over the age of 65 (the age at which people living in the Global North typically retire), and approach older persons as either objectively unique (with distinctive social, physical, and psychological characteristics and needs) or as socially and culturally constructed as unique in ways that do not reflect the realities of their capacities and their lives. But there are often tense debates and divisions within this wide field of aging studies. Social gerontology has critiqued medically focused studies of aging for disregarding the social and historical context in which people age. Critical gerontology has taken much aging-related research to task for overemphasizing the elderly’s frailty and vulnerability,

unintentionally depicting them as more needy and vulnerable, and less resilient and resourceful, than they actually are, and thus as a strain on the social system rather than as productive members of society. Many studies of aging have been critiqued for failing to explore and represent the vast diversity of the aging population, or for exaggerating the distinctiveness of specific aging groups. Finally, even within social gerontology, tensions have emerged over the universality of the aging process, with some scholars arguing that distinctive generations have aged within such unique sociohistorical circumstances that generalizing across generations is problematic at best. This tension, and the tensions identified above, can be seen in the literature on aging “in general,” and are particularly evident in studies of gay male aging.

Aging Gay Men and the Problem of Representation Just as the term aging is difficult to define, with various definitions linked to investigators’ host discipline, so is the term gay male. Men who experience and/or pursue same-sex desires, erotic attachments and arrangements, and romantic relationships do not necessarily identify as gay, bisexual, or queer, and those who do may redefine their sexual identity at certain points in their lives. Scholars of public health constructed the term men who have sex with men (MSM) to better quantify men who engage in same-sex sexual practices. But this category does not capture the social roles or identities that these men adopt or, indeed, the social relationships and social worlds in which these men engage. As a result, research into the lives of aging gay men, as well as the lives of younger gay men, focuses on data gathered from men who are willing to identify as gay, to the exclusion of those whose sexual identities are more fluid or complex. Moreover, as many men who do identify as gay decline to identify as such to those whom they do not personally know (e.g., researchers), studies of gay men of all ages typically rely upon data related to gay men who are relatively open about their personal lives, to the exclusion of

Aging and Gay Men

many others. Men who do tend to agree to participate in research into gay male experiences are typically recruited through formal gay organizations, and thus research often overrepresents middleclass, White men living in cities. This overrepresentation is particularly likely in studies of older gay men who faced much harsher treatment by formal institutions and friends, family, and coworkers in their early lives than have younger gay men who grew up during or after gay liberation (generally dated as beginning with the Stonewall uprising of 1969), and who are thus generally less willing to disclose their gay male identity to researchers.

Gay Male Aging in Historical Context: The “Problem” of Generations Early studies of gay male aging were launched in the 1970s in the United States by scholars committed to disproving the prevailing myth (held by the general public and alleged “aging experts” alike) that older gay men (and women) were more isolated, less physically and mentally healthy, and lonelier than were older heterosexuals, as the former allegedly suffered from weak romantic and family relationships and were prone to youthful promiscuity as well as victimized by a gay culture that excluded gay people over the age of 40. Displaying a lack of knowledge about gay aging, this “expert opinion” drew on social gerontology’s focus, at the time, on the presumed danger of people becoming less socially integrated and satisfied in later life (allegedly linked to the “crisis of role loss,” meaning the loss of positive social roles as workers and parents due to mandatory retirement and to their children leaving home). But these early small-scale empirical studies showed that older gay men were not, in fact, as isolated or unsatisfied as had been assumed (e.g., most of these studies’ informants were in long-term relationships), nor were they experiencing worse mental health than were older heterosexuals. These studies also argued that gay men’s experience with surviving various crises (coming out, struggling with sexual identity, rejection by friends and family) made them more capable of managing crises of

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role loss, but this line of reasoning was later questioned. Importantly, the men interviewed for these early studies, and who exhibited good social integration and positive life satisfaction, had grown up in the pre–gay liberation era, when the dangers of disclosing one’s homosexuality or of having it discovered by others led most to keep their homosexuality private; much of the gay politics and discourse prevailing at the time these studies were published had assumed that being “in the closet” carried with it psychological strain, fear, and guilt which would express itself in later life in negative ways. These early studies challenged this assumption, pointing to a much richer inner life, and much stronger and more complex social relations, among older gay men than had previously been assumed. These studies, and some conducted later with this generation of gay men, showed the “closet” to have provided a sense of safety and security in dangerous times—a feeling that endured as these gay men entered their later years. Thus these early studies uncovered two important findings related to older gay men, particularly those who had come of age in the pre-Stonewall era. First, according to the sociologist John Alan Lee, the pre-Stonewall emphasis on “passing” as heterosexual placed older gay men in the valued position of guiding younger gay men through a private gay male network to introduce them to other “passing” gay men and school them in the codes of the gay male subculture. This granted older gay men a positive social status that, as the gay world became more open and accessible, older gay men have lost. Second, these studies uncovered intergenerational tensions between the pre–gay liberation generation of gay men who had come of age before gay identity politics and its mandate to “come out” to homosexuals and heterosexuals alike, and the post–gay liberation generation of gay men, who had come of age in the post–World War II era and within a sociopolitical milieu in which that mandate held a central role. In 1990, the gay activist and oral historian John Grube distinguished between “natives” of the pre– gay liberation gay male community and the

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“settlers” (gay liberationist men who embraced a new way of life based upon a politicized gay identity). From the perspective of “natives,” gay liberation threatened and derided their way of life based upon sequestering their gay lives in a private world. More recently, Dana Rosenfeld, a sociologist, found these same ideological tensions in her interviews with gay men born before 1930, who came of age—and identified as gay—before or after 1969. In her study, those gay men who had identified before 1969 viewed gay liberation’s politicization, and its call for public disclosure of one’s own homosexuality, as foolhardy and dangerous—just as their gay male contemporaries who had identified as gay after 1969, and thus through the ideological parameters of gay liberation, viewed those who rejected gay liberation, and continued to “pass” as heterosexual, as repressed and inauthentic. Rosenfeld’s work points to ideological divisions within the same generation of gay men based on when in the history of gay politics and culture they identified as gay. To capture the intersection between these and similar historically specific ideological divisions, on the one hand, and identification as a member of a specific category of person, on the other, Rosenfeld introduced the concept of the identity cohort, which she defined as those who identified as a member of a particular category (here, gay men) at the same historical moment on either side of a significant historical shift in ideologies of the self. Rather than posit a unitary, invariable “coming out” process, then, Rosenfeld drew on insights from social gerontology and life course theory, both of which view the aging process and the experience of later life as causally connected to processes of social change. These findings brought to the fore the significance of the historical era in which gay men came of age and identified as gay for sexual identity, social relationships with other gay men and with heterosexuals (including family), and management of information regarding their sexuality. Although gay male culture is still changing, and will no doubt ground different sexual identities, experiences, and relationships among future generations of older gay men, current research into gay male aging necessarily relies on gay men who are

currently over the age of 65 (although many studies of “gay aging” use data about or collected from people in their 50s, a group that social gerontologists would consider middle-aged rather than elderly). For these men, the major social shifts in gay politics, culture, and social organization that shaped their later lives are (a) the emergence of gay liberation, as the pre-Stonewall gay world— organized around relatively secret, even underground, gay societies—evolved into a gay community that was increasingly politicized, vocal, visible, and organized, and (b) HIV/AIDS. Following the early wave of studies into gay male aging summarized above, later studies of gay aging began to focus on gay men born in the post–World War II era, who had formed their gay male identities in a gay liberationist context. These gay men lived within a relatively open gay world that was, increasingly, taking the shape and identity of a gay community celebrating same-sex practices and culture in open as well as in private, closed settings.

Social Networks, Social Support, and Mental Health The most recent studies of gay men and aging have been less concerned with disproving myths about gay aging than with documenting gay men’s social networks and relationships. In contrast to many younger gay men today, these currently older gay men had not come of age with access to legalized same-sex marriage. But a number were found to have been heterosexually married and to have fathered children before they adopted a gay identity, and thus to have adult children on whom they can rely for support in later life, although they are less likely to have children than do their heterosexual peers, which limits their access to childbased caregiving and support. Moreover, for these and for childless older gay men, the gay community’s reliance on “friends as family” has been found to ground social support networks in later years to a much higher degree than is the case among heterosexual men. Gay men rely on these networks, and on partners and formal gay community organizations, in ways that distinguish them from heterosexual elders.

Aging and Gay Men

Given the significant and well-substantiated correlation between social support and mental health and well-being across the life course and into older age, the role of these social support resources has particular salience for studies of gay male aging, especially as recent research has questioned earlier findings that older gay men’s mental health is equivalent to that of their heterosexual peers. Evidence has emerged that compared with older heterosexual men, older gay men report higher levels of poor health, depression, and psychological stress, and have a higher risk of disability, than do older heterosexual men (although, regardless of sexual orientation, romantic partnerships protect against poor physical and mental health). While research has yet to identify the causes of these differences, researchers suggest that the most likely factors are the current and the lifelong consequences of stigma and related fears of (and, indeed, actual instances of) discrimination, harassment, and abuse; the stresses of keeping their sexual identity secret from others; and the personal, social, and psychological costs of the AIDS epidemic of the 1980s and 1990s, and of the high incidence of HIV within the gay male population. Other likely factors are the ageism that many older gay men experience as a core feature of gay male social worlds, and that is likely related to the changes in these worlds identified above and noted by John Grube decades ago, and concerns over entering formal health and social care institutions in later life that may discriminate against, marginalize, or otherwise disadvantage them due to staff or other residents’ homophobia. Several scholars have predicted that the baby boom generation of gay men, who formed their gay male identities according to gay liberationist principles, will enter later life with a different set of expectations regarding their treatment and care than had the pre-Stonewall generation, with a central expectation of being able to live openly as gay men within nursing homes and other long-term settings. There is strong evidence that older gay men and women feel trepidation about seeking medical help from a system with a history of discriminating against them (and that, indeed, had defined homosexuality

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as a medical condition within their own lifetime), although observational and other empirical studies of the experiences of older gay men in long-term settings has yet to be conducted. That said, there is also evidence that older gay men “age successfully,” provided that they have developed the skills to master or resolve adversity, negotiate the realities of aging, and develop necessary resources.

Gay Male Aging and HIV/AIDS These concerns over long-term care in later life take on added significance when considering the disproportionate number of gay men living with HIV in comparison with heterosexual men. Gay men over the age of 50 are members of a generation that witnessed and experienced the highest rates of AIDS-related deaths at the peak of the AIDS epidemic (1981–1996), when AIDS-related deaths were at their highest in the Global North. These gay men, many of whom are now living with HIV, lost a substantial and disproportionately high number of friends and partners to AIDS in these earlier years, so that their current friendship and social support networks are so depleted as to potentially compromise their desired friendshipbased care in later life. The psychological effects of these losses are so significant as to have spurred several studies into AIDS-related “multiple loss syndrome” in the 1990s, and we have yet to fully understand how they affect the mental health and quality of life of older gay male survivors of the AIDS epidemic, including those who have been living with HIV for decades. These long-term survivors constitute a population in themselves, but the number and proportion of gay men aged 50 and above has also grown in recent years. The aging of HIV has sparked a wave of studies across disciplines into the physical and mental health of older gay men (as well as older heterosexual men and women) living with HIV, which has uncovered both “successful aging with HIV” and poor health; challenging personal, social, and financial circumstances; compromised social support systems; and distressing feelings of uncertainty about their future health and social stability

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as gay men age. Some recent research has found that AIDS-related bereavement exacerbates the already significant toll that homophobia takes on the mental health of older gay men. For this population, experiences and fears of antigay discrimination and ageism within the gay male community combine with concerns over HIV-related stigma, both within and outside of the gay male community, the challenges of living with a chronic condition, and uncertainties over the long-term impact of HIV and HIV medications. Not surprisingly, this introduces high levels of mental stress. In this context, the role of community-based support, friends-as-family, and romantic partnerships become especially salient for aging gay men. Dana Rosenfeld See also Ageisms in LGBTQ Cultures; Aging, Social Relationships, and Support; Families of Choice; Health Care Providers, Disclosure of Sexual Identity to; HIV/AIDS and Aging; HIV/AIDS and Social Support; Sexual Fluidity; Stonewall; Support Groups and Resources

Further Readings Dannefer, D., & Phillipson, C. (Eds.). (2010). The SAGE handbook of social gerontology. Thousand Oaks, CA: Sage. Fenkl, E. A., & Rodgers, B. L. (2014). Optimistically engaging in the present: Experiences of aging among gay men. SAGE Open, 4(3). doi:10.1177/ 2158244014545463 Fredriksen-Goldsen, K. I., Emlet, C. A., Kim, H.-J., Muraco, A., Erosheva, E. A., Goldsen, J., & Hoy-Ellis, C. P. (2013). The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. The Gerontologist, 53(4), 664–675. Grube, J. (1990). Natives and settlers: An ethnographic note on early interaction of older homosexual men with younger gay liberationists. Journal of Homosexuality, 20(3/4), 119–135. Halkitis, P. N. (2013). The AIDS generation: Stories of survival and resilience. New York, NY: Oxford University Press.

Klein, S. J. (1994). AIDS-related multiple loss syndrome. Illness, Crisis, & Loss, 4(1), 13–25. Lee, J. A. (1987). What can homosexual aging studies contribute to theories of aging? Journal of Homosexuality, 13, 43–71. Lyons, A., Croy, S., Barrett, C., & Whyte, C. (2014). Growing old as a gay man: How life has changed for the gay liberation generation. Ageing and Society, 35(10), 2229–2250. Lyons, A., Pitts, M., Grierson, J., Thorpe, R., & Power, J. (2010). Ageing with HIV: Health and psychosocial well-being of older gay men. AIDS Care, 22(10), 1236–1244. Rosenfeld, D. (2003). The changing of the guard: Lesbian and gay elders, identity, and social change. Philadelphia, PA: Temple University Press. Rosenfeld, D., Bartlam, B., & Smith, R. (2012). Out of the closet and into the trenches: Gay male baby boomers, aging, and HIV/AIDS. The Gerontologist, 52(2), 255–264. Sagie, O. (2015). Predictors of well-being among older gays and lesbians. Social Indicators Research, 120(3), 859–870. Wight, R. G., LeBlanc, A. J., De Vries, B., & Detels, R. (2012). Stress and mental health among midlife and older gay-identified men. American Journal of Public Health, 102(3), 503–510.

AGING

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LESBIAN WOMEN

The aging experience for lesbian women is often discussed in the research literature as the experiences of “older lesbians”—that is, women over the age of 55 who identify their sexual orientation as lesbian. Although exact numbers are currently not known, it has been estimated that there are anywhere from 500,000 to 2 million older lesbians in the United States, and this number is projected to double by 2030. This entry first discusses the need for specific and separate knowledge that focuses exclusively on the lesbian experience of aging. Next, the entry describes several key areas of need and struggle, as well as areas of strength and resilience in the areas of identity and health. These issues are examined within the current historical

Aging and Lesbian Women

context and provide future considerations as lesbian women continue to age. The current research on aging lesbians is growing, but it is still quite limited; the limitations in knowledge are also discussed.

Specific Focus on Aging Lesbians Lesbians are a subgroup that falls under the larger umbrella term of LGBTQ. Although it is often important for political strength and in terms of solidarity for the LGBTQ community to be discussed as one (i.e., “LGBTQ people”), the reality is that in daily life each subgroup often has very different experiences and needs. Specifically, lesbian aging has been shown to be dissimilar from gay male aging. For example, research has found that aging gay men report concern with their physical appearance and attractiveness as they age; however, research on aging lesbians has found that they express minimal concerns about physical appearance and attractiveness, and in fact feel that their decreased experience as sexual and physical objects as women is a welcome change. Another example of how lesbians and gay men’s experience of aging differs is in the area of health, such that aging lesbians have been found to be at risk for specific cancers that are not applicable to gay men (discussed further below). Thus, it is very important that the aging lesbian experience be discussed and studied independently from the other subgroups within the LGBTQ community. Past research has not always considered the experiences of each subgroup separately. Historically, the bulk of the research on LGBTQ aging has been primarily about aging gay men, and, specifically, about the upper-middle-class, educated, White gay male experience. Newer studies are increasingly likely to analyze data from lesbians and gay men separately, and current trends have also included focusing only on one sexuality/identity in a study.

Identity and Sexual Orientation One very specific concern in terms of lesbian aging is that of invisibility. Several studies have addressed

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the reality that older lesbians are nearly invisible in society, mainly as a result of heterosexism (the assumption that all people are heterosexual). However, specifically for older lesbians, there is the experience of having once been defined by society in terms of their sexual behaviors, but now as older adults they are then ignored, as they are assumed sexless. Thus as they age their sexual orientation is not of concern to most of society. As well, the research literature suggests that older lesbians are at risk for a triple threat of oppression: As women: Women today still face and must navigate many situations where they are limited as a result of their gender and sex; As lesbians: Sexual minorities, such as women with a lesbian identity, face potential oppression in a variety of settings and situations; As older persons: Ageism and the resulting oppression are well-documented experiences for older persons.

An additional factor that adds to older lesbian invisibility is that many older lesbians will intentionally return to “the closet” in several areas of their life as a response to feeling vulnerable in older age to increased oppression. Many older lesbians are not “out” in public situations such as in health care or employment settings due to fear of discrimination or biased treatment. They do, however, typically remain out in social relationships, with the majority being out in their family relationships and friendships. In fact, aging lesbians have reported a lifetime of varying experiences in terms of sexual behaviors, relationship orientations, and identity. Specifically, one of the largest studies to date on older lesbians found that approximately half of the women had been married to men, had sexual fantasies that included men, and had engaged in sexual relationships with men. Many of the women reported midlife transitions to a lesbian identity, but the majority reported lesbian identification at very young ages. Thus, it appears that aging

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lesbians who were once married to men did so to hide their sexual orientation and to fit into general society, while some have experienced attraction to men at various points in their life. A very small subset of older lesbians remain married to men for legal and financial protections, with some reporting marriages to gay men so that both might have the safety and benefits that marriage can provide. It is believed that as LGBTQ marriage rights increase, future cohorts of older lesbians will be less likely to marry men. The majority of older lesbians, however, are involved in current long-term relationships with women, with these relationships having lasted longer than the average for heterosexual marriages in the United States. However, because of the lack of federal government recognition of these relationships, older lesbian couples do not benefit from the financial and legal protections that marriage includes (i.e., preferential tax rates, social security, retirement benefits, health insurance, disability, housing rights, guardianship of children and grandchildren). Older lesbians report many stressors and difficulties as a result of these lacking rights. As marriage rights increase for the LGBTQ population, it is expected that future cohorts of aging lesbians will have decreasing concerns in this area. However, it is interesting to note that the majority of older lesbians describe resistance to the traditional experience of marriage because of its historical roots in patriarchy and female role expectations within marriage. Thus the older lesbians in future cohorts could provide new information on the organization of relationships, and the experience of identity, within marital relationships. It is important to note that despite a lifetime of various sexual experiences and interests, and regardless of how out or closeted they are, the women in these studies did indeed identify as lesbian, and not as bisexual or another identity label. This may be the result of the current cohort of older lesbians coming of age in the 1970s when both the second wave of feminism and the Stonewall riots were occurring, when sexuality and sexual orientation were brought to the forefront of the political arena, and when a lesbian identity label was an important part of those historical

movements. Current trends that show a variety of sexual orientation terms and identity labels (queer, pansexual, etc.) suggest that the dominant use of “lesbian” as a sexual orientation label will decrease in future cohorts. It is also important to note that despite sometimes returning to the closet (as discussed earlier), the majority of older lesbians report feeling very positive about their lesbian identity and about the aging experience in general. The current cohort of aging lesbians is in fact more positive about their lesbian identity and their own aging than the last studied cohort of aging lesbians. It is believed that these positive experiences will also increase with future cohorts, as increased acceptance of the LGBTQ community occurs and if aging continues to be a focus within the social and health arenas.

Health: Physical and Emotional Part of why the current cohort of aging lesbians is positive about their own aging is that thus far, they are a fairly physically healthy group with selfreports of excellent or good health. The health literature on older lesbians reports that the most common health-related issues include obesity, high blood pressure, and arthritis. Although historically a physically active group, the current cohort of aging lesbians has reported a decrease in physical activity, which parallels the general decrease in physical activity seen in the overall population of the United States. Aging lesbians are known in the health literature to be at greater risk for both ovarian and breast cancer due to fewer pregnancies and fewer months of breastfeeding when compared with heterosexual women. Thus it is important that health care providers are aware of the sexual orientation of their female patients so that lesbians are screened more aggressively for these conditions. It should be noted, however, that as legal and medical benefits are increased and extended to lesbian couples, there will most likely be a corresponding increase in childbearing, thus an increase in pregnancies and in breastfeeding, and thus a corresponding decrease in being at risk for these types of cancers. Thus what is true in terms of at-risk health

Aging and Lesbian Women

conditions for the current cohort of aging lesbians will not necessarily be true for the next cohort. Similarly, lesbians are known to have higher rates of both cigarette and alcohol use than their heterosexual counterparts. However, this rate is seen to decline with age, and the majority of older lesbians do not smoke or drink to excess; however, many older lesbians do report past use of both. Again, these rates may continue to decline with future cohorts as they have decreased within the past two cohorts of older lesbians. These decreases are seen as a result of both overall general population decreases and also decreases specifically within the LGBTQ community as a result of social acceptance. That is, historically, the higher-than-average rates of both smoking and alcohol use by LGBTQ community members has been understood as an adaptation to “minority stress,” and thus recognized as a means of coping with nonacceptance, hostility, and discrimination on account of sexual orientation. As acceptance and rights increase for LGBTQ community members, rates of both alcohol and cigarette use (as well as drug use) are expected to decrease. Health care providers should be aware of the risks associated with minority stress and how aging lesbians experience them. Although rates of substance use are lower in older lesbians, there is still the possible history of these behaviors, which may result in health problems, and thus requires proper screening by health care providers. The current cohort of aging lesbians report experiencing multiple difficulties in accessing health care such as lack of insurance, distance from providers, and limited treatment options, with more than half of this population not being out to their health care providers. As well, the overwhelming majority of aging lesbians has expressed interest in aging, lesbian-only communities and is fearful and resistant to traditional retirement, rehabilitation, assisted living, and nursing homes with heterosexual couples or men present. This is likely a result of their experiences of being discriminated against and general discomfort with aging as members of a minority. In terms of emotional health, the current cohort of older lesbians rated their emotional health as

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excellent or good when responding to a national survey. When reporting mental illness, depression and anxiety are the most common symptoms found in the literature. As a group, older lesbians are open to utilizing therapists and mental health providers and report having gone to therapy mainly for identity, relationship, and depression issues. Widowed and celibate lesbians report the highest rates of depression. Widowed lesbians are at particular risk for depression due to the issues they face as a result of stressful legal and financial barriers due to their relationships not being recognized (as discussed above). As well, widowed lesbians report that emotionally their relationships and loss are often neither recognized nor seen as legitimate, which compounds their loss. Overall, the current cohort of older lesbians is a very resilient cohort who have lived in a time when they could be committed to a psychiatric facility, could have their children removed from their legal custody, and could be legally fired on the basis of their sexual orientation alone. Despite this they remain an active, engaged, highly educated group that feels positive and hopeful about their own aging, their lesbian identity, their health, and their relationships. Many older lesbians are still working, involved in the raising of their grandchildren, and active in political and social groups.

Limitations to Our Knowledge The current state of knowledge about aging lesbians should be understood within the historical context of their cohort and in consideration of the social and political environment. How culture and legal barriers impact the women in these cohorts changes with each cohort. Additionally, the age, race, socioeconomic status, and education level of the older lesbians that are being studied also impact our current state of knowledge. Most of the knowledge we have is based on research conducted with small numbers of older lesbians who are typically young-old (i.e., 55 to 65) rather than old-old (i.e., 75 and older), are predominantly White (with little to no African American or other racial minorities represented), report high incomes, and are

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Aging and Transgender People

highly educated. Although researchers are making efforts to reach more diverse older lesbians, attempts have been mostly unsuccessful. What we know about lesbian aging could potentially be very different if researchers were able to talk to members of racial minorities, the very old, those of low socioeconomic status, and those with comparatively little formal education. However, from what we do know, the experience of lesbians as they age differs greatly from that of gay men, heterosexual women, and even their older lesbian “sisters.” This points to the importance of continuing to study and report on the experiences of lesbians as they age. Paige Averett See also Ageisms in LGBTQ Cultures; Aging, Sex, and Sexuality; Aging, Social Relationships, and Support; Discrimination Against LGBTQ Elders

Further Readings Averett, P., & Jenkins, C. (2012). A review of the literature on older lesbians: Implications for education, practice, and research. Journal of Applied Gerontology, 31, 537–561. Averett, P., Yoon, I., & Jenkins, C. (2011). Older lesbians: Experiences of aging, discrimination and resilience. Journal of Women & Aging, 23, 216–232. Claassen, C. (2005). Whistling women: A study of the lives of older lesbians. Binghamton, NY: Haworth Press. D’Augelli, A., & Patterson, C. (1995). Lesbian, gay and bisexual identities over the lifespan: Psychological perspectives. New York, NY: Oxford University Press. Gabbay, S., & Wahler, J. (2002). Lesbian aging: Review of a growing literature. Journal of Gay & Lesbian Social Services, 14(3), 1–21. Goldberg, S., Sickler, J., & Dibble, S. (2005). Lesbians over sixty: The consistency of findings from twenty years of survey data. Journal of Lesbian Studies, 9(1/2), 195–213. Kehoe, M. (1989). Lesbians over 60 speak for themselves. New York, NY: Harrington Park Press. Meezan, W., & Martin, J. (2009). Handbook of research with lesbian, gay, bisexual, and transgender populations. New York, NY: Routledge.

AGING

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TRANSGENDER PEOPLE

Transgender and gender-nonconforming people face many of the same aging-related challenges as other individuals. However, they also have many unique ways of experiencing the consequences of aging. This entry outlines the variety of agingrelated challenges present in today’s transgenderidentified communities. It begins by discussing the prevalence of elder trans-identified persons.

Aging and the Transgender Experience Who Are the Current Trans and Gender-Nonconforming Elders?

Here, we will consider the age of entrance into the elder population to be 65 years old. The Administration on Aging states that the U.S. population of persons 65 years or older numbered 39.6 million in 2009 (the latest year for which data are available). By 2030, it is projected that there will be about 72.1 million older persons in the United States. The National Institute on Aging global projections for the 65-years-or-older cohort are 524 million in 2010 with this number expected to increase to 1.5 billion in 2050. Given the diverse number of gender descriptors in the transgender community, it is difficult to provide accurate estimates for the number of gendernonconforming community members in the United States and globally. We can, however, make some reasonable estimates. Using 1999 census data and an estimate of 3% to 7% transgender population prevalence, Tarynn Witten, a scholar in transgender aging, estimated that there were approximately 347,000 to 1,041,000 transgender-identified persons in the United States over 65 years of age. Witten also estimated that the worldwide population of transgender-identified persons was in the range of 4,097,020 to 12,291,060. Based upon more recent 2010 population estimates, Witten has argued that the U.S. population estimates should be revised to be between 1.2 and 2.8 million transidentified individuals over 65 years of age. There is little information available to make population

Aging and Transgender People

estimates for gender-nonconforming elder populations in other specific countries.

Social Factors in Aging Ageism and Its Consequences

Western elders are often discriminated against as a consequence of their actual chronological age or for how old they appear. For example, some potential employers may believe that elders are “too expensive” to pay for, or that those elders cannot “perform” certain predefined tasks, or that they have a longer learning curve than younger potential employee candidates. Trans elders face these and additional barriers in employment due to being transgender-identified. Many jobs depend upon how a person looks; consequently “passing” may be important. Transphobia can limit job availability thereby diminishing hiring potential. Different age cohorts are now appearing in the trans community. Cohort effects are important in understanding ageism and other factors within the gender-nonconforming community. Trans elders often hold viewpoints that come from different life histories. For example, words like queer may mean different things to different generational members. This can create intergenerational conflict and thereby generate subsequent ageist perspectives that may propagate within the trans community. Complicating matters is the intersectionality of ageism and trans identity with racism and other isms. Little is known about these complex intersections, and there has been very little research into the challenges and consequences of such intersections. Social Support Networks

There is abundant gerontological research literature supporting the importance of social networks in aging. These networks may involve birth families, legal families, families of choice, friends, individuals from various social organizations (clubs, religious organizations, service organizations, health care systems), and other support

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individuals such as caretakers and health caregivers. It is well known that individuals with stronger social support networks are less susceptible to the negative consequences of aging. However, identifying as transgender often profoundly affects network structures and can actually increase susceptibility by altering or reducing network structure and connectivity. Family Structure and Function. Many of today’s trans elders came out after their children had reached adulthood and left home. For some of these elders, their family members were supportive of the transition while others suffered strains and even breaks in family connectedness. Estimates from recent large cross-sectional research studies suggest that 40% of the overall community has never been married and as much as 55% of respondents have no children. Further, research by Karen FredriksenGoldsen, a senior researcher in LGBT health and aging, as well as research by Tarynn Witten, suggests that between 25% and 30% of trans-identified individuals live alone. To compensate for social network loss, many trans elders created families of choice. Yet over 30% of Witten’s respondents stated that they did not know who would take care of them in the event of a major illness or when the need arose. Religiosity/Spirituality and Faith Support Networks. The importance of spiritual/religious networks in the lives of the elderly cannot be overestimated. Trans-identified individuals belong to a diverse array of religions and faiths, and issues facing religious involvement within the trans-identified community are complex. Positive religious and spiritual experiences can enhance resilience, reduce stressors, and create important social networks. Negative religious experiences can result in the opposite—heightened risk factors and more negative physical and mental health outcomes. Friendship and Intimacy Networks. As friends and family die or move away, many elders find that their friendship support networks gradually diminish. Trans elders not only suffer these changes in network support but also lose friends and family

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due to their gender changes. Some individuals address this challenge by acquiring a pet. Others build networks via the Internet or by attending trans-related community events. Some simply choose to live alone. Of those that choose to live alone, research shows a significantly greater number having “feminine” gender self-perceptions than having “masculine” self-perceptions. Many elders hope that the transition will not affect those family relationships that are in place prior to transition. However, it is rare that this is the case. Moreover, the results of transition are often disastrous, leading to subsequent divorce, isolation from family and friends, and a significant degree of aloneness. Intimacy, sexual or otherwise, is important across all ages. However, as the body ages, it is not often perceived as being as attractive as it once was. In addition to the natural processes of aging, the trans body may age in ways that make it ambiguous in ways that are uncomfortable for potential dating partners. Further, the stigma of being trans-identified also diminishes the potential dating population pool. Many potential partners, upon discovering that an individual is transidentified, feel violated, and the relationship will end, sometimes violently. One common perception of elderly persons is that they lose their desire for sexual intimacy. While age-related changes may alter sexual ability, this does not mean that it alters sexual interest and a desire for physical intimacy. In fact, many trans elders have an increased desire to experience sexuality in their new identity. This may lead to behaviors that are considered a “second adolescence.” Elders of the population are frequently untrained in the important sexual protection measures for today’s world, and this can lead to increased risk of HIV/AIDS/STDs in later life. Sexuality is a key component of quality of life and well-being, and the need to express one’s sexuality continues into old age and may even continue into nursing-home or at-home elder care environments. Caregivers in such environments may find expressions of sexuality difficult in the general elderly population and more difficult with transidentified persons. This can be particularly

complex when the trans person has dementia or when the physical body and the gender expression do not appear to be in sync with each other.

Financial Factors in Aging We do not know very much about the fiscal status of the overall transgender-identified population. The work of Fredriksen-Goldsen and her team shows that 47.56% of her respondents were below 200% poverty level. Witten’s work showed 37% of her respondents (overall) were living below the 2013 federal 200% poverty level for a family of one person and 56% were living below the poverty level for a family of two persons. Considering only those individuals over the age of 65, Witten’s study showed that 28.9% were living below 200% poverty level. Moreover, Witten found that individuals with “feminine” gender self-perceptions had higher income levels than those individuals with “masculine” gender self-perceptions. Many of Witten’s survey respondents stated that they did not have enough money, or had just enough money, for basic life requirements. Additionally, many felt that they were under moderate-to-extreme financial strain.

Retirement and Pension Planning Like many other life phases, retirement can be complex. The differences between age cohorts and their plans for retirement are significant. Balancing the need to transition with the needs of a solid fiscal retirement can be problematic. When people think about retirement, they typically consider such things as where they will live, how they will support themselves, what kind of medical care they will be able to afford, and how they would like to live out the remainder of their lives. These are natural concerns for all individuals, trans and non-trans alike. Witten’s research has shown that only 59.5% of the respondents (across all ages) have a pension or other form of retirement plan, and that this too varied by gender self-perception. When asked why individuals did not have pension plans, individuals cited underemployment, needing

Aging and Transgender People

everything they earn just to survive, barely surviving day-to-day, and using retirement funds for transition expenses.

Health Care Factors in Aging There are now many well-known considerations that contribute to a healthy and satisfying quality of life for all individuals across the life span, including trans persons. Self-Care

Self-care is essential. Exercise (walking, bike riding, water-related exercise, and other aerobic exercises) is crucial. Maintaining a quality diet is important. Keeping cholesterol intake down, watching for fatty liver disease, not overindulging in sugary food and drink, and minimizing alcohol intake are important contributors to a better level of physical health. For individuals who take hormones, stopping smoking should be a priority. Smoking significantly increases the risk of cardiovascular and cerebrovascular events. Aging increases the risk for these events; smoking exacerbates that risk. Regular monitoring for diabetes, HIV, and colon cancer are all part of taking care of the elder trans body and should be part of regular self-maintenance. Regular oral hygiene should be part of the daily routine. As individuals age, it is increasingly possible to lose teeth due to cavities, periodontitis, and general oral infection. Tooth loss can lead to numerous negative medical consequences. While there is no research on how hormones may mediate this, research does show that simple things such as dry mouth can exacerbate oral health problems. Medical Care

Some things require visits to a health care facility (clinic, physician’s office). If one has the body part, one has to take care of it (e.g., getting regular cervical examinations and Pap smears; or getting regular prostate examinations). While there are no clear-cut data on risk factors around hormone use in the trans population, research shows that

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hormones can influence the occurrence of breast, uterine, ovarian, and prostate cancer. Breast cancer screening should be a regular part of every individual’s physical examination. Periodic screening for osteoporosis should also be a regular part of every trans elder’s physical examination. Hormones can mediate bone protection and bone loss. It is now estimated that 1 in 3 people will develop Alzheimer’s disease (AD). For trans-identified individuals, the onset of AD means eventual loss of the current identity and has severe implications for later-life care and for the well-being of the individual. Periodic monitoring for AD and other forms of dementia should be a regular part of the trans elder’s medical care. The literature on trans persons and aging documents the increased use of alcohol, drugs, and smoking with age. As individuals age, social networks begin to collapse, ageism becomes increasingly present, financial difficulties increase, and health begins to decline. Coupled with these normative factors, elders begin to face their own mortality. Moreover, along with these changes, trans persons must face questions around self-actualization. All of these factors can drive increased substance abuse as the trans person ages. Many of the current elders decided to transition or transitioned in mid- to later life. Later-life transition carries a number of additional challenges. Hormones may or may not be desired. If desired, hormone levels must be monitored carefully. There is very little research literature on midto later-life hormone dosing. Similarly, little is known about when to stop hormone use. Moreover, in an effort to attain more rapid transition, some elders may abuse/misuse hormones, getting them over the Internet or from illegal providers rather than seeking out competent medical supervision. Side effects of abuse can range from minor damage to loss of life. Some trans elders desire gender-confirmation surgery, while others do not, or cannot afford it even if they so desire it. Surgery in mid- to later life carries with it certain additional risks due to the person’s age. While age is not an exclusion from transition, age-related changes can affect the

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Aging and Transgender People

transition process. Physical changes in the body may make healing slower and can result in unsatisfactory postsurgical results. Risk of cerebrovascular or cardiovascular events may increase. Diabetes and blood pressure changes are also risk factors. Mental Health Care

Gerontological literature has established that early-life and life course negative events can increase later-life mortality and morbidity. Given the endemic history of violence, abuse, discrimination, isolation, and transphobia experienced by current trans elders, it is not surprising that transidentified individuals have significantly higher rates of stress, depression, anxiety, and fear than either their LGB peers or gender-nonconforming individuals. Suicidal ideation has been shown to be significant in gender-nonconforming individuals, and suicidal ideation increases in all elders whether or not they are gender nonconforming. Some trans persons have stated that they have plans in place to commit suicide before needing to access elder care. Research and community reports document that today’s elder trans persons have a history of suffering violence and abuse (physical, mental, financial, sexual, and verbal) across the life span. Growing older increases vulnerability to such abuse. Elder abuse can also appear in the form of not allowing elders to live as their actualized selves in elder care facilities, disrespect, denial of hormones, outing the elder, and failure to provide needed medical attention and sharing of medical information. Research has shown that many trans elders fear what will happen to them in elder care facilities and that they would rather live out their lives at home if at all possible. Paying for Later-Life Care

Survey research data suggests that most trans elders expect to use some combination of personal savings and government support to pay for laterlife care. Medicare Part B is the part of Medicare that covers routine preventive care. However, trans persons may face challenges in coverage when medical identification does not match gender

presentation. Medicare Part D covers prescription drugs. Many elders cannot afford Part D, and problems may occur when Medicare deems hormones as not medically necessary. And because Medicare does not currently cover transitionrelated surgeries, these additional costs must be borne by the elder desiring them. For a number of elders, these costs come out of retirement funds. Although it was not true in the past, military veterans are now able to obtain transition-related care through the Veterans Health Administration (VHA). All necessary preventive care, hormone therapy, mental health services, preoperative evaluation, and postoperative care are now available to veterans. The VHA does not provide for transitionrelated surgeries. In some states, incarcerated individuals may be allowed to have prescribed hormones. Only one state (California) currently has any provision for transition-related surgeries for the incarcerated.

Legal Challenges in Later Life and at End of Life Later-life and end-of-life challenges provide many complex scenarios for those who do not identify as transgender. For those so identified, this time period may become even more complex and difficult. Transgender status can have a profound effect on many later-life and end-of-life facets. Research study data show that the trans-identified population as a whole is significantly unprepared for any sort of end-of-life issue, with less than 30% of survey respondents having advance directives or powers of attorney in place. Steve Rothaus’s 2014 news story in the Miami Herald, about a male-tofemale transperson who, against her wishes, was buried as a man, illustrates the degree of significance in having advance directives, living wills, power of attorney, and health care power of attorney in place. Legal documents should detail the trans elder’s wishes should they be unable to speak for themselves, detail final wishes, state who has control of the body, detail visitation rights at any medical facility, provide for one person to speak for the elder in the event that legal and medical decisions need to be made, and protect the trans

Aging and Transgender People

elder should family relationships be strained. Other legal documents impact partners and families. Trans elders need to have carefully crafted wills and estate plans in place to protect any partnerships that developed during their lives. Wills also speak to how possessions will be distributed, and these are important, as families of choice are not protected legally without such documents. Insurance and social security can be problematic due to marriage laws and name changes.

End-of-Life (EOL) Factors in Aging Given the long history of negative interactions with the health care system, trans elders are very reticent to make use of traditional elder care facilities. Nearly 40% of Witten’s survey respondents stated that they had little to no confidence that they would be treated respectfully. Respondents stated worries and fears around being given the incorrect drugs, being denied hormones, being denied needed care, physical and verbal abuse, fears of being forced to leave the nursing home and becoming homeless, and of not being allowed to live out the remainder of their days as their true selves. Additionally, trans elders have expressed fears that their last wishes would not be carried out. Survey respondents’ concerns revolved around such things as incorrect name/gender identity on death certificates and/or gravestones. Others expressed fear that funeral directives would not be respected. The Miami Herald story by Steve Rothaus documents denial of last wishes. Autopsy also represents a challenge as some trans elders are not out and their true birth sex may be discovered only upon autopsy. As a result of these worries, some elders of the community have stated that they are prepared to de-transition (undo as much of the previous surgeries and hormone treatments as possible), while some individuals have selfeuthanasia plans in place in order to avoid having to worry about getting older. As death approaches, many factors come into play. Pain management (palliative care) may become important, as will hospice care. Given that many trans elders are fearful of the kind of treatment they will receive during this period of life,

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this fear may lead to dissatisfactory end-of-life experiences for the dying and their respective family, friends, and allies. Religious/spiritual/faith needs can become critical during this time, but may be problematic because of the transgender identification of the dying person. Closure events become important for both individuals who are dying as well as those around them. Self-identity may be lost due to dementia, creating a strain for support staff and families. Delirium may cause confusion and inhibit the ability to meet someone’s final needs. Much research needs to be carried out in this area. We also know little about end-of-life issues for trans elders in Veterans Affairs facilities or for those who are incarcerated. For families of trans elders, death can also be difficult. Numerous gender-related questions become important. Should the funeral be open/ closed casket and if so, how should the deceased be dressed? Funeral ceremonies can become challenging not just from the perspective of how to refer to the deceased but also from the perspective that some religious organizations believe that being transgender is a sin and refuse to allow ceremonies to take place in their facilities or to allow the deceased to be buried in their graveyards. Obituaries can become challenging when one considers how to refer to the gender of the deceased. Legal control of the body and of various post-death decisions can also be complex when considering whether the family of origin versus the family of choice has final legal decision-making power.

Conclusion Aging is a complex process that involves many challenges. Identifying as gender nonconforming adds to those challenges. Today’s trans elders have endured a history of violence, abuse, discrimination, and denial of care. Trans identification can lead to a complex state marked by depression, sadness, loneliness, anger and frustration, anxiety, regret, feelings of loss, and decreased levels of happiness. In addition to psychological stressors, trans and gender-nonconforming people are frequently at increased financial risk. Financial stability may be sacrificed due to lack of employment or the

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Ally Development and Programming

high cost of surgeries. Loss of a job can undermine a relationship or family, leading to anger, resentment, frustration, depression, and isolation. The body of literature for transgender experiences of later life and end of life is relatively new and growing. As the younger cohorts move into middle and old age, many more questions will need to be answered. There is still much to learn about patterns and implications of the aging transgender life course. Tarynn M. Witten See also Transgender People and Religion/Spirituality

Further Readings Finkenauer, S., Sherrat, J., Marlow, J., & Brodey, A. (2012). When injustice gets old: A systematic review of trans aging. Journal of Gay & Lesbian Social Services, 24, 311–330. Fredriksen-Goldsen, K. I., Cook-Daniels, L., Kim, H.-J., Erosheva, E. A., Emlet, C. A., Hoy-Ellis, C. P., … Muraco, A. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54, 488–500. McFadden, S. H., Frankowski, S., Flick, H., & Witten, T. M. (2013). Resilience and multiple stigmatized identities: Older transgender/intersex identified persons reflect on aging. In J. Sinnot (Ed.), Positive psychology and aging (pp. 247–269). New York, NY: Springer. Meier, S. C., & Labuski, C. M. (2013). The demographics of the transgender population. In D. L. Poston Jr. (Series Ed.) & A. K. Baumle (Vol. Ed.), International handbook on the demography of populations: Vol. 5. International handbook on the demography of sexuality (pp. 289–327). New York, NY: Springer. Porter, K. E., Oala, C. R., & Witten, T. M. (2013). Transgender spirituality, religion & successful aging: Findings from the Trans MetLife survey. Journal of Religion, Spirituality & Aging, 25(2), 112–138. Redman, D. (2011). Fear, discrimination and abuse: Transgender elders and the perils of long-term care. Aging Today, 32(2), 1–2. Rothaus, S. (2014, November 21). Transgender woman dies suddenly, presented at funeral in open casket as a man. Miami Herald. Retrieved from http://www .miamiherald.com

Witten, T. M. (2014). End of life, chronic illness, and trans-identities. Journal of Social Work in End-of-Life & Palliative Care, 10(1), 34–58. Witten, T. M. (2014). It’s not all darkness: Robustness, resilience, and successful transgender aging. LGBT Health, 1(1), 24–33.

ALLY DEVELOPMENT PROGRAMMING

AND

Allies have been instrumental to many social movements, including those for LGBTQ rights. The term ally refers to individuals who engage in social change efforts in coalition with social groups to which they do not themselves belong. Allies may have more social power, status, or privilege than the group with whom they are allied. However, it is also possible for alliances to form across different marginalized social groups. Social change efforts can include working on one’s own internal biases and stereotypes (consciousness raising), interventions (both interpersonal and institutional) designed to raise awareness of the existence of different groups and their right to equal treatment, and actions intended to create broader communities of support for marginalized people, as well as activism to change policies and laws. This entry describes who LGBTQ allies are, how researchers have attempted to understand them, the development of ally identities and activism, and intervention programs designed to foster ally commitments. This research has taken place almost entirely in the United States; while some of the general points may translate to different contexts, others may not.

Allies and LGBTQ Communities Given the diversity of LGBTQ communities, there are many possibilities for alliances between different identity groups. Because space does not permit an exhaustive overview of all allies in the LGBTQ context here, we will address those most studied in the social science literature. Most often, the term LGBTQ ally is applied to heterosexual people engaged in social change for

Ally Development and Programming

LGBTQ people. However, there is increasing interest in understanding cisgender allies to transgender people, and such allies can include cisgender people who are LGBQ or heterosexual. Further, there are periods in which alliances across other identity differences within LGBTQ communities have developed. For example, during the AIDS crisis, many lesbians were activists alongside gay men fighting for recognition of, and increased research on and treatments for, AIDS. Lesbians could be considered allies in this context as their personal stake may sometimes have been different from that of gay men, as was the degree to which AIDS directly affected their respective communities (of course, this also differed along lines of race). There are also alliances built across class and race differences that critique mainstream LGBTQ organizations’ narrow focus on marriage equality, as opposed to economic justice, or state-sanctioned regulation of sexuality. These latter two examples highlight the ways in which conceptualizing alliances can be difficult within the context of a “community” that includes diverse sexual and gender orientations, preferences, and identities, as well as race, class, age, and (dis)ability differences. This entry focuses on the better-understood development of heterosexual allies, with the acknowledgment that many of these processes may be similar in the development of other kinds of allies.

Methodological Overview of Research on Allies Research on ally development has been based primarily on either school- (K–12) or college-aged individuals. Most nonstudent samples have included clinical practitioners, such as therapists and social workers. Further, the research on heterosexual allies (and the small body of work on cisgender allies) has been largely descriptive; there are relatively few survey-based studies. Therefore, current knowledge is based largely on first-person, or case-study, accounts of ally awareness and development, with a growing body of larger interviewbased or survey studies. There are two broad ways in which one can understand the literature on how people become allies: (a) developmentally focused

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models, which examine ally identity as well as ally activism, and (b) research on the particular characteristics, motivations, attitudes, and experiences that predict ally social change behaviors, with less consideration of ally identity. Although the literature does not always make this distinction between identity and behavior, it is an important one, as discussed below. Developmental Models of Ally Commitments

Based on existing racial/ethnic, as well as feminist, identification models, developmental models examine how LGBTQ ally identity and commitments unfold across time. They involve several stages that are presented as both discrete and linear, although researchers acknowledge that they are often neither. These stages are usually some combination of the following: pre-encounter/pre-consciousness; encounter; immersion; and integration. These terms are borrowed from William Cross’s model of Black identity development; they are not terms that all researchers have used. Pre-encounter or pre-consciousness is a period during which the individual may not be aware of, understand, or care about the oppression experienced by LGBTQ people. Often, this period is also characterized by a taken-for-granted quality or unawareness of one’s privilege. Encounters may involve an uncomfortable or upsetting event or experience that raises one’s awareness of LGBTQ oppression and/or one’s own privilege. For many allies, this may be when they witness an LGBTQ friend or family member experience discrimination. For others, the encounter need not be negative; it may take the form of a role model, friend, or exposure to LGBTQ people in general. During the immersion phase, people may educate themselves about LGBTQ issues, build networks or friendships with LTBTQ communities or people, feel alienated from other heterosexual or cisgender people, or feel ashamed of or uncomfortable with one’s privilege. During integration (which may be difficult to distinguish from immersion), individuals find ways to enact their commitment to LGBTQ people and social justice, while also acknowledging their own position(s) of relative privilege and power.

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Ally Development and Programming

This kind of linear, stage-based model of identity development has been criticized. Lisa Diamond, in discussing the application of stage-based models to sexual identity development, has pointed out that identity processes are more complex in actuality. Individuals may “skip” some stages; the ordering of stages may differ from person to person; people may “revisit” or renegotiate stages as they are exposed to new ideas or new social or political contexts; and the transition between stages may not be smooth or even discernable. In fact, empirical research on ally activists has shown that some people first become engaged in activism and then develop a political consciousness around LGBTQ issues, thus challenging the idea that consciousness always precedes engagement. Case studies and interview-based studies allow researchers to explore and explicate these kinds of dynamic processes more readily than survey-based research. Therefore, it is not surprising that most research drawing on these developmental perspectives has been largely qualitative and/or has focused on individual accounts of ally identity development. Individual-Level Predictors of Ally Commitments

A growing body of work has examined individual differences associated with ally behaviors (and sometimes identity). Rather than looking at the progressive development of ally identity over time, this research has examined the role of individual-level differences and experiences in predicting ally commitments to LGBTQ issues. Research has identified two broad sets of motives among heterosexual allies: those based on fundamental principles (such as commitments to justice for LGBTQ people, commitment to legal equality, and a desire to use their own heterosexual or cisgender privilege on behalf of marginalized sexual- or gender-identity minorities) and those based on personal relationships, roles, or experiences (such as having an LGBTQ family member, or wanting to share the positive experience of marriage). Other research has shown that knowing an LGBTQ person, positive attitudes toward LGBTQ people, and rejection of heteronormative beliefs are all associated with LGBTQ ally activism.

Developing Allies Through Programming Most evaluation research on programs to develop allies is also based on school-aged and college students. Programming includes the creation of “gay– straight” alliances or “safe zones” for young people, educating non-LGBTQ people about LGBTQ issues and communities via intergroup dialogue classes or role-playing workshops, and “speaker panels” where members of the LGBTQ community share their experiences. A few universities also now offer training or workshops with the explicit aim of teaching individuals to be LGBTQ allies. The goals of these programs may vary, but generally include at least one of the following: to challenge stereotypes about sexual- and gender-identity minorities; to raise awareness of and challenge the stigmatization and discrimination faced by LGTBQ people; to raise awareness of heterosexual/cisgender privilege; to teach people how to recognize and act to stop discrimination, bullying, or harassment; and to foster opportunities for LGBTQ and nonLGBTQ people to interact and talk with one another. Research has shown that these interventions increase participants’ positive attitudes and empathy toward LGBTQ people, their awareness of anti-LGBTQ bias and heterosexual/cisgender privilege, and their confidence in their ability to recognize and interrupt harassment or bullying. A challenge for research in this area is the question of whether people who seek out these (usually voluntary) experiences are more likely to want to become allies in the first place. Therefore, the degree to which programs would be effective with people who are actively resistant to becoming allies is unclear.

Conclusion Allies have been of particular interest to researchers not only because of the important role that they play in social movements, but also because they are often working to create social change that may reduce some of their privilege. Further, the costs associated with being stigmatized by association with marginalized groups can be high. It is important to find ways to raise consciousness

Ally Experience

without triggering defensiveness and to acknowledge realistic fear of stigmatization. Perhaps more important is the need to provide potential allies with tools to act. Raising awareness of bias against LGBTQ communities without also teaching allies how to challenge that bias may result in passive bystanders, not actors. An important limitation in current research on allies is that there is often not a distinction made between ally identity and behaviors. Identity, while predictive of behavior (depending on its specificity), is distinct from it. Therefore, positive attitudes toward LGBTQ people and feeling like an ally may be different from acting as an ally. Most studies examining behavioral outcomes have not tested whether these same people identify as LGBTQ allies. Practically, the distinction may not always be important, but it may help us understand the difference between sympathetic bystanders and people who actually act on their beliefs. Finally, most of the focus to date has been on heterosexual allies. Given within-group differences along lines of gender identity, race, class, age, and (dis)ability, there is much work to be done to increase our understanding of how alliances within LGBTQ communities develop. The diverse needs of different LGBTQ people, and the historical inattention to these differences within LGBTQ social change movements, means that there is promise for forging new alliances that are not yet well understood. Nicola Curtin and Glenda M. Russell See also Activists in College; Ally Experience; CrossCategory Friendships; Gay–Straight Alliances (GSAs); LGBTQ Social Movements (Assimilation vs. Liberation)

Further Readings Dessel, A. B., Woodford, M. R., Routenberg, R., & Breijak, D. P. (2013). Heterosexual students’ experiences in sexual orientation intergroup dialogue courses. Journal of Homosexuality, 60(7), 1054–1080. Evans, N. J., & Broido, E. M. (2005). Encouraging the development of social justice attitudes and actions in heterosexual students. New Directions for Student Services, 2005(110), 43–54.

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Fingerhut, A. W. (2011). Straight allies: What predicts heterosexuals’ alliance with the LGBT community? Journal of Applied Social Psychology, 41(9), 2230–2248. Myers, D. J. (2008). Ally identity: The politically gay. In J. Reger, D. J. Myers, & R. L. Einwohner (Eds.), Identity work in social movements (pp. 167–188). Minneapolis: University of Minnesota Press. Russell, G. M. (2011). Motives of heterosexual allies in collective action for equality. Journal of Social Issues, 67(2), 376–393. Wernick, L. J., Dessel, A. B., Kulick, A., & Graham, L. F. (2013). LGBTQQ youth creating change: Developing allies against bullying through performance and dialogue. Children and Youth Services Review, 35(9), 1576–1586. Woodford, M. R., Kolb, C. L., Durocher-Radeka, G., & Javier, G. (2014). Lesbian, gay, bisexual, and transgender ally training programs on campus: Current variations and future directions. Journal of College Student Development, 55(3), 317–322.

ALLY EXPERIENCE Allies of the LGBTQ movement are heterosexually identified people who support the rights of LGBTQ people and who are active in that support. Increasingly, LGB people who identify as cisgender and who actively support transgender (trans) people and their rights are also referred to as allies—in this case, allies to the trans community. Allies to the LGBTQ community have a very broad range of experiences. The specific geographical and political context within which allies engage exerts a large influence on the tasks they are called upon to undertake in counteracting anti-LGBTQ stigma, the skills they draw on, the social resources they have at their disposal, and the nature of the demands and difficulties they encounter as they carry out their work. This entry describes the range of activities that allies undertake and the experiences they encounter, including a consideration of the impact of the political and social context on their involvement; motives that facilitate and sustain ally work; the role of stigma and stigma management; stressors of ally work and resources to address these; and the rewards of being an ally.

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Ally Experience

The Importance of Context Being an ally may be relatively easy in some contexts, and may even reap social rewards. In other contexts, working as an ally may expose someone to a great deal of negative feedback and even danger. To illustrate: Consider the situation of two allies undertaking the same activity, such as writing a letter to the editor of the local newspaper supporting passage of a proposed hate-crimes law that includes sexual orientation and gender identity protections. The first ally lives and works in a small town in a part of the country that is very politically conservative. The second ally lives in a liberal urban area in a region with generally liberal politics. The two allies undertake the exact same activity, but the social and political meaning of their action and its potential to generate positive and negative reactions from others differ markedly. Generally, the degree of difficulty and the social or even physical risk of allies’ roles depend on the climate for LGBTQ people in that region. However, there may be important exceptions. Sometimes allies who are working in a relatively benign context may, like LGBTQ people themselves, encounter unexpected and seemingly incongruous homophobic acts that can cause major disruption or distress. Conversely, allies, again like LGBTQ people, may find themselves in the midst of a virulently anti-LGBTQ social climate, and yet encounter a touching degree of support and concrete aid, sometimes from unexpected sources.

Motives That Facilitate and Sustain Ally Engagement Allies’ experiences cannot be disentangled from the motives that prompt them to engage in ally behavior and that sustain their work in this area. Research has identified two primary categories of motives supporting ally behavior among heterosexual persons. The first category comprises motives associated with core values. Allies in this group tend to articulate their motives as one aspect of a larger understanding of and commitment to social and political change. Prominent among the principles described by allies as prompting them to

act as allies are justice, civil rights, patriotism, religious beliefs, moral principles, and a felt need to make good use of the privilege that comes with being in nonstigmatized groups relative to sexual orientation and gender identity. Allies in this general category often engage in social action for multiple causes over time. Motives in the second general category are based on specific roles and relationships. Allies in this group often exhibit shorter-lived engagement in ally activities, frequently describing more situationally driven involvement. Among the points of emphasis offered by allies in this general category are the following: professional roles that result in their being drawn into acting as an ally; relationships with LGBTQ family members and friends; a desire to share with others the riches of marriage; efforts to gain closure on past experiences; efforts to transform guilt through action; and anger related to perceived unfairness in the social treatment of LGBTQ people. Research suggests that the particular motives that influence allies to become involved in collective action for LGBTQ rights are not necessarily the same as the motives that sustain engagement. An ally, for example, may initially get involved because a gay friend asks her to do so, in which case she is acting on the basis of a relationshipbased motive. She may then have increased contact with LGBTQ people from whom she learns about the negative impact of the stigma they face. This information provides another level of motivation that may allow her to draw on a long-term commitment to justice, which sustains her engagement in pro-LGBTQ activism. In addition to basic motivations to engage in collective action for LGBTQ equality, certain factors, both intrinsic and extrinsic to the person, may serve to facilitate an individual’s participation as an ally. These facilitating factors include a sense of self-efficacy, the desire to make a difference, willingness to take risks, tolerance for ambiguity, a spouse/partner who supports the ally’s activism, and the presence of a definable threat to the LGBTQ community. Many allies report having held pro-LGBTQ attitudes for a period of time before becoming active in working for LGBTQ

Ally Experience

equality. They further report, however, that it was difficult to know how to get involved in collective action. In many cases, being asked to undertake a specific task was all that was needed to spur them to action.

Stigma and Stigma Management Courtesy stigma—or as it has been termed more recently, stigma contagion—sometimes adds a degree of complexity to the experience of being an ally. This sort of stigma occurs when individuals who support the interests of a stigmatized group are themselves seen in a very negative light. In fact, these allies may be treated with an antagonism similar to that directed toward members of the stigmatized group. Allies, therefore, may—by virtue of their activism—court the twin dangers of being mistreated in a way that mirrors how LGBTQ people are treated and having some of the privilege normally reserved for heterosexuals withdrawn. Because sexual orientation is typically not a visible characteristic, heterosexual allies may also face a reaction that is not usually encountered by allies to stigmatized groups whose membership is visibly apparent. That is, heterosexual and cisgender allies’ sexual orientation and/or gender identity may be called into question—and with it, their honesty—by others who cannot understand that a heterosexual and/or cisgender person would risk taking a stand in support of a stigmatized group to which they do not belong. When faced with courtesy stigma or stigma contagion, allies are well advised to call upon strategies that LGBTQ people also can use when confronting anti-LGBTQ bias. It is helpful for members of both groups to adopt what has been termed a “movement perspective,” which includes a political analysis of their encounters with bias. This perspective allows them to see their own negative experiences with bias as less a personal problem and more a manifestation of a collective social bias—that is, sexual prejudice (an umbrella term for homophobia, heterosexism, biphobia, transphobia, and genderism). The movement perspective serves to locate the problem at its origins— that is, in the attitudes and behaviors that convey

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dislike for people based simply on group membership. Further, this perspective, with its identification of sexual prejudice as a collective problem, allows allies to employ collective solutions—working with others, developing political analyses with others, and receiving support from others. In addition to cultivating a movement perspective, allies can help to sustain their commitment to their collective action by taking periodic breaks from more intense forms of activism. Another source of complexity for allies is confronting the internalized stereotypes, misconceptions, and negative attitudes about LGBTQ people that are part of the cultural knowledge base that virtually everyone learns over the course of his or her life. It appears that this task is easier for allies than for many others, in part because their involvement as allies provides extensive contact with LGBTQ people, providing the opportunity for them to acquire facts about LGBTQ individuals and their communities. Allies’ contact with LGBTQ people is especially helpful in challenging stereotypes when their involvement is sustained, involves working with LGBTQ people together as equals, and entails working toward a common goal. Allies who have been relatively successful at this process report several other factors that have helped them overcome their automatic biases about LGBTQ people. One strategy is to approach sexual prejudice as a pervasive phenomenon that everyone needs to work through and to see this as a process, not a cause for shame. Some allies report that it is especially helpful to have one or two members of the LGBTQ community of whom they can ask questions, especially questions about the LGBTQ community that are generally not discussed. Notably, allies indicate that when they are criticized for their lack of knowledge, they are less likely to continue their engagement in activism.

Stressors and Rewards of Ally Involvement In addition to the challenges already described, allies report a number of stresses associated with their status and work as allies. These stressors include the necessity of subjecting their own longterm beliefs to scrutiny, strains with others in their

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Antigay Ballot Initiatives (and LGBTQ Activism)

social communities who disagree with their ally activities, and guilt about past participation in prejudicial feelings and behaviors. On the other hand, allies are able to identify a number of resources upon which they draw for their ally work. These resources include learning facts about the LGBTQ community; finding consistency between their religious beliefs and their ally behavior; having control over their own timing in pursuing ally work; finding a balance between recognizing sexual prejudice in the world and working through one’s own internalized sexual prejudice; support from family and friends; recognizing areas in which they are privileged; and refusing to allow anti-LGBTQ rhetoric to define the terms of the debate about LGBTQ rights. Despite the complexities and challenges associated with being an ally, many allies have no difficulty identifying the rewards that ensue from their participation in collective action for LGBTQ equality. Prominent among those rewards are increased empathy, enhanced personal power, feeling gratified by the opportunity to be of service, enhanced courage, greater creativity, an expanded sense of humanity, deepened religious beliefs, and increased depth in personal relationships. While research with allies in the cause for LGBTQ rights suggests some general patterns, allies—like members of any group—may differ greatly from each other in many respects; no two are alike. LGBTQ people who work with allies are advised to get to know the unique aspects of those allies who are a part of their movement. Glenda M. Russell and Nicola Curtin See also Activists in College; Ally Development and Programming; Community Climate; Cross-Category Friendships; LGBTQ Social Movements (Assimilation vs. Liberation)

Further Readings DiStefano, T. M., Croteau, J. M., Anderson, M. Z., Kampa-Kokesch, S., & Bullard, M. A. (2000). Experiences of being heterosexual allies to lesbian, gay, and bisexual people: A qualitative exploration. Journal of College Counseling, 3(2), 131–141.

Duhigg, J. M., Rostosky, S. S., Gray, B. E., & Wimsatt, M. K. (2010). Development of heterosexuals into sexualminority allies: A qualitative exploration. Sexuality Research & Social Policy, 7(1), 2–14. Fingerhut, A. W. (2011). Straight allies: What predicts heterosexuals’ alliance with the LGBT community? Journal of Applied Social Psychology, 41(9), 2230–2248. Horne, S. G., Rostosky, S. S., & Riggle, E. D. B. (2011). Impact of marriage restriction amendments on family members of lesbian, gay, and bisexual individuals: A mixed-method approach. Journal of Social Issues, 67(2), 358–378. Myers, D. J. (2008). Ally identity: The politically gay. In J. Reger, D. J. Myers, & R. L. Einwohner (Eds.), Identity work in social movements (pp. 167–188). Minneapolis: University of Minnesota Press. Russell, G. M. (2011). Motives of heterosexual allies in collective action for equality. Journal of Social Issues, 67(2), 376–393.

AMERICAN INDIAN SEXUALITIES See Native American/First Nations Sexualities

ANTIGAY BALLOT INITIATIVES (AND LGBTQ ACTIVISM) One common tactic of those who oppose LGBTQ rights in the United States is the use of referendum and initiative processes to either pass new antigay laws or rescind existing LGBTQ-positive laws. These antigay ballot initiatives happen at the municipal or state level and have been an effective strategy for the religious Right, as the initiatives are frequently successful. This entry reviews the history of antigay ballot initiatives, the types of measures used, and their effects on the LGBTQ movement and community.

Historical Background The use of antigay ballot measures in the United States began quietly. In the 1970s, gay, lesbian, and

Antigay Ballot Initiatives (and LGBTQ Activism)

bisexual organizers were quietly passing municipal nondiscrimination ordinances that provided protections in housing, employment, and/or public accommodations based on sexual orientation. Because it was too challenging to pass a nondiscrimination law at the federal or state level, these municipal and county ordinances allowed for some local protections for gay, lesbian, and bisexual individuals. By 1974, 14 of these ordinances had been passed in municipalities across the country with little opposition. However, in Boulder, Colorado, in 1974, members of the community opposed to such an ordinance collected petitions to put it on the ballot in a referendum. In a referendum, voters get to decide whether or not an ordinance remains law. In this case, Boulder voters struck down the new ordinance with a landslide of opposition to it. This same process was repeated a few years later in Dade County, Florida, but with much national attention and fanfare. Celebrity Anita Bryant, former Miss America contestant and spokesperson for Florida orange juice, was a leader in opposing a Dade County nondiscrimination ordinance. Bryant and her Save Our Children campaign became quickly known for their rhetoric about the dangers of gay rights, specifically their arguments about religious rights and influence on children, implying, for example, that gay men were pedophiles looking to recruit children. The national visibility of the campaign and the victory in Dade County for Bryant’s organization emboldened the growing religious Right, a pro–traditional family conservative movement mobilized in opposition to feminism, abortion, secularization, and gay rights, among other issues. Shortly after Dade County’s ballot measure, California state senator John Briggs, who worked with Bryant on her Florida campaign, sponsored the California Defend Our Children Initiative, a response to a 1975 California law that protected gay and lesbian teachers from being fired. Popularly called the Briggs Initiative, this new law would have required the firing of teachers who were lesbian or gay, or who “advocated homosexuality.” Rather than a referendum to overturn an existing law, this initiative was an attempt to write a new antigay law through the ballot measure process. Overwhelmingly opposed by teachers’

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unions and then-governor Ronald Reagan, the Briggs Initiative lost at the ballot box by a million votes. These two forms of ballot measures—the referendum and the initiative—have persisted as the most common forms of antigay ballot measures since 1974. Between 1974 and 2013, 172 such measures were put on the ballot, mostly by the religious Right. The religious Right attempted at least another 150 ballot measures, circulating petitions and running campaigns that did not collect enough signatures to get a referendum or initiative on the ballot. Overall, however, these ballot measures have been a successful tactic for the religious Right to roll back LGBTQ rights, as 70% of those ballot measures resulted in either rescinding an existing LGBTQ rights law or creating a new antigay law.

Types of Ballot Measures Antigay ballot measures vary in their focus. Forty percent of these ballot measures are attempts to rescind municipal or state nondiscrimination laws that include sexual orientation or gender identity/ expression. Nondiscrimination protections based on gender identity/expression serve to protect transgender people and other individuals with nonnormative gender expression. Almost one quarter of these ballot measures are legal restrictive ballot measures, which are attempts to prevent all future LGBTQ nondiscrimination laws in a given state or municipality. An additional 30% of all ballot measures are related to same-sex marriage or domestic partnerships. State constitutional amendments to ban same-sex marriage are the most common form of these relationship-recognition ballot measures. These same-sex marriage bans are put on the ballot by the legislature or a citizen petition process, depending on the requirements of each state. This form of ballot measure is also the most successful type of ballot measure, as the religious Right has a higher success rate with these than any other kind. There have also been ballot measures on other subjects that impact the LGBTQ movement, including a spate of ballot measures about HIV/AIDS in California in the 1980s. Although these ballot measures have been sponsored from Hawaii to Maine, they are more

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common in states and municipalities with a lenient referendum and initiative process and a strong religious Right presence. Thus, 64% of all ballot measures are in the following seven states, listed in order of frequency from highest to lowest: Oregon, California, Michigan, Florida, Maine, Washington, and Colorado. States like Oregon and California have high rates of initiatives in general as they have a straightforward petitioncollection process and little judicial or legislative review of ballot initiatives. In some states with no referendum and initiative mechanism, state legislatures have sponsored constitutional amendments that then must go to a popular vote. This tactic is used most commonly to pursue the enactment of same-sex marriage bans. It has been used in states such as South Dakota, Montana, and Louisiana, which have little history of ballot measure campaigns. The religious Right and the LGBTQ movement typically go head-to-head in these ballot measure campaigns. Both movements mobilize followers, recruit volunteers, attract press attention, and frame their arguments about the ballot measure through political ads, flyers, and commercials.

Major Ballot Measures Several ballot measures that have been important milestones in the use of these methods by the religious Right are Oregon Ballot Measure 9 (1992), Colorado Amendment 2 (1992), California Proposition 8 (2008), and the November 2012 initiatives. Oregon Ballot Measure 9

The year 1992 was an important turning point in the history of antigay ballot measures. Religious Right campaigns in Oregon and Colorado sponsored similar antigay ballot measures that were the first major legal-restrictive initiatives. These initiatives were an attempt to legally constrain the LGBTQ movement by eliminating all existing and future nondiscrimination laws along with general “government promotion of homosexuality.” In Oregon, the Oregon Citizen’s Alliance (OCA), led by vocal antigay activist Lon Mabon, sponsored legal-restrictive initiatives in the cities of

Corvallis and Springfield in early 1992, which were test cases for the Oregon Ballot Measure 9 statewide initiative in November 1992. Ballot Measure 9 was one of the most extreme antigay initiatives in that it eliminated all existing and future nondiscrimination laws, along with requiring the firing of lesbian and gay teachers in public schools (along with anyone openly supportive of lesbian, gay, bisexual, transgender, or queer rights), and the removal of all books approving of homosexuality. Ultimately, Oregon voters rejected Ballot Measure 9; however, Mabon and the OCA persisted in sponsoring additional legal-restrictive initiatives (often called “the son of 9”) at the state and municipal levels for the next two years, passing these initiatives in more than 30 towns across the state. For the LGBTQ movement, the Ballot Measure 9 campaign was one of its first big victories, and some of the tactics used in Oregon, such as door-to-door canvassing and voter identification, were used in campaigns across the country. Colorado Amendment 2

In the same 1992 election, Colorado antigay activists sponsored their own statewide legalrestrictive initiative. The organization Colorado for Family Values (CFV) sponsored Amendment 2, a legalistic initiative that eliminated future and existing gay rights laws in the state. CFV had originally mobilized to defeat an ordinance in conservative Colorado Springs. Colorado Amendment 2 distinguished between “true” minorities and gays by using legal language about “protected classes” and “minority status.” CFV innovated with a secular, legalistic argument about LGBTQ rights that became widely used by religious Right campaigns across the country. This language included a legalistic argument about how lesbian and gay rights were “special rights” that usurped the rights of “true minorities” like African Americans. Through this argument, the religious Right was able to appeal to voters who were (1) ambivalent about civil rights and (2) African American community members. Colorado voters passed Amendment 2, which led to an almost immediate legal challenge. This legal challenge resulted in a repeal of the Colorado

Antigay Ballot Initiatives (and LGBTQ Activism)

Amendment 2 law by the U.S. Supreme Court in the 1996 case Romer v. Evans. This ruling invalidated state legal-restrictive initiatives but also affirmed the legitimacy of sexual orientation as a minority-group category. This case set an important precedent for future Supreme Court rulings, including the abolition of sodomy laws in Lawrence v. Texas (2003) and the establishment of same-sex marriage rights in some states in United States v. Windsor (2013). California Proposition 8

In early 2008, the California Supreme Court legalized same-sex marriage, and religious Right organizations quickly collected petitions to put a constitutional amendment on the ballot to ban same-sex marriage in the state. When Proposition 8 was voted on in November 2008, more than 18,000 same-sex marriages had already been conducted in the state of California. There were two things that were historic about California Proposition 8. The first was that it was the first time there were both legal same-sex marriages in a state and a ballot measure to rescind them. It received a great deal of national attention and funding due to this set of circumstances. Second, the size and scale of the campaigns was remarkable. The religious Right campaign to pass Proposition 8 successfully defeated the largest LGBTQ campaign in U.S. history, a campaign that dwarfed any other ballot measure campaign that came before it. There were protests across the country when Proposition 8 was passed, and it inspired the play 8 by Dustin Lance Black. Like Colorado Amendment 2, this proposition was declared unconstitutional in the federal courts, and California same-sex marriages resumed in June 2013. The November 2012 Initiatives

Same-sex marriage bans were the most successful ballot measures for the religious Right, passing by large margins in almost every state except for one same-sex marriage ban in Arizona and a domestic partnership referendum in the state of Washington. The success of the religious Right in passing ballot measures related to same-sex marriage came to a

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head in the November 2012 election when the LGBTQ movement won four major statewide ballot measures about marriage. All four votes were historic wins. In Minnesota, voters defeated a proposed constitutional amendment aimed at banning same-sex marriage, which allowed the later legalization of same-sex marriage in the state. In Maryland and Washington, where the state legislatures had passed same-sex marriage measures, voters elected to retain legal same-sex marriage through referendum. And in another first, Maine voters legalized same-sex marriage through an initiative that was sponsored by the LGBTQ movement.

Impact on the LGBTQ Movement and Community These ballot measures have impacted the LGBTQ movement and community in multiple ways. First, running large-scale campaigns puts a strain on movement and community resources, time, and energy. Campaigns require tremendous resources in a concentrated period of time. Even a municipal ballot measure may require more than 10,000 volunteers to make phone calls, go door-to-door to talk to voters, put up yard signs, and organize rallies. It took the LGBTQ movement decades to build enough organizing skill, grassroots strength, and funding to win campaigns, and even then same-sex marriage bans have been difficult to defeat. The local nature of ballot measure campaigns means that the strength of a campaign is dependent upon the resources of existing organizations in a given area. Early lesbian and gay ballot measure campaigns struggled with marshalling enough resources and funding to run successful campaigns. This demand for resources in ballot measure campaigns can cause strain for social movements, drawing resources away from organizations that are already strapped for cash. Then these funds often disappear into thin air as political ads or consulting fees rather than fueling durable social movement organizations. These ballot measures can also distract social movement organizations from existing projects; for example, in many states same-sex marriage bans interrupted work on anti-bullying legislation or nondiscrimination laws. Resources had to be diverted

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to the most urgent pressing issue, an impending ballot measure. Campaigns also require a level of consensus about tactics that can be challenging for any social movement, but particularly challenging for one as diverse as the LGBTQ movement. These campaigns tend to increase movement dissent and marginalize direct action and queer activism. Queer activism challenges campaign work by advocating for the importance of proud, diverse representations of the LGBTQ community. In many campaigns, if LGBTQ lives are represented at all, they are typically White, gender-normative, middleclass gay men or lesbians in monogamous relationships. In so representing the LGBTQ community, diversity within the movement is stifled and community members who are less palatable to mainstream voters—such as drag queens, transgender women, or leathermen—are hidden from view. In addition, there are frequently tensions over racial coalition building during ballot measure campaigns that exacerbate existing tensions and racial marginalization within the LGBTQ movement. The effort that goes into fighting antigay initiatives is rarely rewarded with success. The referendum and initiative processes are unkind to minority rights, particularly civil rights to protect unpopular minorities. In areas where LGBTQ rights are unpopular, even the most diligent LGBTQ campaign cannot succeed. For example, even the most effective campaign to fight same-sex marriage bans had little success until there was a dramatic shift in public opinion about same-sex marriage. This situation, in which LGBTQ organizers and volunteers work tirelessly for a campaign that loses, can be demoralizing and challenging. At the end of a campaign, particularly a losing campaign, there may be little to show for all the resources used. For example, in many campaigns to fight same-sex marriage bans, the campaign aired ads that framed the issue as a constitutional issue with little mention of gay or lesbian lives. At the end of the campaign, these ads were often criticized for taking money from the community but not contributing to social movement goals of acceptance for LGBTQ lives. Finally, there is a psychological toll for LGBTQ community members during ballot measure

campaigns. Religious Right campaigns often rely on existing homophobia or transphobia in the local population in order to win a campaign. Early religious Right campaigns relied on messaging about gay men as sexual predators, which was transformed in the 1990s into legalistic arguments about “special rights.” Same-sex marriage ban campaigns often emphasize the benefits of children having one mother and one father, along with the sanctity of marriage and concerns about the teaching of samesex marriage in elementary schools. Since the late 1990s, an increasing number of religious Right campaigns to rescind municipal nondiscrimination laws included arguments about transgender individuals, specifically transgender women. These arguments frame transgender women as “men in dresses” trying to invade the bathrooms of women and children. The proliferation of these homophobic and transphobic arguments can be psychologically painful for LGBTQ residents and create a hostile and at times dangerous community to live in. Overall, these ballot measures are an integral part of the movement for LGBTQ rights. They are a tactic used by the religious Right to stall the progress of the movement, and they have had a profound impact on LGBTQ movements and communities across the country. Amy L. Stone See also Defense of Marriage Act (DOMA); Discrimination Against LGBTQ People, Cost of; Discrimination Against LGBT People in the Public Sector; Employment Non-Discrimination Act (ENDA); Housing, Protection Against Discrimination in; LGBTQ Social Movements (Assimilation vs. Liberation); Marriage Equality, Landmark Court Decisions; No Promo Homo Policies; Transgender Inclusion in the LGBTQ Rights Movement; Workplace Discrimination

Further Readings Fejes, F. (2008). Gay rights and moral panic: The origins of America’s debate on homosexuality. New York, NY: Macmillan. Fetner, T. (2001). Working Anita Bryant: The impact of Christian anti-gay activism on lesbian and gay movement claims. Social Problems, 48(3), 411–428.

Anxiety Fetner, T. (2008). How the religious Right shaped lesbian and gay activism. Minneapolis: University of Minnesota Press. Gallagher, J., & Bull, C. (1996). Perfect enemies: The religious Right, the gay movement, and the politics of the 1990s. New York, NY: Crown. Russell, G. M. (2000). Voted out: The psychological consequences of anti-gay politics. New York, NY: New York University Press. Stein, A. (2001). The stranger next door: The story of a small community’s battle over sex, faith, and civil rights. Boston, MA: Beacon Press. Stone, A. L. (2012). Gay rights at the ballot box. Minneapolis: University of Minnesota Press.

ANXIETY This entry provides an overview of the experience of anxiety among sexual minorities. First, it discusses disparities in anxiety disorders related to sexual orientation, including specific anxiety-provoking situations for different groups of sexual minorities. Next, it reviews etiological models for the development and maintenance of anxiety in these populations. The etiological models describe some of the unique risk factors for anxiety and consequences of anxiety in these populations. Additionally, treatment considerations for mental health professionals who work with sexual-minority clients are reviewed. Special attention is given to social anxiety disorder, given that it has received the most empirical attention among sexual minorities and it may be particularly relevant to these populations. Given the paucity of research specifically focused on anxiety among gender minorities, this entry focuses primarily on sexual minorities. A section of this entry is devoted to anxiety among transgender individuals; readers are encouraged to consult specific entries in this volume on gender minorities for more nuanced discussions of their unique experiences.

Sexual-Orientation-Related Disparities in Anxiety Disorders Population-based studies have documented higher rates of anxiety disorders among sexual minorities

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compared with heterosexuals, including panic disorder, agoraphobia, obsessive-compulsive disorder, generalized anxiety disorder, and social anxiety disorder (also referred to as social phobia). Although most of these studies have focused on adults, sexual-orientation-related disparities in anxiety have been demonstrated as early as middle school (approximately 11 to 13 years old). This suggests that sexual minorities are at increased risk for anxiety compared with heterosexuals, and that this risk begins relatively early in life and extends into adulthood. Among the anxiety disorders, social anxiety disorder is one of the most common and has received the most attention among sexual minorities. Social anxiety disorder refers to an extreme fear of social or performance situations that involve exposure to unfamiliar people or possible judgment by others. Socially anxious individuals fear that they will act in a way that will be embarrassing or that others will be able to notice their anxiety symptoms. Further, socially anxious individuals tend to perceive social interactions as more threatening than non-socially anxious individuals, and their symptoms are maintained by their fear of negative evaluation. In order to receive a diagnosis of social anxiety disorder, an individual must recognize that his or her fear is excessive or unreasonable. This has led scholars to question the appropriateness of the diagnosis for sexual minorities, given that their fears of negative evaluation and rejection due to their sexuality are often realistic possibilities. Sexual minorities are at increased risk for experiencing discrimination and violence as a result of their stigmatized social status. Even for those who do not personally experience discrimination or violence, the general knowledge of stigma and prejudice related to sexual-minority identities can lead to concerns about negative evaluation, rejection, and possible discrimination. Thus, regardless of one’s personal experiences with discrimination or violence, sexual minorities may learn to be vigilant toward cues of potential rejection. In sum, among sexual minorities, anxiety in social situations may be the consequence of realistic possibilities of discrimination rather than an indication of a psychiatric disorder.

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In an effort to accurately characterize the anxiety that sexual minorities experience, the construct of rejection sensitivity has been expanded to explain the difficulties that gay men often experience in their interpersonal functioning. Rejection sensitivity refers to the extent to which one anxiously expects to be rejected based on one’s stigmatized identity. It shares some features with social anxiety, such as concerns about the reactions of others, thoughts about rejection, and emotional arousal in response to interpersonal situations. However, rejection sensitivity is unique in that it acknowledges the realistic concerns about rejection that minority group members may have. Thus, the anxiety that sexual minorities experience in social situations may reflect realistic concerns based on their experiences with and knowledge of societal stigma rather than a psychiatric disorder. However, even if the anxiety is rooted in the realistic possibility of rejection or discrimination, it may be out of proportion to a given situation. For instance, if a sexual-minority individual is anxious about the possibility of being rejected in a situation that involves people who he or she knows are accepting of sexual minorities, then such anxiety may no longer reflect a realistic possibility in that situation. Although sexual-orientation-related rejection sensitivity was initially applied to gay men, it has since been extended to address the unique experiences of other sexual-minority groups, including lesbians and bisexual women.

Anxiety-Provoking Situations Social interactions can be anxiety provoking for sexual minorities. Similar to other minority group members, sexual minorities can experience increased alertness and vigilance when interacting with dominant group members, because they may fear that they will be rejected or discriminated against. Further, sexual minorities who try to downplay or conceal their sexual orientation may experience more anxiety in social interactions than those who do not, because they face the possibility of having their sexual orientation discovered. The situations in which sexual minorities experience anxiety can differ depending on their gender

and sexual orientation. Gay men tend to experience anxiety in situations that involve mostly or exclusively heterosexual men, such as in locker rooms at gyms or while watching sports with other men. Given that these situations often involve stereotypical behavior of heterosexual men, gay men may worry that their sexual orientation will be discovered or that others will react negatively to their sexual orientation. Sexual-minority men are also at risk for experiencing discrimination from medical professionals, given assumptions that gay and bisexual men have HIV/AIDS. Thus, sexualminority men may experience anxiety in medical contexts, such as getting blood drawn or having a physical examination. In contrast, sexual-minority women are at risk for being sexually objectified by heterosexual men. Heterosexual men often eroticize female same-sex sexual behavior and they may proposition sexual-minority women to have sex with them and another female. Thus, sexualminority women may experience more anxiety in situations that involve heterosexual men, given the possibility that they may be sexually propositioned. Finally, bisexual individuals may experience anxiety among heterosexuals as well as lesbians and gay men, given that they experience stigmatization and discrimination from both communities.

Etiological Models for Anxiety The minority stress theory is the predominant conceptual framework for understanding why sexual minorities are at increased risk for psychiatric disorders, including anxiety disorders. Minority stress theory posits that sexual minorities experience unique stressors related to their stigmatized social status, which accounts for their increased risk for psychiatric disorders. Several minority stressors included in this model may be particularly relevant to anxiety. First, sexual minorities are at increased risk for discrimination and violence compared with heterosexuals, which in turn are risk factors for anxiety. Second, sexual minorities learn to anticipate being rejected because of their sexual orientation, thus leading them to be vigilant for cues of potential rejection during interactions with

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others. Finally, some sexual minorities attempt to conceal their sexual-minority identities in order to avoid potential negative consequences, which can contribute to ongoing anxiety about whether or not others know about their sexual orientation. Although minority stress theory is the prevailing etiological model for psychiatric disorders among sexual minorities, a specific etiological model for anxiety among gay men has been developed. This model posits that childhood gender nonconformity and early parental disapproval of self-expression lead gay men to anticipate negative reactions from others and to protect against these reactions by downplaying or concealing their sexual orientation. In turn, these expectations of rejection and attempts to downplay or conceal one’s sexual orientation can lead to ongoing anxiety. The model overlaps with minority stress theory in its emphasis on expectations of rejection and sexual orientation concealment in the development and maintenance of anxiety. However, it is unique in its emphasis on childhood gender nonconformity and parental disapproval of self-expression as early life stressors for many sexual minorities. Thus, the model provides a developmental framework for understanding the etiology of anxiety among sexual minorities. This is consistent with general etiological models of anxiety, which emphasize temperament, early stress, relationships with parents, and perceptions of environmental control. Consistent with the model, there are particularly rigid gender roles for boys, and those who violate these norms are more likely to be targeted for discrimination and violence, even from their parents and other family members. Gay men tend to report being more effeminate and engaging in more gender atypical behavior during childhood compared with heterosexual men. If parents (and others) disapprove of gender atypical behavior and respond in a punitive manner, then these boys may go on to develop self-consciousness in public and, in turn, anxiety. Further, downplaying or concealing one’s sexual orientation is a common strategy used by sexual minorities to cope with the potential for discrimination. For those who have experienced disapproval of their gender atypical behavior, they may be particularly likely to monitor their

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behavior in an effort to control who knows about their sexual-minority identity. However, constantly deciding whether or not to disclose one’s sexual orientation can be a stressful process, and it can tax one’s cognitive and emotional resources. Many sexual minorities also monitor their behavior in an effort to avoid engaging in behaviors that will be perceived as gender atypical. For instance, gay men may try to appear more masculine by monitoring and attempting to reduce effeminate speech and behavior. This too can be highly demanding of cognitive and emotional resources, which can lead to ongoing anxiety, particularly in social situations. The model has not been extended to sexualminority women or bisexual individuals, but it is likely that some aspects will translate to different gender and sexual orientation groups. Although gender atypical behavior is more socially acceptable among girls than among boys, there is still stigma associated with it for girls. Thus, for gender atypical girls who are raised in families or environments that discourage such self-expression, these girls may go on to develop more self-consciousness and to be more likely to conceal their sexual orientation. Further, bisexual individuals often experience invalidation of their bisexual identities from heterosexuals as well as lesbians and gay men. If they experience such invalidation of their genuine self-expression and self-identification, then this could lead them to be more self-conscious in public and to monitor their behavior in an effort to avoid disclosing or referencing their bisexuality. Although not explicitly mentioned in either etiological model described, research has demonstrated that the attributions that sexual minorities make in response to perceived discrimination also play an important role in the development of social anxiety. Sexual minorities appear to be at increased risk for social anxiety subsequent to discrimination if they believe that discriminatory events are costly and have widespread implications. This attribution style appears to be anxiety-provoking independent of how often someone actually experiences discrimination, and it also exacerbates the negative effects of discrimination. Thus, if a member of a sexual minority is discriminated against

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and thinks that discrimination is going to have a major negative impact on his or her life, then he or she is likely to experience more social anxiety subsequent to the discrimination. Although this entry focuses on anxiety, it is worth noting that anxiety can lead to additional mental and physical health problems, including depression, substance use, and risky sexual behavior. The extent to which sexual minorities anxiously expect to be rejected because of their sexual orientation is associated with negative outcomes in multiple domains, including social and academic functioning as well as mental and physical health. Research has also demonstrated that anxiety is associated with substance use and risky sexual behavior among gay and bisexual men. Sexual minorities may choose to drink alcohol and use drugs as a way to self-medicate or reduce their discomfort in uncomfortable situations. For instance, if a sexual-minority member is in an environment in which it is not clear if one’s sexualminority identity will be accepted, then he or she may use substances as a way to cope with the anxiety. Further, once under the influence of alcohol or drugs, then cognitive abilities may be impaired, such that individuals may be less able to make thoughtful decisions about the sexual behavior that they engage in and the safety precautions that they take.

Treatment Despite the development of evidence-based treatments for anxiety disorders, mental health professionals may not recognize that sexual minorities experience realistic concerns about negative evaluation and rejection from others. Mental health professionals can help sexual-minority clients to differentiate between situations that are dangerous and those that may be safe but perceived as dangerous due to previous experiences. Additionally, given the costs of concealing one’s sexual orientation, therapists can provide psychoeducation about the paradoxical effects of concealing one’s sexual orientation in an effort to increase accurate perceptions of the relative safety and threat of selfexpression. Further, given evidence that negative

thoughts and feelings about one’s sexual orientation and expectations of rejection may be mechanisms through which discrimination influences social anxiety, they may be important areas to target as a way to reduce distress among sexualminority clients. Although discrimination is largely out of one’s control, the cognitions that result and maintain anxiety can be reduced through cognitive interventions. In the context of an LGB-affirmative therapeutic environment, cognitive-behavioral therapy can be an effective approach to dealing with the negative consequences of discrimination. Additionally, heterosexual mental health professionals who affirm sexual minorities have the potential to provide sexual-minority clients with corrective learning experiences that counteract their expectations of rejection. For instance, if a gay male client has a history of being discriminated against by heterosexual men, then his involvement in a therapeutic relationship with a heterosexual male professional who is accepting of sexual minorities has the potential to begin to counteract his previously developed beliefs about how people are going to treat him based on his sexual orientation.

Transgender Populations Similar to sexual minorities (i.e., LGBQ individuals), transgender individuals (i.e., those whose sex assigned at birth is discordant with their current gender identity) are also at increased risk for anxiety compared with cisgender individuals (i.e., those whose sex assigned at birth is concordant with their current gender identity). Further, transgender individuals experience unique stress associated with stigmatized social status as gender minorities, including variations of the stressors previously described for sexual minorities. Scholars have extended minority stress theory to explain the increased risk for mental health problems, including anxiety, among transgender individuals relative to cisgender individuals. Transgender individuals experience high rates of discrimination and violence and, as a result, they are at risk for internalizing negative societal attitudes toward gender nonconformity as well as for expecting to be

Asexuality

rejected because of their gender minority identity. Unfortunately, while societal attitudes toward sexual minorities have become increasingly positive in recent years, the same shift in attitudes toward gender minorities has not occurred. Thus, the realistic possibilities of discrimination and violence remain for many transgender individuals. The issue of concealment may be particularly relevant for transgender individuals. There is some evidence that transgender individuals at the beginning of their transition experience more anxiety than those at later stages of their transition. It is possible that this anxiety relates to the extent to which they think others will perceive them according to their current gender identity. Brian A. Feinstein See also Closet, The; Hate Crimes; Heterosexism; Homophobia; Internalized Homophobia; Microaggressions; Minority Stress; Sexual Minorities and Violence

Further Readings Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Consulting and Clinical Psychology, 81, 545–557. Burns, M. N., Kamen, C., Lehman, K. A., & Beach, S. R. H. (2012). Minority stress and attributions for discriminatory events predict social anxiety in gay men. Cognitive Therapy Research, 36, 25–35. Feinstein, B. A., Goldfried, M., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of self-stigma and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80, 917–927. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730. Meyer, I. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Meyer, I. (2003). Prejudice, social stress, and mental health in LGB populations: Conceptual issues and

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research evidence. Psychological Bulletin, 129, 674–697. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029. Pachankis, J. E., & Bernstein, L. B. (2012). An etiological model of anxiety in young gay men: From early stress to public self-consciousness. Psychology of Men and Masculinity, 13, 107–122. Pachankis, J. E., & Goldfried, M. R. (2006). Social anxiety in young gay men. Journal of Anxiety Disorders, 20, 996–1015. Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306–317.

ASEXUALITY This entry describes asexuality, a form of sexual identification that has become increasingly widely recognized in a little over a decade. Commonly defined as the absence of an experience of sexual attraction, the recognition of asexuality complicates many aspects of our existing understanding of sexuality and raises important questions for how we study it. Much academic and lay discussion of sexuality assumes that everyone experiences sexual attraction, but the emergence of the asexual community demonstrates the falsity of this assumption. This entry begins with an introduction of the asexual identity and the different meanings it can have for a self-identified asexual. It then turns to common experiences shared by asexual people in spite of the differences among them. Finally, the difficulties faced by many asexual people and their origins in the wider social context are introduced into the discussion.

Asexuality as Identity and Sexual Orientation An obvious response when confronted by asexuality is to ask precisely what it is. The Asexuality Visibility and Education Network (AVEN), integral

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in the development of the contemporary asexual community, describes an asexual person as someone who does not experience sexual attraction. This view of asexuality treats it as a sexual orientation, framed as involuntary in contrast to the choice of celibacy. It is frequently presented as a fourth sexual orientation (following heterosexuality, bisexuality, and homosexuality) that has heretofore gone largely unacknowledged, a problematic exclusion that the activity of AVEN and others seeking to promote the visibility of asexuality intend to ameliorate. While the psychological literature has tended to approach asexuality in these terms, seeking to distinguish asexuality as a sexual orientation from Hypoactive Sexual Desire Disorder (HSDD), with which there are superficial similarities, the sociological literature has stressed the novelty of asexuality as a distinctive form of social identification that emerged in the early 21st century. Recognizing the differences between these approaches helps us retain a distinction between asexuality as an identity and asexuality as a sexual orientation. Drawing this distinction is important because it prevents us from confusing questions about asexuality as a term in increasingly common currency through the world, with questions of those underlying characteristics that lead people to identify as such in contemporary circumstances. Secondary analysis of the United Kingdom National Survey of Sexual Attitudes and Lifestyles (NATSAL) suggests that between 0.5% and 1% of the population have never experienced sexual attraction to anyone, but this research tells us nothing about how widespread asexual identification has become. Unless we distinguish between asexuality as identity and asexuality as sexual orientation, it is difficult to analyze the relationship between the experiences identified by NATSAL and the process through which people with such experiences choose to identify as asexual when encountering it as a social identity. While the singular term asexual can seem to imply uniformity, it is important to recognize the diversity that exists among those identifying as asexual and to understand how this has emerged and continues to do so. Tracking this diversity can

prove challenging, at least initially, given it is expressed through an elaboration of new terms and concepts that can at times seem dizzying. There has been rapid growth of a rich vocabulary for describing human intimacy within the asexual community, one born out of converging experiences of being rejected by the wider sexual culture and a commitment to expressing one’s own experience in a subjectively satisfying way. Much of this terminology has relevance beyond the asexual community alone, helping shed light on aspects of intimate experience that tend to be overlooked when we assume the universality and uniformity of sexual attraction. This is one sense in which understanding asexuality can help us understand sexuality more broadly. Outside of the discourse surrounding asexuality, it is common to conflate romantic and sexual attraction, understanding them as two sides of “attraction” itself and failing to consider their distinct characteristics. However, within the asexual community, an important distinction is drawn between romantic sexuality and aromantic asexuality. Neither group experiences sexual attraction, but the former experiences romantic attraction while the latter does not, with romantic attraction being experienced as a desire for proximity and intimacy with partner(s) that nonetheless lacks the sexual component that is commonly assumed to accompany attraction of this form. It is important to recognize that those who experience neither romantic nor sexual attraction do not therefore lack any inclination to form meaningful personal relationships, instead simply not experiencing either a romantic or sexual dimension to the formation of these connections. The absence of sexual attraction from such intimate relationships is frequently experienced as complicating the binary categories of partner/friend and has led asexual people to consider which factors characterize intimate relationships and to find new ways of expressing this intimacy. There is a great deal of variation in how asexual people feel about sexual activity, sometimes described in terms of individuals being sex-averse, sex-neutral, and sex-favorable. Some asexual

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people experience an active aversion to sexual activity, ranging from a mild distaste to an intense repulsion at the idea of it. Others are simply indifferent to sexual activity, manifesting in an absence of interest in the idea and, in some cases, a willingness to participate in sexual activity for reasons extrinsic to it, such as enjoying the intimacy with a sexual partner while deriving no satisfaction from the sexual act itself. Sex-favorable asexuality has been a topic of many recent discussions in online asexual community spaces, with some making the case that there has been a tendency to overlook the existence of sex-favorable asexual people within the community itself and within the academic literature. Understanding sex-favorability necessitates consideration of the distinction between sexual desire and sexual attraction. While commonly invoked as part of the “umbrella” definition introduced at the start of this entry, the issue of sex-favorable asexuality invites deeper interrogation into how this distinction is understood. It has usually been framed in terms of the notion of a “nondirected sex drive” that leads to a desire for “release” but in a way that involves no sexual object. However, in the case of sex-favorable asexuals, this involves a stronger sense of regarding sexual activity favorably but in a manner not defined by sexual attraction to a partner, encompassing a diverse range of possibilities that are rendered invisible if asexuality is understood solely in terms of sex-neutrality or sex-aversion. While there are common experiences that invite explanation, the diversity found within the category of asexuality should caution us against reductive attempts to explain what causes people to be asexual. Recognizing this diversity should not lead to a rejection of etiological questions but should lead us to treat them with great caution; to ask about the causes of “asexuality” might be a problematic question in a way that is not the case with asking about the causes of specific experiences that lead people to define as such. Addressing these questions can be difficult because they traverse disciplinary boundaries. Psychological research addressing such questions has tended to consider the characteristics that

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correlate with asexuality, while sociological research has tended to address the social context within which the asexual identity has come to be socially recognized. Though the formation of the asexual community was dependent upon the Internet facilitating discussion between geographically dispersed people, in the process elaborating upon what it means to be asexual and allowing collaboration that aims to increase its visibility, it does not in itself explain what it was about the circumstances of these people that impelled them to seek such connections in the first place, or why finding the asexual community spaces online can be so important for people who are in the process of coming to identify as asexual.

The Social Context of Asexuality Most asexual people report strikingly similar lists of typical responses received when they have attempted to discuss their absence of sexual attraction with family, friends, or peers who are not asexual. These might include suggesting they are “late bloomers,” proposing that they haven’t “met the right person yet,” inquiring into their mental health, speculating about past sexual abuse, and invoking “hormones” as a means to explain their asexuality. What these responses share is a refusal to accept asexual experience and an inclination to explain it away as a symptom of some underlying pathology. In other words, sexual attraction is assumed to be universal and so its absence must reflect something being wrong with the person in question. The sheer pervasiveness with which this assumption is upheld, as evidenced in the near universality with which asexual people report having received these dismissive reactions, suggests we might best understand this marginalization of asexuality in terms of broader questions of the cultural status of sex and sexuality. In this sense, we can see the emergence of asexuality as a social identity as part of a broader pattern of cultural change in sexual matters that, in turn, might contribute in socially significant ways to further changes in these aspects of social life.

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Asian American/Pacific Islander Sexualities

However, considering these broader issues must not obscure the fact of prejudice against asexual people in everyday life of a sort irreducible to this basic failure to understand asexuality. Our understanding of these issues is still at an early stage, and empirical research faces the conceptual challenge of distinguishing between behavior that is unintentionally marginalizing (rendering asexual experience invisible on the basis of unacknowledged assumptions) and that which is intentionally stigmatizing (seeking to dismiss or denigrate asexual experience). Though both are likely to be harmful to asexual people, there are at least prima facie conceptual and empirical grounds for expecting the former to be significantly less durable than the latter. Unintentionally marginalizing behavior might decrease as a function of greater cultural visibility, but intentional stigmatization will not necessarily do so and may perhaps even increase as an unintended consequence of greater social recognition of asexuality. Invoking visibility raises an obvious question of what explains its apparent increase. There are four mechanisms underlying this. First, there is the numerical growth in people identifying as asexual, each one helping contribute to the spread of knowledge about asexuality. Second, there is the emergence of asexuality studies as an interdisciplinary field of inquiry, predominantly though not entirely in the anglophone world, leading to research publications and public engagement activities that contribute to the visibility of asexuality. Third, there has been a rapid growth in media interest in asexuality, encompassing both print and broadcast media. Fourth, there has been the visibility and education activism undertaken in an organized way by those within the asexual community. In practice, all four mechanisms have been mutually reinforcing, with visibility activism supporting the work of academics and journalists, academic research providing talking points for media coverage, media interest providing a motivating factor for academic engagement, and all of these factors both contributing to and benefiting from the growing number of people identifying as asexual. Mark Carrigan See also Sexual-Identity Labels; Sexual Norms and Practices

Further Readings Bogaert, A. F. (2004). Asexuality: Prevalence and associated factors in a national probability sample. Journal of Sex Research, 41(3), 279–287. Bogaert, A. F. (2012). Understanding asexuality. Lanham, MD: Rowman & Littlefield. Carrigan, M. (2011). There’s more to life than sex? Difference and commonality within the asexual community. Sexualities, 14(4), 462–478. Carrigan, M., Gupta, K., & Morrison, T. G. (2013). Asexuality special theme issue editorial. Psychology & Sexuality, 4(2), 111–120. Chasin, C. J. (2015). Making sense in and of the asexual community: Navigating relationships and identities in a context of resistance. Journal of Community & Applied Social Psychology, 25(2), 167–180. Hinderliter, A. (2013). How is asexuality different from hypoactive sexual desire disorder? Psychology & Sexuality, 4(2), 167–178. Scherrer, K. S. (2008). Coming to an asexual identity: Negotiating identity, negotiating desire. Sexualities, 11(5), 621–641. Scherrer, K. S. (2010). What asexuality contributes to the same-sex marriage discussion. Journal of Gay & Lesbian Social Services, 22(1–2), 56–73.

ASIAN AMERICAN/PACIFIC ISLANDER SEXUALITIES Queer and trans sexualities have existed across Asian American/Pacific Islander (AAPI) countries and communities over a long period of time; however, there continue to be silences and gaps in documenting and valuing these sexualities. Queer is an umbrella term that encompasses lesbian, bisexual, gay, and questioning as well as other sexual orientation identities. Trans is also an umbrella term that refers to gender identities such as transsexual, genderqueer, male-to-female (MtF), and female-to-male (FtM), among others. Estimating accurate numbers of queer and trans people currently in the United States is challenging because of societal heterosexism, which fosters a homophobic and transphobic environment where queer and trans AAPI people may not feel comfortable disclosing their sexualities and gender identities. In

Asian American/Pacific Islander Sexualities

addition, queer and trans AAPI people in the United States also experience societal racism, which compounds issues of heterosexism, resulting in minority stress. Therefore, in order to understand the current lives, resilience, and coping of queer and trans people and communities, one must understand the influences of family, intersectionality, and experiences of the dual impacts of racism and heterosexism, in addition to the historical legacies and colonization that queer and trans AAPI people have experienced. The current entry addresses AAPI sexualities, resilience and coping of AAPI communities, and AAPI queer and trans liberation movements.

AAPI Queer and Trans Sexualities Current literature suggests that the U.S. socioeconomic climate perpetuates the marginalization of both people of color and individuals identifying as LGBTQ. In contrast, the stereotype of AAPIs as a “model minority” (which asserts that AAPIs have equaled if not surpassed the standards set by White majority culture) suggests holistic success for AAPI citizens in the United States. However, the concept of AAPIs as a model minority adds an intricate layer of tension to the enculturation of AAPI individuals, particularly for those who identify as LGBTQ, who must balance multiple complex identities. While the largely accepted AAPI values of collectivism and community may support the racial identity development of AAPI individuals, AAPIidentifying people who also identify as LGBTQ often experience conflicting feelings regarding their sexuality. For example, South Asian individuals are often hesitant to use terminology such as gay, lesbian, bisexual, and queer as identifiers due to the fact that South Asian culture often qualifies such identities as a Western disease, which in turn causes fear of cultural alienation for AAPI individuals who identify as LGBQ. Therefore, the intersectionality of racial and sexual identity may become cumbersome for individuals with AAPI values who wish to honor their LGBTQ identity and lifestyle. Many experience difficulty pairing their racial/ethnic and sexual identities and

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struggle with how to share their authentic self with others, leading to a decreased likeliness to be out, especially for AAPI LGBTQ men. For instance, according to a 2004 survey, only 60% of LGBT AAPI individuals reported being out to their parents. Yet, in the same study, over 82% of AAPI LGBT respondents indicated that they experience racism within the White LGBT community, and 96% of respondents said that homophobia and/or transphobia was a problem in the AAPI community, thereby suggesting extreme marginalization from multiple communities for individuals identifying as both AAPI and LGBT. The multiple marginalizations that queer and trans AAPI individuals experience contribute to increased psychological distress. Specifically, research has suggested that racist events, heterosexist discrimination, and internalized heterosexism are positively related to high levels of psychological distress. The numbers of racist events reported by AAPI LGBTQ individuals increase the higher their levels of “outness.” Furthermore, health stressors seem increasingly dire for individuals identifying as AAPI and transgender. A 2011 report of the National Transgender Discrimination Survey provides data showing that individuals who identify as AAPI and transgender experience particularly devastating levels of discrimination, leading to extreme poverty, increased rates of HIV, increased numbers of suicide attempts, high rates of unemployment, increased rates of physical and sexual assault, and increased rates of homelessness in addition to experiencing housing, education, employment, and health care discrimination. Health research has often excluded or neglected AAPIs, a reality that is fueled in part by the belief that they represent a model minority and also a healthy minority based on national statistics that point to a greater life expectancy. Asian Pacific Islanders have also been called the “forgotten minority.” A good example of the “forgotten minority” experience is the scarcity of studies on AAPI queer women, transgender people, young people, and South Asians. There is a mistaken belief that AAPIs are somehow perfect and do not make mistakes like contracting HIV/AIDS. Moreover, there is reluctance within the AAPI

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community to accept or even recognize that HIV/ AIDS is a problem. A 2008 study by the Centers for Disease Control and Prevention (CDC) found a steady increase in the number of AAPIs being diagnosed with AIDS in recent years. Asian Pacific Islander transgender and gender-nonconforming people show a devastatingly high rate of HIV infection. Currently, the majority of AAPIs who are infected with HIV are men who have sex with men, which typically is connected to unprotected sex, substance abuse, and low HIV testing rates. HIV testing sites and programs that are culturally sensitive to AAPI community identity and provide early and regular testing and social support are most effective in reducing the spread of HIV/AIDS among the AAPI gay community. Although AAPIs are often viewed as healthier than the rest of the population, especially compared with other minority groups, substance abuse is a contributing factor in the spread of HIV/AIDS within this community, which has been ignored or portrayed as a minor problem. As with much of the research with AAPI groups, study findings on substance use are limited. Substance use disorders were historically thought to be the lowest among AAPIs. However, recently published data suggest otherwise for some AAPI subgroups (i.e., Chinese, Korean, Filipino, Vietnamese, Asian Indian, and Japanese). For example, alcohol use remains very close to that of non-AAPI population groups. An emerging trend is the use of and dependence on methamphetamines among Pacific Islanders. Many factors seem to influence AAPI substance use, including acculturation pressures related to immigration, socioeconomic factors, and being U.S.-born, with those AAPIs who were foreign-born facing greater adjustment challenges. There are many barriers to substance abuse treatment for AAPIs involving cultural values, personal factors, and issues of practicality (e.g., accessibility). The model minority myth persists for AAPIs across many sociocultural factors even in the area of domestic violence, which involves violent or aggressive behavior within the home in which violent abuse of a spouse or partner occurs. Domestic violence within the AAPI community exists, and yet researchers often overlook this

social problem. Furthermore, community and health service providers have not clearly understood AAPI attitudes and cultural differences (e.g., political and religious; traditional social roles; an array of languages) that contribute to domestic violence. Instead they view AAPIs as one monolithic group, thereby ignoring cultural influences. According to a 2009 study by Mieko Yoshihama, a scholar in social work, and Firoza Chic Dabby, a domestic violence advocate, the literature points to a high prevalence rate of intimate partner violence in AAPI homes. Further, a 2012 report by the National Coalition of Anti-Violence Programs (NCAVP) found intimate partner violence to be a disturbing and sometimes deadly problem facing LGBTQ communities of color; and this report found that AAPI survivors constituted 4% of the respondents surveyed. The level of police misconduct toward the LGBTQ community and profiling that targeted immigrant communities were also disturbing findings of the report. Since the September 11, 2001, terrorist attacks, immigrant communities have undergone greater scrutiny, and the South Asian community has been especially targeted. Currently, immigration reform has not enjoyed great support from the AAPI LGBTQ community.

Resilience and Coping of AAPI Queer and Trans Communities While AAPI queer and trans communities do face challenges in the form of microaggressions, macroaggressions, and internalized heterosexism as discussed above, AAPI queer and trans people also develop resilience and coping strategies that assist them in navigating this oppression. For instance, in a 2011 study of AAPI queer college students, Mitsu Narui, a sociologist, found that his sample with certainty experienced multiple marginalizations, but participants were simultaneously reflecting on these experiences and using them to foster their own agency, self-exploration, and empowerment. Similarly, Aldalberto Aguirre and Shoon Lio, both sociologists, discussed the experiences of AAPI people in general in the United States being viewed as “perpetual foreigners.” However, they

Assisted Reproductive Technologies (ARTs)

also describe opportunities for and examples of AAPI resistance in venues such as AAPI neighborhoods, college organizations, and activist and labor groups, in addition to queer and feminist spaces. Queer and trans AAPI narratives have also been published, such as Q & A: Queer in Asian America (1998) by David L. Eng and Alice Y. Hom; Keven K. Kumashiro’s Restoried Selves: Autobiographies of Queer Asian/Pacific American Activists (2004); and Kim Fu’s For Today I Am a Boy (2014). These narratives—along with efforts to document queer and trans roots in AAPI countries and communities—provide powerful examples of liberation and resistance to oppression they face.

AAPI Queer and Trans Liberation Movements In large part because of the increasing accessibility of the Internet, queer and trans people have used the Internet and social media to support grassroots social justice and liberation movements. For instance, in the South Asian queer and trans community, the organization Trikone has worked diligently in large U.S. cities and in other countries (e.g., Australia) to provide spaces where their members can gather, socialize, and grow the movement for increased acceptance and affirmation of South Asian queer and trans people. In the United States, NQAPIA (National Queer Asian Pacific Islander Alliance) was founded with the explicit intention to highlight, affirm, and empower queer and trans AAPI people in the United States. NQAPIA is particularly important for the queer and trans AAPI community, given its focus on supporting immigration rights, advocating for queer and trans workplace protections, and strengthening family relationships in the lives of queer and trans AAPI people. While national queer and trans organizations often work on issues such as gay marriage, NQAPIA also takes an intersectional approach to address the issues of racism and heterosexism that uniquely influence the lives of queer and trans AAPI communities. Anneliese Singh, Rodney Pennamon, and Lauren Moss

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See also African American Sexualities; HIV/AIDS and Racial/Ethnic Disparities; Immigration; Intimate Partner Violence, Female; Intimate Partner Violence, Male; Latina/o Sexualities; Substance Abuse and LGBTQ People; Substance Abuse Treatment and Recovery; Substance Abuse/Dependence and Transgender People

Further Readings Dang, A., & Hu, M. (2004). Asian Pacific American lesbian, gay, bisexual and transgender people: A community portrait. New York, NY: Policy Institute of the National Gay and Lesbian Task Force. Retrieved from http://www.thetaskforce.org/downloads/reports/ reports/APACommunityPortrait.pdf Fu, K. (2014). For today I am a boy. New York, NY: Houghton Mifflin Harcourt. Kumashiro, K. K. (2004). Restoried selves: Autobiographies of queer Asian/Pacific American activists. Binghamton, NY: Harrington Park Press. National Queer Asian Pacific Islander Alliance. (n.d.). Mission statement. Retrieved from http://www .nqapia.org Singh, A. A. (2008). A social justice approach to counseling Asian American/Pacific Islanders. In C. Ellis & J. Carlson (Eds.), Cross cultural awareness and social justice issues in counseling (pp. 147–167). New York, NY: Routledge. Trikone. (n.d.). About us. Retrieved from http://www .trikone.org/index.php/about-us/trikone Yoshihama, M., & Dabby, C. (2012). Domestic violence in Asian, Native Hawaiian and Pacific Islander homes. San Francisco, CA: Asian and Pacific Islander Institute on Domestic Violence. Retrieved from http://www .apiidv.org/files/Facts.Stats-APIIDV-2012.pdf

ASSISTED REPRODUCTIVE TECHNOLOGIES (ARTS) The term assisted reproductive technologies (ARTs) refers to a range of techniques that are used to assist in the process of achieving a pregnancy. These methods and techniques may also be referred to as infertility treatment or fertility treatment. LGBTQ individuals and couples typically lack a partner of a different sex with whom they can

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conceive a child (a situation that is sometimes referred to as “social infertility”). ARTs that use donated sperm, eggs, and embryos provide LGBTQ individuals and couples, or three or more individuals, the opportunity to achieve pregnancy and to raise a child from birth. This entry first examines exactly what ARTs are, who uses them, and why. The various risks associated with ARTS are then addressed, followed by a brief summary of the outcomes of families created by ARTs.

What Are ARTs? In-vitro fertilization (IVF) is a process in which an egg is fertilized with a sperm in the laboratory, and the resulting embryo is transferred to a uterus. This procedure, resulting in the birth of the first IVF baby in 1978, typically involves the use of the intending mother’s egg and uterus, and the intending father’s sperm. The resulting child therefore has a genetic relationship to both parents and has a gestational link to the mother. A number of ARTs involve the use of gametes (sperm or eggs) that are provided by a third party, or donor. These techniques are often referred to as reproductive donation, or third-party assisted reproduction. One of the oldest procedures of this nature is sperm donation, a process in which a woman is inseminated with the sperm of a donor (or a man who is not her partner). This is a relatively straightforward procedure in which semen is transferred to the vagina via syringe. ARTs have advanced at a rapid pace, and today IVF is just one of many complex and sophisticated ARTs that is available. Newer procedures that typically utilize the sperm and egg of a heterosexual couple include intracytoplasmic sperm injection (ICSI), which was introduced in the early 1990s. This technique, necessarily also involving IVF, is the injection of a single sperm into an egg in  vitro. It can be used to overcome many male fertility problems, and for heterosexual couples using ARTs, ICSI has to a significant extent replaced the use of sperm donation. Egg donation is a more complex and intrusive procedure that utilizes IVF techniques. Following the retrieval of an egg from a donor, sperm is used

to fertilize the donated egg in the laboratory, and the resulting embryo is then transferred to the intending mother’s uterus. It is only since 1984, following advances in IVF, that it has been possible for a woman to become pregnant and give birth to a child to whom she is genetically unrelated. Families can also be created through surrogacy arrangements, in which a woman carries a child to term for the intending parent(s). Surrogacy can be a relatively low-technology procedure, in which conception occurs using sperm of the intending parent (or a donor) and the egg of the surrogate, who carries the child to term (referred to as genetic or traditional surrogacy). Surrogacy can also be a more high-technology procedure involving IVF techniques, whereby the sperm of one intending parent or donor and the egg of the other intending parent or a donor are used to create an embryo, which is then transferred to the surrogate (referred to as gestational surrogacy). In the latter kind of surrogacy arrangements, the surrogate who carries the pregnancy to term and gives birth has no genetic relationship to the child. Another assisted reproductive technology that assists in the process of achieving a pregnancy is embryo donation. In families created through this procedure, the child lacks a genetic relationship with the intending parent(s), creating a situation that is similar to adoption. Yet unlike adoptive parents, those who start their family using donated embryos experience a pregnancy and raise their child from birth. More recently there have been advances in the field of fertility preservation, with techniques and approaches to freezing, and subsequently thawing, sperm, eggs, embryos, and ovarian tissue, becoming more efficient and reliable. Potentially, these techniques give individuals the opportunity to conceive and achieve pregnancy with a child with whom they are genetically related, even though their most fertile years may have passed due to advanced age or illness.

Who Uses ARTs? Single and coupled LGBTQ individuals typically lack a male or female partner with whom to conceive a child. Third-party reproductive techniques, such as sperm donation, egg donation, and

Assisted Reproductive Technologies (ARTs)

surrogacy therefore assist LGBTQ individuals and couples to achieve a pregnancy. In the absence of a male partner, single and coupled LGBTQ women can become pregnant through sperm donation. Women who conceive a child in this way have a number of options from which to choose. They can conceive using an anonymous sperm donor, purchasing semen from an online sperm bank, or a sperm bank provided by a particular fertility clinic. These women may have very little or no information about the donor, and they may wish for this arrangement to be permanent. Others may wish to have a great deal of information about the donor and want their child to have the option to access identifying information about him in the future. Others may ask a friend, family member, or acquaintance, with whom they have an existing relationship or with whom they have come into contact online, to act as a sperm donor. Some women may hope and intend for the donor to be present in the child’s life, to varying degrees, whereas others may wish for the donor to play no role in the child’s life. These different categories of donation (sometimes referred to as anonymous, open-identity, and known) may change over time. For example, an anonymous donor about whom parents and children have basic information might be easily located using an online search engine. A man who registered as an open-identity donor, who has agreed that the child can contact him in the future, may move abroad and become untraceable. The choices and decisions that women make about the sperm donor will likely be influenced and/or constrained by the regulation of ARTs in their country of residence, financial considerations (with certain options being more expensive than others), and their personal beliefs and preferences about what is important for their family and for the future child’s well-being. These various options may also seem relatively insignificant in comparison with the goal of getting pregnant, or these options may not all be known or obvious to intending parents who may struggle to find information about the various routes to parenthood that are available to them. In addition to sperm donation, single and coupled LGBTQ women may utilize IVF techniques. For lesbian couples using IVF and donated sperm,

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both women have the opportunity to have a biological link to the child (i.e., an embryo may be created with the egg of one woman, who will have a genetic relationship to the child, and her partner may then carry the child to term, having a gestational link to the child). Lesbian couples using IVF also have the opportunity to take turns in becoming a genetic parent. One mother may have a genetic relationship to their first child, and her partner may be the genetic parent of their second child. Single LGBTQ women may also utilize IVF techniques if they need assistance in getting pregnant with their own eggs, or the eggs of a donor. For LGBTQ individuals and couples who cannot conceive due to the absence of a female partner, surrogacy may be a viable option for starting a family. For those who pursue gestational surrogacy, an embryo might be created with the sperm from one man and the egg of a donor, which is then implanted into the uterus of a surrogate. As with lesbian couples, gay male couples that want more than one child can potentially take turns in becoming a genetic father. The children in these families may therefore have a genetic link to one father, and their sibling may be genetically related to the other father. If two different egg donors have been used, it is possible that the children growing up in these families will have no genetic relationship with their sibling(s). Single and coupled LGBTQ individuals may also have various options from which to choose when pursuing parenthood through the use of ARTs. We are now living in an era in which assisted reproduction is global. In countries in which surrogacy is permitted, the regulation of the procedure and process varies widely, as does the cost. Single or coupled LGBTQ men may therefore choose to pursue surrogacy outside of their country of residence, be that in the United States, Mexico, Canada, or elsewhere. Intending fathers in these families may also have various options to consider when selecting an egg donor. They may choose to use a donor from the country in which their surrogate resides or they may choose to select an egg donor from their country of origin and/or residence, for a variety of reasons (e.g., personal preference, cost, availability). As with sperm donors, the egg donor may be anonymous,

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open-identity, or known. It is worth noting once again that the decisions that LGBTQ men face may likewise be influenced and/or constrained by regulation and legislation in their country of residence, financial considerations, and personal beliefs and convictions as to what matters for family relationships. LGBTQ individuals and couples may become parents through the use of embryo donation. They may also decide to utilize various techniques of fertility preservation, in the hope of conceiving a child in the future to whom they may be genetically related. Most recently, a child has been born following womb transplantation, and this too may be an option for LGBTQ individuals who cannot become pregnant or give birth to a child.

Why Do People Use ARTs? LGBTQ individuals and couples may choose to start their family using ARTs for a number of different reasons. ARTs allow parents to have a genetic and/or a gestational link to their child, which is not typically possible when building a family through adoption or fostering. This genetic connection may be greatly valued by parents, their families, and the communities and cultures in which they live. LGBTQ individuals and couples may not want to pursue parenthood through adoption or fostering. They may want to experience pregnancy and raise their child from birth, which is a relatively unlikely option for those who choose to foster or adopt, depending on their country of residence (e.g., in the United Kingdom the average age of the child at adoption is currently 3 years old). Those who favor using ARTs over adoption may not wish to raise children who may have emotional, behavioral, or developmental problems as a consequence of their early life experiences, which may have involved neglect and abuse. Also important to consider is that there are many countries in which LGBTQ individuals and couples are unable to access legal parenthood through adoption due to their sexual orientation and/or marital status. Another route to parenthood that LGBTQ individuals may consider is that of coparenting, where individuals and couples who are typically not in an intimate relationship choose to raise children

together. Those who raise a child in this way may not have access to legal parenthood status; therefore, creating a family through the use of ARTs may be a more appealing option. Even if legal parenthood following the use of ARTs is not possible in their country of residence, LGBTQ individuals and couples may achieve the goal of parenthood by traveling abroad to access treatments that are not available to them in their own countries (often referred to as cross-border reproductive care, or reproductive tourism). Routes to parenthood are therefore influenced by individuals’ and couples’ desire to experience a genetic and/or gestational relationship with a child, as well as discriminatory practices that make certain options inaccessible to LGBTQ individuals and couples. Other factors that influence routes to parenthood include cost, prevailing cultural and/or religious attitudes, the beliefs of their family and wider support network, and their own personal beliefs and convictions about what is important for family relationships and children’s well-being.

Risks of ARTs The path to parenthood through the use of ARTs may be a long one. The success rates of techniques such as IVF differ between countries and clinics (as well as the age and health of the recipients using these technologies). Although success rates have generally increased over the last few decades, still less than a third of all IVF treatment cycles result in the birth of babies. This relatively low success rate in combination with the cost of ARTs may be financially challenging, if not prohibitive, for those who wish to become parents. Surrogacy in particular can be a costly procedure for prospective parents, who may need to pay expenses to the surrogate and the egg donor, in addition to agency fees, legal fees, and medical expenses. Compared with children who are conceived through sexual intercourse, there are risks associated with the use of ARTs. In particular, there are risks associated with the drugs used to stimulate egg production, the surgical hazards of egg retrieval, and the process of embryo transfer, resulting in heightened risks of ovarian hyperstimulation syndrome and ectopic pregnancy. The use of ARTs

Assisted Reproductive Technologies (ARTs)

is also associated with an increased risk of multiple births, with levels of risk varying between countries and between clinics. The mortality and morbidity of pregnancies are high for triplets and there are significant risks for twins, most notably that of being born preterm and at a low birth weight, which may have implications for the child’s future physical and psychological development. In addition to the medical risks of ARTs, concerns have been expressed that the stressful experience of undergoing fertility treatment may have a negative impact on parents’ psychological wellbeing and the quality of the couple relationship. There have also been concerns that the process of undergoing fertility treatment may result in parents being excessively overprotective and emotionally overinvolved in their child’s life, as their child may be seen as particularly precious and/or special. There have also been a number of questions and concerns as to how the children in these families will feel about their families as they grow older. For example, how will children feel if they learn that their egg donor was paid a large sum of money? And how will children feel and think about the surrogate as they grow older? The children in these families may discover that they have a number of donor siblings (i.e., genetic half-siblings who were conceived using the same donor, sometimes referred to as “diblings”). Who will these children consider to be family members, and why?

Outcomes of ARTs ARTs continue to develop at a rapid pace. Alongside these technological developments, a body of research has grown that has set out to examine and explore the psychological adjustment of parents and children in these families, and family functioning as a whole. Studies of families created through sperm donation that are headed by lesbian couples have generally found the parents and children in these families to be functioning well. Likewise, of the research that has examined sperm donation families headed by single women, parents and children have been found to be psychologically adjusted and parent-child relationships have been found to be characterized by high levels of warmth. There is much more work to be

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done in this area; for example, the literature that has examined families headed by single women (often referred to as single mothers by choice) has largely focused on families in which children are young. We therefore know little or nothing about family functioning with children in adolescence and beyond. There is also very little empirical work investigating family functioning where single and coupled LGBTQ men have had a child through surrogacy arrangements. Longitudinal research that follows these families over time will be of great value. These newer kinds of families, which did not exist decades ago, have generally been found to be functioning as well as, if not better than, more traditional families in which heterosexual couples have conceived naturally. This has led to the conclusion that there is much that we can learn from these newer family forms. As has been consistently acknowledged for decades, this body of research concludes that it is the quality of family relationships, rather than the structure of families, that is most important when thinking about children’s well-being. Lucy Blake See also Children With LGBQ Parents, Psychosocial Outcomes; Sperm Donor, Choosing a; Sperm Donors’ Involvement in Children’s Lives; Surrogacy

Further Readings Freeman, T., Graham, S., Ebtehaj, F., & Richards, M. (Eds.). (2014). Relatedness in assisted reproduction: Families, origins and identities. Cambridge, England: Cambridge University Press. Golombok, S. (2015). Modern families: Parenting and child development in new family forms. Cambridge, England: Cambridge University Press. Richards, M., Pennings, G., & Appleby, J. B. (Eds.). (2012). Reproductive donation: Practice, policy and bioethics. Cambridge, England: Cambridge University Press.

ATHLETES See College Athletes; Sports, SexualMinority Men in; Sports, SexualMinority Women in

B house and ball communities can be found in many large American cities including New York, Los Angeles, Oakland, Atlanta, Chicago, Philadelphia, Detroit, Baltimore, and Washington, D.C. In general, the house and ball communities work in tandem to develop and support a community involving individuals of diverse racial, ethnic, sexual, and gender identities, primarily young African American men and Latinos who have sex with men and transgender women. Balls and houses function as different entities, yet work together in forming the vibrant community often known as the ballroom scene or community. Houses are different groups of individuals that compete against each other during balls—underground events that reward individuals who win competitions focused around dance, athletics, and gender expression. Houses are social networks led by a “mother” and/or “father.” House parents serve roles akin to that of traditional mothers and fathers and generally remain involved in the house and ball community past young adulthood. Responsibilities of the parents include creating rules (which are then passed down and voted on by other house members) and discussing important house topics, such as major balls to attend and assigning status or selecting members for “of the year” awards. Furthermore, each house may be led by the founding parent(s), grandparent(s), and/or godparent(s), whose legendary status is important in lending credibility to a house. House structure varies across regions and across houses. Research

BALLROOM SCENE, THE The ballroom scene is a community comprising primarily African American and Latina/o gay, bisexual, transgender, and questioning youth and young adults. The ballroom culture has its roots in the annual Harlem balls of the 1920s, drag shows involving working-class, mostly African American men under the age of 30 performing in elaborate female attire. In addition to offering entertainment for spectators at these annual balls, young men dressed in women’s attire, or “in drag,” competed in costume competitions for cash prizes. Over the years, the ballroom scene has become more inclusive of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth from a variety of racial and ethnic backgrounds. This entry is intended to provide a brief overview of the ballroom scene, and what are known as house and ball communities, as well as a brief review of recent research identifying aspects of the community that offer both support and risks. The ballroom scene first attracted mainstream attention after the award-winning documentary film Paris Is Burning was released in 1990. In addition, the singer and performer Madonna’s iconic and popular music video Vogue brought the signature moves of the ballroom scene—vogue dancing—to mainstream culture as it featured the popular entertainer performing vogue dancing along with members of the ballroom scene. Today, 103

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has found that additional individuals who help run a house can be titled governess, ambassador, duke/ duchess, emperor/empress, and officers such as a sergeant-at-arms and secretary. It is also common for house parents to train a prince or princess to assume the house leader position in the future. The general members of each house are referred to as the “children”; they generally join the community during late adolescence to early adulthood. House size can range from as few as 5 active members to as many as 100. Typically, seniority dictates those who help run a house, as these members are likely to be established, win trophies, travel periodically to other states, and have been involved in the scene the longest. Houses are typically named after fashion designers or other entities involved in the fashion industry. Examples of house names include the houses of Balenciaga, Chanel, Blahnik, Ebony, Escada, Xtravaganza, Khan, LeBeija, Milan, Mizrahi, Ninja, Omni, and Revlon. Each city in which a ballroom community exists may have as few as 5 and as many as 20 different houses. Nationally, each house is usually a part of a larger network with a formal board and hierarchical structure. Most houses are run in a democratic fashion and are led by one or two parents at the local level. National meetings for each house are held at different times and locations and offer members an opportunity to network with each other. Balls are events that bring members of the different houses together to compete in a series of events. At the balls, house members compete in different categories that showcase their dancing, athleticism, style, creativity, and “realness”—or ability to “pass” as a specific type of person. Major categories of competition include (1) fashion (e.g., labels, European/American runway, butch queen up in pumps); (2) realness (e.g., executive realness, schoolboy realness, butch/femme queen realness); (3) performance (e.g., vogue, realness with a twist); and (4) beauty (e.g., sex siren, body, face). Balls are typically organized by a house or by others working with LGBTQ communities; a ball may focus on a theme such as HIV prevention or other issues of importance. During competitions, individuals competing in a specific category come to the ballroom floor and

perform for a panel of judges. The judges are typically house parents, leaders, or others who are not competing and are knowledgeable about what each event requires. Performers attempt to “get their tens”—meaning that they meet the minimum requirements of a category and can move on to an elimination round against their competitors. These elimination rounds or “battles” typically have competitors compete one-on-one against each other; elimination rounds continue until a winner is declared. Prizes for winning a competition can include cash, a trophy, or another meaningful item. Research indicates that these communities offer both support and risk to their members, with high rates of HIV, drug use, and illicit activities. For example, one study in New York found an HIV prevalence rate of 17% among house and ball members. Other research identified high rates of sex work and escorting among members. By contrast, however, the ballroom scene offers a number of supportive mechanisms to young LGBTQ individuals. For example, there is evidence to suggest that a significant proportion of ballroom community members were forced out of their homes on account of their sexual or gender identities. The ballroom community offers a “fictive kin” network complete with mother and father and siblings that can support its members. In addition, the balls themselves offer the participants a social environment where they are not only accepted, but also have an opportunity to be celebrated and rewarded for their talents and creativity, qualities for which they have elsewhere only been ridiculed or ostracized. Katrina Kubicek See also Drag; Families of Choice; Transgender and Gender-Nonconforming Youth of Color

Further Readings Chauncey, G. (1994). Gay New York. New York, NY: Basic Books. Kipke, M. D., Kubicek, K., Supan, J., Weiss, G., & Schrager, S. (2013). Laying the groundwork for an HIV prevention intervention: A descriptive profile of the Los Angeles house and ball communities. AIDS and Behavior, 17(3), 1068–1081.

Bear Community Kubicek, K., McNeeley, M., Holloway, I., Weiss, G., & Kipke, M. D. (2013). “It’s like our own little world”: Resilience as a factor in participating in the ballroom community subculture. AIDS and Behavior, 17(4), 1524–1539. Livingston, J. (Producer/Writer). (1990). Paris is burning [Motion picture]. United States: Miramax Films. Murrill, C. S., Liu, K., Guilin, V., Colon, E. R., Dean, L., Buckley, L. A., . . . Torian, L. V. (2008). HIV prevalence and associated risk behaviors in New York City’s house ball community. American Journal of Public Health, 98(6), 1074–1080.

BEAR COMMUNITY Bears, so called, are a group of gay men who have positioned themselves outside the mainstream gay culture. They have constructed a gender expression based on body acceptance and “natural” masculinity. Their presence within the sexual-minority community has expanded our understanding of gay masculinities by including nurturance, intimacy, role flexibility, and emotional connection. Also, bears provide critiques of the common classism, perfectionism, and intimacy avoidance within gay culture. This entry begins with a brief history of the development of the bear community; continues with a discussion of how bears define their identity, gender, and sexuality; and concludes with an overview of controversies that have arisen in the history of the bear movement.

A Brief History of the Bear Movement The term bear became a part of the gay vernacular in the 1980s, typically used in the context of large cities such as San Francisco, New York, and Toronto, to refer to a subsection of the gay community. Some cultural theorists trace the beginnings of the term to the famous article published in the Advocate on July 26, 1979, titled “Who’s Who in the Zoo: A Glossary of Gay Animals.” Others believe that a group of gay men within the community began self-identifying as bears as early as the 1970s. Still others place the beginning of the bear community even earlier, all the way back to

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the 1960s. What is clear is that the bear identity developed out of the leathermen of the 1960s and Girth and Mirth of the 1970s, organizations that shared common venues and held similar values. During the 1980s, bear communities began to be established across the nation all the way from California to Iowa to New York. Before the end of the decade, bears held their first official community party, called “Bear Hug.” Bears initially held these invitation-only events with the intention of creating a setting to socialize and engage in erotic and safe sex play. However, the early unification of the bear movement was set in 1986 and was highly influenced by civil-rights activism that resulted from the AIDS epidemic and the gay liberation movement. At this time, bears borrowed practices and techniques from these movements in order to increase their visibility. Specifically, the bear movement asked individuals within their community to engage in a second coming out to claim their bear identities. The commitment to the bear identity included displaying a bear appearance and holding a critical stance toward mainstream gay culture. The bear culture valued a “natural” masculinity that was reflected in a heavier, less sculpted body in working-class clothing as opposed to the genteel masculinity that typified the broader gay community and was represented by youthful sculpted physiques in stylish dress. By the end of the 1980s, the Lone Star Saloon had opened in San Francisco, becoming the first official bear bar. The 1990s has been described by some writers as the formalization phase of the bear community. The first bear magazine began circulating, displaying erotic images of bears. Soon, a second bear magazine was created as well as the first bear photography book, The Bear Cult: Photographs by Chris Nelson. The popularity of bear communities reached its apex by the mid-1990s, with 40 bear clubs throughout the United States. Each of these clubs would hold special events such as bear contests in which men performed runway shows wearing workingmen’s uniforms, appearing as construction workers, mechanics, and plumbers. These contests were so well attended that the national and international Mr. Bear competitions were created to further unify the community.

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Currently, many bear associations continue to exist across the United States and hold major parties once a year known as bear weekends and bear runs. These associations establish new clubs and hold dance nights that are attended not only by bear-identified men, but also by their “admirers.” This shift in the usage of bear spaces has helped expand membership within the bear community. Also increasing membership, the bear community has become highly organized in establishing a strong Internet presence. Multiple associations in the United States and around the world, including Canada, Europe, Central America, and New Zealand/Australia, use websites to maintain their community connections. One such website, www .bear411.com, is a major source of information for those who would like to learn more about bear culture, be informed about community events, or find other bear-identified men. Along with contemporary technological shifts, multiple GPS-based applications for smart phones that help men find others in proximity has aided in the communication among bears. Bear media and cultural artifacts circulate within the mainstream gay community, helping increase bear visibility. Referred to as “bearphernalia,” these artifacts include plush teddy bears, movies, documentaries, books, magazines, flags, bumper stickers, shirts, and mugs.

The Identity, Gender, and Sexuality of Bears Bears value the aesthetic of the “natural” man, a look that may be conceptualized as less maintained and more rugged. The physical characteristics of bears usually include (1) facial hair (beards, moustaches, and goatees), (2) general body hirsuteness, and (3) a heavy-set (burly or stocky) mature physique. The last criterion, however, has shifted over time and some subclassifications have developed within the community. For instance, “muscle bears,” as the name suggests, have a more robust physique, and “otters” are skinnier or lanky; however, both styles incorporate facial and body hair. In addition to their physical appearance, bears are

distinguished by their blue-collar or working-class attire, typified by ripped jeans, baseball caps, T-shirts, and flannel shirts. Essentially, bear culture challenges not only heterosexual notions of masculinity but also the aesthetic portrayal of mainstream gay men, which has usually been characterized as youthful, trim, clean-cut, and engaged in visual arts or literary high culture. Associated with the ideals of “natural” masculinity, the bear community is known for body acceptance as well as comfort with maturation and aging. For this reason, older members are an active part of their communities. In addition, the demeanor of bears reflects a relaxed masculine attitude and easy-going outlook, hence the comfort with their bodies and age. Socially these attitudes are translated into camaraderie and inclusivity. Within their community, the values of bears are juxtaposed with and contrasted to those of the mainstream gay community, usually depicted as shallow, petty, competitive, and exclusive. Whereas socially, bear identity provides an alternative to mainstream gay culture and redefines gay masculinity, their gender expression can result in invisibility in both gay and heterosexual social spheres. Bears may not be perceived as gay by others and sometimes are not accepted by other gay men. This creates a conflict for some bears who want their sexual orientation to be acknowledged. For this reason, bear identity is solidified via participation in international, national, and local events. These events provide bears a place to encounter other bears, and to develop relationships and support. The sexuality of human bears is quite different from that of the aggressive, dangerous, and dominating animal. Bear masculinity incorporates attitudes of nurturance, affection, and emotional expression—elements that in Western contexts traditionally have been attributed to femininity. In addition, actual sexual acts and positions are negotiated within a particular relationship wherein being a top (sexual insertive) or bottom (sexual receptive) is not directly linked with masculinity. However, age does play a role within relationships, with older partners taking the “daddy” role and

Bear Community

being more assertive, nurturing, and guiding; and younger or less experienced partners, usually referred to as “cubs,” adopting a more receptive and passive role. Also, given the community’s body acceptance, bear sexuality masculinizes and eroticizes the whole body by emphasizing caressing and cuddling as an important relational practice. The structures of bear relationships are varied and differ from couple to couple. Some bears opt for open, non-monogamous, and/or polyamorous relationships. Other couples may be in closed/ monogamous relationships. Despite these differences, men within the bear community believe that bears tend to have longer-lasting relationships and are more sexually active than other gay men.

Controversies Related to the Bear Movement Many perspectives have been put forth to understand the complex interaction between masculinity and socioeconomic class within the bear community. Some cultural theorists have viewed the bear community’s adoption of a working-class aesthetic as problematic given that a lot of these men belong to the middle and upper classes. Given that many bears do not hold blue-collar jobs—actually most have been typified as being in the computer industry— this practice of “blue-collar drag” can be seen as the reaffirmation of these men’s class privilege. A second critique of the bear movement centers on its relative racial homogeneity and the lack of representation of bears from different racial and ethnic groups. Despite the bear community’s efforts to diversify, the majority of men are still White (and of middle- to upper-class backgrounds). There are few bears of color present in what may be considered “bear media,” such as movies, magazines, and advertisements with bear themes. Also, bears of color who are present within the community may object to taxonomic practices of White bears. For instance, terms such as “black bears” are used to refer to Black men, and “panda bears” refers to Asian/Asian-American men. This taxonomy is particularly controversial given the history and dehumanizing practices of linking non-White

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races to animals. Also, White men are labeled just as bears, and not polar bears.

Conclusion The bear movement throughout its history has provided a space for men who have positioned themselves outside the mainstream gay culture. They have formed a type of gay masculinity that is based within an aesthetic that values naturally hirsute and unsculpted bodies, relationships that prize nurturance and intimacy, and sexuality that values role flexibility and emotional connection. Perhaps because of their adoption of workingclass imagery, their presence within the wider gay community has provided a critique of classist attitudes, emphasis on physical perfectionism, and the avoidance of intimacy. Ultimately, their visibility not only has helped move their community forward but has diversified the typology and expectations of gay men. Francisco I. Surace and Heidi M. Levitt See also Leather Culture; Masculinities; Sexual Attraction, Behavior, and Identity; Social Class; Social Class and Sexuality, Intersections Between

Further Readings Hennen, P. (2005). Bear bodies, bear masculinity: Recuperation, resistance, or retreat? Gender & Society, 19(1), 25–43. Hunt, D. (Producer/Director). (2008). Bear run: Celebrating the bear community [Motion picture]. United States: Pearl Wolf Productions. Ingram, M. (Producer/Director). (2010). Bear nation [Motion picture]. United States: View Askew Productions. Langway, D. (Producer/Director). (2010). BearCity [Motion picture]. United States: BearCity Limits. Langway, D. (Producer/Director). (2012). BearCity 2 [Motion picture]. United States: BearCity Limits II. Levine, M. P., Iardi, P. M., & Gagnon, J. H. (1997). In changing times: Gay men and lesbians encounter HIV/AIDS. Chicago, IL: University of Chicago Press. Levitt, H. M. (2006). Butch, femme, bear and leatherman: A programmatic exploration of gender identities

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within gay and lesbian subcultures. In K.-S. Yip (Ed.), Psychology of gender identity: An international and comprehensive perspective (pp. 105–121). Hauppauge, NY: Nova Science. Manley, E., Levitt, H., & Mosher, C. (2007). Understanding the bear movement in gay male culture. Journal of Homosexuality, 53(4), 89–112. Rofes, E. (1997). Academics as bears: Thoughts on middle-class eroticization of workingmen’s bodies. In L. Wright (Ed.), The bear book: Readings in the history and evolution of a gay male subculture (pp. 89–99). Binghamton, NY: Haworth Press. Smith, T., & Bale, C. (2012). Guide for the modern bear. Townsend, WA: Pixelita Press. Suresha, R. (2009). Bears on bears: Interviews and discussions. Birmingham, AL: Bear Bones Books. Willoughby, B. L., Lai, B. S., Doty, N. D., Mackey, E. R., & Malik, N. M. (2008). Peer crowd affiliations of adult gay men: Linkages with health risk behaviors. Psychology of Men & Masculinity, 9(4), 235–247. Wright, L. (1997). The bear book: Readings in the history and evolution of a gay male subculture. Binghamton, NY: Haworth Press. Wright, L. (2001). The bear book II: Further readings in the history and evolution of a gay male subculture. Binghamton, NY: Haworth Press.

BEREAVEMENT See Dying, Death, and Bereavement

BIAS IN THE CRIMINAL JUSTICE SYSTEM Although people commonly refer to the criminal justice system in the United States, there are actually many criminal justice systems—at the federal, state, and local levels—each of which is a constellation of agencies working toward (a) preventing crime and disorder, (b) apprehending and punishing criminal offenders who commit crime, (c) rehabilitating offenders, and (d) restoring victims of crime to make them whole. Crime, in turn, is conduct that threatens the existing social order and,

therefore, has been prohibited; sanctions attach to it. Because our social order is dominated by straight, White, male Christians, it is unsurprising that, historically, women and minorities—including LGBTQ people—have been subjected to especially harsh treatment by the criminal justice system. This entry addresses LGBTQ people’s attitudes toward the criminal justice system and vice versa, provides an example of why the attitudes of criminal justice personnel matter, and then concludes with a description of current and developing employment practices affecting LGBTQ people within this system.

LGBTQ Attitudes Toward the Criminal Justice System Understanding the attitudes of sexual minorities toward the criminal justice system is important for a variety of reasons. First, research shows that sexual minorities are disproportionately likely to be the victims of hate crimes involving serious violence. Second, the increased harm is exacerbated since many victims of these crimes decide not to report them to the police because they fear hostility and abuse at the hands of the police. Third, restorative and other services for these victims may require more nuanced approaches than those for other victims. Male victims of abuse, for example, who receive assistance in learning to “fight back,” benefit from a reconstructed, nonvictim identity that helps them move past the assault. Research on the attitudes of LGBTQ persons toward the criminal justice system is mixed. On one hand, LGBTQ people, as compared with their straight, gender-conforming counterparts, have been shown to report (a) less trust in the police, (b) lower perceived legitimacy of the police, (c) less respect from the police, (d) poorer treatment by the police, and (e) less fairness from the criminal justice system. On the other hand, LGBTQ people have been found overwhelmingly to be satisfied with the police. Regardless of the extent to which sexual orientation or gender identity might influence attitudes toward the criminal justice system, it is clear that, like their gender-conforming, heterosexual counterparts, the attitudes of LGBTQ

Bias in the Criminal Justice System

people are related to a plethora of variables, including age, victimization history, income, political persuasion, and empathic concern.

Criminal Justice System Attitudes Toward LGBTQ Persons The evolution of attitudes within the criminal justice system toward sexual minorities is illuminated by a review of two important U.S. Supreme Court decisions on the constitutionality of sodomy laws. In Bowers v. Hardwick, a 1986 decision ruling Georgia’s sodomy statute constitutional, the Supreme Court determined that [t]he issue presented is whether the Federal Constitution confers a fundamental right upon homosexuals to engage in sodomy and hence invalidates the laws of the many States that still make such conduct illegal and have done so for a very long time. The case also calls for some judgment about the limits of the Court’s role in carrying out its constitutional mandate.

In a single sentence, the Court laid out four different rationales for authorizing the continuing condemnation of homosexual behavior through criminal law, namely, that (1) there is no fundamental right to engage in sodomy, (2) homosexual persons should not be entitled to special treatment, (3) citizens have the right to express their moral opprobrium through state law, and (4) same-sex behavior has been condemned throughout history. Less than two decades later, in Lawrence and Garner v. Texas (2003), however, the Court would judge this approach unfavorably: To say that the issue in Bowers was simply the right to engage in certain sexual conduct demeans the claim the individual put forward, just as it would demean a married couple were it to be said marriage is simply about the right to have sexual intercourse. The laws involved in Bowers and here are, to be sure, statutes that purport to do no more than prohibit a particular sexual act. Their penalties and purposes, though, have more far-reaching consequences, touching upon the most private human conduct, sexual

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behavior, and in the most private of places, the home. The statutes do seek to control a personal relationship that, whether or not entitled to formal recognition in the law, is within the liberty of persons to choose without being punished as criminals.

Lest any doubt exist about its view of the Bowers decision, the Court, in a stinging rebuke, held that “Bowers was not correct when it was decided, and it is not correct today. It ought not to remain binding precedent. Bowers v. Hardwick should be and now is overruled.” Although it is tempting to view this evolution in sodomy case law as evidence of a sea change in tolerance, such a conclusion would be too hasty. At the time of the Lawrence decision, 13 states prohibited sodomy and 9 singled out same-sex behavior. Many states subscribe to a lock-and-key conceptualization of appropriate human sexual behavior in which anything other than the “right” key going into the “right” lock is considered sodomy. Thus, creative heterosexual behavior can run afoul of sodomy statutes as well. Moreover, in Lawrence only a bare majority of the Supreme Court held that the right of privacy extended to same-sex sexual intimacy. Justice Sandra Day O’Connor agreed with the outcome, but for a different reason. As we see unfolding now in the context of marriage equality, justice is available largely through the courts and even then, sometimes by thin majorities. Finally, the criminal justice system is populated by conservative employees and conservative ideals—all seeking to maintain the discriminatory status quo.

Police Attitudes Toward LGBTQ Persons Maintenance of the status quo is the essence of conservatism, the dominant philosophy of police officers. Studies of police have consistently shown a strong conservative bias. Research has repeatedly demonstrated that the police generally have antiquated perspectives on sexuality and tend to have punitive attitudes toward sexual minorities who commit crimes. They tend to subscribe to negative stereotypes of LGBTQ people and to feel superior.

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On the other hand, there appears to be a lack of congruence between attitudes and behavior. In fact, studies generally fail to demonstrate a direct relationship between unfavorable attitudes toward gays and lesbians and discriminatory behavior. This has not always been the case, however, as discriminatory practices of the past were much more blatant and led to bitter conflict. On the heels of the civil rights movement for African Americans during the 1960s, the LGBTQ civil rights movement was born out of the crucible of such conflict. The flashpoint occurred in New York City in the summer of 1969 at a gay tavern in Greenwich Village. The patrons of the drag bar were accustomed to frequent raids, but in the early morning hours of June 28, 1969, a routine raid became anything but. The patrons resisted the police, then assaulted them, and then riots broke out over the following days. Years of frustration at being discriminated against and denied their personhood bubbled up among the bar’s patrons, and a movement was born; enough was enough. Unfortunately, police harassment—or the perception thereof—persists. In 2013, a decade after the Supreme Court held same-sex sexual intimacy to be constitutionally protected, East Baton Rouge Parish (Louisiana) Sheriff Sid Gautraux targeted gay men for arrest on account of conduct that was clearly legal. Harassment of LGBTQ persons, of course, is problematic. Proper police practices, though, can and should be informed by the LGBTQ status (and associated characteristics) of perpetrators. Recent research suggests that certain characteristics that vary among LGBTQ people (e.g., openness about sexual orientation, internalized homophobia, and connection to the lesbian, gay, and bisexual community) may be associated with certain types of offending patterns. Moreover, once arrested, sexual-minority detainees may require different treatment with regard to housing decisions.

targets of arrests and prosecutions. LGBTQ people are also victims of crime—indeed at higher rates than their gender-conforming, heterosexual counterparts—and, therefore, are entitled to protection by and vindication through the criminal justice system as well. Because sexual orientation and gender identity may influence differential victimization rates, comfort levels with the criminal justice system, and restorative treatment approaches, among other factors, the system needs to be willing and able to respond with the kind of sensitivity, compassion, and competence other victims have come to expect.

The Criminal Justice System as Employer Although the criminal justice system cannot choose its perpetrators or victims, it can and must choose its employees. Discrimination against LGBTQ persons in general is well documented. Recent studies suggest that gay and lesbian applicants for criminal justice system jobs are less likely to progress beyond initial screening in the hiring process. Such discrimination is more likely (a) in some parts of the country than others, (b) with jobs associated with stereotypically male and straight traits than those without such associations, and (c) against gay men than against lesbians. Once LGBTQ persons are hired, employers often treat them as outsiders. LGBTQ employees in general, and gay male police officers in particular, report feeling pressure to hide their sexual orientation. Ironically, this is easier now than in the past because criminal justice agencies are increasingly refraining from exploring matters of sexuality and gender identity as part of the background investigatory process. Thus, aspects of their sexuality and gender identity pose added challenges that LGBTQ employees must balance alongside the demands of their jobs.

A Brighter Horizon Restoring Victims to Make Them Whole Appropriate responses to LGBTQ persons involve more than proper treatment when they are the

There are promising signs that the criminal justice system employment context for LGBTQ employees is improving. Earl Warren was chief justice of

“Big Data” Bias in LGBTQ Research

the United States Supreme Court from the mid1950s through most of the 1960s. One of his guiding principles, which informed the overall direction of the Court, was that the criminal justice system had to undergo massive reform to safeguard and guarantee the Constitutional rights of all citizens, thereby ensuring that the criminal justice system was populated by professionals who represented the communities they served. This coincided with President Kennedy’s Executive Order 10925 directive that agencies “take affirmative action to ensure that applicants are employed, and that employees are treated during employment, without regard to their race, creed, color, or national origin.” As a result of these developments, the all-White, all-Christian, allmale, all-straight criminal justice agencies of the 1950s and 1960s gave way to a more diverse workforce. Although criminal justice agencies have been slower to embrace sexually diverse and gendernonconforming employees than they have been to accept ethnic and racial minorities and women, considerable progress has been made. Gay, lesbian, and bisexual officers are serving openly, and agencies are beginning to be more accepting of transgender employees as well. As noted above, agencies are de-emphasizing these issues in background investigations. Some agencies are changing their policies to clarify that sexual-minority and gendernonconforming employees are welcome. Some agencies have gone so far as to recruit LGBTQ and intersex persons to work for them. The Fort Worth Police Department in Texas, for example, actively recruits LGBTQ employees and has allowed one of its gay officers and several of his straight allies to appear in a statewide freedom-to-marry advertisement. Those agencies that have accepted LGBTQ persons into their ranks have discovered that the transition has not been as challenging as they had anticipated. Gradually, agencies have come to accept these employees as part of the new normal. Although full acceptance is still a goal for the future, considerable progress has been made. Phillip M. Lyons

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See also Criminal Legal System and LGBTQ People; Discrimination Against LGBTQ People by Law Enforcement; Incarceration; Laws Banning Homosexuality and Sodomy; Marriage Equality, Landmark Court Decisions; Police Officers/Law Enforcement Officials; Sexual Minorities and Violence; Stonewall

Further Readings Bowers v. Hardwick, 478 U.S. 186 (1986). Lawrence and Garner v. Texas, 539 U.S. 558 (2003).

“BIG DATA” BIAS RESEARCH

IN

LGBTQ

The term big data, which originated in the business world, is used widely in many fields, whereas it is just emerging in others, such as the social sciences. The wide availability and rapid development of technology has produced an array of public and private big data sources with a wealth of information. Data sources can be informal, such as reading friends’ posts on Facebook or using a search engine to check on someone before a first date. Sources can also be formal, such as United States Census Bureau figures on the number of samesex-headed households. As used here, big data refers to datasets whose large size or complex contents can be used to inform decision making, monitor trends, understand complex phenomena, solve problems, and/or improve quality of life. Such datasets often include so much data that they are extremely difficult to use, and most software cannot process all of the information for analysis. Consider Facebook again. If we wanted to use Facebook to examine public reaction trends related to recent marriage equality rulings, various posts on people’s pages could be good data. However, Facebook collects much more extensive data, too, that could offer additional information about ruling reactions. Data include time of posts about ruling reactions, number of “likes,” demographic profiles of everyone making or responding to a post, and how quickly posts are

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made, to name a few. The amount and types of data available are immense, far more than can be used in any single study. Yet, the quantity and complexity of big data does not always produce betterquality information than smaller, more traditional datasets, and may even lead to increased sources of bias. For example, Facebook only has a like button—and not a dislike option. This entry discusses some of the biases related to big data (e.g., representativeness, validity of findings), particularly in studies of LGBTQ populations, after further defining big data within the social sciences.

Defining Big Data in the Social Sciences In social sciences, big data refers to large quantitative and/or nationally representative datasets that allow application of research findings to a larger population with varying degrees of generalizability. There are population-based studies, such as the United States Census, that examine an entire population and whose results are considered almost completely generalizable. Others may include a sample of a population, drawn to ensure it is proportionately representative; sample size can vary greatly from less than 1,000 to well over 10,000. For example, consider public opinion polls examining marriage quality using random samples. Though considered highly generalizable to the population from which the sample was drawn, a margin of error illustrates how results may vary when corrected for possible bias. Other big datasets are longitudinal, either following the same group of people over time or asking the same questions to representative groups of different people over time (i.e., panel studies). For any study to be considered potentially generalizable, the sample obtained should mirror the population from which it was drawn (e.g., it should be similar in terms of gender, age, race/ethnicity, sexual orientation). In instances where the sample may not be nationally representative but was followed longitudinally, results are considered somewhat generalizable given the ability to identify time order of variables. These types of datasets are examined by researchers for patterns and trends pertaining to

social issues like marriage/romantic relationships (United States Census, British Cohort Study), health (Add Health, Youth Risk Behavior Surveillance System [YRBSS]), attitudes and beliefs (General Social Survey), and population demographics (United States Census, American Community Survey). Great expense and labor are spent collecting and maintaining these datasets because they offer unique information and insights in areas like disease, cohabitation and marriage, poverty, and demographic composition. In fact, these data may be used to influence policy decisions such as marriage equality or the ability of same-sex couples to adopt. As such, big data is increasingly used to identify and understand LGBTQ individuals and same-sex-headed households. Unfortunately, the use of big data for such purposes is fairly new and continues to be hindered by potential biases.

Bias in LGBTQ-Related Research The usefulness of big data is dependent on its quality. In some ways, big data has been beneficial by creating access to previously unattainable information. For example, YRBSS data showed that lesbian, gay, and bisexual youth encounter discrimination from schools and peers, and are at higher risk of engaging in suicide attempts as a result. As with any research, however, these benefits bring challenges. Potential sources of bias include, but are not limited to, representativeness, validity of findings, and valuing big data over qualitative research. Representativeness

Representativeness is the degree to which any sample represents the population from which it was drawn, and partially determines the extent to which results are generalizable. Although sampling strategy choice influences representativeness, the focus here is only on biases related to questions used to identify LGBTQ respondents in national datasets. Only in the past decade or so have datasets begun to include such questions, and most still do not include questions that allow us to identify LGBTQ respondents. The absence of sexual

“Big Data” Bias in LGBTQ Research

orientation questions clearly leads to biases in existent data and derived estimates. Proxy questions are sometimes used in an attempt to identify LGBTQ respondents and make use of big data. For example, some researchers have tried to estimate the number of same-sex couples using data from the United States Census, which did not include a specific question about sexual orientation. Estimates were made by identifying couples that (a) shared a sex and (b) identified themselves as married or in an unmarried household. Researchers found that just 1 in 7 couples was accurately identified using this method. Future versions of the United States Census will include questions that facilitate improved counting of LGBTQ households, thereby promoting representativeness. When questions related to sexual orientation or relationship status are included, the questions’ wording can bias results because questions are often are asked from a heterosexist point of view; that is, relationships and behaviors are conceptualized in heterosexual terms, thus invalidating or ignoring the LGBTQ lived experience. For example, according to some estimates, the number of adults who identify as LGBTQ in big datasets ranges between 5.2 and 9.5 million. Additional estimates show other ranges, such as between 2.2% and 4.2% or between 4.0% and 5.6%. Clearly, the differences are large, reflecting potential bias in question wording. In addition to affecting our estimates of the LGBTQ population, biased survey questions leave researchers without a clear sense of LGBTQ issues or processes in domains such as health, employment, family, youth, relationships, and education. The Sexual Minority Assessment Research Team, which is housed at the Williams Institute at the University of California, Los Angeles, suggested a way to assess sexual orientation that reduces heterosexist bias. First, the researcher should ask what respondents consider their selfidentity (gay, lesbian, bisexual, or heterosexual). Since sexuality is understood differently in nonWhite populations, it may be appropriate to include options such as two-spirit, same gender loving, homosexual, down low, or queer. Next, inquire about sexual behavior, including the

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gender of sexual partners in the recent past and throughout life. Finally, ascertain sexual attraction, the sex or gender of individuals to which one feels attracted. For adolescents, who may not yet have engaged in sexual activity, attraction may provide more useful and less biased data. Including multiple transgender response options (i.e., transgender male-to-female, transgender female-to-male, and transgender) when asking respondents’ gender is also needed, in order to reduce bias and represent an often ignored part of the LGBTQ community. Importantly, even when adequate questions are included, underreporting bias is a concern that hinders representativeness. Given the historical mistreatment of minorities in society and research as well as fear of being outed, some LGBTQ people are hesitant to report sexual or gender identity. Validity and Use of Findings

Big datasets often rely on single-item global measures to represent concepts, thereby allowing them to examine myriad topics but without much depth. Further, big data often is used for comparison purposes; yet, it fails to include variables unique to the experiences of LGBTQ individuals and families. This can limit the validity of findings, and when such findings are used for comparison purposes can lead to biased interpretations. For example, research suggests that relationship satisfaction is comparable between same- and differentsex couples. However, we know that discrimination negatively influences LGBTQ individuals and couple relationships. Yet, most big data does not include measures of LGBTQ discrimination, and therefore cannot account or control for it. Suggesting a similarity between couple types without accounting for discrimination is biased and not a valid comparison or interpretation of the findings because it can render invisible the potential higher resilience, and satisfaction, among same-sex couples. Moreover, comparisons reinforce the privileged status of heterosexuality. Another example of such privilege in comparison studies is the assumption that all same-sex couples are the same (monolithic

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assumption). Some studies have grouped all samesex couples together and then compared them with different types of different-sex couples (e.g., cohabiting, married). The choice of “cohabiting” or “married” may not be available to all same-sex couples (i.e., due to lack of laws that permit marriage, or a fear of being outed in a largely disaffirming community if one moved in with a partner), nor do all same-sex couples wish to create such types of relationships that can reproduce heterosexual ideals (i.e., long-term partnership or nuclear family structure), preferring other living arrangements (i.e., nonresidential partnerships) instead. However, most studies assume comparability, and this can create one type of conceptual bias. Likewise, using data with conceptual biases can produce varied interpretations, including misrepresentation and overgeneralization of findings. For example, in a publication that was met with widespread scholarly criticism, Mark Regnerus claimed that children raised by same-sex parents are more likely to experience sexual abuse and to attempt suicide than children raised by a different-sex couple. According to critics, however, his research did not actually support that conclusion. Regnerus used responses solely from youth born into heterosexual marriages that later ended in divorce and had a parent who ever had at least one same-sex relationship. Essentially, then, the study never actually measured outcomes of children raised by same-sex couples and therefore comparisons with children raised by continuously married differentsex couples are invalid. Regardless, the study is continually cited in proposed adoption legislation and marriage equality cases, perpetuating harmful myths about same-sex couples and parenting and also demonstrating the value afforded to big data.

Valuing Big Data Over Qualitative and Small-Scale Quantitative Data Big data is valued over qualitative and small-scale quantitative data because of its ability to achieve levels of generalizability. In the case of LGBTQ research, qualitative data may hold the unique position of enhancing the validity of big-data

findings. Qualitative data can illustrate domains of research bias and may guide question development for inclusion in quantitative investigations, especially those related to new phenomena, as well. Additionally, qualitative data can help researchers understand the nature and meaning of findings such as those related to the comparison of relationship satisfaction between same- and different-sex couples, discussed earlier in this entry. All types of data, when used in concert, can provide a richer, more nuanced, and holistic understanding of findings. For instance, quantitative studies suggest 15% to 43% of LGBT Americans experience workplace discrimination. The large range may represent bias based on how questions were phrased in the studies and the types of discrimination assessed in each. It also is likely biased due to underreporting, often associated with respondent fears of reporting in surveys or because surveys often do not include questions about unique experiences. The ranges above included quantitative measurement of general acts of discrimination (e.g., job denial or loss, physical and verbal abuse), but did not include microaggressions (e.g., overheard phrases such as “that’s so gay,” being asked who the “real” parent is when a same-sex couple is at a work social with their child). Evidence of microaggressions, uniquely experienced by minority groups, has been captured by qualitative inquiries since the 1970s, yet remains largely undocumented by quantitative studies. These qualitative studies suggest that even the 43% figure above may be an underestimate and it does little to tell us about the different types of discrimination experienced or how certain types of discrimination may be related to various outcomes (e.g., well-being). Utilizing quantitative data to document trends and qualitative approaches to add depth and meaning can produce breadth and depth of knowledge, thereby reducing bias.

Future Directions As the number of large datasets increases and new information is gleaned, it is critical to improve data quality, the cornerstone of evidence driving national

Binational Same-Sex Couples and Families

and global decisions, policies, and programs. To gain the most meaningful insight as big data develops and the LGBTQ community increases in visibility, researchers must ask more complex social questions, requiring the collection of better data with reduced bias. This requires balance between the high cost and difficulty of collecting big data. Forecasts suggest large-scale, high-performance computing will produce data that require shifts in research practice and that bring increased ease and reduced collection costs. If bias is reduced, the future of big data promises to revolutionize LGBTQ research, allowing researchers to move from the current form, large-scale longitudinal datasets, to analyzing real-time data on whole populations, answering complex questions about behavior with power and confidence. But there is no need to wait to implement best practices. Advocating for the inclusion of LGBTQ individuals and families in big data collection can continue alongside increased efforts to reduce bias in question wording and inclusion of variables unique to the LGBTQ experience, allowing more accurate comparisons to be made. Although bias will unavoidably remain a part of all research, it is important to be vigilant in making it visible and interpreting findings accordingly. Brad van Eeden-Moorefield and Lisa Chauveron See also Demographics and the LGBTQ Population; Heterosexist Bias in Research; Methodological Decisions by Researchers of LGBTQ Populations; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity; Psychological Approaches to Studying LGBTQ People; Qualitative Research; Quantitative Research; Research, Use of Large Datasets in; Sampling

Further Readings Gates, G. (2014). LGBT demographics: Comparisons among population-based surveys. Los Angeles, CA: Williams Institute. Retrieved from http:// williamsinstitute.law.ucla.edu Herek, G., Kimmel, D., Amaro, H., & Melton, G. (1991). Avoiding heterosexist bias in psychological research. American Psychologist, 46, 957–963.

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Meyer, I. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. Russell, S., & Muraco, J. (2013). The use of representative data sets to study LGBTQ-parent families: Challenges, advantages, and opportunities. In A. Goldberg & K. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 343–356). New York, NY: Springer. Sexual Minority Research Assessment Team. (2009). Best practices for asking questions about sexual orientation on surveys. Los Angeles, CA: Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu

BINATIONAL SAME-SEX COUPLES AND FAMILIES Historically, the topics of same-sex marriage and immigration reform have been debated as separate political issues. Both issues, however, have impacted the lives of LGBTQ immigrants and their American partners. Presently in the United States, families that include same-sex binational couples are part of the increasingly diverse family landscape. Binational couples are defined here as same-sex partnerships in which one spouse or partner is an American citizen or resident and the other is a foreign national. For years, the ideological underpinnings inherent in immigration laws separated committed couples, forced couples into exile, and resulted in the deportation of partners/spouses of Americans under the Defense of Marriage Act (DOMA). This entry describes the sociocultural context in which binational couples are situated and the challenges they face today. In the following sections, the entry presents the demographics of binational families, the ways in which DOMA directly impacted immigration law and the lives of binational families, the positive ramifications DOMA’s repeal has had on binational families, and the challenges and obstacles binational families continue to face even after the U.S. Supreme Court struck down state bans on same-sex marriage.

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The Demographics of Binational Couples As of 2010, data from the American Community Survey estimated that 12% of same-sex couples in the United States had at least one noncitizen partner. The Williams Institute found that among noncitizen partners in same-sex binational couples, 45% are Latina/o and 14% are Asian/Pacific Islander. The majority of noncitizen partners come from Mexico (25%), Canada (8%), and the United Kingdom (6%). Data from the study proposed that a quarter of male binational couples and 39% of female binational couples are raising an estimated 17,000 children. Another study published by the Williams Institute in 2013 found that from 2005 through 2011, same-sex couples were as likely as opposite-sex couples to be binational.

DOMA’s Impact on Binational Couples Designed to define marriage as the legal and valid union between a man and a woman, DOMA ensured that same-sex marriages recognized by individual states would not be entitled to more than 1,000 federal marriage benefits, including immigration benefits. Under DOMA, Americans in same-sex relationships were not allowed to bring their noncitizen partner/spouse to the United States or provide citizenship to their settled immigrant partner living with them in the United States. Instead, Americans were forced to decide between staying in the United States without their partner and starting a new life with their family abroad. To comply with immigration law, many binational couples alternated between living in the United States for a few months and abroad for the rest of the year. Married couples in which one partner is transgender were required to demonstrate that their unions qualified as valid opposite-sex marriages under state law to gain immigration benefits. Foreign nationals living in the United States with their American citizen partners were forced to choose between the following options: face voluntary deportation; apply for a temporary visa; assume undocumented status for an indefinite period of time or, perhaps, for a lifetime; or move the family

to another country where same-sex binational families are fully recognized. In many cases, the noncitizen partner’s deportation interfered with previously established household relationships and seriously disrupted parent–child attachments. At times, foreign nationals were deported back to countries that criminalize homosexuality and persecute individuals based on their sexual orientation and gender identity or expression; penalties currently range from small fines to death sentences. American citizens who followed their partners after deportation often faced several challenges including leaving their support network, native language, career, and elderly parents behind. Research conducted by Anusha Kassan and Nadine Nakamura in 2013 found that binational couples often immigrated to Canada when the pursuit of legal status by the foreign national through student or work visas in the United States was no longer a viable option.

Hardship Under DOMA Because immigration control is partly responsible for nation making and national security, immigration officers rigorously consider sexuality and its overlapping identities including gender, race, and class at the time of admission. Unique barriers surface for LGBTQ immigrants as they are many times situated at the intersection of homophobia, racism, and anti-immigrant sentiment. Moreover, the U.S. economic crisis together with the declared “War on Terror” turned immigration into a disputed sociopolitical topic. After the September 11, 2001, terrorist attacks on the United States, stricter immigration laws induced ongoing psychological stress for immigrant families living in the interior of the nation as they potentially faced long-term family separation as a result of deportation or voluntary departure. In 2006, researchers working for Immigration Equality and Human Rights Watch found that binational couples living in the United States suffered from emotional hardship and feelings of immobility, isolation, fear, anxiety, and terror as a result of the “forced confidentiality” that came with threats of facing family separation. In the case

Binational Same-Sex Couples and Families

of same-sex binational couples with children, invisibility was perceived as a defensive coping strategy that protected families from experiencing parent–child separation. Binational parents had to navigate the persistent tension between recognition and protection. Further, they were forced to make important determinations about disclosure when interacting with various systems (e.g., religious community, employment, and education), especially when they perceived homophobia within their immigrant communities. Same-sex binational couples were forced to learn how to function in a social system while dealing with heterosexism, overt discrimination, violence, and the psychological symptoms that result from helplessness. In the case of LGBTQ ethnic and racial minorities, language, cultural barriers, and racism inside mainstream LGBTQ groups may interfere with their integration into the local LGBTQ community. For example, Latina/os in same-sex binational relationships frequently have to navigate multiple cultural values including religious beliefs, a strong sense of masculine pride (i.e., machismo), and family loyalty. They are often forced to decide between living their life openly as members of the LGBTQ community or following the conventional expectations of their family of origin and church communities. During their coming-out process, LGBTQ Latina/os often suffer major losses including family, church, and social support. Mainstream LGBTQ groups can create an atmosphere of confusion and distress when they reject or challenge the cultural beliefs, values, and traditions of LGBTQ ethnic and racial minorities.

DOMA’s Demise: A Victory for Binational Couples While supporters of same-sex marriage argued that DOMA endorsed and legitimized the inequality to which same-sex couples are subject, opponents of same-sex marriage contended that DOMA legitimately followed a tradition of male–female unions. They argued that providing marriage rights to same-sex couples would lead to a downfall of the “traditional” institution of marriage and damage the health of children. Supporters of

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family equality claimed that “tradition” should not be confused with discrimination and underlined the constitutional promise of the equal protection of laws for all Americans as the foundation for the fundamental right to marry a person of one’s choosing. On June 26, 2013, supporters of marriage equality claimed victory when the U.S. Supreme Court struck down Section 3 of DOMA in United States v. Windsor and recognized marriages of same-sex couples at the federal level. As a result, President Obama directed United States Citizenship and Immigration Services (USCIS) to review immigration visa petitions filed on behalf of a same-sex spouse in the same manner as those filed on behalf of an opposite-sex spouse. With this victory, a number of parent–child relationships neglected under DOMA were recognized for purposes of citizenship sponsorship and transmission, and foreign nationals married to U.S. citizens were given the opportunity to obtain immigrant visas for their children. This was a partial win for same-sex binational families residing in nonrecognition states as they were expected to travel and marry in states that recognized same-sex marriage to qualify for immigration benefits. Another challenge faced by binational couples after the U.S. Supreme Court’s Windsor decision was the issue of divorce. For same-sex couples residing in states that did not perform same-sex divorces, divorcing spouses was a complex process as there was contentious debate over which jurisdiction should perform the divorce. Thus, if same-sex binational couples married prior to divorcing their spouses, USCIS may have considered the marriage to be polygamous and invalid for immigration benefits. After the United States v. Windsor decision, some states continued to endorse bans on same-sex marriage despite empirical evidence that illustrated the harmful psychological effects of policies restricting marriage rights for same-sex couples. In 2010, Mark L. Hatzenbuehler, Katie A. McLaughlin, Katherine M. Keyes, and Deborah S. Hasin proposed that lesbian, gay, and bisexual (LGB) people living in states with constitutional bans on gay marriage demonstrated a significant increase in the

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prevalence of mood disorders, generalized anxiety disorder, alcohol use disorders, and psychiatric comorbidity. In contrast, psychiatric disorders did not increase significantly among LGB respondents living in states without constitutional amendments prohibiting same-sex marriage. With this and similar research in mind, supporters of marriage equality advocated for the equal protection, recognition, and mental health of same-sex couples nationwide. On June 26, 2015, the Supreme Court’s landmark decision in Obergefell v. Hodges required all states to issue marriage licenses to same-sex couples, including same-sex binational couples. This decision invalidated state laws banning same-sex marriage, required all states to recognize same-sex marriages previously performed in other jurisdictions, and provided the equal right to divorce regardless of where the couple married. This decision gave same-sex binational couples living in states that had bans on gay marriage the freedom to marry in the state of their choosing and enjoy spousal benefits including all state tax benefits. It is important to state that civil unions or domestic partnerships are not accepted for immigration purposes at this time. It remains unclear exactly how relevant the Supreme Court’s decision will be for same-sex binational families raising children in a post-Obergefell Obergefell world.

Today’s Struggles When United States Citizenship and Immigration Services (USCIS) reviews immigration visa petitions filed on behalf of a same-sex spouse, the government asks couples to provide evidence that their marriages are valid. Same-sex binational couples sometimes have difficulty proving to the Department of Homeland Security that their marriage is a genuine or “bona fide union” because they often lack the same forms of evidence or proof that opposite-sex couples have available (e.g., family and/or friend testimonies of the marriage). As a result, they may find themselves facing unsupported accusations of marriage fraud. An article published by Benjamin Edwards in 2013 argues

that immigration officials should understand the culture-specific differences between same-sex and opposite-sex marriages before determining whether a marriage is valid or fraudulent. Although it may be suspicious when an opposite-sex couple has not openly declared their marriage to friends and families, same-sex couples may choose to keep their relationship private to avoid having traumatic conversations with relatives. Considering available research identifying the prevalence of psychiatric disorders among LGB populations that lived in states with bans on samesex marriage, special attention should be given to same-sex binational couples that lived in those states for years. Unfortunately, although LGBTQ immigrants are in need of quality health services, including mental health care, research conducted by Karma R. Chavez in 2011 suggested that when LGBTQ immigrants needed help with health care concerns, they turned to family and friends as they perceived a lack of cultural competence and cultural awareness from service providers.

Conclusion Overturning Section 3 of DOMA yielded significant victories for same-sex binational families, such as eligibility to obtain immigration benefits for foreign national partners and the potential for children of foreign nationals in same-sex-binational relationships to gain immigrant visas. Nevertheless, numerous obstacles and threats continue to affect these families even after the Supreme Court’s decision to invalidate state bans on same-sex marriage in Obergefell v. Hodges. The U.S. Constitution grants the legislative and the executive branches sole power to regulate all aspects of immigration law. Congress, for example, has the power to exclude immigrants from entering the United States. Thus, even in a post-Obergefell world, same-sex couples remain vulnerable to the power Congress holds to change immigration law. While marriage equality provides undeniable positive outcomes for same-sex binational families, unrelenting hardships uphold the necessity for continued attention to this population.

Biphobia

On November 20, 2014, President Obama announced a series of executive actions to provide up to 5 million undocumented immigrants protection from deportation. Although these measures aim to help immigrants who have U.S. citizen children and spouses, such protection excludes more than 267,000 undocumented LGBTQ immigrants, many of whom are unmarried LGBTQ binational couples. With that in mind, future immigration reform needs to be LGBTQ-inclusive and protect undocumented LGBTQ immigrants from being deported to countries that criminalize homosexuality. Although many same-sex binational couples have celebrated the repeal of DOMA and the Supreme Court’s decision in Obergefell v. Hodges, inclusive immigration reform and policy at the state level are needed to fully recognize and protect unmarried same-sex binational families. Daniela G. Domínguez and Jacqueline E. Coppock See also Defense of Marriage Act (DOMA); Discrimination Against LGBTQ People by Law Enforcement; Freedom to Marry (and Other Marriage Equality Organizations); Immigration; Marriage Equality, Landmark Court Decisions

Further Readings Canaday, M. (2009). The straight state: Sexuality and citizenship in twentieth-century America. Princeton, NJ: Princeton University Press. Chavez, K. R. (2011). Identifying the needs of LGBTQ immigrants and refugees in southern Arizona. Journal of Homosexuality, 58(2), 189–218. Domínguez, D. G., Solórzano, B. H., & Peña, E. (2012). Non-heterosexual binational families: Resilient victims of sexual prejudice and discriminatory immigration policies. Journal of GLBT Family Studies, 8(5), 496–508. Edwards, B. P. (2013). Welcoming a post-DOMA world: Same-sex spousal petitions and other post-Windsor immigration implications. Family Law Quarterly, 47(2), 173–189. Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay,

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and bisexual populations: A prospective study. American Journal of Public Health, 100, 452–459. Human Rights Watch, & Immigration Equality. (2006). Family, unvalued: Discrimination, denial, and the fate of binational same-sex couples under U.S. law. New York, NY: Author. Retrieved February 16, 2016, from https://www.hrw.org/sites/default/files/ reports/FamilyUnvalued.pdf Kassan, A., & Nakamura, N. (2013). “This was my only option”: Career transitions of Canadian immigrants in same-sex binational relationships. Journal of LGBT Issues in Counseling, 7(2), 154–171. Konnoth, C. J., & Gates, G. J. (2011). Same-sex couples and immigration in the United States. Los Angeles, CA: Williams Institute.

BIPHOBIA The term biphobia describes forms of prejudice and discrimination against bisexual people. It covers antibisexual sentiments and negative attitudes regarding bisexual people and their (alleged) characters, bodies, relationships, families, and sexualities. The concept gained currency within bisexual activism in the course of the 1990s. There is a family resemblance with the term homophobia, which the psychologist George Weinberg defined in 1972 as an “abnormal dread” of being in proximity with homosexuals. In its contemporary usages, the meanings associated with the term homophobia have broadened beyond the interpersonal to include also cultural and institutional features of antigay discrimination. The same applies to biphobia and other related concepts, such as lesbophobia or transphobia. Bisexual activists interpret biphobia as a distinctive mode of oppression that is different from homophobia, even if there are overlaps regarding certain core themes. A major difference is that bisexuals are likely to experience biphobia not only in heterosexual but also in lesbian and gay spaces. Biphobia encompasses sets of stereotypes, forms of denial (e.g., the claim “bisexuals don’t exist”), or erasure through appropriation (e.g., if bisexuals are seen as closeted or confused homosexuals or misguided heterosexuals). Major anti-bisexual

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stereotypes include the representation of bisexuals as oversexed, promiscuous, and greedy people, who are incapable of monogamy, prone to be swingers, or high-risk partners with respect to sexually transmitted diseases. These assumptions often go hand-in-hand with the view that bisexuals are shallow and narcissistic. The notion that “bisexuals have the best of both worlds” is a benign variant of the oversexualization trope. The belief that bisexuality does not exist or is only a transitory phase takes manifold forms. It stamps everyone who identifies as bisexual a liar or a self-deluding person. In these cases, bisexuals are seen as being as stuck in an immature state, incapable of figuring out their (allegedly) true orientation. The popular metaphor of the “fencesitter” ridicules bisexuals as cowards (who do not have the guts to face the stigma of proudly being lesbian or gay) or as commitment-phobic voyeurs (who refuse to take part in the work of building institutions and communities). In politicized lesbian and gay circles, bisexuals also often experience misrepresentation as untrustworthy allies, cop-outs, or traitors. The distinctive features of a stereotype depend on the wider social context and on the subjectivities of the people involved in an interaction. For example, the stereotype that bisexual women will always leave their woman partner for a man remains largely confined to lesbian-feminist settings. For Black and minority ethnic women, the stereotype of oversexualization is aggravated through a confluence of racist and sexist assumptions. The discourse of the “down low” targets specifically African American men and Latinos through their description as dishonest partners and HIV carriers. Biphobia is not a uniform discourse, but a differentialist and differentializing practice that intersects with other forms of oppression. According to Kenji Yoshino, heterosexual and lesbian and gay cultures conspire in an “epistemic contract of bisexual erasure” that enforces bisexual invisibility. Bisexuals are erased both individually (as in claims such as “they are not bisexual, it’s just a phase”) and collectively (as in claims such as “bisexuality does not exist”).

Critiques of the concept of biphobia have focused on its fixation on the psychological and interpersonal dimension. This implies a focus on individual prejudice rather than structural forms of oppression and their effects, such as poverty, exclusion from services, and workplace discrimination. Alternative concepts, such as bi-negativity and monosexism, aim to avoid such trappings. There has been intense debate on the respective value of these concepts and in particular on the nature of the interrelation between biphobia and monosexism. The term monosexism (and its variations in languages other than English) has had currency in bisexual politics since the 1990s. Monosexism denotes a form of power or structure of privilege that is based on the presumption that every person is (or should be) monosexual, that is, attracted to one sex (or gender) only. For Miguel Obradors, the prevalence of the concept of biphobia has been damaging to bisexual politics, because it fosters a liberal form of identity politics that is concerned with bi representation within institutionalized LGBT lobby politics. Mistrusting what some consider the treacherous solidarity of the “LGBT” rhetoric, Obradors advocates a shift of analysis from biphobia to monosexism in order to ground a radical bisexual politics that also tackles structural inequalities. Shiri Eisner argues that monosexism works in tandem with biphobia. For her, monosexism names the power structures that underpin biphobia. It is both the base and cause for the manifestations of a culture of biphobia. An advantage of the language of monosexism is that, in contradistinction to biphobia, it does not define a target group (i.e., “bisexuals”). This broadens the perspective to recognize that dualistic conceptualizations of gender and sexuality victimize many groups of people, whose identities go beyond the gender binary (including, among others, omnisexuals, pansexuals, queers, anthrosexuals, polysexuals, multisexuals, and fluid or gender-blind people). There are divergent opinions regarding the question as to whether monosexism is an effect of heterosexism and the patriarchal gender order or

Bisexual Inclusion in the LGBTQ Rights Movement

whether it designates an independent power structure. While some prefer the concept of monosexism over biphobia, others have criticized theories of monosexism for failing to highlight the significance of gender divisions or to account for the hierarchization of monosexualities, which results in a structural subordination of lesbian and gay under heterosexual identities. Christian Klesse See also Bisexual Inclusion in the LGBTQ Rights Movement; Bisexual People and Community; Bisexualities; Bisexuality, Female; Bisexuality, Male; Heterosexism; Homophobia; Monosexism; Transgender Inclusion in the LGBTQ Rights Movement

Further Readings Eisner, S. (2012). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Klesse, C. (2011). Shady characters, untrustworthy partners, and promiscuous sluts: Creating bisexual intimacies in the face of heteronormativity and biphobia. Journal of Bisexuality, 11(2–3), 227–244. Obradors-Campos, M. (2010). Deconstructing biphobia. Journal of Bisexuality, 11(2–3), 207–226. Ochs, R. (1996). Biphobia: It goes more than two ways. In B. A. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority (pp. 217–239). London, England: Sage. Yoshino, K. (2000). The epistemic contract of bisexual erasure. Stanford Law Review, 52(2), 353–461.

BISEXUAL INCLUSION RIGHTS MOVEMENT

IN THE

LGBTQ

Bisexual activists have played an important role in nearly every stage of the modern LGBTQ rights movement in the United States, though their contributions have at times been minimized or erased. This entry outlines the inclusion of bisexual people in the history of the broader LGBTQ rights movement dating back to the turn of the 20th century,

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discusses the history of bi-specific activism and advocacy, and addresses the current challenges for the bisexual community and rights movement.

History of the Modern LGBTQ Rights Movement In the late 19th and early 20th centuries, Magnus Hirschfeld, a German physician, began work that inspired some of the earliest LGBTQ organizing in the United States. Hirschfeld was an advocate for the decriminalization of homosexuality within Germany, and operated under the motto of “Justice Through Science.” He believed that discrimination and prejudice directed at sexual-minority people could be mitigated by the transmission of factual information about homosexuality to the general populace. In 1879, Hirschfeld founded the first institute dedicated to the scientific study of sexuality. Hirschfeld’s work in Germany inspired Henry Gerber to form his own gay rights group—the Society for Human Rights—in Chicago in 1924. While this group was short-lived, it is credited as being the first gay rights organization in the United States, and Henry Gerber was inducted into the Chicago Gay and Lesbian Hall of Fame in 1992. The creation of the Society for Human Rights led to the development in 1950 of the Mattachine Society, a social and advocacy group for gay men, which in turn inspired the creation of the Daughters of Bilitis, an advocacy group for lesbians founded in 1955 in San Francisco. In each of these cases, the groups were designated specifically for gay men and lesbians, respectively. During this time period, however, bisexuality gained wider recognition in the United States, partly due to the work of Alfred Kinsey with his 1948 publication Sexual Behavior in the Human Male along with Sexual Behavior in the Human Female in 1953. In these works, bisexuality was defined behaviorally, as the Kinsey scale asked only about actual sexual experiences. Kinsey was one of the earliest researchers to recognize the natural variance in human sexual behavior and that not all people were exclusively heterosexual

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or gay or lesbian. This led to wider social recognition of the concept of bisexuality, and in 1963 the Sexual Freedom League, a society supporting freedom in sexual expression, was formed in New York City. While the group advocated for sexual liberalism generally, it was one of the first advocacy groups to be inclusive of bisexuality. The event that many see as the catalyst for the mobilization of the LGBTQ rights movement in the United States began at a bar in New York’s Greenwich Village in 1969, when sexual and gender minorities began reacting with violent protest to police raids and mistreatment. The Stonewall riots led to wider recognition of the oppression that LGBTQ people experienced in the United States and spurred political organizing efforts from within the community. One of the activists was a self-identified bisexual woman named Brenda Howard, dubbed the “Mother of Pride,” who organized the first annual march in remembrance of the Stonewall riots. Though Howard and other bisexual activists played a critical role in organizing the LGBTQ rights movement, bisexual people were often rendered invisible at such events. For example, bisexual rights had no presence in the first annual March on Washington for Gay and Lesbian Rights in 1979, and it would be another 14 years before the march included “bisexual” in its title.

Bisexual Activists and Advocacy Bisexual activists such as Brenda Howard have been advocating for the inclusion of bisexual rights within the overall LGBTQ rights movement for decades in the United States. In earlier years, much of this advocacy was aimed simply at visibility and recognition of the existence of bisexual people. During the 1970s, bisexual support and advocacy groups were formed, including the National Bisexual Liberation Group in New York, founded by Don Fass. This group published one of the earliest newsletters for the bisexual community, The Bisexual Expression. Other groups formed during this decade include the San Francisco Bisexual Center, the Bisexual Forum in New York, and BiWays in Chicago.

The 1970s also saw the development of organizations for gay and lesbian advocacy around the theme of “pride” following the Stonewall riots, and bisexual activists were involved in this organizing. For example, Bill Beasley, one of the initial organizers of the Los Angeles gay rights movement, advocated for the inclusion of bisexual and transgender in the title of San Francisco’s Gay Freedom Day Celebration Committee, a change that did not come about until 1996. Fritz Klein, a psychiatrist, also advocated for bisexuality and bisexual people during the 1970s. Klein founded the Bisexual Forum and developed the Klein sexual orientation grid, a measure of sexual identity that includes not only sexual behavior (as does the Kinsey scale), but also other variables like sexual fantasy and social preference. This modification of sexual identity measurement was seen as an improvement in terms of bisexuality and sexual fluidity, as it recognized that sexual behavior is not the only determinant of sexual identity. The 1980s saw an increase in group political organizing within the bisexual community, and advocacy led by bisexual activists around the HIV/ AIDS outbreak early in the decade. The East Coast Bisexual Network (now the Bisexual Resource Center) was founded in this decade, as well as BiPOL in San Francisco. The development of BiPOL led to the sponsorship of one of the first bisexual rights rallies in 1984, which occurred during the Democratic National Convention in San Francisco. A few years later, in 1987, a group of bisexual people marched in what was still named the March on Washington for Gay and Lesbian Rights. March organizers put out a Civil Disobedience Handbook with a piece on the visibility of the bisexual rights movement written by Lani Ka’ahumanu. This was one of the first essays in a gay and lesbian publication to focus on bisexual people and issues. Organizing that emerged from the HIV/AIDS epidemic started in the early 1980s and included both public health outreach and efforts to combat bisexual prejudice. Bisexual men in particular were portrayed as being conductors of HIV between heterosexual and homosexual communities—a

Bisexual Inclusion in the LGBTQ Rights Movement

stigma that still exists today. In terms of public health outreach, David Lourea and Cynthia Slater were two bisexual activists who made significant strides in including bisexual people in HIV/AIDS advocacy. Lourea successfully advocated for the inclusion of bisexual men in the San Francisco Department of Public Health’s official statistics regarding HIV/AIDS, and Slater organized the first information switchboard specifically for women’s HIV/AIDS support. Bisexual activism in the 1990s gained further visibility for the bisexual community, as well as inclusion in larger LGBTQ groups. BiNet USA, a bisexual advocacy group, was founded early in the decade and continues to promote bisexual resources and support today. In 1991, the Task Force on Bisexual Issues was founded by cochairs Ron Fox and Sari Dworkin, for the American Psychological Association Division 44: The Society for the Study of Lesbian, Gay, Bisexual, and Transgender Issues. As mentioned above, the March on Washington changed its title to the March on Washington for Lesbian, Gay, and Bi Equal Rights and Liberation, including bisexual people in the title for the first time while still excluding trans people. In the later part of the decade, Michael Page designed the “Bi Pride” flag; Page also helped organize the first annual Celebrate Bisexuality Day on September 23, 1999. In the last 15 years, bisexual activism has spurred a significant increase in academic research regarding issues for bisexual people, including the establishment of the Journal of Bisexuality in 2000. Assessment of biphobia in heterosexual, gay, and lesbian populations has become possible through development of bisexual-specific measures of prejudice, which has led to recognition of the prevalence of biphobia and the effect it has on bisexual people. Research regarding bisexual issues during this time has also revealed the disparities in mental and physical health reported by bisexual people in comparison with heterosexual and gay and lesbian people. In growing recognition of this problem, the Obama administration held a summit with bisexual advocates and government officials to discuss health issues specific to the bisexual

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community in 2013, and the Bisexual Resource Center declared March 2014 as bisexual health awareness month.

Current Needs for Bisexual Inclusion in the LGBTQ Rights Movement There is a need for inclusion of bisexual people and advocacy within the LGBTQ rights movement, because there are numerous issues specific to bisexual community, identity, and experience that are harmful to bisexual people. Two of the primary issues are addressed here—biphobia and health disparities experienced by bisexual people. Biphobia is prejudice and discrimination that targets bisexual people. While it contains elements similar to homophobia in that bisexual people may be discriminated against for engaging in relationships with people of the same sex, it also entails aspects that are not included in homophobia, such as the stereotype that bisexual people are merely heterosexual or gay and lesbian people who are just confused about their sexuality. As seen above, it can also include the exclusion of bisexual people from broader LGBTQ political organizing and recognition. Bisexual people, and in particular bisexual men, are viewed more negatively than lesbian and gay people, and they experience discrimination from both heterosexual and LGBTQ communities—an experience that is thought of as double discrimination. Biphobia presents itself in many ways, from harmful stereotypes of bisexual people to the erasure of bisexuality as a legitimate sexual identity. It can negatively affect the health of bisexual people through minority stress and lack of appropriate health resources. A second primary area of concern for bisexual advocacy is that of the health disparities experienced by the bisexual community in comparison with the health status of heterosexual and gay and lesbian people. Over the past decade, researchers have consistently found that bisexual people report poorer mental and physical health compared with others. The 2010 National Intimate Partner and Sexual Violence Survey conducted by the Centers

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for Disease Control and Prevention (CDC) found that the lifetime prevalence of rape, physical violence, or stalking by an intimate partner was higher for bisexual men and women than for either heterosexual or gay and lesbian people. More recently, the 2013 National Health Interview Survey, also conducted by the CDC, found that a higher percentage of bisexual people reported experiencing serious psychological distress in the past 30 days. Currently, the bisexual community is facing systematic health disparities that are likely driven in part by social inequity stemming from biphobia and bisexual prejudice. As such, it is critical that the LGBTQ rights movement recognizes these disparities and includes these issues within political and social organizing. It is equally critical that bisexual voices and perspectives from a diversity of social locations are included and heard within the LGBTQ rights movement to ensure that any organizing addresses the concerns of all bisexual people. Corey Flanders See also Bisexual People and Community; Bisexualities; Bisexuality, Female; Bisexuality, Male; LGBTQ Social Movements (Assimilation vs. Liberation)

Further Readings Barker, M. (2004). Including the B-word: Reflections on the place of bisexuality within lesbian and gay activism and psychology. Lesbian and Gay Psychology Review, 5(3), 118–122. Deihl, M., & Ochs, R. (2009). Biphobia. In M. Adams, W. J. Blumenfeld, R. Castaneda, H. W. Hackman, M. L. Peters, & X. Zuniga (Eds.), Readings for diversity and social justice: An anthology on racism, anti-Semitism, sexism, heterosexism, ableism, and classism (2nd ed., pp. 276–280). New York, NY: Routledge. Eisner, S. (2013). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Klein, F. (1993). The bisexual option (2nd ed.). New York, NY: Routledge. Ochs, R., & Highleyman, L. (1999). Bisexual movement. In B. Zimmerman (Ed.), Lesbian histories and cultures: An encyclopedia (pp. 112–114). New York, NY: Garland.

BISEXUAL PEOPLE

AND

COMMUNITY

When discussing bisexual people and community, it is important to first define the term bisexual and clarify to whom the term applies. While some people who identify as bisexual may be attracted to only two sexes or genders, many people who identify as bisexual are attracted to a spectrum of people inclusive of more than just cisgender men and women. Thus, it is more accurate to define bisexuality as a sexual identity describing romantic or sexual attraction to more than one sex and/or gender. As for who the term bisexual applies to, the answer is simply to those who self-identify as bisexual. Many people experience attraction to or engage in sexual or romantic behavior with more than one gender, but do not identify as bisexual. They may instead identify as heterosexual or gay or lesbian, or they may identify with another multisexual identity (i.e., attracted to more than one sex and/or gender), such as pansexual or omnisexual. In fact, many people who identify as bisexual also identify with another label, thus calling themselves, for example, bisexual and queer. Sexual identity does not always dictate sexual behavior, so it is important to recognize that self-identification is necessary. Recent research with nationally representative samples in the United States and Canada has found that the number of bisexual people is similar to or greater than the number of people who identify as gay or lesbian. One of the most conservative recent estimates of the size of the bisexual population in the United States is from the 2013 National Health Interview Survey, which included questions on sexual identity for the first time. The researchers in this case reported that 0.7% of the 30,000 people interviewed identified as bisexual. If we generalize to the United States population as a whole, this translates to approximately 2.2 million people who currently identify as bisexual. Other studies with nationally representative samples have found higher rates of bisexuality, including a study by William D. Mosher and colleagues that found that 1.8% of

Bisexual People and Community

men 18 to 44 years of age said they thought of themselves as bisexual, and 2.8% of women. These numbers likely underestimate the actual population of bisexual people, as people who would identify under the bisexual umbrella may not self-identify as bisexual in these studies and are not given an option to claim a different non-monosexual identity. Additionally, in the case of the National Health Interview Survey, the rate of bisexual people may be particularly underestimated, as data are collected face-to-face between an interviewer and participant as opposed to anonymously.

Bisexual Community In general, community has been found to be important and protective for people of minority and stigmatized groups. For example, some research shows that social support provides a buffer against minority stress experienced by marginalized groups. Research has also found that developing a positive group identity can help provide a source of self-esteem for individual group members, and help minimize the effects of stigma from outside the group. Thus, social support, and particularly social support from members of one’s identity group or community, is likely important for the health and well-being of minority group members. For bisexual people, community may be more elusive than for other minority or marginalized groups. While bisexuality is included in the lesbian, gay, bisexual, transgender, and queer community acronym (LGBTQ), many bisexual people do not feel entirely comfortable in either queer or heterosexual communities. Tension can exist between people who identify as lesbian or gay and people who identify as bisexual, some of which stems from biphobia, or bisexual prejudice, a concept that will be addressed below. Thus, while some broader LGBTQ communities can and do provide forms of social support for some bisexual people, these spaces are not always perceived as welcoming. Further, bisexual people may not feel entirely comfortable in mainstream heterosexual communities, as here, too, they are perceived as being different.

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There are fewer opportunities available for bisexual-specific community groups than for broader LGBTQ associations. There are instances of groups in larger metropolitan areas such as the Toronto Bisexual Network, or the American Bisexual Institute in San Francisco. There also exist online communities for bisexual people on platforms like Reddit, a large multipurpose online forum. However, there are fewer bisexual-specific communities and spaces in less-populated areas of the United States, and in environments like high schools where LGBTQ student groups are often advertised as gay–straight alliances, effectively erasing bisexuality altogether. Bisexual people who do not have access to bisexual-specific community space may feel a lack of institutional social support. Current research on bisexuality and community has also identified a lack of community for bisexual individuals. Researchers have begun to investigate what effect this potentially has on the well-being of bisexual people. Absence of social support has the potential to be particularly harmful for bisexual people, as recent research has found that bisexual women report worse mental and physical health in comparison with either heterosexual women or lesbians. Bisexual men also consistently report worse overall health than heterosexual men. Since previous research has found that community and social support are beneficial for members of minority groups in general, it is reasonable to hypothesize that the lack of community experienced by many bisexual people results in their missing the health and well-being benefits of community. Some research has found support for this, whereby bisexual men and women report that supportive relationships and access to community are beneficial to their mental health—though at times experiences of biphobia inhibit their ability to connect with the LGBTQ community.

Challenges to Forming Community If bisexual people find supportive communities less frequently than people of other minority groups, and there are fewer bisexual-specific groups

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available, then there are likely barriers unique to bisexual people in finding and forming community and social support. Two potential barriers that will be addressed here are visibility and biphobia, or bisexual prejudice.

Visibility

In North American society, people typically categorize individuals’ sexual orientation identity via the gender of their partner, when they are partnered. This may often (though not always) be an accurate shortcut to identify a person’s sexual orientation identity if they are monosexual, but it leads to misidentification of bisexual people, as it is less common for people to be seen in relationships with multiple people of varying genders at the same time. In general, there are fewer social markers for people who identify as bisexual. In fact, past research has indicated that due to the invisibility of bisexuality, many people who identify as bisexual themselves are unaware of having met other bisexual people. This invisibility of bisexual identity is known as bisexual erasure. While having an invisible marginalized identity can be beneficial in the sense that people have more control over when they want to make that identity public, many bisexual people also report feeling anxious about unintentionally “passing” as monosexual. For bisexual people who are in mixed-gender relationships (i.e., relationships with people who are not of the same gender), there is often the stress of balancing the recognition of privilege with passing as heterosexual, and thus being allowed all the privileges of being heterosexual, while also embodying an identity that is being erased. Alternatively, when people are in same-gender relationships, they may also not be comfortable in disclosing their bisexual identity, as this may lead to discrimination within the queer community. Recent research indicates that bisexual women desire a space dedicated to bisexual and non-monosexual people, so they do not have to worry about keeping a part of their identity hidden from other community members.

Bisexual Prejudice

Another aspect that may act as a barrier to forming community for bisexual people is bisexual prejudice. Bisexual prejudice takes many forms, and can often influence the behavior and lived experience of bisexual people. This is closely tied to bisexual erasure, as experience or expectation of bisexual prejudice may influence whether bisexual people come out or not in monosexual groups. In fact, bisexual people on average choose to come out less frequently than gay and lesbian people, in part due to concern that their identity will be misunderstood by others. Other stereotypes about bisexuality include assumed promiscuity of bisexual people, inappropriate sexualization, blame for spreading sexually transmitted infections, and denial of bisexuality as a legitimate, stable sexual identity. Because of these prejudices, bisexual people may not feel comfortable coming out as bisexual in all spaces, and consistently deal with minority stress stemming from the experience of this discrimination. Researchers have also found that bisexual prejudice comes from both heterosexual and gay/lesbian communities, a phenomenon called double discrimination. As such, people who identify as bisexual may feel alienated from both communities. Further, as there are fewer bisexual-specific social or support groups, there is not always the option for bisexual people to participate in a bisexual community.

Suggestions for Forming Community As two of the major barriers for forming community for bisexual people are invisibility and bisexual prejudice, two ways to increase the potential for bisexual community are continuing to increase the visibility of bisexual identity and educating others about bisexual prejudice. In particular, campaigns that target visibility of bisexuality can help raise awareness that not all people can be identified by the gender of their partner. For example, a research group in Toronto, Canada, conducted a poster campaign that depicted bisexual people who are frequently misidentified, such as pregnant

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or trans bisexual people. Additionally, increased awareness and visibility of bisexuality could increase the ability of bisexual people to connect with each other and form community. Educating monosexual people about bisexual prejudice can also help increase the potential for bisexual people to find supportive community. As people become more educated about the harmful effects of bisexual stereotypes, monosexual communities may become safer spaces for bisexual people to be able to come out. In this way, bisexual people could be their whole selves in environments that were not specifically dedicated to bisexual and other non-monosexual people. Corey Flanders See also Biphobia; Bisexual Inclusion in the LGBTQ Rights Movement; Bisexualities; Bisexuality, Female; Bisexuality, Male

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BISEXUALITIES This entry introduces the topic of bisexualities, which can be broadly defined as emotional, romantic, and/or sexual attraction to people of more than one sex/gender. To consider bisexualities is important in part because it allows for the exploration and interrogation of how all sexual identity categories are constructed. To give a sense of the commonality of bisexuality, according to recent reports, approximately 3.5% of U.S. adults identify as lesbian, gay, or bisexual (LGB) and around half of those (1.8%) identify as bisexual. United Kingdom estimates are lower, suggesting that 0.5% identify as bisexual. The current entry explores the theoretical underpinnings and complexities of bisexual identities since the late 1800s to the present day. It then briefly focuses on other people’s (mis)understandings of bisexuality and bisexual marginalization, or biphobia.

Further Readings Dodge, B., Schnarrs, P. W., Reece, M., Goncalves, G., Martinez, O., Nix, R., … Fortenberry, D. (2012). Community involvement among behaviourally bisexual men in the midwestern USA: Experiences and perceptions across communities. Culture, Health & Sexuality: An International Journal for Research, Intervention and Care, 14(9), 1095–1110. Hutchins, L. (1996). Bisexuality: Politics and community. In B. A. Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority (pp. 240–259). Thousand Oaks, CA: Sage. Mosher, W. D., Chandra, A., & Jones, J. (2005). Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Advance Data From Vital and Health Statistics, 362, 1–56. Ross, L. R., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496–502. Voss, G., Browne, K., & Gupta, C. (2014). Embracing the “and”: Between queer and bisexual theory at Brighton BiFest. Journal of Homosexuality, 6(11), 1605–1625.

A History of Theorizing (Bi)Sexual Identities Same-sex relationships have been documented in historical writings and literature since at least the Victorian era. These relationships included intimate or romantic friendships between women often prior to, or alongside, their marriage to a man, although it is less clear whether these relationships would have been sexual. What has been established is that sexual behavior was not considered to indicate anything about sexual identity until the end of the 19th century. Therefore, it is important to acknowledge that the meanings of sexual behavior and relationships have evolved over time. The turn from behavior to identity has been attributed to the work of early sexologists such as Karl Heinrich Ulrichs, Richard von Krafft-Ebing, Magnus Hirschfeld, Henry Havelock Ellis, and Sigmund Freud, all of whom began theorizing and writing about sex in the late 1800s and early 1900s. Early sexologists initially conceptualized

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sexuality in relation to the gender of the person. Ulrichs (1825–1895) was a lawyer who developed a theory of the third sex or uranism, proposed as an “explanation” and category for lesbians, gay men, and transgender people. In this “inversion model,” homosexual men were considered to be female minds or souls trapped in male bodies and homosexual women vice versa. Psychiatrist and sexologist Krafft-Ebing (1840–1902), sometimes labeled the “founding father” of sexology, also theorized homosexuality as inverted masculinity and femininity and conceptualized lesbians as “masculine” and gay men as “effeminate.” It is clear how these notions persist today through images of “butch lesbians” and “camp gay men,” which reflect the pervasive and persistent influence that “inversion” theories have had within Western culture. However, some contemporary scholars have pointed out that these sexologists created a binary model of sexuality. Binary models of sexuality only account for the possibility of two sexualities—heterosexuality and homosexuality. The inversion theories developed by early sexologists positioned heterosexual men and women as directly opposite to each other, and homosexual men and women as opposite to each other and to heterosexual men and women, respectively. When masculinity and femininity and homosexuality and heterosexuality are understood as direct opposites, within what has been termed the heterosexual matrix, then gender and sexuality become conceptualized as dichotomous. It is difficult to locate bisexuality within this either/or model. Scholars have argued that these binary models contribute to the dismissal of bisexuality and bisexual people. Physician Hirschfeld (1868–1935) first considered bisexual people (termed psychic/physical hermaphrodites) to be those with male and female characteristics that would recede during the course of development. However, reflecting the shift from gender identity to sexual identity, the term bisexual also came to refer to those who were sexually attracted to both males and females. Sexologists had various biological and social theories regarding bisexuality, including that bisexuality was the

starting point from which both heterosexuality and homosexuality evolved (with “same-sex” attraction receding in heterosexual development and “other-sex” attraction receding in homosexual development). It has also been argued that Freud (1856–1939) believed that all humans had a bisexual disposition. Bisexuality, then, has been theorized alongside homosexuality since the work of these early sexologists. Their work saw a turn away from an early focus on gender toward the creation of sexual identities—with individuals’ behaviors as the defining characteristic of sexual identity. Critically, these sexologists set up a binary understanding of sexuality that omitted bisexuality and introduced notions of bisexuality as a temporary stage of human sexual development. It is these theories that created the underpinnings of our present-day understandings of sexuality.

Contemporary Understandings of Bisexual Identities Some contemporary definitions of bisexuality stay close to the conceptalizations of early sexologists, while other versions resist and move beyond their binary understandings. What all these ideas have in common is that they are affirmative of the notion of people being attracted to more than one gender. Bisexuality as a Third Identity

While identity is often defined by sexual behavior (the acts in which we engage), bisexual people may prefer to define their sexuality based on attraction (the feelings we have toward others). Accordingly, bisexual identity has sometimes been defined as a capacity to be emotionally, romantically, and/or sexually attracted to both men and women. In this understanding, bisexual identity becomes a third sexual identity category in addition to heterosexuality and lesbian/gay identities. It is also fundamentally similar to them in being a fixed and permanent form of identification. However, it does nonetheless differ in that the person is

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bisexual, not monosexual (i.e., the assumption that attraction can only be in one direction—toward either men or women; attraction to more than one gender is not considered a possibility). Bisexual people are attracted to more than one sex/gender and therefore do not fit within a monosexual model of attraction. During the 1950s, pioneering sexologist Alfred Kinsey (1894–1956) was the first to introduce the idea of sexuality as a continuum. Heterosexuality and homosexuality were positioned at opposite ends of Kinsey’s 7-point scale, which ranged from exclusive heterosexuality (0) to exclusive homosexuality (6), with attraction to both sexes in the middle. This model was revolutionary in challenging the assumption that homosexuality and heterosexuality were mutually exclusive, and in creating space in between these two identities where bisexuality could potentially be positioned. However, binary understandings of sexuality continued to be upheld because bisexuality could only be defined in relation to heterosexuality and homosexuality and therefore relied on these categories to exist. When bisexuality is understood as a third identity “in between” heterosexuality and homosexuality, then bisexual people can claim a stable identity position and have the option to identify as a collective social group. This can be useful in attempts to achieve inclusion for bisexual people (in laws and equality agendas), which can help make bisexuality more visible and validated—a strategy that served gay men and lesbians well during the gay rights movement. However, it also relies on bisexuality being located within the same binary understandings that were developed by the early sexologists who traditionally dismissed and overlooked bisexuality.

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This has led to interpretations of bisexuality as equal attraction to men and women and as unidimensional. While some bisexual people feel equally attracted to men and women, others do not, and they reject the idea of sexuality as being pinned to a fixed midpoint. Instead they see their attractions as fluid and open to flux and change over their lifetimes. Further, some consider bisexuality to be multidimensional. During the late 1970s, psychiatrist Fritz Klein (1932–2006) tried to capture these notions in his 21-point scale, which measured past, present, and ideal behaviors on scales of attraction, behavior, fantasy, lifestyle, emotional and social preference, and self-identification. Bisexual people may also challenge binaries by rejecting the idea of only two sexes/genders, instead recognizing multiple sexes/genders including trans identities. In these more fluid understandings of bisexuality, notions of stable and fixed identity categories such as “men” and “women” and “homosexual” and “heterosexual” begin to be called into question. Some acknowledge this by using alternative identity labels such as pansexual. When bisexuality is considered as fluidity there can be an attempt to specifically affirm the existence of bisexuality in its own right, instead of in contrast to other sexualities. However, if fluidity is defined as a spectrum or space between homosexuality and heterosexuality, then these categories remain and the binary is maintained. On the other hand, if these categories are rejected entirely, then a wider challenge to identity is posed in which the logical conclusion is the rejection of homosexuality, heterosexuality, and therefore, eventually, of bisexuality itself. Bye-Bye Bisexuality?

Breaking Down the Binaries

Bisexuality has also been defined as a fluid sexuality that has the capacity to challenge and break down binary understandings of gender and sexuality. Common critiques of Kinsey’s scale arise from the idea that bisexuality is “in the middle” of a single scale of heterosexuality and homosexuality.

Perhaps the most radical way in which bisexuality has been defined is when traditional identity labels are explicitly rejected and instead the term queer is embraced. During the early 1990s, philosopher Judith Butler and others critiqued binary divisions of sex, gender, and sexuality, demonstrating that these are socially constructed and that

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they (and the assumed inherent links between them) can therefore be destabilized and deconstructed. In queer accounts, identities such as bisexuality and transgender trouble conventional stable and binary understandings of sexuality and gender. Some individuals embrace this perspective, and prefer to identify their sexuality as queer rather than as bisexual. However, the deconstruction of these categories leaves no identity labels with which to articulate a shared sense of identity. This makes it that much more challenging to create communities and shared solidarities. In turn, this limits the opportunities for political strategies that aim to emancipate a group, leading to a risk of continual stigmatization. This means a risk of perpetual invisibility for bisexual people, who without a distinct identity label to unite around, disappear entirely. Further, even to talk about sexuality generally requires drawing on the only available language, which is rooted in the very binary models it critiques and rejects.

(Mis)Understandings of Bisexuality How bisexual people make sense of and define their own identities may also be influenced by their own beliefs and by whether they are involved in lesbian, gay, and/or bisexual communities. Research and theory has focused not only on how bisexual people understand their identities but also on how others (mis)understand bisexuality. There are a number of misconceptions about bisexuality, often arising from binary models of sexuality that simplify, overlook, and/or dismiss the existence of bisexuality. Bisexuality has been considered a stigmatized and marginalized identity and conceptualized as invalidated or invisible. Bisexual people may experience biphobia from both heterosexual and lesbian/gay populations, a phenomenon that has sometimes been termed double discrimination. One key misconception about bisexuality is that it does not really exist and that women who claim to be bisexual are purely performing samesex behaviors (such as kissing) in order to titillate and attract heterosexual men. Others consider

bisexuality to be a temporary state and position bisexual people as really heterosexual or lesbian/ gay people who have yet to “make up their minds” or “pick a side.” This may be exacerbated by developmental models of sexuality that position bisexuality as a part of identity development. While this can hold true for some lesbians and gay men, who may temporarily identify as bisexual before later claiming a lesbian or gay identity, for others bisexual identities are valid and enduring. Another assumption is that bisexual people are equally attracted to men and women. (While some bisexual people may be, not all are.) Further, some believe that because bisexual people are attracted to more than one gender, they must therefore have to have multiple (and simultaneous) sexual relationships to “be bisexual.” However, behavior is not a prerequisite of identity, and heterosexual people are rarely required to “prove” their sexuality. Many bisexual people have positioned their identity based on attraction (rather than behavior) and may never have engaged in a sexual relationship either at all, or with more than one gender. Similarly, the idea that bisexual people are attracted to “anyone and everyone” has meant that bisexual people’s ability to be committed and monogamous has been questioned. However, current relationship status does necessarily indicate identity, and many bisexual people do continue to identify as bisexual within stable monogamous relationships. Notions of non-monogamy have caused further stigmatization for bisexual people, especially during the early era of HIV/AIDS, when their (assumed) sexual behaviors were linked with sexually transmitted diseases. Other bisexual people may have multiple relationships that are non-monogamous or polyamorous. However, research has shown that openness and honesty (rather than cheating and lying) are highly valued. These (mis)understandings can have negative consequences for bisexual people’s sense of self and mental and physical well-being. In summary, there are a range of understandings and misunderstandings of bisexuality that are likely to

Bisexuality, Female

impact whether, or how, people define themselves as bisexual and their experiences of bisexual identification. Nikki Hayfield See also Biphobia; Bisexuality, Female; Bisexuality, Male; Pansexuality; Polyamory; Queer; Sexual-Identity Labels

Further Readings Angelides, S. (2001). A history of bisexuality. Chicago, IL: University of Chicago Press. Bowes-Catton, H., & Hayfield, N. (2013). Bisexualities. In C. Richards & M. Barker (Eds.), The Palgrave handbook of the psychology of sexuality and gender. London, England: Palgrave Macmillan. Eisner, S. (2013). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Esterberg, K. G. (2002). The bisexual menace: Or, will the real bisexual please stand up? In D. Richardson & S. Seidman (Eds.), Lesbian and gay studies (pp. 215–227). London, England: Sage. Hayfield, N., Clarke, V., & Halliwell, E. (2014). Bisexual women’s understandings of social marginalisation: “The heterosexuals don’t understand us but nor do the lesbians.” Feminism & Psychology, 24, 352–372. Hemmings, C. (2002). Bisexual spaces: A geography of sexuality and gender. London, England: Routledge. Rust, P. C. (2004). Two many and not enough: The meaning of bisexual identities. In M. S. Kimmel & R. F. Plante (Eds.), Sexualities, identities, behaviors, and society (pp. 216–229). London, England: Oxford University Press.

BISEXUALITY, FEMALE This entry provides an introduction to female bisexuality. It begins with a discussion of the definition of bisexuality, with attention to how bisexuality may intersect with gender. Next, it discusses the estimated size of the female bisexual population in the United States. Finally, it ends with a

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discussion of various issues pertaining to female bisexuality. These issues include diversity within female bisexuality, prejudice and discrimination, and female bisexual health.

Definition of Bisexuality The definition of bisexuality can vary, as some people would define bisexuality in terms of being sexually attracted to only men and women (adhering to a gender binary), whereas other people define bisexuality much more broadly. In the interest of inclusivity, the definition used here is a broader definition. Specifically, bisexuality is a sexual identity that describes an individual who (a) has the capacity for sexual and/or romantic attraction to more than one gender and (b) selfidentifies as bisexual. This definition highlights two important aspects of bisexual identity. First, it is important to recognize that self-identification is a necessary component of bisexuality, as identity is not always congruent with behavior. For example, some people may experience sexual attraction to more than one gender, or may even engage in sexual behavior with more than one gender, but still not identify as bisexual. Second, it is also important to consider not only behavior, but also attraction, in the definition of bisexuality. It is entirely possible for a person to have only engaged in sexual or romantic behavior with one gender while still experiencing attraction to more than one gender. There are also many terms people use to label their sexual identity other than bisexual that still may fall under what Shiri Eisner describes as the “bisexual umbrella.” Similar to how the term queer is used as an umbrella term to capture the spectrum of sexual and gender minority identities, bisexuality is at times used as an umbrella for all non-monosexual sexual identities. Monosexuality is a term used to describe sexual and/or romantic attraction to only one sex or gender, such as heterosexual and gay and lesbian. Therefore, nonmonosexuality, or what is sometimes referred to as multisexuality, refers to all sexual identities that describe people attracted to more than one sex or

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gender. Within the concept of the bisexual umbrella, many people will use the label bisexual in public spaces where they feel other non-monosexual identities will not be easily understood. For example, some people who identify as pansexual, omnisexual, or fluid may tell others they are bisexual if they feel that term also applies to them (i.e., the speaker), and they feel the individual they are interacting with will not know what is meant by pansexual or omnisexual.

Prevalence of Bisexuality The prevalence of bisexuality is difficult to estimate in the North American population, in part due to some of the issues described above. For instance, how bisexuality is measured creates a large amount of variance. If researchers measure bisexuality strictly by behavior, meaning that researchers impose the label of bisexual on any individual who engages in sexual behavior with more than one gender, then the prevalence of bisexuality would look quite different from the rate observed in a study that simply asked people how they identified. Often, researchers have to evaluate what they are truly interested in measuring for their study, and then use that to inform how they frame questions around sexual orientation identity. For example, a researcher interested in sexual risk behaviors for women who have sex with men and women will likely frame questions behaviorally as opposed to how the participants self-identify. Conversely, if a researcher is interested in social support differences between people who identify as lesbian versus women who identify as bisexual, then asking about self-identification would be more pertinent. A study that measured bisexuality using multiple definitions found that when measured by sexual behavior, approximately 3% of women reported sexual contact with men and women in the past year; however, 13.1% of women reported some attraction to both men and women. This same research found 2.8% of women aged 18 to 44 identified as bisexual. The rate of bisexual identification was much higher among young women, with 7.4% of

women 18 to 19 years old and 3.5% of women 20 to 24 years old identifying as bisexual. As there is a wide array of issues to consider when measuring the prevalence of bisexuality, it is no surprise that reported rates of bisexuality vary across studies. However, many estimates suggest that rates of bisexuality are at least as high as, if not higher than, the rates of people who identify as gay or lesbian. Fritz Klein, a bisexual researcher and activist, estimated on the basis of previous research that the rates of bisexuality varied from 2 to 11 times that of gay and lesbian people, depending on how bisexuality was measured. Even so, most estimates of bisexuality are likely low. Because of stigma associated with bisexuality, some women may not feel comfortable identifying as bisexual on a survey or in an interview even if they privately identify as bisexual. Further, some women who identify under the bisexual umbrella but typically use a different non-monosexual identity label may not indicate on a survey that they identify as bisexual.

Diversity in Bisexuality Just as it is important to recognize the diversity within the overall LGBTQ community to avoid erasing differences within the community, it is important to recognize the diversity within bisexuality as well. From an intersectional perspective, which emphasizes that individuals have multiple identities that are inseparable from one another, we cannot simply consider one aspect of identity or social location of an individual. All of the identities that a person embodies interact with one another. In the context of bisexual women, we cannot just consider sexual and gender identity; we must also consider other social factors such as socioeconomic status, racial or ethnic identity and racialization, ability, and age as potentially salient aspects of identity. The lived experience of, for example, a Black, cisgender, bisexual woman will likely differ from the experience of a White, transgender, bisexual woman. Because lived experience has a direct influence on important outcomes such as health, it is important to consider how

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experience differs within the bisexual community in order to be able to appropriately address any resulting social and health inequities. Sexual Identity and Fluidity

In considering diversity among bisexual women, sexual identity and sexual fluidity are important aspects of that diversity. Just as the labels people use to describe their sexual orientation identity may vary, sexuality can also in itself vary over time. Researchers such as Lisa Diamond and Roy Baumeister have investigated sexual fluidity, or the notion that sexual desire, attraction, and behavior change over time, in the context of female sexuality. It appears that a greater proportion of women experience sexual fluidity in comparison with men— although whether that difference is based on social construction of sexuality or on biological determinants is debated. Thus, women who do not experience sexual desire or attraction to more than one gender at one point in life may begin to do so later, and vice versa. As such, lived experiences may be quite different for a woman who identified as heterosexual or lesbian and then later bisexual, compared with a woman who has always identified as bisexual.

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deal with discrimination based on their sexual identity, transgender bisexual women face what is sometimes described as double discrimination, or discrimination based on their gender and sexual identity. Socioeconomic Status

Socioeconomic status disparities within the bisexual community can result in a variety of outcomes such as insecure housing and even one’s feeling of safety in coming out at work. While this research has not been conducted for bisexual women specifically, researchers have found among lesbian women that socioeconomic status influenced how they felt about coming out at work. Namely, having a higher socioeconomic status was associated with feeling more able to combat discrimination in the workplace. Socioeconomic status is also important to consider, as it is strongly linked to the ability to access resources such as quality health care. Disparities in access to health care may have a particularly negative effect for some bisexual women, as research has found that bisexual women on average report worse overall health compared with lesbians and heterosexual women. Racialization

Gender Identity

Another point of diversity among bisexual women is gender identity. This can refer to both presentation of female identity that does not conform to social gender norms of femininity, as well as identifying as cisgender, transgender, or another nonbinary gender identity such as genderqueer or genderfluid. Embodying a cisgender identity often allows people social privilege, while people who embody a trans identity can experience genderidentity–based prejudice and discrimination. Because this discrimination can result in differences in access to education, employment, safety, and health care services, it is important to recognize that women who are bisexual and cisgender will have different lived experiences from women who are bisexual and trans or genderqueer. For example, whereas cisgender bisexual women may

Racialization is the act of applying racial stereotypes to other people or groups that do not identify with those stereotypes. This can result in racial discrimination, or racism. Racialization also can be linked to socioeconomic status and health. Bisexual women of color and bisexual women who are racialized experience racial discrimination, which can lead to fewer job opportunities or lower rates of pay. Further, racism is perpetuated in the broader LGBTQ community, so bisexual women who are racialized may find less social support from such communities. Thus, they may receive fewer of the mental health benefits that stem from being part of a community. As such, it is important to keep in mind how the lived experiences of bisexual women who are racialized may be impacted by racism, while those who are not racialized may experience privilege as a result.

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Ability

Although there is little research considering ability and sexuality, generally it is found that people who experience disability are assumed to not have sexual desire or attraction, much less identify as a sexual minority. In the context of bisexuality, this may have other implications inasmuch as dominant stereotypes of bisexuals are that they are hypersexual and that one must have had sex with people of more than one gender in order to be bisexual. With this confluence of prejudice, it may be even more difficult for people with disabilities to be visible as bisexual. Further, bisexual women with disabilities may also have restricted access to LGBTQ spaces and communities that fail to accommodate their disability, thus again resulting in less social support from the broader LGBTQ community. Age

Bisexual women’s experiences change over the course of their lives, and in particular young bisexual women may face different prejudices than do older bisexual women. Bisexual people on average come out later than gay and lesbian people, and are often more selective in what environments they come out in. This may be in part because of the stigma that bisexuality is just a phase rather than a legitimate sexual identity. For young bisexual women, there is the added issue of assumed experimentation, or the idea that young bisexual women are not actually bisexual but are just performing as bisexual for the sexual gratification of men.

Prejudice and Discrimination As we have seen, different intersections of identity can influence how one experiences one’s bisexual identity, in particular within the context of prejudice and discrimination. While bisexual women experience some aspects of homophobia or heterosexism, these terms do not fully encapsulate the experience of prejudice and discrimination bisexual people face overall. Biphobia, or bisexual prejudice, also includes aspects of discrimination

that are specific to how others perceive bisexuality. Robyn Ochs, a bisexual researcher and activist, has also pointed out that bisexual people face double discrimination, as they experience discrimination not only in the heterosexual community but within the LGBTQ community as well. Some of the dominant stereotypes about bisexual people are that (a) bisexuality does not exist; (b) people who say they are bisexual are really gay men or lesbians who are afraid to come out, or alternatively are heterosexual people wanting to take space away from gay and lesbian people; (c) bisexual people are incapable of monogamous relationships; (d) bisexual people are promiscuous; and (e) bisexual people are vectors for sexually transmitted infections. For bisexual women, there is also the eroticization of their sexuality, as women engaging in sexual behavior with other women is portrayed as “hot” or “sexy” through mainstream pornography and even nonpornographic film and television. Research on attitudes toward bisexual people has found that negative attitudes toward bisexual people are more prevalent than negative attitudes toward gay and lesbian people, again demonstrating the distinction between homophobia and biphobia. Bisexual erasure is a term used to describe stereotypes and behaviors that make bisexuality invisible, and researchers have indicated that erasure and invisibility are prominent issues for bisexual women. For one thing, bisexual erasure can make it difficult for bisexual women to find one another and form community. There is no agreed-upon “symbol” of bisexuality, and thus there are no visible social markers for bisexual people to be able to publicly identify themselves and each other. Researchers have found that the lack of supportive community potentially contributes to the higher rates of physical and mental health disparities experienced by bisexual women in comparison with heterosexual and lesbian women. In particular, social support has been found to be a strong buffer of minority stress among marginalized groups. However, if bisexual women experience prejudice and discrimination in both heterosexual and LGBTQ communities, and further have difficulty locating other bisexual people to form community

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with, then they may not have the same opportunities to receive social support in relation to their sexual identity that other sexual-minority people enjoy.

Health Recent research has found that bisexual people, and in particular bisexual women, experience health disparities compared with heterosexual, gay, and lesbian people. For example, research has found that bisexual women report higher rates of generalized anxiety disorder than heterosexual and lesbian women, have higher rates of lifetime suicidality, and have higher diagnoses of 7 out of 10 mood and anxiety disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Bisexual women have also been found to be more likely than heterosexual and lesbian women to report mental distress and poor functional health, and have a higher likelihood of reporting lower overall physical health than heterosexual women. Bisexual women also report higher levels of diagnoses for sexually transmitted infections, and higher rates of tobacco and alcohol use, than heterosexual women. Further, bisexual women have been found to report higher rates of intimate partner victimization and sexual coercion in comparison with heterosexual and lesbian women. As evidenced by recent research, bisexual women on average experience differences in their health status in comparison with heterosexual and lesbian women. Moreover, some bisexual women may be at greater or lesser risk for negative health outcomes based on the additional stressors added by the experience of discrimination in other identities. While little is currently known about what social factors are driving this health disparity, it is likely that experience of discrimination and lack of social support play a role. Corey Flanders See also Biphobia; Bisexual People and Community; Bisexualities; Bisexuality, Male; Monosexism; Sexual Fluidity; Sexual-Identity Labels

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Further Readings Diamond, L. M. (2009). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press. Ebin, J. (2012). Why bisexual health? Journal of Bisexuality, 12(2), 168–177. Eisner, S. (2013). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Balsam, K. F., & Mincer, S. L. (2010). Disparities in health-related quality of life: A comparison of lesbians and bisexual women. American Journal of Public Health, 100(11), 2255–2261. Mosher, W. D., Chandra, A., & Jones, J. (2005). Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Advance Data From Vital and Health Statistics, 362, 1–56. Ross, L. E., Bauer, G. R., MacLeod, M. A., Robinson, M., MacKay, J., & Dobinson, C. (2014). Mental health and substance use among bisexual youth and nonyouth in Ontario, Canada. PLOS One. doi:10.1371/ journal.pone.0101604 Ross, L. E., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100(3), 496–502.

BISEXUALITY, MALE Research on behaviorally and self-identified bisexual individuals has been largely absent from previous social and behavioral science, including studies that examine relationships of sexual orientation and identity with health. Most previous research on health among “lesbian, gay, and bisexual” and “same-sex” populations has not distinguished bisexual individuals from lesbians and gay men. The aims of this entry are to provide an overview of male bisexuality in terms of both behavior and identities, to examine the diversity of expressions of male bisexuality across cultures, and to offer a brief review of research that has examined bisexual men separately from and compared with homosexual and heterosexual men in regard to health. This research indicates a pattern whereby

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bisexuals tend to report higher rates of health concerns when compared with both homosexuals and heterosexuals. Considering this, the entry offers insights on new directions for public health research and practice specifically with bisexual individuals, in order to better understand and address their health needs.

Male Bisexual Behaviors and Identities Because definitions of heterosexual, homosexual, and bisexual may vary substantially depending on culture and context, some basic conceptual definitions are necessary for framing our exploration of health among bisexual individuals. Self-identified bisexual: Individuals who use the word bisexual in referring to their own sexual orientation, preference, and/or identity. Behavioral bisexual: Individuals who engage in sexual activity with male and female (and sometimes transgender) partners, usually within a time period specified by the respective researchers.

Alfred Kinsey’s pioneering sexuality research at Indiana University has shown that, in addition to exclusively heterosexual and exclusively homosexual individuals, substantial numbers of men and women in North American samples have historically reported sexual attraction and involvement with both men and women. In addition, bisexual has only existed as a sexual orientation and identity label since the latter half of the 20th century, having originally denoted an individual who possessed both male and female sex characteristics; the development and meaning of our contemporary usage of bisexual have received notably less scientific attention than homosexual identity. Bisexuality is certainly not rare. Indeed, in some samples (including population-based samples), bisexual individuals outnumber exclusively homosexual individuals. However, interpretation of data on the general prevalence of bisexuality is complex. Regarding behavioral bisexuality, several large empirical studies from the United States show that differences exist across studies in terms of the time frame in which the sexual behavior was measured. One study using nationally representative

data found that behavioral bisexuality among men was between 0.7% and 5.8% (in the previous year and since puberty, respectively) in the general population of the United States. Another study estimated that 1.0% (approximately 1.2 million) of the U.S. adolescent and adult male population had behaved bisexually in the past year. In terms of self-identified bisexuality, Indiana University researcher Debby Herbenick and her team conducted a refined assessment of sexual behavior and identity in a large probability sample of adolescents and adults in the United States, with the National Survey of Sexual Health and Behavior. They found that self-identified bisexuality among men was between 1.5% and 2.6% (among adolescents, ages 14 to 17, and adults, respectively). The Chicago group estimated that the percentage of individuals who self-identify as bisexual in the general population of the United States is around 0.8% for men. Although these percentages may seem relatively small, they reflect a large number of individuals when the total size of the population is considered. Within more specialized samples, such as those composed of gay and bisexual men and men who have sex with men (MSM), the prevalence of bisexuality has varied widely depending on the recruitment venue and the demographics of the participants, particularly in terms of ethnicity. Reported rates of behavioral and self-identified bisexuality have been consistently found to be higher among African American men and Latinos than among White men. The relationship between sexual behavior and identity is complex, and fluctuations in self-identity have been found to occur often. However, longitudinal studies of bisexual individuals show that bisexual identity remains stable for many self-identified bisexual men and women. Self-identified bisexual individuals also report high rates of bisexual behaviors. Focusing on sexual identity among men who engaged in recent bisexual activity in the midwestern United States, Brian Dodge and colleagues at Indiana University found that over 60% of those men classified themselves as bisexual, with a further 16% not identifying with any label whatsoever. Overall, men were heterogeneous in terms of sexual self-identification; they were diverse in how, when,

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where, and to whom they identify, and how and why they arrived at their identities. The authors noted the dynamic and fluid nature of sexual identities and behaviors, even as bisexuality can be considered a stable foundation for this to occur.

Diverse Experiences and Expressions of Male Bisexuality Numerous patterns of bisexual behaviors and identities have been documented demonstrating that bisexual men are exceedingly diverse across cultures and societies. The cultural and social context in which bisexuality occurs has proven to be an important factor in understanding bisexual behaviors, identities, and related factors. For example, a substantial body of ethnographic research has shown that Latin American and Caribbean bisexual men are unique in the ways they construct, express, and experience their sexualities, often basing identity in relation to the assumed behavioral role in sexual activity (i.e., activo for partners who penetrate and pasivo for partners who are penetrated). Such research reminds us that familiar Anglo-American conceptualizations of sexual orientation are culturally specific and that their imposition on Latinos and other groups may be problematic. Although research on diverse expressions of bisexuality is critically important, a disproportionate number of studies published in Englishlanguage, peer-reviewed journals continue to focus on men in North American, European, and Australian contexts. Studies on bisexual men in other contexts are relatively fewer. Both behavioral and self-identified bisexuals constitute exceedingly diverse populations. Because of this, caution must be used in extrapolating the results of studies based on varying sampling frames and recruitment methods in a global context.

Male Bisexuality and Health The World Health Organization has conceptualized health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Health is determined by

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socioeconomic and environmental factors, is linked to behavior (including sexual risk behavior), and may be positively influenced by effective public health interventions. With the emergence of gay and lesbian identity theory in the early 1960s and 1970s, a relatively polarized debate arose between North American mental health professionals who held antigay versus gay-affirmative perspectives on sexual orientation. While homosexuality was ultimately declassified as a mental disorder by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders in 1973, bisexuality per se has never been officially classified or declassified as a mental disorder. The concept of bisexuality has been either implicitly subsumed under the label of homosexuality or altogether left out of the debate between those who sought to affirm the lives and lifestyles of homosexual individuals and those who sought to pathologize them. While a debate still continues as to the “pathology” of nonheterosexual orientations in some mental health and religious circles, current best clinical practice, according to the American Psychological Association, characterizes bisexual, homosexual, and heterosexual orientations and identities as healthy and valid. A substantial amount of recent research has explored relationships between sexual orientation and identity and mental health, an important component of overall health and well-being. In discussing the limitations of a comprehensive review of mental health research focusing on lesbian, gay, and bisexual (LGB) populations, UCLA scholar Ilan Meyer agrees that recent evidence shows that such intracommunity distinctions are significant, and that bisexual men and women may be exposed to more stressors and may have greater mental health problems than lesbians or gay men. Indeed, the personal and social circumstances of bisexual women and men may be markedly different from lesbians and gay men, including both mental health stressors and supports. The inability to distinguish bisexual individuals from homosexual individuals has been cited as a significant limitation of previous research if the intention of such inquiry is to understand relationships between sexual identity/behavior and mental health.

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A growing number of studies have examined mental health concerns among bisexual individuals separately from homosexual and heterosexual individuals. For example, Antony Jorm and colleagues recruited participants for a large-scale 20-year longitudinal study of mental health using sampling frames established through Australian electoral rolls. They compared mean scores of several standard mental health measures, adjusted for age and gender, among bisexual, homosexual, and heterosexual participants. The researchers found significant differences between the sexual orientation groups such that the bisexual group was highest on all measures of depression, anxiety, alcohol misuse, and negative affect. Based on these findings, the researchers concluded that bisexual orientation is associated with more psychological distress and higher rates of mental health problems in comparison with homosexual and heterosexual orientations and hypothesized that the social pressures faced by bisexual individuals are unique. It is significant that bisexual and homosexual participants have been combined together in the majority of behavioral science research studies on HIV/AIDS despite the emergence of a voluminous body of literature that has explicitly associated bisexual behavior and identity with significant psychosocial risk factors for HIV infection, particularly among men. Researchers have found that bisexual men report higher rates of sex work and injection drug use than exclusively homosexual men. A recent meta-analysis demonstrated that while bisexually behaving men were less likely to have HIV than men who had sex only with men, they were 5 times more likely to have HIV than men who had sex only with women. Unfortunately, very few intervention efforts have been designed that consider the patterns, meanings, and implications of bisexual men’s sexual behavior with both male and female partners. Research on substance use and its relationship with sexual risk behavior also experienced a rapid increase with the emergence of HIV/AIDS as a public health issue. Bisexual men have been largely ignored in early and influential studies on injecting drug use (IDU) even though they constituted a sizable subset of individuals in IDU samples. Despite

well-documented differences between bisexual and homosexual substance users, most studies on the relationship between sexual orientation and substance use still collapse bisexual and homosexual individuals together during analyses and discussions.

Final Thoughts and Future Considerations There is a lack of behavioral and social science research that has focused on the lived experiences of bisexual men, compared with research on the experiences of homosexual and heterosexual men. While substantial numbers of men and women in individual studies of health in GLB populations identify as bisexual or report sex with both men and women, researchers have traditionally used a dichotomized (homosexual–heterosexual) framework in terms of sexual orientation. The relative invisibility and social denial of bisexuality in contemporary society, including among academia and funding agencies, may contribute to the lack of scholarly research on male bisexuality. Attempting to interpret differences in health disparities among bisexual, homosexual, and heterosexual individuals is complex. Given the diversity of bisexual individuals, and the ways in which they experience and express their sexualities, it is difficult to isolate global factors that may be related to increased risk of mental health problems observed in previous studies. Bisexual individuals share with lesbians and gay men similar burdens on the basis of their sexual orientation and identity, particularly in regard to their same-sex practices and desires. Similar to lesbians and gay men, bisexual individuals face hostility, discrimination, and violence on the basis of their sexual orientation. The psychological and social effects of stigma, discrimination, and minority stress have been repeatedly documented in LGB samples. However, the prevalence of such experiences specifically among bisexuals is difficult to estimate because of the invisibility of bisexual individuals in previous studies, as well as their being collapsed into samples of gay men and lesbians. Another potential explanation for elevated rates of health problems among bisexuals is that, along

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with the burdens shared with lesbians and gay men, bisexual individuals may also face additional stressors specifically on the basis of their bisexual behaviors and/or identity. These unique factors might also explain the higher rates of mental health problems among bisexual individuals when compared with homosexual and heterosexual individuals in previous mental health research. The existence of biphobia, or the stigma and discrimination experienced by bisexual individuals from both heterosexual and homosexual individuals on the basis of their bisexual orientation and/or identity, has been extensively illuminated in community-based and, more recently, scientific literature. In another probability sample, University of California, Davis, researcher Gregory Herek found that heterosexual individuals expressed negative feelings toward bisexual men and women at higher rates than all other religious, racial, ethnic, and political minority groups assessed (including lesbians and gay men), save for injecting drug users. Consequently, bisexual individuals are at risk of social isolation since they may often lack social support from any ongoing and visible community, including the “gay” community. Elizabeth Saewyc and colleagues at the University of British Columbia highlight that bisexual adolescents report significantly fewer health protective factors, such as family and school attachments, than their straight or gay counterparts. Even with the emergence of lesbian, gay, bisexual, and transgender (LGBT) services and organizations that are inclusive at face value and intended to assist and provide support to LGBT individuals, some gay men and lesbians continue to reject and ostracize bisexual and transgender individuals. Particularly in the context of the move toward heteronormative “marriage equality,” some may disavow these more “radical” forms of sexuality in an attempt to accommodate to the larger society. Researchers have just begun to investigate how bisexual individuals may experience such double discrimination from both heterosexuals and homosexuals and how biphobia may impact the lives and, in particular, the mental health of bisexual individuals. Experiences of social adversity and discrimination can be theoretically linked to future psychosocial and behavioral

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disparities that may, in turn, affect physical health. For example, profound and persistent substance use and mental health disparities among HIV-positive behaviorally bisexual men have been found to coincide with relatively poorer viral load suppression compared with exclusively homosexual men in longitudinal cohort studies in the United States. Overall, it is critical that future research on health be based on more diverse populations of bisexual, homosexual, and transgender individuals. Generalizing to all nonheterosexual individuals from previous samples of primarily White, welleducated, upper-middle-class self-identified lesbians and gay men is dangerous because results may be misleading and simplistic. For example, research has suggested that many bisexual individuals have little or no interaction in “gay” social spaces, including gay bars, clubs, parades, and community centers. Few researchers have made attempts to specifically recruit bisexual individuals outside of “gay” spaces from which LGB samples are often drawn. Future research would benefit from the development of innovative strategies to locate, recruit, and examine bisexual individuals who may not frequent “gayidentified” venues. More research on bisexual men is also required outside of the context of HIV/AIDS risk and drug use. While these are important topics, these studies reveal only a limited amount of information about a very small segment of the bisexual population. Research is needed that explores the lived experiences of bisexual men beyond sexual and other health-risk behaviors in more representative samples across a variety of global contexts. Brian Dodge, M. Reuel Friedman, and Vanessa Schick See also Bisexuality, Female; Sexual Fluidity; SexualIdentity Labels

Further Readings Baldwin, A., Dodge, B., Schick, V., Hubach, R. D., Bowling, J., Malebranche, D., … Fortenberry, J. D. (2015). Sexual self-identification among behaviorally bisexual men in the midwestern United States. Archives of Sexual Behavior, 44(7), 2015–2026. doi:10.1007/s10508-014-0376-1

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Dodge, B., Jeffries, W. L., & Sandfort, T. G. M. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk Black men who have sex with men and women (MSMW). Archives of Sexual Behavior, 37(5), 683–696. Dodge, B., Schnarrs, P. W., Goncalves, G., Reece, M., Martinez, O., Malebranche, D., … Fortenberry, J. D. (2012). The significance of privacy, trust, and comfort in providing health-related services to behaviorally bisexual men. AIDS Education and Prevention, 24(3), 242–256. Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., Bowling, J., … Reece, M. (2014). From BIAS to bisexual health disparities: Attitudes toward bisexual men and women in the United States. LGBT Health, 1(4), 309–318. Friedman, M. R., Wei, C., Klem, M. L., Silvestre, A. J., Markovic, N., & Stall, R. (2014). HIV infection and sexual risk among men who have sex with men and women (MSMW): A systematic review and metaanalysis. PLOS One, 9(1), e87139. doi:10.1371/ journal.pone.0087139 Herek, G. M. (2002). Heterosexuals’ attitudes toward bisexual men and women in the United States. Journal of Sex Research, 39(4), 264–274. Jorm, A. F., Korten, A. E., Rodgers, B., Jacomb, P. A., & Christensen, H. (2002). Sexual orientation and mental health: Results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 188, 423–427. Kinsey, A. C., Pomeroy, W., & Martin, C. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders. Klein, F. (1978). The bisexual option: A concept of one hundred percent intimacy. New York, NY: Arbor House. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Muñoz-Laboy, M. A., & Dodge, B. (2007). Bisexual Latino men and HIV and sexually transmitted infections risk: An exploratory analysis. American Journal of Public Health, 97(6), 1102–1106.

Rust, P. C. R. (2000). Bisexuality in the United States: A social science reader. New York, NY: Columbia University Press. Saewyc, E. M., Homma, Y., Skay, C. L., Bearinger, L. H., Resnick, M. D., & Reis, E. (2009). Protective factors in the lives of bisexual adolescents in North America. American Journal of Public Health, 99(1), 110. Schick, V., & Dodge, B. (2012). Introduction to the special issue: Bisexual health: Unpacking the paradox. Journal of Bisexuality, 12(2), 161–167. Weinberg, M. S., Williams, C. J., & Pryor, D. W. (1994). Dual attraction: Understanding bisexuality. New York, NY: Oxford University Press. World Health Organization. (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, NY, 19–22 June, 1946 (Official Records of the World Health Organization, No. 2, p. 100). Geneva, Switzerland: Author.

BLACK COLLEGES See Historically Black Colleges and Universities, LGBTQ Students at

BODY IMAGE DISTURBANCE AND EATING DISORDERS IN LGBTQ PEOPLE This entry focuses on body image disturbance and eating disorders in lesbian, gay, bisexual, trans, and queer people. The term body image refers to people’s perceptions, feelings, and thoughts about their body. Other terms synonymous with body image include body (dis)satisfaction, body esteem, and weight satisfaction, which all focus on people’s satisfaction with their body. Body image concerns dramatically impact a person’s quality of life, significantly influencing self-esteem as well as psychological and physical health. It is well known that body dissatisfaction is linked to problematic eating behaviors at both clinical (i.e., requiring medical or psychological intervention) and nonclinical levels.

Body Image Disturbance and Eating Disorders in LGBTQ People

For many people, body dissatisfaction is a key contributor to the development of clinical problems such as anorexia nervosa (where people maintain a low body weight by restricting their food intake, making themselves vomit, and exercising excessively) and bulimia nervosa (where people try to control their weight by restricting their food intake, then binge eating and purging the food from their body by making themselves vomit or using laxatives). Binge-eating disorder (where people eat large amounts of food in a short period of time and feel a lack of control while doing so) is linked to depression and feelings of inadequacy, which may also result from body dissatisfaction. Nonclinically, body image concerns are related to dietary restriction and unhealthy weight control practices. Dietary restriction and disordered eating are often considered behavioral indicators of an individual’s body dissatisfaction and desires to alter his or her body shape. Therefore, although body image concerns and disordered eating behaviors are separate issues, many researchers simultaneously examine the two. People’s body image and eating behaviors are often shaped by the appearance ideals of the society in which they live. For women in Western cultures, current mainstream (heteronormative) body shape ideals include long legs, large breasts, a slim waist, and, most significantly, a very thin body. For men, body shape ideals include a tall, slender, and muscular physique, with a flat, toned stomach. While men and women currently experience social pressures to conform to these ideals, historically women’s appearance has been society’s focus. It is well known that women experience more body dissatisfaction and disordered eating behaviors than men; up to 80% of all women will experience body dissatisfaction, and around 90% of people with an eating disorder are female. Historically, research exploring body image and disordered eating behaviors has focused on heterosexual women. Recently, a small but growing body of research has begun to include LGBTQ people. This entry provides a brief overview of some of this research, examining any differences between heterosexual and LGBTQ people’s body image and eating behaviors, and discussing possible reasons

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for these differences. There is a distinct lack of research on trans- and queer-identified people, and therefore this discussion necessarily focuses on lesbians, gay men, and bisexual people. The term LGB is used where appropriate in this entry to reflect this bias in research. The omission of transand queer-identified people is a significant gap in knowledge about body image concerns and eating behaviors.

LGB and Heterosexual People’s Body Image Concerns and Eating Behaviors There has been some exploration of similarities and differences in the level of body image concerns and disordered eating behaviors reported by LGB and heterosexual people. The focus of such research studies has tended to be comparisons between lesbian and heterosexual women, and gay and heterosexual men. Bisexual people are sometimes excluded from these studies. There is a lack of clarity in the findings of comparisons of body image between lesbian and heterosexual women. Early researchers often found that lesbian women reported less body dissatisfaction than heterosexual women. In contrast, other (generally more recent) studies have concluded that there are no differences between lesbian and heterosexual women. The lack of differences found recently could indicate that lesbian women face increasing pressure to be thin, and/or are increasingly sensitive to dominant heteronormative body ideals, resulting in more body dissatisfaction. Only a small number of comparisons have included bisexual women; no differences were found between their body image compared with that of lesbian and heterosexual women. A problem for much of this research is that lesbian and bisexual participants were typically recruited from LGB communities, whereas heterosexual women were recruited from universities. This has resulted in significant differences in age and weight between the groups; heterosexual women were being compared with lesbian and bisexual women who were older and heavier, and this was not always considered in analysis.

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In contrast to women, research has consistently found that gay men have reported higher levels of body dissatisfaction than heterosexual men. Problematically, many of the body satisfaction scales used in such research were originally developed with women and not necessarily appropriate for use with men. Comparisons that have used scales specifically designed to assess men’s body satisfaction have also found that gay and bisexual men reported more body dissatisfaction and greater drives for muscularity and thinness than heterosexual men. Collectively, this evidence suggests that gay and bisexual men experience more body size anxiety than heterosexual men. It has been theorized, however, that body dissatisfaction is actually similar for all men; differences might have been found because gay and bisexual men are more willing to admit to holding body-related concerns than are heterosexual men. In terms of eating behaviors, heterosexual women, and gay and bisexual men, were traditionally thought to engage in more disordered eating behaviors than lesbian or bisexual women and heterosexual men. Recent research, however, has found no differences between lesbian, bisexual, and heterosexual women in clinical or subclinical levels of anorexia, bulimia, or binge-eating disorder and no differences in weight-control motives for engaging in exercise. Some evidence has even found that lesbian and bisexual girls were more than twice as likely to engage in some disordered eating behaviors (purging or using diet pills) as were heterosexual girls. In contrast, gay and bisexual men still represent a disproportionate number of men seeking help for eating disorders. Researchers have estimated that 42% of men seeking help for eating disorders are gay or bisexual. It is difficult to estimate the prevalence of clinically diagnosed eating disorders within LGB populations, because estimates are dependent on the sample of the population studied: For example, one study identified prevalence estimates of clinical anorexia for both heterosexual women and lesbian and bisexual women at 0%, because no women in the sample had been diagnosed with this condition. More accurate (though still problematic) tend to be estimates of disordered eating behaviors. One

population-based study separately compared male and female adolescents who identified as “heterosexual” or “lesbian/gay/bisexual.” They found the following prevalence rates for heterosexual and lesbian/gay/bisexual women (respectively): dieting 21.8%, 15.2%; vomiting/taking laxatives 4.6%, 5.1%; taking diet pills 4.1%, 8.5%; and binge eating 2.2%, 5.1%. Prevalence rates for heterosexual and gay/bisexual men were dieting 7.2%, 13.2%; vomiting/taking laxatives 0.6%, 0%; taking diet pills 0.5%, 2.6%; and binge eating 0.3%, 5.3%.

LGB Subculture The influence of LGB communities or subculture on people’s body image and eating behaviors differs for men and women. For men, the impact of LGB subculture is fairly clear. LGB communities tend to place significant emphasis on men’s appearance and value particular body shapes/sizes. Slim, toned, and muscular body shapes are highly valued, and gay and bisexual men often feel that they are being judged on whether they conform to these ideals. Such pressures are linked to desires for thinness and muscularity in gay and bisexual men, and affiliation to LGB communities has been found to be a significant predictor of men’s body dissatisfaction and disordered eating behaviors. Gay and bisexual men have reported feeling that LGB subcultures are highly competitive in terms of appearance and body shape. Such competition is pronounced for single men, who experience pressure to look attractive in order to meet a partner. Such pressures from within the LGB community have been used to explain the disproportionately high number of gay and bisexual men with eating disorders. Conflicting Ideas: Women and LGB Subculture

Two conflicting theories as to the influence of LGB subculture on lesbian and bisexual women were proposed in the 1980s. In contrast to the pressure that men experience, Laura Brown theorized that LGB subculture is protective of lesbian and bisexual women’s body image concerns and eating behaviors, because such communities

Body Image Disturbance and Eating Disorders in LGBTQ People

(although diverse in nature and values) reject the mainstream heteronormative emphasis on women’s weight, and are more accepting of diverse female bodies. Consequently, lesbian and bisexual women should experience fewer sociocultural pressures to be thin than heterosexual women, resulting in less body dissatisfaction and fewer disordered eating behaviors. In contrast, Sari Dworkin argued that LGB subculture cannot protect women from experiencing body dissatisfaction or disordered eating behaviors, as all women grow up and live in mainstream society and are consequently subjected to the same pressures to conform to an idealized female appearance. According to this theory, all women, regardless of their sexuality, are taught that they must be thin to conform to the culturally defined standard of “beauty,” and those who do not conform are stigmatized, rejected, and pressured to alter their appearance. Research exploring these two conflicting theories has found that LGB communities have their own appearance norms, which often value a “healthier” range of body sizes/shapes than heterosexual ideals, and promote messages that reject mainstream beauty norms. Research findings that lesbians have described less weight concern after coming out and becoming part of an LGB community support this argument. Recently, however, it has been determined that appearance norms within LGB communities are becoming more mainstream and there is an increasing focus on slenderness (although a toned and athletic body, rather than extreme thinness, is ideal). Therefore, lesbian and bisexual women can experience pressures to have a slender body from within LGB subculture. This indicates that while the source of pressures to be slim may, at times, be different from those of heterosexual women, LGB women still experience demands to conform to particular body sizes.

Intimate Relationships Body shape ideals are often transmitted through relationships with family, friends, and intimate partners. One major difference between LGB and heterosexual people is their choice of partners for

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romantic/sexual relationships. Therefore, this has been explored as one possible explanation for differences in body satisfaction and disordered eating. The Value of Physical Appearance to Men

It has been argued that physical appearance and body size are particularly important for heterosexual women and gay men in terms of their attractiveness to men. As lesbian women may not be concerned with being seen as desirable by men, they may feel able to resist social pressures to conform to the “ideal” thin body size. It is claimed that because lesbians are often sexually independent from men and are encouraged to appreciate women’s bodies, societal appearance-related pressures may be less salient for them and may have less of an impact on their body satisfaction and eating behaviors. A partner’s physical appearance and body size does seem to be particularly important for men. Studies of personal ads comparing lesbians, gay men, and heterosexual men and women have found that men—both gay and heterosexual— described desired partners in terms of their body shape more often than women, and this was often the first descriptor of a preferred partner. Similarly, when lesbian and heterosexual women’s and gay and heterosexual men’s preferences for thinness in a partner were compared, both groups of male participants reported higher preferences for thinness and attractiveness in a partner than did either group of women. In qualitative research, bisexual women have described experiencing more pressure to be thin from male partners than female partners. It seems, then, that men are more concerned about their partner’s body size than women seem to be, regardless of the gender of their potential partner. Therefore, it is likely that desires to be attractive to men (e.g., for gay men, heterosexual women, and possibly bisexual people) create pressures to be thin and look attractive, which are linked to the consequent problems of body image concerns and disordered eating. Single gay and bisexual men may particularly feel these pressures, and are known to report more drive for thinness,

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bulimic behavior, and dietary restriction than gay and bisexual men in relationships, or single heterosexual men. Once again, bisexual people have been overlooked in much of this research. It is important to explore how desires to attract a partner influence bisexual people, in order to fill this gap in knowledge. Additionally, bisexual people may be in the unique position of being able to compare pressures from male partners with pressures from female partners. Women’s Same-Sex Relationships

Lesbian and bisexual women have reported fewer appearance pressures within same-sex relationships than within different-sex relationships. Attraction to women who do not necessarily embody the thin ideal has encouraged lesbian and bisexual women to question mainstream ideals of “beauty,” and fostered positive feelings about their own body size. Female partners may also understand the social pressures that women experience, providing empathy and support for women experiencing body image concerns and disordered eating behaviors. Women’s same-sex relationships, however, can also be a cause of certain concerns. Some women may make comparisons between their partner’s body size and their own; if they feel unhappy with the result, they engage in healthy or unhealthy eating behaviors to change their body shape. It has also been suggested that female partners can be just as critical of a woman’s body size as male partners. Lesbian and bisexual women may be influenced by butch/femme stereotypes and societal assumptions about the gender expression of partners in same-sex relationships. Stereotypically, butch lesbians are associated with masculinity, which, in terms of appearance, includes wearing masculine clothes and shoes, having short hair, and being muscular. In contrast, femme lesbians are associated with femininity and are often only acknowledged within the boundaries of a same-sex relationship (alone they are often either invisible as lesbians or misread as heterosexual). Some women in same-sex relationships have received comments

about their gender expression, particularly the assumption that one of them was “butch,” based on their appearance and body size. This can be a cause of concern for women who do not identify as butch or femme, and consequently such women can become anxious as to how they are perceived when in public with their partner. Other Causes of Difference

There are many other possible causes of difference between LGB and heterosexual people. Three well-known concepts that have been linked to LGB people’s body image and disordered eating behaviors are feminism, discrimination, and internalized homonegativity. Feminist ideology is known to be somewhat protective of women’s body image concerns and disordered eating behaviors. Women who identify as feminist tend to be more critical of mainstream body shape ideals for women, considering them to be unrealistic and a tool of patriarchal oppression. Feminist identity can be important for many lesbian and bisexual women, as they reject heteronormative patriarchy when they “come out” and embrace a sense of unity with other women. Therefore, lesbian and bisexual women may be more likely to be critical of mainstream heterosexist ideals and pressures, and be less susceptible to associated body image concerns and disordered eating behaviors. Social discrimination and experiences of violence and rejection by family, friends, and the wider public has been posited as a cause of the high levels of disordered eating among LGB people. This is known as minority stress theory. This theory states that stressors related to possessing a marginalized identity have direct health consequences through the psychological distress they cause, and the (often unhealthy) health behaviors used to cope with them. These stressors also have consequences in terms of willingness to access health care services. According to this theory, disordered eating behavior may be one way in which LGB people cope with the sexuality-related discrimination they experience. Internalized homonegativity, a controversial concept whereby a lesbian, gay, or bisexual person

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accepts heteronormativity and negative societal attitudes toward LGB people, has been tentatively linked to gay men’s body image and disordered eating behaviors. It is known that internalized homonegativity is linked to low self-esteem, and low self-esteem in turn is linked to body dissatisfaction and unhealthy body-shaping behaviors. There is, however, a lack of indication as to whether and how internalized homonegativity influences men’s body image concerns and eating behaviors. Further research is needed on this topic before any conclusions can be made. Caroline J. Huxley See also Body Modification; Body Size and Weight; Butch–Femme; Embodiment; Internalized Homophobia; Masculinities; Masculinity Stereotypes; Romantic Friendships

Further Readings Brown, L. S. (1987). Lesbians, weight, and eating: New analyses and perspectives. In Boston Lesbian Psychologies Collective (Ed.), Lesbian psychologies: Explorations and challenges (pp. 294–309). Urbana-Champaign: University of Illinois Press. Bryn Austin, S., Ziyadeh, N., Kahn, J. A., Camargo, C. A., Jr., Colditz, G. A., & Field, A. E. (2004). Sexual orientation, weight concerns, and eating-disordered behaviors in adolescent girls and boys. Journal of the American Academy of Child & Adolescent Psychiatry, 43(9), 1115–1123. Dworkin, S. H. (1988). Not in man’s image: Lesbians and the cultural oppression of body image. Women & Therapy, 8(1–2), 27–39. Feldman, M. B., & Meyer, I. H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. Filiault, S. M., Drummond, M. J., & Anderson, E. (2012). Bisexual men and body image. Psychology & Sexuality, 5(3), 191–200. Huxley, C. J., Clarke, V., & Halliwell, E. (2011). “It’s a comparison thing isn’t it?” Lesbian and bisexual women talk about their body image and relationships. Psychology of Women Quarterly, 35(3), 415–427.

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Legenbauer, T., Vocks, S., Schafer, C., Schutt-Stromel, S., Hiller, W., Wagner, C., & Vogele, C. (2009). Preference for attractiveness and thinness in a partner: Influence of internalization of the thin ideal and shape/weight dissatisfaction in heterosexual women, heterosexual men, lesbians, and gay men. Body Image, 6(3), 228–234. Morgan, J. F., & Arcelus, J. (2009). Body image in gay and straight men: A qualitative study. European Journal of Eating Disorders, 17(6), 435–443. Morrison, M. A., Morrison, T. G., & Sager, C. L. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A meta-analytic review. Body Image, 1(2), 127–138.

BODY MODIFICATION Body modification refers to the range of practices that individuals undertake to alter the physical appearance of the body. Often used to reference tattooing and piercing, it also includes practices such as branding, cutting, and scarring, as well as cosmetic surgical procedures that vary from breast augmentation to calf implants. Broader conceptualizations of the term also include exercising, dieting, and weight lifting, as well as adornment practices such as tanning, makeup use, and nail coloring. Historical and cross-cultural accounts of body modification reveal its universality. For example, in the late 1700s, Captain James Cook, a British explorer, and his navy crewmen were introduced to tattooing by native Tahitians. Earrings have been found on mummified remains more than 5,000 years old. And, in the 1500s, Gaspare Tagliacozzi, now considered the father of plastic surgery, wrote the first textbook on plastic and reconstructive surgery. Today, body modification has become prevalent in the United States. This entry discusses the rise in body modification rates in the United States and continues with an examination of various motivations for undergoing body modification, including specific motivations observed in the LGBTQ community. The following section focuses on the

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debate about body modification: Is body modification empowering or oppressive? Finally, this debate is situated in a discussion about the health risks associated with body modification—risks that are compounded by the laxity of government regulation of the body modification industry.

The Rise in Body Modification in the United States Rates of tattooing, body piercing, and cosmetic surgery are all rising in the United States. Tattoos and piercings have now expanded to include a range of socioeconomic classes, suggesting that these practices are no longer confined to specific subcultures. This increase is noteworthy given that some workplaces regulate “body art” such as tattoos and piercings. While critics argue that such regulation is outdated and conservative, it is nevertheless legal. So long as this regulation does not discriminate against a protected legal category such as race, sex, religion, age, or nationality, employers are within their rights. Today, nationally representative surveys estimate that about 24% of adult Americans have a tattoo and that 14% have piercings. While tattooing is equally common in both sexes, women are more likely to pierce their bodies. Unlike with tattooing and piercing, only a small portion of adult Americans undergo cosmetic surgical procedures. Board-certified surgeons perform about 1.6 million procedures each year, with breast augmentation (about 290,000 surgeries) and nose reshaping (about 220,000 surgeries) topping the list. Surgeons perform the majority (87%) of procedures on women and individuals who identify as White (up to about 80% of all procedures, depending on the type of procedure), followed by Hispanics, African Americans, and Asian/Pacific Islanders.

Motivations for Body Modification While motivations range by type of body modification, researchers studying tattoos and piercings have identified several motivational categories. For example, they have found that individuals use

piercings as fashion accessories to embellish the body, and that those who have tattoos emphasize their aesthetic qualities, even referring to them as pieces of art. However, they have also found that body art can hold deeper psychological meaning. Specifically, tattoos and piercings can serve as an avenue for “identity work” insofar as individuals view the body as an outgrowth of the self and perform “body projects” to express their unique personalities. Indeed, individuality is one of the most commonly recurring themes in the tattooing and piercing literature. Researchers have also observed that sexual pleasure is a motivating factor for body modification. For example, research has found that some individuals report direct sexual stimulation from nipple and genital piercings. Meanwhile, other individuals turn to body modification as a testament to their high pain threshold and tolerance. The pain associated with these procedures can demonstrate not only toughness, but also the courage to engage in these practices. Interestingly, the stimulation of pain correlates with the release of endorphins—neurotransmitters that send electrochemical signals within the central nervous system. The release of endorphins can lead to positive emotions, as well as an anesthetizing effect on the body, thus reducing the perception of pain. For this reason, some researchers maintain that the experience of undergoing tattooing and piercing can have an addictive quality.

Body Modification and the LGBTQ Community Some individuals are motivated to obtain tattoos and piercings to demonstrate affiliation with others or a group. Body adornment can thus serve as a permanent sign of commitment to a friendship, love connection, or subcultural group. This group identification can implicitly or explicitly signify the rejection of, or resistance to, mainstream culture. In this way, this motivational theme relates to the theme of identity work. That is, individuals may use body modification to express their unique sense of self, as well as how this unique self is

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connected to a community. Notably, researchers have observed that body modifiers in the LGBTQ community, particularly because of their structurally oppressed social position, report that they see their bodies as a canvas to inscribe affirmation and belonging to a community and to express their LGBTQ identity. In this way, body modification can represent an affiliation with an oppressed other. Research on body modification in the LGBTQ community, as well as other oppressed groups such as women, racial/ethnic minorities, and individuals with disabilities, further reveals that some individuals turn to body modification as a personal catharsis. For example, some women who have survived sexual and physical abuse deliberately mark their bodies, painfully and permanently, in order to reclaim them. Through a conscious effort to inscribe the body with personal meanings, body modification is a direct confrontation of past pains; it is an intentional rewriting of the body’s history. Modification can thus have a self-healing effect, and even deter behaviors that might be considered more harmful. Researchers studying the LGBTQ community have also found that more extreme forms of modification such as branding, scarring, and cutting serve a similar bonding and transformative function. That is, these forms of body modification allow individuals to signify group membership, as well as to cope with life stressors and oppression based on race, gender, class, and/or sexuality. As such, body modification in these communities is far from a perverse and grotesque form of selfmutilation, but rather a mechanism to connect with like others, and to reclaim and reaffirm an authentic self. At the same time these various forms of body modification serve empowering functions for members of the LGBTQ community, scholars acknowledge that there are limitations to this type of body rebellion. First, whether they are tattoos, scars, or piercings, body inscriptions are often hidden under clothing and often only revealed in certain circles, thereby suggesting a limit to their political subversiveness. But even when revealed,

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their subversiveness depends on an observer’s gaze. So it is possible that instead of being read as a form of reclamation or an ironic distortion of the body, outsiders interpret body modification as a form of individual perversion, particularly among sexual minorities. Consequently, mainstream discourses about pathology and sexual deviation are not challenged, but rather reinforced in the eyes of observers. Furthermore, as body modification practices become more mainstream and popular—as they statistically are—they lose their marginal and subversive character.

Body Modification as Empowerment or Oppression? Some feminist scholars have thus argued that body art and other forms of body modification are not empowering reinscriptions that transgress body boundaries. Instead, they are a form of selfmutilation that appeals to oppressed social groups such as young lesbians and gay men largely because they are framed in the language of choice and political resistance. This perspective maintains that body modification is not resistance to hegemonic structures, but rather a direct result of sexual oppression and a disempowered social position that results in self-loathing, body hatred, and lowered self-esteem. Accordingly, those holding this perspective view body modification as part of a larger continuum of harmful bodily cultural practices. The discussion about whether practices such as tattoos and piercings are subversive forms of empowerment or signs of oppression mirrors larger debates in the cosmetic surgery literature. On the one hand, some feminists emphasize that cosmetic surgery—particularly if it results in a body that aligns with hegemonic beauty norms—is oppressive. They label those who have it “cultural dopes.” That is, they posit that those who have cosmetic surgery buy into a larger beauty culture that says that they need to look a certain way to feel good and be accepted in society. This perspective assumes that individuals, particularly women, are cultural objects somewhat devoid of agency.

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They engage in these surgeries because they are swayed by cultural discourses, including media depictions of idealized beauty. On the other hand, some feminists argue that individuals who engage in aesthetic body modification are “savvy cultural negotiators” who undergo these practices to empower themselves. This second theoretical perspective emphasizes agency and portrays individuals who undergo surgery as empowered actors. They obtain these surgeries to reap psychological, social, and material benefits—that is, to increase body esteem, their appeal to potential mates, and job opportunities. However, some scholars have recognized the limits of this type of individual empowerment. For example, while these practices may benefit an individual woman, they simultaneously reify a beauty culture that is oppressive to women as a collective. Thus scholars have recognized that aligning with one theoretical camp over the other is to miss the big picture when it comes to an individual’s relationship to aesthetic culture. Individuals can be both passive objects and subjective actors. In other words, individuals who elect body modification potentially exercise agency, but do so within social and cultural structural constraints.

Body Modification and Health Risks Theoretical debates about whether body modification is empowering or oppressive must be situated in a discussion about the medical risks associated with body modification practices. The Mayo Clinic, a nonprofit medical practice and research group, identifies specific risks with tattooing. For example, tattoos can cause skin problems such as keloids (raised areas caused by an overgrowth of scar tissue), skin infections, and allergic reactions caused by dyes. These allergic reactions can occur even years after a tattoo is imprinted. Other serious medical risks include the possibility of contracting a blood-borne disease if the equipment used is contaminated with infected blood. These diseases include tetanus, hepatitis B, and hepatitis C. Rates of contraction, however, are unknown.

Body piercings carry similar risks. Blood-borne diseases, including tetanus and HIV, can be contracted from contaminated equipment. Moreover, the Mayo Clinic cautions that piercings can cause tearing or trauma when accidently caught and torn out, and that piercings on the tongue can chip teeth or even damage the gums. An initial piercing on the tongue can even interfere with chewing, swallowing, and breathing due to swelling. Finally, cosmetic surgery risks include loss of sensation, scarring, infection, loss of mobility, and even death. It is for these reasons that medical authorities encourage patients to undergo these procedures only when performed by boardcertified surgeons. However, there is little regulation of the tattooing and piercing industry. Some medical professionals (who often have to deal with the complications associated with body art) have demanded the regulation of tattoo artists, as well as regulations regarding the sterilization of instruments. They have also pressed for federal regulation of tattoo inks—substances that are currently not subject to Food and Drug Administration approval. There is also little screening of customers. No federal age requirement exists, but most states require that a person obtaining a tattoo must be legally considered an adult—defined in most states as 18 years of age. In sum, rates of body modification are on the rise. Although individuals modify their bodies for many reasons, body modification holds special meaning for LGBTQ individuals, particularly in the form of self-expression and community affirmation. Debates about body modification center on whether it is a form of empowerment or subjugation, with some scholars arguing that it is a form of self-mutilation that appeals to young lesbians and gay men because of its affiliation with the rhetoric of political resistance. These debates must be considered in light of the health risks associated with body modifications, particularly given the lack of industry regulation. Samantha Kwan See also Body Size and Weight; Butch–Femme; Drag; Embodiment; HIV and Treatment; Sexual Attraction, Behavior, and Identity

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Further Readings American Society of Plastic Surgeons. (2014). 2013 plastic surgery statistics report. Arlington Heights, IL: ASPS National Clearinghouse of Plastic Surgery Procedural Statistics. Davis, K. (1995). Reshaping the female body: The dilemma of cosmetic surgery. New York, NY: Routledge. DeMello, M. (2000). Bodies of inscription: A cultural history of the modern tattoo community. Durham, NC: Duke University Press. Featherstone, M. (Ed.). (2000). Body modification. Thousand Oaks, CA: Sage. Heyes, C. J., & Jones, M. (Eds.). (2009). Cosmetic surgery: A feminist primer. Burlington, VT: Ashgate. Jeffreys, S. (2000). “Body art” and social status: Cutting, tattooing and piercing from a feminist perspective. Feminism & Psychology, 10, 409–429. Laumann, A. E., & Derick, A. J. (2006). Tattoos and body piercings in the United States: A national data set. Journal of the American Academy of Dermatology, 55, 413–421. Pitts, V. (2003). In the flesh: The cultural politics of body modification. New York, NY: Palgrave Macmillan. Wohlrab, S., Stahl, J., & Kappeler, P. M. (2007). Modifying the body: Motivations for getting tattooed and pierced. Body Image, 4, 87–95.

BODY SIZE

AND

WEIGHT

Body size and weight are affected by various norms and expectations—both those within the larger society and those within the LGBTQ community. Although eating disorders such as anorexia and bulimia impact LGBTQ people, and will be referred to briefly in this entry, the major topics will be the influences of gender, environment, LGBTQ cultures, and history on the body size and weight of LGBTQ people. The controversy surrounding body size and weight—not only as a cultural identifier, but as an indicator of physical and mental health—is presented.

Disparities It is well documented that lesbians, as a group, have larger bodies than heterosexual women, and

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that gay men have higher rates of eating disorders than heterosexual men; the rates of eating disorders among gay men are more in line with the rates of heterosexual women. Eating disorders are sometimes seen as a way to achieve or maintain a particular body size or weight. There is little evidence to support any differences in body size and weight in bisexual men compared with heterosexual men; however, there is some literature that indicates that bisexual women, on average, weigh more than heterosexual women. Transgender people have not been part of the discourse on body size or weight in the same way, although there is anecdotal evidence that transgender women feel pressure to lose weight to fit in as women, and transgender men may try to “bulk up” to pass more easily as men. It must be emphasized that no two people view the topics of body size and weight in exactly the same way. It is also impossible to write about body size and weight without including some explanation of differences in gender, culture, era, and environment, as all have a major impact on how body size and weight are perceived and experienced. Body size and weight are often affected by the individual’s not conforming to societal and cultural expectations, and may have consequences for health and well-being. Ideal body size and weight are, for the most part, prescribed by culture; in turn, norms about ideal body size and weight are perpetuated and enforced by cultural discourses (e.g., media, education, medicine/health care, societal attitudes). Notably, LGBTQ people have a history of nonconformity to cultural norms (which in some cases is quite adaptive, enabling them to form supportive relationships and communities, thereby conferring survival). This nonconformity may extend to the physical body.

Gender An important distinction needs to be made between sex and gender. Sex is determined at birth (or before) and assigned according to specific genetic markers. Biologically, sex differences serve several functions. Related to body size and weight, females need more body fat than males to accommodate reproduction. It is also expected that men need

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larger muscle mass to carry out societal expectations related to physical labor. The biological determination of sex predisposes many cultures to develop and accept stereotypical expectations of femininity and masculinity. Gender is not as easy to understand as sex. Whereas sex is assigned at or before birth, gender is an expression of maleness and femaleness that is highly individual and can vary between the extremes of male and female. Throughout history, girls who behaved or dressed in ways not typically female have been labeled tomboys and boys who behaved or dressed in ways not typically masculine have been labeled sissies. Thus, historically and across many cultures, it was not widely accepted that individuals could display or enjoy cross-gender characteristics. This is beginning to change. A small and seemingly insignificant example of this is that before the 1940s, women and girls did not wear pants (unless they were working on a farm). Pants, or trousers, were considered clothing for men only. When a woman wore pants, she was considered masculine and publicly ostracized for this choice. Likewise, men who dressed as women were, and still are in many cases, castigated for being feminine or queer. As science gains a better understanding of the real differences between men and women, the lines are being blurred, and, just as sexuality is commonly identified on a continuum as opposed to a binary, gender is experiencing the same evolution today. Historically, many cultures have depicted masculinity and femininity as synonymous with large and small bodies, respectively. Particularly in the past 50 years, to be feminine has meant to be willowy, thin, and weak, and masculinity implies physical bulk, being powerful and strong. Therefore, when a woman is large and strong, she is perceived as more masculine than feminine, which may or may not affect her sense of identity. Since power is inextricably linked to masculinity in many cultures, the allure of power and strength to some women is a fair trade for their identification with the feminine. The advantage of viewing gender as a continuum, then, is that individuals are

allowed more expression of body sizes and shapes than if there is only a binary male or female option.

LGBTQ Culture/Community LGBTQ culture is extremely diverse. Just as specific ethnic groups have distinct and similar traditions as other ethnic groups who live in the same geographic region, LGBTQ people exhibit similarities and differences. Culture is a compilation of language, traditions, religion, art, music, knowledge, morals, laws, customs, and habits that are rooted in, and acquired through, belonging. It is important to appreciate (especially in the United States) that individuals’ overall identity may reflect the influence of several cultures. LGBTQ people also experience these influences, and are also shaped by the gay community. The collective gay community also has its own language, traditions, religion, art, music, knowledge, morals, laws, customs, and habits that may shape individuals. In turn, differences within distinct L, G, B, T, and Q groups contribute many dynamic aspects to gay culture as well. For example, many lesbian and bisexual women are involved in feminist organizations and activities that critique heterosexist beauty standards, and therefore may not be inclined to engage in weight-loss activities. Gay men, on the other hand, are confronted with an emphasis on physical appearance in the bar/club scene as well as online dating and sex hookup sites. There are many examples of gay cultural influences for each separate group within the gay community. Thus, when attempting to understand weight and body size in LGBTQ populations, it is important to understand the variability in the norms and expectations to which LGBTQ people are exposed. Another example is the finding that lesbians and bisexual women are heavier than heterosexual women. There are many possible reasons for this. For example, their heavier weights may represent and reflect a backlash to unrealistic standards of beauty forced on women from the male-dominated fashion industry; it also may reflect greater athleticism and muscle mass among a subset of lesbian women, as

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compared with heterosexual women. In addition, norms in lesbian communities are typically more accepting of diverse body sizes, shapes, and ability levels. There is also evidence that higher rates of alcohol consumption and bar food may contribute to higher weight among lesbians. From a cultural and historical perspective, this may be explained by LGBTQ people frequently socializing in bars and absorbing influences from a bar culture because of not being accepted in other social venues. What it does not explain is why women’s weight seems to be more affected than the weight of men. These arguments have some support in the literature, but none alone is likely a total explanation. Gay men have higher rates of eating disorders than heterosexual men or lesbians, and evidence suggests this may be due to gay men wanting to be attractive to other men, which supports the same prescriptive standards of beauty applied to men as to women. Some research finds the same degree of body surveillance and scrutiny among gay men as among heterosexual women. There is not much information on bisexual men or women or transgender men or women, but their attitudes about body size and weight might be shaped by the communities and relationships to which they belong. For example, bisexual or transgender women in same-sex relationships may adopt lesbian community norms; transgender men in relationships with heterosexual women may try to appear more like heterosexual men.

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bodies as “unattractive” to labeling them as “unhealthy” and a potential burden on society. This trend disproportionately impacts lesbian and bisexual women, but adds pressure to all populations and may add additional guilt and shame about the body for those who are larger. Weight stigma may create health problems independent of weight. Finally, LGBTQ communities have been impacted by feminism. For 50 years, there has been feminist pressure to stop objectifying women’s (and men’s) bodies, but it has yet to make any serious impact on U.S. cultural norms.

Environment LGBTQ communities may also have diverse opportunities for physical activity and varying access to adequate nutrition. Some studies find that female same-sex couples are more likely to live in poverty than other couples, forcing them into lowerincome neighborhoods that may be less safe in general, and less safe specifically for LGBTQ people. This also creates less access to healthy food, and fewer options for recreation. All these conditions increase stress and are associated with weight gain. Larger, more integrated LGBTQ communities may have not only sports leagues and opportunities for recreation that may promote health, but also health clinics and health education programs that are culturally appropriate and tailored to subsets of L, G, B, T, and Q communities.

The “Weight Paradox” Era/Historical Period Body size and weight acceptance are illustrated in fashion and in common health trends during every historical period. Indeed, it is not coincidental that when tuberculosis was rampant in Europe and throughout the United States (1820s through 1940s), it became fashionable to be extremely thin. In countries and eras where wealth was demonstrated by having enough or more than enough to eat, larger bodies were desired as an indicator of prestige. Recently, there has been a shift in discourses in the United States, from viewing larger

Recently, there is some discussion and exploration into the phenomenon of a weight paradox, especially among lesbians. The weight paradox is explained as a discrepancy between the assumption that increased body size and weight equate with higher risk for certain chronic diseases (e.g., type 2 diabetes, heart disease, hypertension, some cancers, asthma) and from research findings that do not bear the expected results. To date, there has been little research designed to explore this observation, particularly in LGBTQ populations. With the recent change in demographic questions being

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asked on national health surveys, it may be possible to either further define and support, or dispel, the weight paradox in LGBTQ populations. The Health at Every Size (HAES) movement, popular on the West Coast, is an example of a different way of looking at body size and weight. The weight paradox is in line with the assertions of HAES in that it supports the possibility of maximizing health regardless of how a body looks, or how much it weighs. It shifts the focus from needing to lose weight to be healthy to getting healthier regardless of a person’s weight or size. There is growing evidence that this focus in LGBTQ populations can (and does) benefit many people, especially those with no genetic predisposition to chronic diseases.

Minority Stress Being LGBQ places an individual in a sexualminority group—nonheterosexual. LGBQ people are also members of other minority groups (e.g., racial, ethnic, religious, gender, economic) and as stresses from each identification layer upon one another, physical and emotional problems may develop. For some, internalized minority stress is manifest as guilt and shame about the physical body. Overeating and eating disorders are coping mechanisms that are frequently used to temper, soothe, or exaggerate feelings that result from minority stress. As alluded to earlier in the entry, lesbians tend toward overeating as a means of coping with stressors, and gay men tend toward weight restriction (e.g., anorexia and/or bulimia). Recovery programs for eating disorders are difficult to find for men, and since it is also necessary to address stigma from living with a minority sexual orientation, the difficulties are compounded. For lesbians, overeating may be more acceptable inasmuch as many lesbian women are less likely to impose heterosexist stereotyping of body size, shape, and weight on other women. This seeming acceptance of bigger bodies does not preclude stigma from general society or even from other lesbians. There is a faction of lesbian women who are very body-conscious and do not subscribe to

the acceptance of larger bodies. Also, as mentioned earlier, there are conflicting fears among academics and health care providers that acceptance of larger bodies will perpetuate the epidemic of obesity among lesbians or other women who partner with women and that the emphasis on weight will, itself, become a new layer of stigma. If examined from an ecological perspective, change to support better health must happen at all levels, including the outermost layer, which is policy. Policies that are supportive of healthpromoting environments can permeate into institutions (such as health care), communities (such as LGBTQ communities), families, and social circles, and finally to the individual. Consideration of multiple minority-related stressors must be infused into new ecological models that will lessen health-related disparities for LGBTQ people.

Conclusion With the pandemic spread of obesity, there has been little research that suggests whether the L, G, B, T, and Q populations are at an increased risk for obesity-related health conditions in the same way that heterosexual people are. Chronic illnesses thought to result from obesity may actually stem from minority stress, poor food choices, or other factors besides weight. Several characteristics of national health policy, health institutions, the environment, genetics, culture, and individuals compound the risks, for both obesity and elevated health risks. Further, labels used by LGBTQ communities identify, celebrate, and stigmatize their members at the same time. The same is true for labels that are used to identify body size and weight: stick-thin, skinny, emaciated, bony, skeletal, fat, morbidly obese, super obese, and even obese are interpreted by many as extremely stigmatizing. Others embrace the words as honoring who they are and how they identify, including the words queer and fat. For many, neither is acceptable; for others, they are badges of honor and embraced. This constitutes reclamation of the true meaning of the words, which convey honesty and acceptance of being different or unique.

Bondage, Dominance/Submission, Sadism/Masochism (BDSM)

Building different interventions and solutions from an ecological perspective is likely the best way to shift the emphasis from body size and weight to better health and tailored plans for LGBTQ communities. Infusing the ecological model with attention to minority stress will strengthen both planning and health outcomes for LGBTQ people. Sarah C. Fogel and Michele J. Eliason See also Body Image Disturbance and Eating Disorders in LGBTQ People; Health Disparities; Minority Stress; Physical Disabilities

Further Readings Austin, S. B., Nelson, L. A., Birkett, M., Calzo, J. P., & Everett, B. (2013). Eating disorder symptoms and obesity at the intersections of gender, ethnicity, and sexual orientation in US high school students. American Journal of Public Health, 103, e16–e22. Balsam, K., Molina, Y., Beadnell, B., Simoni, J., & Walters, K. (2011). Measuring minority stress: The LGBT People of Color B Scale. Cultural Diversity and Ethnic Minority Psychology, 17(2), 163–174. Eliason, M. J., Ingraham, N., Fogel, S., McElroy, J., Lorvick, J., Mauery, R., & Haynes, S. (2015). The paradox of weight in sexual minority women: A systematic review. Women’s Health Issues, 25(2), 162–175. Fogel, S. (2010). But I have big bones! Obesity in the lesbian community. In S. L. Dibble & P. A. Robertson (Eds.), Lesbian health 101: A clinician’s guide (pp. 165–181). San Francisco, CA: UCSF Nursing Press. Morrison, M., Morrison, T., & Sager, C. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women? A metaanalytic review. Body Image, 1(2), 127–138. Siever, M. (1994). Sexual orientation and gender as factors in socioculturally acquired vulnerability to body dissatisfaction and eating disorders. Journal of Consulting and Clinical Psychology, 62, 252–260. Ward, B. W., Dahlhamer, J. M., Galinsky, A. M., & Joestl, S. S. (2014, July 15). Sexual orientation and health among U.S. adults: National Health Interview Survey, 2013. National Health Statistics Reports, 77. Retrieved from http://www.cdc.gov/nchs/data/nhsr/ nhsr077.pdf

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Wen, M., & Kowaleski-Jones, L. (2012). The built environment and risk of obesity in the U.S.: Racialethnic disparities. Health and Place, 18, 1314–1322. Wichstrom, L. (2006). Sexual orientation as a risk factor for bulimic symptoms. International Journal of Eating Disorders, 39, 448–453. Yean, C., Benau, E. M., Dakanalis, A., Hormes, J. M., Perone, J., & Timko, C. A. (2013). The relationship of sex and sexual orientation to self-esteem, body shape satisfaction, and eating disorder symptomatology. Frontiers in Psychology, 4. doi:10.3389/fpsyg .2013.00887

BONDAGE, DOMINANCE/SUBMISSION, SADISM/MASOCHISM (BDSM) The acronym BDSM stands for bondage, dominance/ submission (DS), and sadism/masochism (SM). It is an umbrella term for a variety of practices in a sexual context that involve intense stimulations of body and mind. It is a community term that has replaced the older term sadomasochism (SM) for at least two reasons. First, BDSM introduces a broader range of practices than the emphasis on sensation or pain in SM alone. The boundaries of the term BDSM remain fuzzy, though, as it remains contested whether fetishes (such as leather, rubber, worshipping of certain body parts) and other related practices (e.g., nonmainstream practices such as fisting and urination) that are widespread in BDSM communities are considered BDSM proper or not (see the entry on Kink). Second, the term sadomasochism is associated with mental illness and with nonconsensual criminal acts historically, scientifically, and in everyday usage. In contrast, BDSM refers to consensual sexual and erotic practices. Practitioners of BDSM are considered a marginalized sexual minority analogous to gays, lesbians, and bisexuals with a coming-out process of their own, although it remains contested whether BDSM is best understood as a variety of non-normative practices or as a sexual identity.

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This entry continues with a short introduction to BDSM communities, proceeds with an explanation of basic concepts of BDSM, and finally introduces some common practices.

The Lesbian, Gay, Bisexual, Trans, and Queer BDSM Communities The BDSM community is largely organized as separate heterosexual, gay male, lesbian, and queer subsets. The heterosexual and gay male ones are much larger in numbers and resources than the lesbian and queer ones. The BDSM community is also mostly inclusive of transwomen and transmen. Recently, mixed queer spaces—that is, spaces that create opportunities for gay men, bisexual men and women, lesbians, and trans people to play together—have also emerged. Today’s BDSM communities have their roots in gay male biker clubs that emerged in the United States after World War II, establishing a (hyper) masculine, gay leatherman style. These secretive circles passed on BDSM techniques and ethics via personal mentorship and are referred to as the “Old Guard.” Beginning in the 1970s, with growing numbers and in the aftermath of the “sexual revolution,” the community became more accessible. Today, novices tend to be introduced to BDSM through formal organizations that offer workshops, through how-to manuals, and increasingly through the Internet. The lesbian BDSM community started off small in the 1970s and was strongly affected by antiBDSM strands of feminism, which hold that women cannot consent to BDSM activities, because their socialization as submissive makes them reenact patriarchal relations. These debates continue today.

Defining BDSM: Roles and Consent In BDSM terminology, playing refers to BDSM activities, and a session or scene denotes a BDSM encounter, which is usually of limited duration and has a clear, sometimes ritualistic, beginning and ending. For instance, the collaring of a “slave” may mark the entry into roles and the removal of the

collar the closure. The persons who take on the role of being in charge of running the action are referred to as top, and the ones who offer themselves to be acted upon are called bottom. About a third of BDSM practitioners do not prefer one role, but “switch” between them. Generally, the roles that one performs in BDSM are distinct from one’s everyday personalities, such as roles in the workplace or social identities. One can choose to play as top or bottom independently of gender, race, age, level of BDSM experience, and so on. Some practitioners seek to remain in their respective roles constantly within a particular relationship, which is referred to as 24/7 (24 hours a day, 7 days a week). To date, there is no agreed-upon definition of BDSM. It is even contested whether BDSM should be considered sex or rather, for instance, leisure, because it does not necessarily involve genital sex and because research has identified a number of motivations for participating in BDSM, such as realizing erotic fantasies, seeking out spiritual experiences, pushing personal boundaries and social taboos, and experiencing personal growth and healing. It is commonly accepted today that BDSM is distinguishable from violence and rape because of its ethical standards, which rule out nonconsensual activities and permanent damage. If a nonconsensual incident occurs during BDSM activities, it is viewed as an act of (sexual) violence and not BDSM. Since BDSM, with its intense physical and psychological stimulations, is considered voluntary risk-taking, there are two competing concepts in BDSM communities as to how to approach BDSM in a responsible manner: safe, sane, and consensual (SSC) and risk-aware consensual kink (RACK). In SSC, to play safe expresses the need to ensure physical safety, for instance through utilizing technical and medical knowledge such as not hitting the area of the kidneys, or using the right kind of candle wax to prevent serious burns. Sane is often interpreted as being capable of distinguishing fantasy from reality, for instance, refraining from actions that are considered not consentable, such as permanently damaging the

Bondage, Dominance/Submission, Sadism/Masochism (BDSM)

body. In contrast, RACK stresses that absolute safety is illusionary, that sanity is hard to define, and that it is rather important that all parties are aware of the risks they are taking with certain practices and apply risk-management techniques accordingly. Both concepts agree on the significance of consent for an activity to count as BDSM. Practitioners attempt to establish consent consciously and explicitly through prenegotiations and through installing a veto-right during a BDSM encounter, usually in the form of a safe word. If a participant utters this code, the action is supposed to stop immediately. This is why bottoms often report feeling empowered rather than powerless on an underlying level, as they remain in control through their veto-right.

BDSM Practices: Bondage, Sensation, Power, Role-Play The most common practices in BDSM involve either playing with a performed difference in positions of power or with intense stimulations and manipulations of body and mind, or both. While one can differentiate between power play, sensation play, and bondage, most BDSM encounters involve combinations of these elements. Bondage is a term used for a wide variety of practices in which the bottom is immobilized. This can be achieved through the use of wrist and ankle restraints (often made of leather or other soft but durable materials), ropes (made of cotton or hemp), mummification (with kitchen foil and tape), cages, specific bondage equipment such as bondage sleeping bags, vacuum beds, and so on. Often the psychological dynamic involved is about giving up control, being at the mercy of the top, being the sex toy/object for someone, and so forth. But practices like suspension bondage can also be about achieving a state of total abandonment, literally “flying” in the air, or attaining a sense of peace of mind akin to meditation in long-term bondage sessions, with little or no power dynamic between top and bottom. The same holds true for the giving and receiving of intense stimulations or pain, referred to as sensation play, because it is different from the

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everyday experience of pain through the presence of consent and the erotic framework. The motivation to participate in practices such as flagellation (hitting someone with an implement such as a whip or flogger); spanking; placing clamps or dripping hot wax on the body; and piercing, cutting, or branding the skin, differs. Those individuals who enjoy inflicting pain are referred to as sadists, while those who enjoy and are capable of eroticizing the reception of pain are called masochists. But not every practitioner is directly aroused by pain itself; often it is about the symbolic meaning behind it, the challenge to endure it for someone, or the entering of a different state of consciousness, akin to spiritual body stress rituals. Therefore, very particular sensations are sought out, not pain per se. Practices focusing on power dynamics are referred to as dominance/submission (DS), with the top being called a dominant and the bottom a submissive. More specifically, players may also identify as “Mistress/Master” and “slave” or “boy/girl” and so on, depending on the kind of role-play. In DS, participants consciously and collaboratively construct a power differential, for instance through symbolic, sometimes ritualized acts and use of artifacts (such as submissives wearing a collar around their neck, kneeling in front of dominants, polishing their boots) and through establishing different rules for dominant and submissive (such as when the submissive is not allowed to use furniture, has to ask for permission to speak, relieve themselves, touch themselves or the dominant, and so on). Such a set of rules for behavior for a submissive is referred to as protocol. In DS, exercising or giving up power is eroticized. Sometimes references to reallife historical slavery, the service work industry, or human–animal relations may serve to reinforce this power dynamic, though mostly it is an erotic fantasy, rather than a realistic version, of these social power relations that is the basis for BDSM scenarios. DS often involves role-playing, although some practitioners prefer to interact with their everyday personalities, making it as “real” as possible. Role-play can take many different forms and refer to real-life institutions as well as fantasy worlds. Within gay/bi male communities, master– slave, daddy–boy, puppy play, and military scenarios

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are most common. In the les/bi/trans/queer communities, a variety of other scenarios such as vampire– human, teacher–student, secret police, and so on are engaged in as well. Furthermore, playing with gender (for instance embodying a gender other than one’s everyday gender) is very popular, while in gay men’s spaces it seems to be limited to performances of (hyper)masculinity. Some of these practices are considered edge play, if they push a personal boundary of a participant or a cultural taboo, such as incest or historical slavery play. This highlights the fact that risk management in BDSM is not limited to technical aspects and physical safety, but needs to consider emotional care as well.

Collective BDSM Spaces: Play Parties BDSM activities are not limited to private encounters and monogamous relationships. Rather, the BDSM communities have developed a sexual culture with myriad opportunities to play outside couple structures and the bedroom. Practitioners organize so-called play parties privately, collectively in a nonprofit setting, or commercially, providing a space to gather, socialize, and engage in BDSM activities in one-on-one sessions, or in small or sometimes large groups. In the gay/bi men’s community, these spaces tend to be more commercial, while in the les/bi/trans/queer communities, the use of nonprofit spaces for these activities is more common, owing in part to a lack of resources. In the gay/bi men’s community, play parties tend to operate with a “dress code,” making certain fetish outfits mandatory. Gay/bi men’s play parties also tend to have a theme, fragmenting the whole of BDSM into specialties (leather, rubber, skin, bondage night, etc.). In the les/bi/trans/queer communities, play parties tend to include all possible practices and any outfits that practitioners associate with their fantasies and roles. For example, street clothing of a particular gender may be appropriate for gender play. Usually rules exist to ensure that people are not harassed or disturbed while playing, sometimes also regulating safer sex. The rules tend to be different in gay/bi male versus les/bi/trans/queer spaces, with more regulation in the latter. Robin Bauer

See also Hypermasculinity; Kink; Monogamy and NonMonogamy; Sex Positive Movement; Sexual Consent; Sexual Risk-Taking

Further Readings Barker, M., & Langdridge, D. (Eds.). (2005). Contemporary perspectives on sadomasochism (S/M) [Special issue]. Lesbian & Gay Psychology Review, 6(3). Bauer, R. (2014). Queer BDSM intimacies: Critical consent and pushing boundaries. Houndmills, England: Palgrave. Hart, L. (1998). Between the body and the flesh: Performing sadomasochism. New York, NY: Routledge. Kaldera, R. (2009). Double edge: The intersections of transgender and BDSM. Hubbardston, England: Alfred Press. Kleinplatz, P. J., & Moser, C. (Eds.). (2006). Sadomasochism: Powerful pleasures. New York, NY: Harrington Park Press. Langdridge, D., & Barker, M. (Eds.). (2007). Safe, sane and consensual: Contemporary perspectives on sadomasochism. Houndmills, England: Palgrave. Newmahr, S. (2011). Playing on the edge: Sadomasochism, risk, and intimacy. Bloomington: Indiana University Press. Weiss, M. (2011). Techniques of pleasure: BDSM and the circuit of sexuality. Durham, NC: Duke University Press.

BONDAGE AND DISCIPLINE/ DOMINATION AND SUBMISSION (BDSM) See Bondage, Dominance/Submission, Sadism/Masochism (BDSM)

BREAST CARE PEOPLE

FOR

TRANSGENDER

Transgender individuals are born with a biologic sex that does not match their gender identity and expression. They have the same health concerns as

Breast Care for Transgender People

non-transgender people, in addition to a unique set of considerations due to their medical and gendered histories. Transgender individuals require care tailored to their specific situation and choices. This requires medical providers to be caring, be nonjudgmental, and have an accurate understanding of their needs. Although the term transgender can be applied to a broad spectrum of people and groups, for the purposes of this entry it is defined as those persons actively engaged in anatomically and/or physiologically transitioning from their biologic sex to their actual sex. Many undergo hormone therapy and/ or alter their breasts or genitals to facilitate this transition from male to female (MtF) or female to male (FtM). This entry focuses on changes in breast tissue due to hormone therapy, breast binding, mastectomy, or breast augmentation.

Relevant Anatomy and Physiology Individuals in the transgender population often change their breast anatomy and physiology to achieve an aesthetic more congruent with their gender identity. A description of breast tissue development and maintenance is important to provide a basis for understanding their choices. The mature human breast sits between a layer of fat and muscles. Between the breast and the muscles is a network of small veins and arteries; it is here that tissues are separated during a mastectomy. Nerves that supply sensation to the chest and upper arms are immediately next to the breast tissue, which consists mainly of glands, supporting tissue, and fat. There are 10 to 15 tiny openings in each nipple, which in genetic females are attached to the glands of the breast that produce milk. Breast tissue changes throughout a woman’s life, reflecting pregnancy, lactation, menopause, and general aging. The male breast is predominantly fat and supporting tissue, with very little glandular tissue.

Male-to-Female Transgender Individuals An individual who is born male and transitions to female may undergo a combination of feminizing procedures related to her breasts, including

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hormone supplementation, implantation, and augmentation by injection. Hormone Supplementation

Estrogen is primarily used to create female characteristics in the transgender woman, although other medications are sometimes given as well. The speed and degree of changes in breast tissue depend on the individual person, as well as the combination of agents being used. Breast and nipple development are rarely as complete in MtF individuals on hormone supplementation as it is in genetic females. Maximum development is usually achieved after 18 to 24 months of hormone therapy and is permanent, so MtF individuals may choose to consider augmentation after 2 years if they are unsatisfied with their breast growth. Weight gain in thin transgender women may also add to breast volume. General side effects of hormone therapy may include weight gain, galactorrhea (nipple discharge), decreased red cell mass, and decreased sex drive, and in non-transgender women, infertility. No large studies have been conducted to evaluate the adverse effects of hormone therapy on the breast tissue specifically of transgender individuals. However, many studies have been done on nontransgender women who are receiving hormones for a variety of reasons. The results have been varied and difficult to interpret, so more research is required. There are seven instances of breast cancers in MtF individuals noted in the medical literature, and some researchers hypothesize that MtF people receiving these hormones may have a higher cancer risk. This is because many cancers are fed and perpetuated by estrogen. Cancers may be underreported in the small transgender population, or the incidence may rise as the new and growing generation of MtF individuals age. Despite the complex and incomplete evidence related to breast screening of MtF individuals on estrogen therapy, guidelines are widely agreed upon. The Endocrine Society’s recommendation is representative of the consensus, in that MtF transgender individuals should follow the same breast cancer screening guidelines as non-transgender women.

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Breast Implantation

Breast implants are typically made from saline or silicone, encased in elastic shells made from silicone or plastic. The body usually forms a dense capsule of scar tissue around each implant. Early procedures entailed inserting the implant just under the skin; now they are more often placed beneath the chest muscles. This new method does not visibly ripple the skin, and there is less chance of unattractive or unhealthy results. Although the practice of breast implantation is common, in the general and MtF populations, there are safety concerns for all. Many women experience adverse events after surgery, some of which include bleeding, wound infection, or chronic pain. Implant rupture is a common complication. Silicone can leak out and migrate to other parts of the body, leading to pain and requiring surgical removal. Unfortunately, there is little agreement about the preferred method of screening the MtF person with breast implants: mammography, ultrasonography, or magnetic resonance imaging (MRI). Different researchers have come to varying conclusions, although transgender women have deemed all of the procedures nearly painless and of high personal importance. Injection for Augmentation

Various substances for injection into the face, breasts, hips, buttocks, and calves are marketed as minor or relatively inexpensive procedures for MtF individuals to feminize their bodies. The material most often used is silicone oil, but mineral oil and olive oil are also sometimes injected. Improper use can lead to numerous complications, sometimes years later. These may include various infections, loss of vision, hepatitis, migration and disfigurement, chronic ulcers, and swelling of lymph nodes. Treatment for these issues can be complex and painful. Suction of silicone from the breast has been used, but complete surgical removal of the oil is generally considered impossible. Individuals who have had these injections in the breast should

receive subsequent annual mammography and follow-up MRI. Education should address possible adverse events and the avoidance of breast trauma.

Female-to-Male Transgender Individuals People seeking to transition from a female to a male body may pursue a number of procedures that affect their breasts, including hormone therapy, breast binding, and mastectomy. Hormone Supplementation

Testosterone is typically the only hormone prescribed to produce masculinizing effects. Sometimes various methods of birth control may be used to suppress menstruation. Medical research has found no increased risk of serious adverse effects on breast health while taking such regimens. If a mastectomy has not been performed, the Endocrine Society recommends continued mammography screening for individuals on testosterone therapy, a position also supported by the American Cancer Society. Breast Binding

Breasts are perceived by many FtM transgender individuals as a constant reminder of their biologic sex. Binding of the breasts tightly to the torso allows them to be more easily hidden beneath clothing, making it easier to pass as male. Many FtM individuals perceive their breasts and how they choose to hide them as crucial to their gender presentation. There is little specific evidence on the health effects of breast binding, and mention of the practice is usually only one part of broader research studies. There has been an increase in the hormone prolactin observed in those who bind, which is in turn linked to tumor growth. As noted, the Endocrine Society recommends continued annual breast cancer screening, as dictated by the American Cancer Society, for individuals on testosterone therapy. This also applies to FtM people who bind their breasts.

Bullying, Legal Protections Against

Mastectomy

Mastectomy for an FtM person is typically referred to as chest reconstruction, and often involves an initial procedure, followed by scar revisions. There are a number of techniques employed for mastectomy in FtM individuals, depending on a person’s breast volume, skin elasticity, and the position of the nipples. The performance of a mastectomy is made more complex by poor skin quality caused by years of breast binding. Skin elasticity is an important factor in choosing the most appropriate surgical technique. Chronic pain following mastectomy has been reported frequently in multiple studies, some even finding that more than half of women will experience it. Other complications can occur, such as nipple tissue death, contour irregularities, and substantial scarring. The possibility of experiencing pain following a chest reconstruction procedure is a risk that many MtF individuals may be willing to accept; however, the potential for this complication must be discussed. There is no consensus in the literature on how, when, or whether FtM individuals should be screened for breast cancer following mastectomy, but most evidence suggests that pathologic findings in residual tissue are rare. The American Cancer Society recommends that women who have had mastectomies undergo a clinical breast exam annually, which includes examination of the chest wall, skin, and incision. The guideline does not mention the need for radiologic examination, or specific recommendations for transgender people.

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hormone therapy, implantation, augmentation injections, binding, or mastectomy. All of these choices have risks that warrant careful discussion and monitoring by health care providers. Overall, the acceptability of risks associated with these choices must be determined by the individual and not by the provider. In a society that has yet to fully accept transgendered individuals, one of the most valuable things a provider can offer is compassion and acceptance to help this vulnerable population maintain optimal health in the context of their choices. Laura Maycock See also Body Modification; Health Disparities; Hormones and Surgery During Gender Transition; Transgender Health Care; Transgender People and Binding, Tucking, and Packing; Transgender Youth and Cross-Sex Hormones; Transgender Youth and Puberty Suppression

Further Readings Coleman, E. (2012). Standards of care for the health of transsexual, transgender and gender nonconforming people. Retrieved October 16, 2014, from http://www .wpath.org/site_home.cfm Lawrence, A. A. (2007). Transgender health concerns. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual and transgender populations (pp. 437–505). New York, NY: Springer. Maycock, L. B., & Kennedy, H. P. (2014). Breast care in the transgender individual. Journal of Midwifery and Women’s Health, 59(1), 74–81.

Conclusion Health care providers have a responsibility to treat all clients with respect, which includes having a thorough understanding of their unique needs and desires. Transgender individuals are particularly in need of this consideration, reflecting their anatomical and physiological choices and social vulnerability. Transgender individuals perceive their breasts as being an important part of their gender identity. As a result, transitioning often entails a great deal of focus on breast changes through

BULLYING, LEGAL PROTECTIONS AGAINST Over the past several decades, increased attention has been paid to bullying and harassment in schools in general, and bullying of LGBTQ students in particular. Legal protections are some of the most discussed avenues for addressing bullying in school. Although there are a variety of legal

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proscriptions and remedies in place to address school bullying, they still fall short of sufficiently protecting LGBTQ students. This entry reviews the current landscape of both state and federal legal protections against bullying for LGBTQ students in the United States. Although the focus here is on statutory laws, various administrative rules and procedures may also provide a level of protection for LGBTQ students against school bullying, such as school bullying codes enacted by state departments of education. Public education resides primarily in the purview of state and local jurisdictions, and states have been at the forefront in addressing bullying through specific state statutes. Currently, all 50 states and the District of Columbia have passed laws addressing bullying in schools. By and large, these state laws require schools and school districts to develop explicit anti-bullying policies and mandate the content of the policies. The U.S. Department of Education issued a report in 2011 documenting the prevalence and content of state anti-bullying laws and the growth of this legislation over the past decade. These state laws are not uniform across the nation. Their effectiveness in specifically protecting LGBTQ students from bullying depends upon the explicit inclusion of sexual orientation and gender identity/expression among other enumerated categories of protection, such as race/ethnicity, gender, or religion. For example, a study conducted by the Gay, Lesbian & Straight Education Network (GLSEN) of LGBTQ secondary school students found that students living in states with antibullying laws that included an explicit enumeration of sexual orientation and gender identity/expression reported lower levels of peer victimization in school and higher levels of effectiveness of staff response to victimization than LGBTQ students in states that have anti-bullying laws without such enumeration. The enumeration of protected categories is generally set forth in the statutes as an illustrative, but not exhaustive, list of protected categories. The majority of anti-bullying statutes do not include such enumeration. Currently, only 18 states and the District of Columbia include the express

enumeration of protected categories, although all of these include sexual orientation and gender identity/expression. In addition to the District of Columbia, the states that include protections based on sexual orientation and gender identity/expression are Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Jersey, New York, North Carolina, Oregon, Rhode Island, Vermont, and Washington. At the federal level, the U.S. Constitution and civil rights law can provide legal remedies for LGBTQ students who face bullying and harassment. The Equal Protection Clause of the Fourteenth Amendment of the U.S. Constitution guarantees all citizens the same protection under the law. It has been successfully used to hold public school districts accountable for failing to protect LGBTQ students from harassment and bullying and thereby depriving them of equal access to an education. In addition to the Equal Protection Clause, Title IX of the Education Amendments of 1972 has been used to protect LGBTQ students subject to bullying and harassment. Title IX explicitly prohibits sex discrimination in schools that receive federal funding and applies to virtually all public schools and some private schools. Title IX has traditionally applied to providing equal access to girls in school sports and protection from sexual harassment. Recently, the U.S. Department of Education clarified that Title IX applies to discrimination based on sex stereotypes (i.e., discrimination based on failure to conform to traditional notions of masculinity or femininity) and gender identity (i.e., discrimination against transgender students). LGBTQ students who experience bullying and harassment on account of sex stereotypes or gender identity can file Title IX complaints through the Office of Civil Rights of the U.S. Department of Education. Although there are federal legal remedies for school bullying, there is no existing federal legislation explicitly addressing bullying in schools. The Safe Schools Improvement Act is designed to ensure that all students, including LGBTQ

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students, in every state are statutorily protected from bullying and harassment. A bipartisan bill, the Safe Schools Improvement Act, has been introduced in multiple Congressional sessions, and— while never brought up for a vote—had the support of nearly half the House and Senate at the end of the 113th Congress. The Safe Schools Improvement Act would require all primary and secondary schools receiving federal funding to enact an anti-bullying policy that includes specific prohibitions on bullying based on sexual orientation and gender identity/expression. The policy would also have to include other categories, such as race and religion. A similar bill that applies to institutions of higher education, known as the Tyler Clementi Higher Education Anti-Harassment Act, requires colleges and universities to prohibit harassment and establishes within the Department of Education a grant program to support campus antiharassment programs. Emily A. Greytak See also Bullying, Rates and Effects of; Bullying, SchoolBased Interventions for; Education; School Climate; Transgender and Gender-Nonconforming Youth and the Legal System; Violence and Victimization of Youth

Further Readings Gay, Lesbian & Straight Education Network (GLSEN), & National Center for Lesbian Rights (NCLR). (n.d.). Expensive reasons why safe schools laws and policies are in your district’s best interest. Washington, DC: Author. Kosciw, J., Greytak, E. A., Palmer, N. A., Bartkiewicz, M. J., & Boesen, M. J. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian & Straight Education Network. Limber, S. P., & Small, M. A. (2003). State laws and policies to address bullying in schools. School Psychology Review, 32(3), 445–455. Stuart-Cassel, V., Bell, A., & Springer, J. F. (2011). Analysis of state bullying laws and policies. Washington, DC: U.S. Department of Education, Office of Planning, Evaluation and Policy Development.

BULLYING, RATES

AND

EFFECTS

OF

This entry describes findings from research on the bullying of LGBTQ youths. It offers a historical overview of those studies that identify bullying as a significant factor in the well-being of LGBTQ individuals, and provides a summary of the findings from larger, more recent, population-based surveys. The entry then discusses the prevalence of LGBTQ bullying, including the bullying of those who are perceived to be LGBTQ, before turning to a discussion of the long-term implications of those experiences for victims. Finally, this entry offers an overview of current debates about the use of language and whether the use of epithets such as “gay” and “fag” are homophobic.

Rates of Bullying Bullying perpetrated against LGBTQ youths remains a significant education and public health issue. For more than 30 years, LGBTQ support groups and researchers have undertaken studies to understand its nature, prevalence, and long-term effects. Those groups and researchers have encountered hostility from local and national politicians, and the leaders of faith communities, as a result of their attempts to raise the profile of and offer support to LGBTQ young people in school. The very first study to provide data on what we now call homophobic bullying was conducted in the United Kingdom on behalf of the Inner London Education Authority in 1984. Four hundred and sixteen lesbian, gay, and bisexual (LGB) youths were asked about the pressures they faced in school and the ways in which they were discriminated against in the classroom. The results from this pioneering study suggested that 39% of youths had experienced “problems at school,” which included bullying. Of those who experienced problems at school, 25% reported feeling isolated, 21% had been called names or verbally abused, 13% had been teased, 12% had been physically assaulted, 7% had been ostracized by peers, and 7% said they had been pressured to

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change their behavior. By comparison, in 1988, researchers in the United States collected data from 461 gay men and 260 lesbians, which showed that 50% of the men surveyed and 12% of women reported having experienced victimization in junior high schools, rising to 59% and 21%, respectively, in high school. Subsequently, an analysis of the data gathered from various studies conducted by LGB task forces and coalitions across the United States in the late 1980s and early 1990s suggested that, nationally, reports of school-based victimization ranged anywhere from 33% to 49%. By the mid-1990s, community-based studies using samples of LGB youths were beginning to be published. One study of 194 youths attending community groups across the United States suggested that as many as 30% of young men and 25% of young women experienced harassment or abuse in school. In the United Kingdom (UK), a survey of hate crimes perpetrated against British LGBs indicated that around 40% of those under the age of 18 had been attacked at school. By the late 1990s, it was estimated that approximately 1 in 3 LGB youths experienced victimization at school because of their actual or perceived sexual orientation. Since 2000, two large-scale surveys sponsored by a UK charity have demonstrated a shift in the experiences of young LGBs in secondary/high schools and colleges. Data collected in 2012 (from 1,614 youths) was compared with that collected in 2007 (1,145 youths) and showed that reports of bullying decreased from 65% to 55%. However, of those who reported being bullied in the 2012 survey, 58% said they were victims of verbal abuse, 46% were the subject of gossip, and 33% reported receiving intimidating looks. Other forms of victimization included being ignored by peers (31%), cyberbullying (23%), physical abuse (16%), destruction of property (11%), phone/text abuse (9%), death threats (6%), threats with a weapon (3%), and sexual assault (3%). LGB youths attending faithbased schools were more likely to report being bullied than those attending public or secular schools. In the United States, the Gay, Lesbian and Straight Education Network’s (GLSEN) biannual

surveys of bullying and victimization, which began in 1999, illustrate how reports of victimization have changed over time. There has been a noticeable decline in verbal harassment since 2007; however, rates of physical assault have remained relatively stable. Among those who are bullied on the grounds of gender expression, while there has been a concomitant decline in verbal harassment, physical assault has also remained relatively unchanged. In its 2011 survey of 8,584 youths (ages 13 to 20), GLSEN found that 63.5% said that they felt unsafe at school because of their sexual orientation and 43.9% because of their gender expression. Of those who felt unsafe at school, 81.9% said they had been called names or threatened in the last year because of their sexual orientation, and 63.9% because of their gender expression. Additionally, 38.3% reported having been physically harassed (pushed or shoved) and 18.3% said they had been physically assaulted because of their sexual orientation. Among those bullied because of their gender expression, 27.1% said that they had been physically harassed with 12.4% reporting having been physically assaulted. Over half (55.2%) had also been the victims of cyberbullying. Although a great deal of data have been collected on the experiences of LGBTQ people when they were at school, these data have tended to be retrospective and questions have been raised about the ability of adults—even young adults—to remember incidents in detail or provide accurate estimates of the frequency of their bullying. While there is encouraging evidence to suggest that name-calling has diminished over time, it remains a concern that over 50% of LGBTQ youths continue to report being harassed at school.

Prevalence Most of the early studies that focused on LGBTQ bullying relied on self-selecting samples of youths and young adults who were “out” and attending community groups; or who were drawn to the projects because of subject matter and their own

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experiences of violence and harassment. It has therefore been very difficult to establish a prevalence rate for LGBTQ bullying in schools. Two surveys run by a UK national charity have asked young people in schools and colleges about all forms of bullying. The first survey, published in 2013, included 1,843 young people attending colleges across the United Kingdom. Among those youths who had experienced bullying before their 18th birthday, 11.1% said that the bullying they experienced related to “attitudes toward sexuality” with 3.4% reporting that it was the result of “attitudes toward gender identity.” The second survey, published in 2014, which included responses from 3,616 young people, indicated that approximately 7% experienced what was described as “homophobic bullying” at school and 2% had experienced “transphobic bullying.” Between 2001 and 2002, the California Safe School Coalition, together with researchers from the University of California, Davis, surveyed 237,544 students attending schools statewide (Grades 7 to 11; ages 12 to 17 years) who were asked about their experiences of bullying, including incidents of homophobic bullying. Overall, 7.5% of students said that they had been victims of homophobic bullying, with two thirds of those students who identified as lesbian, gay, bisexual, and transsexual reporting that they were victimized because of their actual or perceived sexual orientation. Additionally, those students who were bullied because of their actual or perceived sexual orientation were more likely to report receiving lower grades for academic work (grade “C” or below) when compared with nonbullied peers (24% versus 17%). They were also more likely to report missing school in the past month because they felt it was not safe (27% versus 7%). They were twice as likely to report engaging in healthrisk behaviors such as substance abuse, driving under the influence of alcohol, or being a passenger in a car where the driver had consumed alcohol. They were significantly more likely to report being threatened or hurt by someone carrying a weapon (28% versus 5%), and much more likely to report carrying a weapon to school (19% versus 5%).

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Data from these three surveys provide some index of the prevalence of bullying on the grounds of actual or perceived sexual orientation and gender expression. Approximately 7% of young people experience some form of bullying related to actual or perceived sexual orientation. This figure includes not only LGBTQ youths but also those heterosexual youths who, for whatever reasons, are perceived to be different and thus not members of the heterosexual in-group. Much more research is needed on the health-risk behaviors associated with LGBTQ bullying, and it is particularly worrying that significantly more LGBTQ youths feel the need to carry a weapon to school when compared with their heterosexual peers who experience bullying.

Effects of Bullying The issue of whether homophobic bullying is a significant contributor to the mental health issues found among sexual-minority groups is contested. Some researchers and activists argue that there are methodological flaws in the design of many of the early studies examining LGB mental health where the focus is on negative rather than positive experiences growing up. Those early studies rarely included participants who were transgender or queer/questioning. Some scholars and activists argue that researchers continue to perpetuate a myth of ongoing discrimination and poor mental health among LGBTQ people when homophobia is in fact in decline. However, there is now an emerging body of longitudinal research that suggests that there are indeed long-term and debilitating effects arising from bullying at school, not just for LGBTQ youths but also for those youths who are bullied for other reasons. The long-term correlates of homophobic bullying range from reports of depression, anxiety, and non-expressed aggression through to multiple suicide attempts. In one study conducted in the United Kingdom, it was found that 53% of LGB participants who had experienced bullying at school because of their actual or perceived sexual orientation had contemplated suicide. The

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majority (40%) had made at least one attempt and three quarters of those had made two or more attempts. In the United States, among a community sample of 194 LGB youths, 42% reported having attempted suicide. While researchers have been careful not to link suicide to experiences of peer, family, and community intolerance, increasingly there is evidence that suggests good mental health is intrinsically linked to self-acceptance, which is itself linked to societal acceptance. This finding is corroborated by large-scale populationbased studies, which show that external environmental factors such as the political and social acceptance of sexual minorities plays a significant role in the general well-being and survival rates of LGBTQ people. For example, using pooled data from the 2005 and 2007 Youth Risk Behavior Surveillance surveys (N N = 55,559, ages 13 to 18 years), one U.S. study found that rates of suicide ideation among LGB young people were lower in states and cities where sexual-minority students reported feeling protected (e.g., they had safe spaces to go to or their schools had a gay–straight alliance). In GLSEN’s 2011 survey, high rates of depression and low self-esteem were found among those who reported being victimized at school. Additionally, data collected in California from 237,544 students suggests that 55% of those bullied because of their actual or perceived sexual orientation had experienced depression for at least 2 weeks in the last 12 months (compared with 23% among nonharassed students). Furthermore, 45% had seriously considered suicide (compared with 14% among nonharassed students) and 35% had made a suicide plan (compared with 9% among nonharassed students). However, one UK study found that there is very little difference in scores for depression, anxiety, and non-expressed anger for those who were bullied because of their sexual orientation at school when compared with those who were bullied for other reasons. Overall, both groups were found to have poorer mental health when their scores were compared with those of heterosexual and LGB participants who had not been bullied at school. Finally, data taken from the Longitudinal Study of Young People in England suggest that, among

those who identified as LGB at age 16, while victimization declined with age, young LGB people, particularly young men, are nearly 4 times more likely to experience some form of harassment or victimization after they leave school when compared with young heterosexuals. Depression, anxiety, non-expressed anger, and self-loathing have all been identified as issues common among LGBTQ youths and adults who experienced bullying at school. Rates of suicide ideation have been found to be particularly high among this group, averaging at around 40%; however, some researchers argue that the suicide “script” associated with bullying is so well known among LGBTQ youths that taking one’s own life may be seen as the only solution when bullying occurs. If this is the case, it becomes imperative that alternative scripts encouraging help-seeking behaviors are promoted among those who support LGBTQ youths.

Contemporary Debates on Language Use Criticism of those early studies that explored LGBTQ mental health has been followed most recently with a discussion about the current use of epithets such as “gay,” “fag,” “dyke,” and “tranny” by young people. Cross-nationally, researchers and theorists from the disciplines of sociology and education have suggested that comments such as “that’s so gay” or labels such as “fag” are not homophobic but rather represent new language conventions among young people’s friendship networks. Here, such labels are not associated with sexual orientation; rather, they represent a form of banter or “homosexually themed language” that can be used without causing offense. It is argued that these groups of friends would not consider themselves homophobic or transphobic; rather, they have accepted a much more relaxed attitude toward sexuality and gender expression, which in turn allows them to use those names or labels in a nondiscriminatory way. The use of language and the way outsiders interpret it is an important area of inquiry, and it is one that is ongoing. Ian Rivers

Bullying, School-Based Interventions for See also Bullying, School-Based Interventions for; Community Climate; Gay, Lesbian & Straight Education Network (GLSEN); Homophobia; Homophobic Language in the Peer Group; School Climate; Suicide, Risk Factors for and Prevention of; Transphobia

Further Readings Gay, Lesbian and Straight Education Network. (2011). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: Author. Guasp, A. (2012). The school report: The experiences of gay young people in Britain’s schools in 2012. London, England: Stonewall. Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127, 896–903. McCormack, M. (2013). Mapping the boundaries of homophobic language in bullying. In I. Rivers & N. Duncan (Eds.), Bullying: Experiences and discourses of sexuality and gender (pp. 91–104). London, England: Routledge. Pascoe, C. J. (2005). “Dude, you’re a fag”: Adolescent masculinity and the fag discourse. Sexualities, 8, 329–346. Rivers, I. (2011). Homophobic bullying: Research and theoretical perspectives. New York, NY: Oxford University Press. Robinson, J. P., Espelage, D. L., & Rivers, I. (2013). Developmental trends in peer victimization and emotional distress in LGB and heterosexual youth. Pediatrics, 131, 423–430. Savin-Williams, R. C. (2005). The new gay teenager. Cambridge, MA: Harvard University Press.

BULLYING, SCHOOL-BASED INTERVENTIONS FOR Bullying has recently been recognized as a significant social problem, particularly in schools, where young people spend the majority of their waking hours. The school community has deemed unacceptable a range of peer-to-peer antisocial conduct

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used to intimidate and control others. Unacceptable bullying behaviors range from social exclusion, name-calling, and spreading rumors to harassment, threats, and physical assault. Bullying may occur in person or online. Some behaviors labeled as “bullying” by schools may rise to civilly or criminally sanctioned behavior. According to the American Educational Research Association’s (AERA) recent report on bullying, LGBTQ students, along with students with disabilities and African American students, are the targets of a disproportionate level of bullying in U.S. schools. Because researchers, educators, and parents are beginning to understand how bullying interferes with a student’s ability to learn and negatively affects their well-being, conduct that was formerly minimized and accepted as just a normal part of growing up is now the subject of school-based intervention policies and practices. Anti-LGBTQ bullying, however, is not often integrated explicitly into a school’s prevention or intervention policies or practices. This is likely due to a combination of a school’s lack of awareness and resources, which are maintained by institutionalized forms of anti-LGBTQ discrimination in K–12 schools. Because of this enduring reality, some scholars who research anti-LGBTQ bullying argue against adopting an overly narrow conceptualization of the term bullying because doing so obscures how anti-LGBTQ bullying stems in part from and contributes to an overall hostile school climate for sexual-minority and gendernonconforming youth and adults. They caution that generic anti-bullying interventions will likely not protect LGBTQ youth, and that LGBTQinclusive anti-bullying interventions may ignore the structural inequalities experienced by the LGBTQ community. School-based interventions for bullying differ according to how bullying is defined and measured, the intended scope and goal of the intervention, and the level of educational resources invested. Some interventions are directed at the individual, such as incident-based counseling or disciplinebased approaches often modeled on federal antiharassment law or zero-tolerance antiviolence or

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antidrug policies. Other interventions involve a group of students such as a therapeutic support or skill-building group, student clubs such as gay– straight alliances, and conflict-resolution/peer mediation programs or other restorative justice techniques. Still others engage the whole school to prevent bullying (e.g., character education, positive behavior intervention). The following sections provide an overview of individual, group, and wholeschool approaches to school-based interventions for bullying. Highlighted throughout are ways in which schools have used these tools to create inclusive learning environments for all of their students, regardless of sexual orientation or gender identity.

Individual-Based Interventions Classroom Management

One of the first sites for school-based interventions for bullying is classroom management. Educators are responsible for maintaining an environment that is conducive to learning for all of their students. Instilling and maintaining expectations for student comportment in the classroom (or bathroom, locker room, cafeteria, or hallway) incorporates interrupting and stopping inappropriate behavior, including anti-LGBTQ bullying. Still, according to the Gay, Lesbian and Straight Education Network’s (GLSEN) biennial National School Climate Survey released in October 2014, students aged 13 to 21 who were in Grades 6 through 12 reported that over 40% of school employees never intervene when they hear homophobic remarks; the percentage rises to nearly 60% for negative remarks about gender expression. More than half of the students surveyed also reported that their teachers uttered homophobic and negative remarks about gender expression. These findings are not unexpected given the mix of affirming and negative attitudes toward LGBTQ people found across the United States, and the lack of discussion of LGBTQ issues in preservice training for teachers and other school staff. Supplementary efforts for postgraduates include discretionary participation in professional development to help classroom teachers, counselors, coaches, school bus drivers, and other “frontline” staff feel

confident and prepared to recognize and intervene in any kind of bullying on school grounds or in the digital world. Student Discipline

Over the last decade, statewide anti-bullying laws have been passed in 49 out of 50 states. As a result, most school codes of conduct now incorporate anti-bullying policies, and student discipline constitutes the most common school-based antibullying intervention. Schools enforce these codes, policies, and laws primarily through disciplinary action. The discipline model is built around student and staff awareness of policies related to school-appropriate behavior, and relies on a student (or school employee) to report misconduct via an established procedure. Administrators then evaluate the complaint and determine a suitable response to the individuals involved. When punitive sanctions or other steps are taken against antiLGBTQ bullying, it sends a message to those who perpetrate the behavior, and the student body as a whole, that the school considers it unacceptable. Traditionally, schools have failed to protect LGBTQ students and those labeled as sexual minorities or gender nonconforming. Lacking such protection, students have turned to the courts. Jamie Nabozny, for example, sued his middle school for failing to protect him from persistent antigay peer harassment and violence, even after he repeatedly reported the behavior to school officials; his lawsuit resulted in the landmark decision in 1996 by the 7th Circuit Court of Appeals, which determined that schools must intervene into antigay behavior in order to ensure all students access to education. Nevertheless, no national consensus exists as to the definition of bullying, and Congress has yet to pass a proposed federal anti-bullying bill, such as the Safe Schools Improvement Act. However, the U.S. Department of Education (DOE) has issued “Dear Colleague” letters to schools receiving public funds to guide how they must manage bullying and harassment. In an instructive October 26, 2010, “Dear Colleague” letter, the DOE’s Office of Civil Rights reminded schools that regardless of

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whether particular conduct is included within a school’s anti-bullying policy, they are obligated under federal civil rights law to intervene and protect all students from discriminatory harassment that creates a hostile environment based on a set of protected classes: race, color, national origin, sex, disability, and religion. For the first time, they emphasized that schools must prohibit sexual and gender-based harassment, “regardless of the actual or perceived sexual orientation or gender identity of the harasser or target.” The DOE’s StopBullying .gov website includes additional resources such as a review of state anti-bullying laws and policies, and 11 key components to consider when developing or reforming anti-bullying and antiharassment laws, policies, and procedures. GLSEN has found that enumerated anti-bullying laws and policies— that is, policies that name frequently targeted and vulnerable status characteristics, including actual or perceived sexual orientation and gender identity/expression—are more effective than generic policies. Scholars and advocates alike have raised concerns about the proliferation of anti-bullying laws, punitive school policies, and overreliance on school resource officers and other security measures. Similar to other law-based interventions, student discipline is a reactive, incident-driven, and often blunt approach to a complex and dynamic social problem. Disciplinary interventions can cause unintended consequences, such as outing a student as a member of the LGBTQ community, or discourage students from reporting bullying. Such individual-based interventions assume that antiLGBTQ bullying is a series of isolated events rather than part of what education scholars refer to as the “hidden curriculum” or the overall school climate. That is, the discipline approach blames a few “bad apples” rather than the normative antiLGBTQ school climate. The punitive nature of the discipline approach also has attracted critics due to the intensification of surveillance and policing in the name of school safety. Such critics argue that zero-tolerance and other overly harsh or disparately implemented school safety measures have escalated the severity of sanctions, and disproportionately “push out” school students of color,

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students with disabilities, and LGBTQ students through suspension, expulsion, and referral to juvenile justice. In light of what has been referred to as the “school-to-prison pipeline,” the DOE recommended in its recent Guiding Principles that schools strive to retain students in school, and reduce referrals to law enforcement as part of their efforts to create positive, supportive, and safe schools for all students. Counseling

Students involved in reported incidents of bullying also may be offered individual counseling. When professionals such as counselors, social workers, psychologists, or prevention specialists are part of a school’s staff, and are prepared to advocate for all students, they may provide support, resources, and referrals to students identified as offenders, targets (or victims), or bystanders (witnesses). This counseling work could include risk or threat assessment, identification of shortterm coping mechanisms such as changing a class schedule to avoid contact with the bully, development of long-term modes of resilience, and referrals to community-based resources such as an LGBTQ youth services organization. Notably, the American School Counselor Association’s ethical standards require its members to understand how systemic oppression affects students. This includes knowing the critical difference between LGBTQ students “coming out” on their own terms versus “outing” a student without their consent when intervening into bullying. School staff can signal their support or “allyship” to the LGBTQ community and those targeted with anti-LGBTQ bullying by displaying a safe space sticker, poster, and other relevant resources in their office. This helps students find someone with whom they feel comfortable reporting anti-LGBTQ bullying.

Group-Based Interventions Peer Mediation

Considered an alternative to discipline, restorative justice techniques such as peer mediation are found in schools across the country. Peer

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mediation programs offer students an opportunity to work out disputes with the help of a student cadre trained to be neutral third parties, rather than rely on school personnel to sort out or solve what are understood as low-level conflicts. The goal is to quickly de-escalate incidents before they become disruptive to the learning process, enable students to develop conflict-resolution skills and solve their own problems, and, in the long term, contribute to a culture of mutual responsibility and school belonging. However, similar to the problems associated with the adult use of mediation, when an unequal balance of power is present, such as with domestic violence, critics argue against the use of peer mediation and related conflict-resolution programs as a school-based bullying intervention. Bullying is different from conflict because it has been deemed as unacceptable behavior used to intimidate and control others, and students should not have to bargain or compromise in order to stop such behavior as a means to secure their safety. Furthermore, because peer-mediator skills vary, as does their understanding of LGBTQ issues, this intervention may be harmful when applied to anti-LGBTQ bullying. Finally, peer mediation also has not been fully evaluated to determine its effectiveness as an intervention for bullying more generally.

Student Clubs

School-based interventions for bullying are not limited to those initiated by school staff. Students have organized a variety of school clubs with bullying awareness or anti-bullying activities at the center of their mission. Gay–straight alliances (GSAs) are student clubs developed in response to the pervasive anti-LGBTQ school climate as a mechanism to provide a safe space or haven for LGBTQ-identified students and their allies who encounter bullying and harassment on a regular basis throughout the school day. GSAs also engage in activities such as GLSEN’s National Day of Silence, developed by students to build schoolwide awareness about anti-LGBTQ bullying and harassment. Another type of student-centered school intervention, especially for bias-based bullying, is the Anti-Defamation League’s A World of Difference Peer Trainers antibias education program. Peer Trainers are a group of high school students who learn how to facilitate interactive classroom activities with first-year students about bias and discrimination, the value of diversity, and how to be an ally to all of their peers. Student clubs tap into the power of peer influence among youth. However, student clubs organized around an antibullying mission have been more successful when they are one part of a more comprehensive set of school-based interventions.

Group Therapy

Schools with the resources to do so may offer a range of therapy groups for students requiring additional support. Group therapy offered as a resource to students who bully their peers typically focuses on anger management and selfesteem. Developmental psychologist Sue Linder argues, however, that such an approach is counterproductive. Students who bully, she contends, are not primarily motivated by anger, nor do they necessarily suffer from a lack of self-esteem. Additionally, the group-based nature of this intervention enables students to learn from and reinforce each other’s antisocial behavior, which may exacerbate anti-LGBTQ bullying in particular.

Whole-School Interventions Research unquestionably demonstrates that students who do not feel safe at school are not able to learn effectively and experience educational and health disparities. Thus, education scholars and reformers are turning to the notion of “whole child” or “whole school” to improve student learning in U.S. schools. Whole-school advocates argue for nurturing students beyond their academic skills by incorporating opportunities for social and emotional development throughout the school day. This would create what the Center for Social and Emotional Education (CSEE) calls a positive school climate, where students feel safe not only physically but also socially and emotionally.

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A whole-school approach to bullying draws on this integrated approach to a positive school climate. No one anti-bullying intervention directed at one sector of a school community at one interval can result in meaningful improvement; annual school assemblies may inspire a student audience but are an insufficient approach to transforming a school’s culture. The entire school community must be responsible for and engaged in multiple ways at all times to prevent and intervene in unacceptable antisocial behaviors, including those labeled as bullying, to promote a sense of belonging to the school. Beginning in 2010, the Safe and Supportive Schools (S3) federal grant program offered 11 states the chance over 4 years to experiment with and evaluate the effectiveness of evidence-based comprehensive frameworks such as Positive Behavior Intervention and Support (PBIS) that ultimately intend to enhance student learning and health. Notwithstanding the demonstrated effectiveness of comprehensive interventions, such as the Olweus Bullying Prevention Program (OBPP), rarely do they explicitly or consistently address the unique challenges presented by anti-LGBTQ bullying within their purview. Nor do they focus on recommendations drawn from GLSEN’s school climate research, and affirmed by small-scale case studies, such as supportive educators, inclusive curricula, student clubs, and enumerated policies. From this broader perspective, Elizabeth Meyer is joined by other scholars and advocates who suggest that schools systematically address interlocking forms of sexism and heterosexism, along with ableism, xenophobia, White supremacy, and racism, in order to make anti-LGBTQ bullying and discrimination unacceptable in school as part of their efforts to create a positive school climate for all students.

Conclusion: Needs Improvement Teachers frequently tell students that their academic work or behavior “needs improvement.” School-based interventions for anti-LGBTQ bullying might receive similar feedback. Despite the

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variety and recent growth of anti-bullying efforts across the United States, inclusive interventions for anti-LGBTQ bullying remain at a low level and have yet to be institutionalized across the decentralized education system. Unique to antiLGBTQ bullying interventions are several needs. The school community would benefit from education about terminology related to sexual orientation and gender identity/expression, and an opportunity to address myths and stereotypes attributed to LGBTQ people. Educators, parents, and students alike lack an understanding of the effects of bias-based bullying on education and well-being, and the efficacy of research-based tactics for improving the school climate. Schoolbased interventions for bullying take place within a context where community members may be personally conflicted or outwardly against the acceptance of LGBTQ people, and where laws and policies may not protect against sexualorientation or gender-identity/expression-based discrimination. Discussion of LGBTQ-related education issues may be constrained due to limited community-based resources, including parents who may not be aware of or affirming of their child’s actual or perceived sexual orientation or gender identity/expression, and a lack of culturally responsive social services. Because antiLGBTQ bullying is part of the larger sociolegal context where discrimination and violence persist against LGBTQ people, it would profit from a multidisciplinary and collaborative approach informed centrally by students’ experiences to identify core etiologies and the most effective configuration of individual, group, and wholeschool-based interventions. Madelaine Adelman See also Bullying, Legal Protections Against; Bullying, Rates and Effects of; Education; Gay, Lesbian & Straight Education Network (GLSEN); No Promo Homo Policies; School Climate; School Professionals’ Responses to LGBTQ Training; Schools as Heteronormative Spaces; School-to-Prison Pipeline; Sexualities at School; Transgender and GenderNonconforming Individuals and Bathrooms; Violence and Victimization of Youth

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Further Readings American Educational Research Association (AERA). (2013). Prevention of bullying in schools, colleges, and universities: Research report and recommendations. Washington, DC: Author. Retrieved October 22, 2014, from http://www.aera.net/Portals/38/docs/News%20 Release/Prevention%20of%20Bullying%20in%20 Schools,%20Colleges%20and%20Universities.pdf Brown, J. K., Trone, J., Fratello, J., & Daftary-Kapur, T. (2013). A generation later: What we’ve learned about zero-tolerance in schools. New York, NY: Vera Institute of Justice. Greytak, E., Kosciw, J., & Bossen, M. (2013). Educating the educator: Creating supportive school personnel through professional development. Journal of School Violence, 12, 80–97. Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian & Straight Education Network. Retrieved October 22, 2014, from http://glsen.org/nscs Limber, S. (2003). Efforts to address bullying in U.S. schools. American Journal of Health Education, 34, S23–S29. Meyer, E. J. (2009). Gender, bullying, and harassment: Strategies to end sexism and homophobia in schools. New York, NY: Teachers College Press. Mitchum, P., & Moodie-Mills, A. C. (2014). Beyond bullying: How hostile school climate perpetuates the school-to-prison pipeline for LGBT youth. Washington, DC: Center for American Progress. Retrieved November 2, 2014, from http://cdn .americanprogress.org/wp-content/uploads/2014/02/ BeyondBullying.pdf Movement Advancement Project. (2014). Safe schools laws. Retrieved October 22, 2014, from http://www .lgbtmap.org/equality-maps/safe_school_laws Payne, E., & Smith, M. (2012). Rethinking safe schools approaches for LGBTQ students: Changing the questions we ask. Multicultural Perspectives, 14, 187–193. U.S. Department of Education (DOE). (2010). Dear colleague [Sample letter]. Washington, DC: Author. Retrieved October 22, 2014, from http://www2.ed.gov/ about/offices/list/ocr/letters/colleague-201010.pdf U.S. Department of Education (DOE). (2011). Analysis of state bullying laws and policies. Washington DC: Author.

Retrieved October 22, 2014, from http://www2 .ed.gov/rschstat/eval/bullying/state-bullying-laws/ state-bullying-laws.pdf U.S. Department of Education (DOE). (2014). Guiding principles: A resource guide for improving school climate and discipline. Washington, DC: Author. Retrieved October 22, 2014, from http://www2 .ed.gov/policy/gen/guid/school-discipline/guidingprinciples.pdf

BUSINESS Despite meaningful progress and increasing social acceptance of LGBTQ people in media, entertainment, and culture over the past two decades, openly LGBTQ people continue to be significantly underrepresented in business, especially in the upper echelons of corporate executive suites. There are myriad reasons why this marginalization persists, ranging from personally or externally imposed rules to “cover” or remain closeted while on the job, to the absence of corporate and federal nondiscrimination policies that specifically protect LGBTQ employees, to the slow pace of cultural change in some organizations. At best, LGBTQ employees experience supportive workplaces, led by progressive, inclusive management. At worst, LGBTQ employees face hostility and homophobia while on the job, from colleagues, supervisors, and business partners. This entry examines how the cultural shift in the acceptance of LGBTQ people has impacted their visibility in business; addresses the real and perceived challenges of being publicly “out” in the workplace; and provides perspective on the evolution of corporate inclusion and diversity policies and how those policies may or may not work in practice to create favorable work environments for LGBTQ employees.

Cultural Shifts and Growing Acceptance of LGBTQ People In recent years, the LGBTQ community has seen important gains in the fight toward equality, particularly in the United States. Such gains include

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the 2013 repeal of the Defense of Marriage Act, increased positive representation in media, and an ever-growing awareness and acceptance of LGBTQ people, especially among younger generations. According to a 2013 survey conducted by Pew Research that asked people in 39 countries whether or not society should “accept homosexuality,” an overwhelming majority of respondents in North America, the European Union, and much of Latin America said homosexuality should be accepted. While the Pew Research study found that attitudes toward LGBTQ people varied based on nationality, education, religious beliefs, gender, and age of respondents, the findings indicated a marked shift toward greater acceptance of LGBTQ people, particularly among younger, more educated, and less religious populations. In 2013, 60% of Americans said society should accept homosexuality, compared with 49% of Americans in 2007. The shifting of this cultural tide, however, has been slower to move some corporations and governments toward action. These changing societal views exist within a patchwork of varying corporate policies and have yet to result in a federal antidiscrimination law in the United States that would include the protection of employees based on sexual orientation or gender identity. Although the Employment Non-Discrimination Act (ENDA)—which would prohibit discrimination in hiring and employment on the basis of sexual orientation or gender identity by employers with at least 15 employees— has been introduced during every Congressional session (except for the 109th session) since 1994, the proposed legislation continues to stall.

The Pink Ceiling and The Glass Closet Increasingly, LGBTQ employees have greater access to a wider range of resources to help them on the job. Despite a lack of consistent and uniform policies across corporate America, many companies have recognized the importance and value of providing supportive work environments for LGBTQ employees. Over the past 12 years, the Human Rights Campaign (HRC) has issued a corporate equality index (CEI) that benchmarks LGBTQ-related policies and practices for major

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corporations. In 2014, 82% of employers surveyed for the HRC corporate equality index claimed to have LGBTQ employee resource groups or diversity councils, more than double the amount reported in the HRC’s 2002 index. In addition, 99% of CEI-rated employers include the protection of sexual orientation in their nondiscrimination policies, an increase from 61% in 2002. Meanwhile, 86% of CEI-rated employers provide employment protections on the basis of gender identity, a dramatic increase from just 5% in 2002. Furthermore, 46% of CEI-rated businesses provide transgender-inclusive health-care coverage options, including short-term leave, counseling by mentalhealth professionals, hormone therapy, medical visits to monitor hormone therapy, and surgical procedures. Despite many positive changes in the corporate world, however, a majority (53%) of LGBTQ employees said they are closeted at work, either by choice or by need, according to the HRC. Among many LGBTQ professionals, there is a belief that keeping their sexuality a secret can help to protect their career goals, even if their workplaces have policies in place that ensure protection against discrimination based on sexual orientation. In the United States, companies in 29 states can still legally fire an employee for being gay. The fear of hitting the so-called “pink ceiling” is even more acute for LGBTQ professionals in executive ranks. Until Apple CEO Tim Cook publicly came out as gay in an October 30, 2014, editorial in Bloomberg Businessweek, there wasn’t a single publicly and openly LGBTQ chief executive officer currently working at a Fortune 1000 company. In 2007, John Browne was forced to resign as CEO of BP after he was outed as being gay by a London tabloid newspaper. Browne, who remained in the closet during his entire 30-plus-year tenure with the British oil company, subsequently wrote a book about his experiences, titled The Glass Closet: Why Coming Out Is Good Business. Browne has since said that coming out sooner would have been better for himself and for business, and representing himself more openly and honestly in the workplace would have been better for his employees as well. Although there are chief

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executives who are rumored to be LGBTQ or who are privately open about their sexual orientation, Browne’s public admission of his sexual orientation made him the first current or former chief executive of a major publicly traded corporation to publicly acknowledge that he is gay. In an op-ed for Fortune magazine in 2014, Browne wrote, “The assumption of heterosexuality is one of the reasons that many people in business and in other sectors continue to lead hidden lives.” Browne said the bias toward heterosexuality in business leads LGBTQ workers to selfcensor and bring less than their full selves to the workplace. Studies have shown that remaining (or going back) in the closet has detrimental effects on LGBTQ employees, including decreased job satisfaction, increased anxiety, and poorer performance. Ultimately, studies have shown that being closeted can lead to negative impacts on LGBTQ workers’ chances for professional advancement, including lower retention and decreased visibility. In turn, the dearth of LGBTQ professionals in the executive ranks means there is a grave lack of mentors for early and mid-career LGBTQ professionals to look up to.

Evolving Corporate Inclusion and Diversity Policies In some ways, the experience of LGBTQ professionals mirrors the early experiences of women and minorities in corporate America. Fifty years after the start of the women’s and civil rights movements, there has been some progress to advance the interests and exposure of historically underrepresented groups in business. Today, virtually all corporate nondiscrimination policies have explicit language that protects against gender, racial, or ethnic discrimination. While women and minorities have become more visible in corporate America, they still deal with many of the same struggles for visibility that LGBTQ workers face: Among the 1,000 largest companies in the world, only 48 companies—less than 5%—are led by a woman. Among the Fortune 500, there are 6 Black chief executives, 9 Asian chief executives, and 10 Latino chief executives.

Inclusion and diversity programs and policies that support LGBTQ workers may be on the rise, including the establishment of LGBTQ-related employee resource groups at many companies, and providing the same company health-care benefits for same-sex couples that heterosexual couples receive. However, a full one third of Fortune 500 companies fail to provide comparable health-care benefits to LGBTQ employees. Unlike gender and race, which ordinarily can’t be “covered” in the workplace, LGBTQ employees can sometimes disguise their sexual orientation to be more heteronormative. A 2013 report published by Deloitte University Leadership Center for Inclusion, and authored by Christie Smith and Kenji Yoshino, found that 83% of gay, lesbian, and bisexual workers said they hide aspects of their identities at work, often due to pressure—whether implied or explicit—from their superiors. By contrast, 45% of straight White men reported covering at least one aspect of their identities in the workplace. Notably, this type of “covering” behavior was widespread across the 10 different industries that were studied, resulting in a misalignment of, and inconsistency with, the values of inclusion that many of these companies espoused. There were 3,129 respondents to the survey, which included a diversity of age, gender, race, and sexual orientation across different levels within an organization. A critical finding of the paper was the importance and interconnectedness of fostering inclusive work environments and talent retention. The authors offered a new model for inclusion whereby historically underrepresented groups can work through the myriad challenges that they face together with the support of everyone within an organization, including straight White men, who sometimes have felt marginalized from conversations about corporate inclusion and diversity. The key is to implement programs and apply policies uniformly and consistently that stamp out micro-inequities across all groups.

A Turning Tide in Corporate America When he rang the bell at the New York Stock Exchange to kick off the public offering of shares in

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C1 Financial in August 2014, Trevor Burgess became the first openly gay CEO of a publicly traded bank in the United States. As chief executive of the newly public regional bank, which has 29 locations in Florida, Burgess was required by law to disclose that his husband, Gary Hess, owns shares in the company in its IPO filing to the Securities and Exchange Commission, despite the fact that the couple’s home state didn’t recognize same-sex marriage. While a surprising number of early career LGBTQ professionals said they have chosen to remain (or go back) in the closet in order to “fit in” or to advance in their careers, a growing number of corporate executives are stepping out of the closet, if somewhat tentatively. As BP’s former CEO John Browne and C1 Financial CEO Trevor Burgess have discovered, being publicly and openly out as gay professionals has provided them a platform to help the next generation of LGBTQ business leaders find their own voices—as well as serve as mentors. According to the HRC’s 2014 corporate equality index, 304 businesses achieved a top score of 100% in support of LGBTQ employees. Law firms and banking and financial services companies led the pack, with 81 and 36 companies, respectively, earning top ratings in that year’s corporate equality index. For years, many Wall Street firms have actively promoted workplace inclusion of LGBTQ employees. They have done this by creating LGBTQ networks, connecting LGBTQ employees with mentors within the firm, sponsoring LGBTQ pride events, and encouraging straight employees to join LGBTQ networks to serve as straight allies. In addition, Wall Street firms also are actively recruiting LGBTQ employees and publicly supporting same-sex marriage, and most recently, more than 100 businesses joined a coalition calling on Congress to pass the Employment Non-Discrimination Act (ENDA). Indeed, Wall Street firms now have some of the most LGBTQ-friendly policies in corporate America.

Corporate Policy Versus Corporate Culture As many LGBTQ employees can attest, corporate nondiscrimination policies do not always translate to positive office cultures. While it’s important to have policies in place that protect and support all

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workers, nurturing and sustaining a corporate culture that reflect an organization’s core values requires vigilance and consistency, led and patterned by management. Policies at Wall Street companies may be among the most progressive in business when it comes to the acceptance of LGBTQ workers and ensuring that they feel at ease with colleagues, but these policies are only successful because of endorsements by the firms’ predominantly White, middle-aged, male CEOs. Lloyd Blankfein, CEO of Goldman Sachs Group Inc., has said that the bank’s LGBTQ-friendly policies are critical for talent retention, although he added that the firm’s public support of LGBTQrelated issues, including its support of gay marriage, has resulted in the loss of at least one client. Supporting LGBTQ workers and causes “doesn’t come without a price,” Blankfein said, “but I couldn’t care less.” Other CEOs of Wall Street firms, including John Mack, former CEO of Morgan Stanley; Paul Singer, CEO of Elliott Management Corp.; and Dan O’Connell, CEO of Vestar Capital Partners, have come out publicly in support of LGBTQrelated rights, in large part to support their children who came out as gay. According to a 2012 survey conducted by the Center for Work Life Policy, 41% of LGBTQ employees nationwide remain closeted at work. Furthermore, only 7% of LGBTQ employees ages 18 to 24 are open at work, compared with 32% of LGBTQ employees ages 35 to 44, according to the HRC. This disconnect may be a result of companies having great policies on paper, but also having suboptimal cultures that aren’t conducive to being out. Whether the success or failure of integrating and raising the visibility of LGBTQ workers in companies is measured by outside organizations such as the HRC or through internal human resources metrics, it is clear that LGBTQ people and straight allies must work together to ensure that progress continues. “It is the responsibility of the LGBT minority to overcome their fears,” said BP’s John Browne in his Fortune editorial. “Only they can decide to live a unified private and public life.” Kipp Jarecke-Cheng

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See also Closet, The; Education; Internalized Homophobia; Leadership; Work Environments; Workplace Policies

Further Readings Browne, J. (2014, June 16). Confessions of a gay ex-CEO: How corporate America can unlock the closet. Fortune. Retrieved from http://bit.ly/XpAYNF Browne, J. (2014). The glass closet: Why coming out is good business. New York, NY: Harper Business. Cook, T. D. (2014, October 30). Tim Cook speaks up. Bloomberg Businessweek. Retrieved from http:// bloom.bg/1ExFVGB Cooper, L., & Fidas, D. (2014). Corporate equality index 2014. Washington, DC: Human Rights Campaign Foundation. Ellis, B. (2014, May 19). Wall Street CEOs open up about their gay sons. CNN Money. Retrieved from http:// cnnmon.ie/ZpVwH2 Feintzeig, R. (2014, May 6). Why gay workers decide to stay in the closet. Wall Street Journal. Retrieved from http://on.wsj.com/1wwE0Pc Kwoh, L. (2012, July 25). A silence hangs over gay CEOs. Wall Street Journal. Retrieved from http://on.wsj .com/1qFapAB Smith, C., & Yoshino, K. (2013). Uncovering talent: A new model for inclusion. Westlake, TX: Deloitte University Leadership Center for Inclusion. Retrieved from http://www2.deloitte.com/content/dam/Deloitte/ us/Documents/about-deloitte/us-inclusion-uncoveringtalent-paper.pdf Stewart, J. B. (2014, June 27). Among gay CEOs, the pressure to conform. New York Times. Retrieved from http://nyti.ms/1uALQ7Y

BUTCH–FEMME Butch and femme (also spelled fem) are terms that refer to particular gender identities and/or expressions among lesbian, bisexual, queer, and other sexual-minority women. Butch is typically used to describe sexual-minority women with a more masculine presentation, whereas femme generally describes sexual-minority women with a more feminine presentation. These identities play an

important role in the history of sexual-minority women’s identities and social structures, and continue to have relevance within contemporary sexual-minority women’s communities, although meanings and usage have changed over time. This entry provides a brief review of the terms from their development in the mid-20th century through contemporary usage, focusing on the United States.

Evolution of Butch–Femme Emergence of Butch–Femme

Although masculine and feminine pairings of same-sex couples were described as early as the 1890s, formal butch–femme gender roles came to prominence in the 1940s and 1950s among working-class sexual-minority women in the United States. Lesbian and bisexual women’s workingclass communities were organized around butch– femme identities; an individual who did not identify within either role was referred to somewhat pejoratively as a “kiki.” Butch–femme identities served as social roles that instructed community norms and dating expectations, as well as making sexualminority women visible to each other in a society that was hostile to their existence. Due to rigid gender norms at a time when it still was unconventional for women to wear pants, both butch and femme women often were forced to adhere to traditional female gender expectations to maintain employment, but adopted butch–femme gender expressions when attending bars, house parties, and other community settings. It should be noted that some butch women did not (or could not) limit their masculine presentation to community settings; some would pass as men at work or find work for which their masculine dress was tolerated, whereas others had difficulty attaining work and relied on femme partners for financial support. Within sexual-minority environments, butch women wore pants and masculine dress and generally were expected to initiate romantic advances with femmes and play a protective role in threatening situations. Femmes dressed in traditional or exaggerated feminine attire and typically were expected to take care of the home. With regard to

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sexual roles, butches were expected to take the lead, but reversed heterosexual gender norms by focusing on sexually pleasing their femme partners. Butch women who preferred not to be touched sexually, and were identified as “stone butches,” were accorded higher status in the community. Butch–femme communities were somewhat racially mixed, with women dating across color lines more commonly than among heterosexual pairings at the time, although women of color were more likely to socialize at house parties and White women at bars. Given the gender policing of the times, both literally and figuratively, butches and femmes took great risks in enacting their identities even if only in the bar scene, as bars were often raided. While femmes’ style of dress rendered them less visible to community outsiders when out on their own, they were clearly identified as sexual-minority women when paired with butches. In fact, butch–femme identities often have been credited with making lesbian and bisexual women’s sexuality visible outside of sexualminority communities. A Retreat From Butch–Femme

During the late 1960s and into the 1970s, there was a shift in the cultural understanding of sexualminority women’s gender; as the second wave of feminism developed, gender differences were viewed as the site of sexism, and lesbian feminism emerged. Lesbian feminists typically viewed butch– femme roles and relationships as derivative of problematic heterosexual gender roles and relationships. Butches were seen as replicating patriarchy and femmes as having internalized traditionally oppressive female gender roles. In contrast, unisex or androgynous presentations became de rigueur among lesbian feminist communities, marginalizing lesbians with butch–femme identities or gender expressions, who often conformed or went underground. During this period, lesbianism on the whole was disparaged within many parts of this predominantly university-based White feminist movement, and lesbians were referred to as the “lavender menace,” resulting in a separate lesbian feminist movement offshoot.

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During these times, butch–femme identities still proliferated in many working-class, rural, and racial-minority communities—particularly among Black women and Latinas, as well as within women’s prisons. Working-class and/or racial-minority lesbian and bisexual women often had especially complex relationships with the liberation movements of the day due to racism and classism within many feminist and lesbian, gay, and bisexual groups, as well as sexism and homophobia within many civil rights and labor groups; the 1980s were characterized by these heightening criticisms. As a result, many sexual-minority women who also held working-class and racial-minority identities were less likely to be impacted by the predominantly White middle- to upper-class-led feminist rhetoric against butch–femme. Other lesbians of color developed their own feminist groups, such as the Black lesbian feminist Combahee River Collective, which focused on organizing lesbian feminists of color and articulating and responding to issues related to intersections of race, gender, and sexual orientation.

Reemergence of Butch–Femme and a Multiplicity of Terms During the 1990s, a third wave of feminists began to expand their focus on intersections of gender with race, class, and sexual orientation, and the emphasis on dismantling gender differences to combat sexism became less prominent. In addition, recognition of there being a difference between sex and gender and the potential to view gender as a performance that people enact, rather than a natural product of sex, opened up new possibilities for gender play. Within this context, butch–femme began to reemerge, only with a greater emphasis on gender fluidity. Sexual roles became less strict, with increased acceptance of pairings between similarly gendered women and both butches and femmes potentially initiating sexual encounters. Butch–femme relationships were further recognized as a unique form of erotic gender play that can exist between two women. New terms developed, such as “soft butch,” referring to a somewhat masculine sexual-minority woman, and “high

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femme,” describing a very stylized woman who employs exaggerated feminine dress and makeup and thereby recognizes her own gender performativity. More recently, the term boi has developed among a younger generation, referring to a range of gender identities, including masculine sexualminority women, transmen, and genderqueer folks. While the terms butch and femme have been used in various racial communities, other gender identities have also emerged and sometimes been preferred among racial-minority groups. For instance, the labels stud, aggressive (sometimes shorted to AG), and tomboy are most often used by masculine sexual-minority women of color. Aggressive femme refers to a feminine sexualminority woman who is sexually dominant. These fluid terms may be defined differently across communities, and new terms continue to emerge. Many organizations have popped up to recognize butch– femme culture, such as Femme Collective, a group that emerged in 2005 and has held conferences for several years celebrating femme culture. A significant feature of this group is its emphasis on exploring femme identity and strength, as the role of femmes has historically been undervalued and invisible relative to butch women. Alternatively, DapperQ is a project aimed at increasing visibility for masculine sexual-minority women as well as genderqueer and transmasculine individuals, with a particular emphasis on masculine fashion.

Popular Portrayals: Representations/ Presentations of Butch–Femme Roles Butch–femme roles and relationships also have been portrayed in literature and film, often centering on masculine characters while reflecting the evolving understandings of gender. In 1928, prior to the rise of butch–femme culture, Radclyffe Hall’s The Well of Loneliness centered on the masculine upper-class White Englishwoman character of Stephen Gordon, who was conceived within the model of sexual inversion. In the late 1950s and early 1960s, Ann Bannon published the lesbian pulp series that was later titled as The Beebo Brinkler Chronicles, with Beebo’s unabashed

masculinity and appeal to femmes making her a memorable butch icon. Published in 1993, Stone Butch Blues was set in the late 1960s and introduced the character of Jess Goldberg, of a White working-class Jewish background, whose gender struggle has inspired countless butch women and transgender people. The 2011 film Pariah explored the coming out of a 17-year-old Black lesbian named Alike and has been described as a portrayal of aggressive culture.

Controversies and Complexities As noted above, butch–femme identities have been either critiqued as replicating binary gender norms in heterosexual relationships, or seen as subverting gender norms by revealing the performative aspects of gender, specifically by showing that any gender identity can be mapped onto any body. This latter perspective on butch–femme genders has become more accepted in recent years. At times, tensions have arisen regarding overlaps and distinctions between transgender male identities and butch identities, with butch women sometimes being included under the transgender umbrella term and other times not. There have been specific conflicts in which transmen have been accused of betraying feminist ideals and gaining male privilege when adopting male identities and butch women have been accused of not fully embracing their masculinity. While these tensions remain, it has been suggested that these identity conflicts appear to be resolving in younger generations. Research on sexual-minority women in the United States has suggested that particular dangers for butch women include the high levels of heterosexist discrimination and harassment that they face as well as challenges in finding affirming medical and gynecological care. Finally, many sexual-minority women’s communities outside of the United States include gender roles that share similarities with butch and femme, though in looking at these similarities, care must be taken not to minimize local contextual meanings nor to assume that one system predated or influenced the other.

Butch–Femme

Alternate Meanings of Butch–Femme Butch and femme have been described thus far in relation to butch–femme lesbian and bisexual women’s culture, but these terms can have alternate uses. For instance, in sexual-minority men’s communities, butch has also been used to describe especially masculine men. In Black ballroom culture, terms such as butch and butch queen have context-specific meanings. Femme, while primarily a reference to a sexual-minority woman, also can refer to any feminine woman. Cara Herbitter and Heidi M. Levitt See also Bisexuality, Female; Dating, Sexual-Minority Women; Homosexuality, Female; Intersections Between Sex, Gender, and Sexual Identity; Nonbinary Genders; Policing Masculinities and Femininities; Sexual-Identity Labels; Tomboy Experience; Transgender Identities

Further Readings Faderman, L. (1991). Odd girls and twilight lovers: A history of lesbian life in twentieth-century America. New York, NY: Columbia University Press. Halberstam, J. J. (2012). Gaga feminism: Pregnant men, heteroflexible women and the end of normal. Boston, MA: Beacon Press. Hale, C. J. (1998). Consuming the living, dis(re)membering the dead in the butch/FTM borderlands. GLQ: A Journal of Lesbian and Gay Studies, 4, 311–348.

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Hiestand, K. R., Horne, S. G., & Levitt, H. M. (2008). Effects of gender identity on experiences of healthcare for sexual minority women. Journal of LGBT Health Research, 3(4), 15–27. Kennedy, E. L., & Davis, M. D. (1993). Boots of leather, slippers of gold: The history of a lesbian community. New York, NY: Penguin. Kraus, N. (1996). Desire work, performativity, and the structuring of a community: Butch/fem relations of the 1940s and 1950s. Frontier, 17(1), 30–56. Levitt, H. M., Gerrish, E. A., & Hiestand, K. R. (2003). The misunderstood gender: A model of modern femme identity. Sex Roles, 48, 99–113. Levitt, H. M., & Hiestand, K. R. (2004). A quest for authenticity: Contemporary butch gender. Sex Roles, 50, 605–621. Levitt, H. M., Puckett, J. A., Ippolito, M. R., & Horne, S. G. (2012). Sexual minority women’s gender identity and expression: Challenges and supports. Journal of Lesbian Studies, 16, 153–176. Moore, M. R. (2006). Lipstick or Timberlands? Meanings of gender presentation in Black lesbian communities. Signs: Journal of Women in Culture and Society, 32, 113–139. Munt, S. R. (Ed.). (1998). Butch/femme: Inside lesbian gender. Herndon, VA: Cassell Wellington House. Nestle, J. (1992). The persistent desire: A femme-butch reader. Boston, MA: Alyson Publications. Weiss, J. T. (2007). The lesbian community and FTMs: Détente in the butch/FTM borderlands. Journal of Lesbian Studies, 11, 203–211.

C study of minority groups on campus. In the 1990s, with the proliferation of research studies on sexual-minority populations, researchers started to turn their attention to examining the campus climate for sexual minorities. These early LGBTQfocused campus climate works were interested in how engaging with an educational institution that assumes that everyone is (or should be) heterosexual might affect sexual minorities’ psychological functioning, though some also examined the campus climate’s effect on LGBTQ persons’ academic outcomes or general satisfaction with the institution. Most studies in the 1990s through the early 2000s noted that LGBTQ persons faced a chilly— that is, a largely unwelcoming—campus climate. Given that most of the early researchers of campus climate were in the student affairs and education fields, the preponderance of this literature focused exclusively on the experiences of LGBTQ undergraduates attending four-year colleges. Some researchers looked at sexual-minority students’ experiences navigating the process of coming out to their roommates. Others examined classroom environments, noting that many sexual-minority students were afraid to come out in class—even when it was relevant to the classroom discussion—fearing retribution from their peers or instructors. Many sexual-minority students in these early studies also reported difficulty in finding other LGBTQ peers and enduring homophobic comments constantly heard on campus.

CAMPUS CLIMATE Campus climate is the term used to describe the attitude toward particular groups on campus, as well as the subsequent effects on said group members’ well-being and success while working, living, or studying there. This entry explores three topics related to the campus climate for LGBTQ individuals, with a focus on the United States. (Nearly all of the literature on campus climate focuses on U.S. institutions, with some attention paid to Canadian and British contexts; little campus climate work has examined the college and university environment in other nations.) First, the entry provides a general overview of the campus climate for sexual minorities, nesting its development and change in historical context. The next section reflects on new directions for analyzing and addressing issues related to campus climate. Finally, the literature on the campus climate for various subgroups within the LGBTQ community, including transgender persons and persons of color, will be evaluated.

Campus Climate for Sexual Minorities: From the 1990s to the Mid-2000s The earliest uses of the phrase campus climate come from the 1950s and 1960s, when researchers were interested in the general effect of the campus environment on various psychological outcomes. In the 1980s, the term began to be applied to the 179

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Perhaps the most thorough overview of campus climate has come from the work of Susan Rankin, who developed a campus climate survey to analyze institutions’ generalized attitudes toward sexualminority persons. Rankin used a survey instrument distributed at several 4-year institutions across the nation to gather her data; respondents included gay, lesbian, bisexual, and transgender undergraduates, graduate students, faculty, staff, and administrators. Her findings from the mid-2000s showed that nearly 1 in 3 respondents had experienced harassment on campus themselves, and over half thought harassment of sexual minorities was likely at their institution. Additionally, 1 in 5 respondents had feared for their safety at least once while on campus, and half had actively decided not to disclose their sexual identity to others with whom they lived, worked, or learned. In general, researchers during this period noted that apprehensions about the campus climate, whether experienced or perceived, took a large psychological toll on sexual minorities on college campuses in the United States. Sexual-minority students reported higher levels of stress and lower levels of satisfaction with their institutional social lives than heterosexual students. Although few campuses collected data themselves on LGBTQ student populations’ academic success, many studies indicated that the stressors sexual-minority students encountered also negatively affected their ability to complete college altogether. Studies that focused on living situations or college residential life have reported that roommates often reacted with hostility to a sexual-minority student’s coming out, sometimes resulting in the student having to move to escape the situation. Also, many LGBTQ students noted a lack of mentors; little space or funding available for student groups related to sexual identity; and a lack of training for campus professionals on issues such as inclusive language, available counseling resources for sexual minorities, and the promotion of LGBTQ-friendly environments.

Current Directions for Campus Climate, Mid-2000s to Present There are several new questions in the study of campus climate that may be answered through

research in the coming years. For one, attitudes toward sexual minorities are generally improving. College students, faculty, and staff are reporting all-time high approval ratings for sexual minorities on campus, and even primary and postsecondary schools—where students are socialized before they come to college—report more accepting environments as compared with decades past. This does not indicate the erasure of campus climate problems altogether, however. Although a campus in general may be perceived as safe, sexual-minority respondents in campus climate studies are usually able to identify areas on campus in which they are overtly not welcomed. Likewise, although sexualminority students’ perception of the general campus climate may be positive, these students may still be subject to discrimination at their institutions while being less likely to recognize it or think of it as problematic. Future work on campus climate could disentangle this relationship between increasing social acceptance, potentially hostile sub- or immediate environments on campus, and the gap between LGBTQ individuals’ perceptions versus realities of campus climate. Another factor that affects campus climate that has found widespread proliferation since the mid2000s is the emergence of spaces and offices devoted to meeting the needs of sexual minorities on campus. Although the University of Michigan was the first to offer professional services to sexual minorities on campus in 1971, it is only in recent years that such a large number of campuses are now devoting energy, space, resources, and staff to sexual-minority populations. The literature typically refers to such spaces as LGBTQ resource centers. They may go by different names or be under various organizational auspices from campus to campus, but LGBTQ resource centers, typically staffed by professionals or graduate students, signal to the institution and those who live, work, study, or visit there that sexual minorities are valued members of the community. Given how relatively widespread these LGBTQ resource centers have become (at least at larger institutions), future studies may wish to compare differences between centers (number of staff, type of staffing, organizational structure, funding available, etc.) as determinants of campus climate.

Campus Climate

Another revolution that has shifted conceptualizations of campus climate is the proliferation of data on sexual minorities on campus and issues that pertain to the population. Institutions rarely collected any data on campus climate prior to the mid-2000s, not to mention data on LGBTQ student grades or degree completion. Recently, though, some small liberal arts colleges have started asking if incoming students identify as sexual minorities to help find suitable housing accommodations and to track academic progress. Additionally, many universities have started taking on the work of conducting campus climate surveys of their own to understand the needs and challenges of LGBTQ people themselves. As more institutions collect data on sexual minorities, administrators and researchers can use this information to make informed, data-based decisions that promote a positive campus climate.

Campus Climate: LGBTQ Subgroups Some works have emerged that examine how campus climate might affect subgroups within campus sexual-minority populations differently. For instance, whereas the majority of campus climate literature has focused on undergraduate student populations, many surveys include graduate students, faculty, staff, and administrators in global results. Additionally, some of these works have disentangled the concerns of these populations from those of undergraduate students. Sexualminority faculty, administrators, and staff may choose not to disclose their identities for fear of being fired or losing friends at work, tenure, or reappointment—which may ultimately create a lack of visible mentors on campus for LGBTQ students to seek out. Graduate students, as compared with undergraduate respondents, tend to report lower levels of overt harassment on campus climate surveys, higher levels of activism around issues of sexual-identity equality, and comparable perceptions of campus attitudes toward LGBTQ people. However, research also indicates that analysis of campus climate for graduate students, faculty, administrators, and staff may be more heavily influenced by their immediate environment, such as their department or office unit,

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rather than by the whole institution, as there can be large differences between units within the same college with differing attitudes toward LGBTQ people. Regarding gender differences, there is little statistically significant difference between sexualminority respondents’ perceptions of campus climate or exposure to discrimination and homophobia as a function of gender. However, some qualitative research has explored how the intersection of gender and sexuality do lead to unique concerns for sexual-minority women and sexual-minority men on campus. Compared with other literatures that often lump together transgender concerns along with those of other sexual-minority groups, the majority of campus climate work generally has been careful to separate the experiences of transgender people from those of gay men, lesbians, and bisexual individuals when appropriate. Transgender respondents report higher levels of fearing for their safety and lower levels of social integration as compared with other sexual-minority subgroups. Transgender, genderqueer, and gendervariant respondents also report that name-change policies, gender-identification records policies, and bathroom accessibility are issues of concern. There are subgroups in the LGBTQ community whose perceptions of campus climate are understudied. Thus far, little work has been done to disentangle any differences in perceptions of campus climate between bisexual respondents and other sexual-minority groups. Neither has much been done to separate the experiences of sexual minorities of color from those of White students. Similarly, studies of campus climate based on race tend to overlook analyzing differences between heterosexual and LGBTQ persons of color in their results. The work that does examine the experiences of sexual-minority people of color has tended to focus exclusively on Black populations, noting that respondents often felt a tension between their racial and sexual identities. This led to an avoidance of publicly disclosing sexual identities for fear of being ostracized by racial-minority communities, as well as antipathy toward sexual-minority communities for a lack of attention to racial dimensions of sexuality. More work is needed to examine how bisexual people

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and LGBTQ persons of color, particularly from a wide range of racial groups, view the campus climate. Leigh E. Fine See also Activists in College; Ally Development and Programming; Ally Experience; College Athletes; College Students; Education; Historically Black Colleges and Universities, LGBTQ Students at

Further Readings Beemyn, B. (2003). Serving the needs of transgender college students. Journal of Gay and Lesbian Issues in Education, 1, 33–50. Brown, R. D., Clarke, B., Gortmaker, V., & Robinson-Leilig, R. (2004). Assessing the campus climate for gay, lesbian, bisexual, and transgender (GLBT) students using a multiple perspectives approach. Journal of College Student Development, 45, 8–26. Campus Pride. (2014). LGBT-friendly campus climate index. Retrieved August 5, 2014, from http://www .campusprideindex.org Fine, L. E. (2011). Minimizing heterosexism and homophobia: Constructing meaning of out campus LGB life. Journal of Homosexuality, 58, 521–546. Patton, L. D. (2011). Perspectives on identity, disclosure, and the campus environment among African American gay and bisexual men at one historically Black college. Journal of College Student Development, 52, 77–100. Rankin, S. R. (2005). Campus climates for sexual minorities. New Directions for Student Services, 111, 17–23. Rankin, S. R. (2006). LGBTQA students on campus: Is higher education making the grade? Journal of Gay and Lesbian Issues in Education, 3, 111–117. Rankin, S. R., & Reason, R. (2008). Transformational tapestry model: A comprehensive approach to transforming campus climate. Journal of Diversity in Higher Education, 1, 262–274. Renn, K. A. (2010). LGBT and queer research in higher education: The state and status of the field. Educational Researcher, 39, 132–141. Sanlo, R. (2004). Lesbian, gay, and bisexual college students: Risk, resiliency, and retention. Journal of College Student Retention, 6, 97–110.

Sanlo, R., Rankin, S., & Schoenberg, R. (Eds.). (2002). Our place on campus: Lesbian, gay, bisexual, transgender services and programs in higher education. Westport, CT: Greenwood. Tetreault, P. A., Fette, R., Meidlinger, P. C., & Hope, D. (2013). Perceptions of campus climate by sexual minorities. Journal of Homosexuality, 60, 947–964. Vaccaro, A. (2012). Campus microclimates for LGBT faculty, staff, and students: An exploration of the intersections of social identity and campus roles. Journal of Student Affairs Research and Practice, 44(4), 429–446. Yost, M. R., & Gilmore, S. (2011). Assessing LGBTQ campus climate and creating change. Journal of Homosexuality, 58, 1330–1354.

CANCER

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SOCIAL SUPPORT

Cancer is a group of more than 100 diseases characterized by the uncontrolled growth and spread of abnormal cells. It is the second most common cause of death in the United States; however, survival rates for all cancers have increased substantially due to progress in earlier diagnosis of certain cancers and improvements in treatment. Persons with cancer often need assistance with activities of daily living, family and community responsibilities, and illness management tasks. The prevalence and consequences of cancer and the need for support for LGBTQ persons with cancer have received limited attention in the research and clinical practice literature. However, several trends are leading to an increase in recognition of and knowledge about cancer in LGBTQ adults and the importance of informal and formal social support in their survivorship experience. These trends include more LGBTQ individuals disclosing their sexual orientation to professionals in the health care system, growing public awareness of LGBTQ individuals and their family and chosen kin relationships, and increasing research on the cancer experience of LGBTQ individuals. The next section of this entry provides information about the incidence and prevalence of cancer in adulthood. Next, cancer within the context of survivorship and the importance of social support

Cancer and Social Support

is discussed. The entry concludes with a discussion of the role of informal and formal social support for LGBTQ individuals who are living with cancer.

The Demographics of Cancer Cancer is a major public health concern in the United States with approximately 1 in 3 women and 1 in 2 men receiving a diagnosis of cancer during their lifetime. Incidence and prevalence rates of cancer vary by age, gender, and type of cancer. About three fourths of all cancers are diagnosed in persons aged 55 and older. According to the American Cancer Society, the most common cancer types among women include breast, uterine corpus, colon and rectum, melanoma, and thyroid. Among men, the most prevalent cancer types are prostate, colon and rectum, melanoma, and urinary bladder. Although a small proportion of cancers are hereditary, many genetically susceptible cancers arise from the interplay between common gene variations and lifestyle (e.g., tobacco use, obesity, physical inactivity, excessive sun exposure) and environmental (e.g., carcinogens) risk factors. Less is known about the specific prevalence of cancer among LGBTQ individuals. There is some evidence from general population studies that lesbians and bisexual women have higher rates of breast cancer than heterosexual women. One potential risk factor for breast cancer, as well as uterine cancer, is not having given birth, which is the case for almost two thirds of lesbian, bisexual, and transgender adults who have identified as LBT throughout their lives. In addition, greater obesity and risky health-related behaviors (e.g., smoking, drinking) among lesbian and bisexual women also may contribute to higher risks for breast, ovarian, and colon cancer. Findings from the California Health Interview Survey indicated that gay and bisexual men had lower rates of prostate cancer than heterosexual men, whereas the rate for other cancers, particularly anal cancer, was higher. The human immunodeficiency virus (HIV) infection, which is higher among gay men, has been linked to non-AIDS cancers, including anal, lung, and testicular cancer.

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Cancer Survivorship The National Coalition for Cancer Survivorship introduced the concept of “cancer survivor” in the mid-1990s to replace the concept of cancer as a “death sentence.” Although definitions of survivorship vary with respect to when a person is first considered a survivor (e.g., time of initial diagnosis, posttreatment), all definitions focus on the health and quality of life of the person until the end of life. This includes attention to follow-up medical care; the physical, psychosocial, and economic issues surrounding cancer; the late effects of treatment; and second cancers. As of January 1, 2014, almost 14.5 million persons were cancer survivors. Almost two thirds of cancer survivors received their diagnosis 5 or more years previously; about 15% were diagnosed 20 or more years ago. Although none of the large national cancer registries and surveys of cancer incidence collect data about sexual orientation or gender identity, it is estimated that there are more than a million lesbian, gay, bisexual, and transsexual (LGBT) cancer survivors living in the United States. The more limited research about LGBTQ cancer survivors has shown that there are both positive and negative correlates of cancer and sexual orientation. On the one hand, years of dealing with chronic minority stress around heterosexism and homophobia in their everyday lives has led to greater resilience and a “fighting spirit” that allows LGBTQ individuals to acknowledge and cope with cancer. For example, compared with their heterosexual counterparts, lesbian breast cancer survivors demonstrate a heightened resilience, or “lesbian advantage,” when it comes to fighting breast cancer. Regarding age differences, older LGBTQ individuals have grown up in an environment where sexual orientation disclosure was a greater taboo. Thus, younger LGBTQ individuals are less likely to deny that they have cancer and be more proactive when it comes to getting treatment and support than their older counterparts.

Social Support Like most cancer survivors, LGBTQ people turn to members of their informal and formal social

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networks for help and support during their cancer journey. Informal social support includes the instrumental, emotional, and informational support provided by family members, friends, and neighbors. Formal support for cancer survivors comes from physicians and other professional health care providers as well as community organizations that may provide education, support groups, and other social services during and after treatment. Informal Support

The type, frequency, and amount of informal support cancer survivors receive varies depending on a variety of factors including individual needs and abilities, the type of relationship, and personal resources. For example, family and friends may make hospital visits; accompany the person with cancer to physician or treatment appointments; help with meal preparation, household chores, and transportation; and provide information and emotional reassurance. Social and cultural norms also strongly influence the extent and type of support and care provided by family members. LGBTQ people who have been shunned by their family of origin because of their sexual orientation or gender identity may lean more heavily on their partner, chosen family members, or friends for support. Having a supportive life partner is a key source of resilience in coping with cancer, and the quality of that relationship matters just as much as its presence. Lesbians with cancer report feeling more loved and cared for by their same-gender partners than heterosexual women report. Gay men with prostate cancer report that it is easier to deal with loss of erectile functioning that often accompanies treatment if one is working through the illness with a partner. Research has linked social support to improved adjustment to chronic or serious illnesses, including cancer. The perceived availability of social support is related to better physical and psychological functioning among cancer survivors whereas inadequate social support increases isolation and emotional distress. Receiving support from family and friends also has been positively associated with perceived quality of life. The larger LGBTQ community can

also play an important role in providing informal support. Community awareness programs help to reduce the fear of cancer and the prejudice against those who have it. A supportive LGBTQ community can reassure those with cancer that there are other members of their community who are dealing with this condition. Formal Support

During diagnosis and treatment of cancer, interactions with staff, including doctors, clinic nurses, and specialists, and the social world of cancer clinics play a valuable role in the provision of support. For LGBTQ cancer survivors, fear of discrimination coupled with a history of negative experiences often make them wary of formal care systems. LGBTQ adults have reported a range of negative reactions from health and community service providers including rejection, hostility, harassment, excessive curiosity, avoidance of physical contact, and breach of confidentiality. One of the major problems influencing the lower quality of care from professionals to LGBTQ individuals is that formal education about sexual orientation is not typically included in medical school and the allied health professions. Doctors, nurses, staff members, office managers, volunteers, and other health care personnel may not be knowledgeable about the social and legal issues facing sexual minorities. They may also have certain prejudiced beliefs about the morality and normalcy of having an LGBTQ identity. These problems can be reduced if accurate knowledge about sexual orientation is included as part of education and best practices. Formal care providers often overlook the importance of addressing sexual orientation, thus further marginalizing LGBTQ individuals and their families. In order to help marshal resources from cancer survivors’ informal social support networks—as they define them—health and community care systems must become aware that “family support” is far more extensive than the nuclear family arrangement of married spouses and their children. In addition to learning about the legal and nonlegal partnerships and chosen kin ties established by

Cancer and Social Support

LGBTQ individuals, there are many changes that formal care providers can make to improve the experience of working with professionals. These include being open and inclusive when talking to patients by directly asking if they are in an intimate relationship with a same-gender partner. It also includes revising intake forms so that the only choices are not between male/female and married/ single. Another effective strategy is for health care professionals to make appropriate referrals to community agencies in order to deal with issues of depression and anxiety that may arise in the face of dealing with cancer and its aftermath. Another important formal resource for cancer survivors is support groups. They provide information, education, and emotional support for both cancer survivors and their caregivers. Many communities, particularly those in large urban areas, now offer LGBT cancer support groups where LGBT cancer survivors and their caregivers can come together to share their experiences, knowledge, concerns, fears, and hopes in a supportive and respectful environment. It is especially helpful to be in a support group addressing the particular kind of cancer one has experienced as well as one that does not exclusively cater to heterosexual men and women. Yet, in smaller or rural communities, cancer support groups for specific cancers (e.g., breast cancer survivors’ group; prostate cancer survivors’ group) may not be available, making it all the more important for health care providers to receive sensitivity training about how sexual orientation diversity comes into play with cancer survivorship and family care. A positive development is the rise of Internet-based support groups, such as the LGBT Cancer Support Group sponsored by the National LGBT Cancer Project—Out with Cancer. Grassroots online cancer support groups are especially important for individuals who wish to meet other cancer survivors, participate in online chat groups, and learn from others who are dealing with cancer.

Conclusion With the aging of the general population and the growing visibility of the LGBTQ population, an

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increasing number of sexual-minority individuals will experience cancer and long-term survivorship. The stigma and discrimination they face in the health care system is often mitigated with the support of a caring partner, a caring community, and knowledgeable and sensitive health care professionals. Both kinds of social support—informal and formal—are needed to help LGBTQ individuals cope with cancer and continue to have a high quality of life. Katherine R. Allen and Karen A. Roberto See also Aging, Social Relationships, and Support; Cancer in the LGBTQ Community; Caregiving; Dying, Death, and Bereavement; Health Care Providers, Disclosure of Sexual Identity to; Health Care System; Health Disparities

Further Readings American Cancer Society. Cancer facts & figures 2014. Retrieved from http://www.cancer.org/research/ cancerfactsstatistics/cancerfactsfigures2014 Blank, T. O. (2005). Gay men and prostate cancer: Invisible diversity. Journal of Clinical Oncology, 23, 2593–2596. doi:10.1200/JC0.2005.00.968 Boehmer, U., Miao, X., & Ozonoff, A. (2011). Cancer, survivorship and sexual orientation. Cancer, 117, 3796–3804. doi:10.1022/cncr.25950 Jabson, J. M., Donatelle, R. J., & Bowen, D. J. (2011). Relationship between sexual orientation and quality of life in female breast cancer survivors. Journal of Women’s Health, 20, 1819–1824. doi:10.1089/ jwh.2011.2921 Katz, A. (2011). Gay and lesbian patients with cancer. In J. P. Mulhall, L. Incrocci, I. Goldstein, & R. Rosen (Eds.), Cancer and sexual health (pp. 397–403). New York, NY: Humana Press. Muraco, A., & Fredriksen-Goldsen, K. I. (2013). The highs and lows of caregiving for chronically ill lesbian, gay, and bisexual elders. Journal of Gerontological Social Work, 57, 251–272. doi:10.1080/01634372.201 3.860652 Sinding, C., Grassau, P., & Barnoff, L. (2007). Community support, community values: The experiences of lesbians diagnosed with cancer. Women & Health, 44, 59–79. doi:10.1300/J013v44n02_04

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Usta, Y. Y. (2012). Importance of social support in cancer patients. Asian Pacific Journal of Cancer Prevention, 13, 3569–3572. doi:10.7314/APJCP.2012.13.8.3569 Zaritsky, E., & Dibble, S. L. (2010). Risk factors for reproductive and breast cancers among older lesbians. Journal of Women’s Health, 19, 125–131. doi:10.1089/jwh.2008.1094

CANCER IN THE LGBTQ COMMUNITY Cancer is a complicated disease with multiple points of study and intervention, expressed as a cancer continuum. The sequence varies between health departments and organizations, but is generally understood to include prevention, screening, diagnosis, treatment, survivorship, and end-of-life care. This falsely suggests that all cancer patients move along each step of this line, but not every cancer has a known risk factor and not all cancers lead to death; some people enter the continuum at the point of diagnosis. LGBTQ people, however, experience disparities at every point on the cancer continuum. Accepted wisdom suggests that “cancer doesn’t discriminate,” but the health care system that provides care often does, and early experiences of discrimination by LGBTQ people increase their later risk for multiple types of cancer. Any lingering doubts about the health consequences of discrimination were eliminated recently when a study found that LGBTQ people who live in communities with high levels of antigay prejudice are likely to die 12 years sooner than their peers who are not discriminated against. Information about cancer in the LGBTQ community must be cobbled together from a variety of sources. Studies of LGBTQ cancer risks, screening, and survivorship experience are limited and often focus on small groups of subjects. And, because no cancer registries collect information about gender identity or sexual orientation, definitive information about cancer prevalence and incidence in LGBTQ populations is still unknown. Similarly, treatment facilities and social service organizations may be unaware of the true number of LGBTQ

people they serve because their intake forms do not invite disclosure, and fear of discrimination keeps many patients in the closet. If there are approximately 14 million Americans living with a history of cancer in this country today, there may be as many as 1 million LGBTQ survivors—invisible, underserved, but there. This entry addresses the current state of knowledge about this population, all along the cancer continuum, and provides suggestions for future research and policy changes.

Prevention As a group, all subpopulations of the LGBTQ community experience increased cancer risks. Prevention strategies would be directed at alleviating these risks, many of which can be traced to the stress of living as sexual and gender minorities. A dramatic change in these risk factors could not be accomplished by individual interventions alone, but would require national political and policy shifts as well. As long as LGBTQ people are at risk for homophobia, transphobia, and shaming of alternative gender expressions, they are at risk for choosing coping strategies that increase their vulnerability to cancer. Tobacco use is the single most preventable cause of disease, disability, and death in the United States. According to the most recent surgeon general’s report, LGBTQ people smoke cigarettes at rates that are 68% higher than the rest of the country, increasing the risk for lung cancer, anal cancer, and multiple others. On the whole, bisexual men and women seem to have the highest smoking rates of any subgroup for which data are readily available. There are three main explanations for this disparity. First, lesbian, gay, and bisexual youth who reported higher levels of rejection and hostility were significantly more likely to engage in risky health behaviors, including tobacco use. Second, tobacco companies have aggressively advertised to the LGBTQ community. Finally, gay bars have been one of the few places where many LGBTQ people have found community and social acceptance, but this also contributes to the increased risk of smoking as well as alcohol use and abuse in this population. Research

Cancer in the LGBTQ Community

suggests that the more alcohol a person drinks, and in particular, the more alcohol a person drinks regularly over time, the higher the risk of developing an alcohol-associated cancer. Based on data from 2009, an estimated 3.5% of all cancer deaths in the United States were alcohol related. Alcohol increases the risk for breast, colorectal, liver, and esophageal cancers, among others. In addition to increased alcohol and tobacco use, lesbians, as a group, are more likely to be overweight and less likely to have a biological child before the age of 30. The reasons for the weight difference in lesbians and bisexual women are only partially understood, but probably include less of a reliance on heterosexual standards of beauty, coupled with unhealthy eating patterns that arise from stigma and discrimination. Taking the four factors together, lesbians are considered to have the densest cluster of risk factors for breast cancer. Excess weight and a high-fat diet also increase the risk for cancers in other body parts, including the colon, thyroid, gallbladder, and esophagus. Gay and bisexual men are more likely than heterosexual men to have HPV, the human papilloma virus. HPV is found in 65% of HIV-negative men who have sex with men (MSM) and approximately 95% of HIV-positive MSM. There are many strains of HPV, most of which pose no physical danger. There are four strains, however, that have been implicated in an increasing number of cancer types, such as anal cancer and esophageal cancer. HPV, coupled with smoking, substantially increases the risk for anal cancer.

Screening Populations with increased cancer risks need to be hypervigilant about screening but, unfortunately, this is not the case with the LGBTQ community. While studies are inconsistent in their findings, most report that LGBTQ people have lower rates of all U.S. Preventive Services Task Force (USPSTF) recommended screenings. Multiple barriers to accessing culturally competent care contribute to the problem of low cancerscreening rates for this population. For example,

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LGBTQ people are less likely to have health insurance coverage, with transgender people having the lowest rates of all these subpopulations. Previous negative experiences with the health care system, together with fear of discrimination, keep many LGBTQ people away from the health care system until a crisis requires engagement. Transgender people may want to avoid a focus on body parts that do not fit with their gender identity; trans women neglect prostate cancer screening and trans men rarely go for mammograms or cervical Pap smears. Finding cancer-screening providers who are culturally competent is becoming easier in some parts of the country, but is still often quite difficult. There are less than 5 hours of training in LGBTQ health in an entire medical school education, and most of that focuses on HIV.

Diagnosis Although the science and procedures for diagnosing cancer do not differ based on sexual orientation and/or gender identity, the experience of diagnosis may be affected by this minority status. A cancer diagnosis is clearly frightening for everyone, but for many LGBTQ people the critical first questions about treatment options and recovery are followed immediately by concerns about social stigma. The all-important question of “Will I be healthy?” is compounded by an additional chain of worries. New questions such as “Should I come out to my doctor?” “Will I be safe if I do?” “Will my chosen family be welcome?” and “Will I be offered the information I need to know to take care of my relationship, my sexuality, my fertility, and my family?” become as important, if unasked, as questions about treatment and survival. All diagnosed tumors are reported to cancer registries; the largest one, run by the CDC, is SEER (Surveillance, Epidemiology, and End Results program). Since none of the national cancer registries collect information about sexual orientation or gender identity, valuable information about cancer in the LGBTQ communities is lost. For example, while it is clear that lesbians have increased risks for breast cancer and

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decreased mammogram rates, there is virtually no information about prevalence, incidence, and the stages of breast cancer when detected in this population.

Treatment and Survivorship The word survivorship is often used to refer to a patient from the moment of diagnosis, while some facilities and organizations reserve the term for those people who have completed all cancer treatment, including surgery, chemotherapy, and/or radiation. However survivorship is defined, LGBTQ people experience additional challenges in their encounters with health care systems. For LGBTQ people, cancer can be especially frightening. It can be dramatically more so, and this has long-term health consequences. The recent development of a “patient-centered care movement” has shifted the emphasis of health care from scientific measurements of illness and cure (e.g., blood work and imaging scans) to patients’ assessments of the quality of their own health care. This represents a seismic shift from “what’s the matter” with patients to “what matters” to patients. In fact, measurements of patient satisfaction prove more predictive of health outcomes than provider ratings. Those patients who are the most satisfied with their health care tend to stay healthier. LGBTQ patient satisfaction is compromised by multiple factors, some of which are detailed in what follows. As stated earlier, many LGBTQ people have a history of avoiding the health care system. Once diagnosed with cancer, they are thrust into that system, whether they are prepared for it or not. Avoidance is no longer an option and compounds the stress level of many LGBTQ patients. They must engage with the system in order to survive, even as the interactions bring additional worries about acceptance and pressure for gender conformity. This wariness of the system, coupled with a simultaneous dependence on high-quality cancer care, is a source of constant additional stress for many LGBTQ cancer patients. In an online survey conducted in 2012 by the National LGBT Cancer Network, one survivor reported,

Although my doctor knew all about me, each encounter with new people—with blood draws, ultrasound, breast X-ray, etc.—had the basic anxiety of the procedure and layered on to that, the possibility of homophobia and having to watch out for myself.

Despite national trends, all health care experiences are local. Most people are treated in medical centers near their homes, and their cancer experience is dependent upon the unique staff they meet there and the social policies of that city and state. In nonurban regions, there are limited options for where to receive cancer care and, even when multiple cancer treatment facilities exist, health insurance may be a barrier in selection. Sometimes, the only treatment option is at a hospital with religious affiliations. In localities with multiple hospitals, LGBTQ people may have to make an unfortunate choice between providers, selecting either the more esteemed doctor who is well known for his homophobia or the young oncologist with better cultural competence but less cancer experience. The political landscape surrounding the cancer treatment facility also plays a role in survivorship. For example, LGBTQ discrimination is banned in less than half the states of this country. In the previously mentioned online survey, one cancer patient wrote, “My partner did not come to the hospital because the only good hospital around was a Catholic hospital and I didn’t want my treatment compromised by them finding out about my ‘sinful lifestyle.’” Patients have better outcomes when they can be their authentic selves in treatment. Disclosure of identity and the medical care team’s acceptance of this disclosure are linked to better patient health outcomes, as described in the patient-centered care model. LGBTQ patients must repeatedly weigh the desire to disclose against their fears of substandard treatment as a result. Because cancer treatment involves multiple health care providers, technicians, and clerical staff, the decision to disclose (or not) is repeatedly reconsidered and made. Those patients who are out to their oncologist and radiologist, providers with whom they have repeated interactions during cancer treatment, may choose not to come out to phlebotomists, housekeeping

Cancer in the LGBTQ Community

staff, and social workers who they may interact with only once or infrequently. Their experience is about perceived safety. As one cancer patient in the study wrote, I am comfortable being out as a lesbian. Yet there are settings in which there is that situation of asking myself, do I want to have this discussion today, with this person, does it matter??? I bring it up when it seems to matter to the situation and the opportunity is available. Sometimes the process of coming out over and over is tiresome. Chemo Treatment and recovery from surgery is a full time job . . . it is a matter of cost/benefit analysis.

Most cancer patients and survivors create informal teams of people for support through the treatment process. These people may accompany them to appointments, make hospital visits, and/or help with chores, children, and pets at home. Compared with other survivors, LGBTQ people often have some striking differences in those they turn to for support during cancer treatment. For many people in this community, the most important relationships exist outside of legal definitions; that is, they are legal strangers. Traditional intake forms that ask only about marital status may miss these bonds of responsibility and support. Also, it is not uncommon for LGBTQ people to be rejected by their biological family because of their sexual orientation and/or gender identity, and this rift is not necessarily healed following a cancer diagnosis. Treatment centers that do not welcome and respect an LGBTQ person’s support team are subtly conveying discrimination. As one survivor from the online survey said, “It is important to know where it is safe to bring a partner, because my family hates me and even my mother told me right before surgery that she hoped I would die in surgery and that she wished I had never been born.” Cancer treatment is not only physical; it is also embedded in the culture in which the care is given. Cancer care is rife with unexamined messages about appropriate gender expressions and concerns. For lesbian survivors, many of whom are gender nonconforming, the educational materials, pink ribbons, and expectations of breast reconstructive surgeries are particularly alienating. When LGBTQ

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people fall outside these expectations, they can be isolated or stressed or even experience substandard care. Many lesbians have had to repeatedly defend their decision to not have breast reconstruction following a mastectomy. The gendered cancer survivorship expectations of men can be seen in the pressure to adopt a masculine stoicism about the disease. The common metaphors of war and of “battling” their cancer can be particularly offputting. As a lesbian cancer survivor from the online survey stated, “Being a lesbian facing having your breasts cut off, it would be good if they did not assume you were concerned about how ‘men’ would see you in the future!” Health care providers are often unaware of cancer’s unique impact on LGBTQ sexuality, fertility, relationships, and family, leaving these survivors with unanswered questions. Support groups for patients and caregivers are not always places LGBTQ survivors can safely voice their concerns and receive support. And the partners of LGBTQ cancer survivors may not feel comfortable in the traditional caregiver groups. For example, the gay partner of a prostate cancer survivor may not learn what he needs in a support group where all the other members are women; the same may be true for the female partner of a lesbian breast cancer survivor. In addition, the language in most printed materials assumes marriage and heterosexuality. For example, prostate cancer treatment often compromises erectile functioning, and most of the literature addresses the impact in terms of vaginal intercourse. To work effectively with gay male survivors, however, health care providers and social workers need to be competent at discussing posttreatment anal penetration and anal-receptive sex. Most providers receive no education that would help them answer questions on these topics. As one a gay man in the online survey expressed, I am a gay male and a bottom. The chemo, hormone, surgery, and radiation took almost two years—during which I lost all sex drive and my penis shrank. Erectile drugs have created a different erection than I used to have. I would have appreciated more detailed, comprehensive information about what to expect.

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Career Development and Trajectories

Conclusion There is no single solution to the cancer burden in the LGBTQ community, for there is not one simple problem. Change must come from a variety of sources and occur on multiple levels. To reduce the increased cancer risks in LGBTQ people would require not just individual shifts in behaviors, but elimination of the discrimination that leads to unhealthy behavioral choices. State policies that ban discrimination have already been shown to improve mental health, reducing the need to lean on coping strategies like tobacco and alcohol. Increasing cancer-screening rates in the LGBTQ population requires more than increased access to health insurance, which the Affordable Care Act offers. Reluctance to engage with the health care system can only be upended with extensive cultural competence training of all health care providers and administrative staff. Then, collaboration with or outreach to trusted LGBTQ organizations could help spread the news of safety and welcome. Funding for these changes would be easier to acquire if there were more data on cancer incidence and prevalence; thus, national cancer registries need to start collecting information about sexual orientation and gender identity. Finally, cancer treatment, both physical and psychosocial, must begin to address the differences in the needs and support systems of LGBTQ survivors. Liz Margolies See also Cancer and Social Support; Chronic Illness; Discrimination on the Basis of HIV/AIDS in Health Care; Health Care Providers, Disclosure of Sexual Identity to; Health Care System; Health Disparities; Health Disparities, Transgender People; Smoking

Further Readings American Lung Institute. (n.d.). Smoking out a deadly threat: Tobacco use in the LGBT community. Retrieved from http://www.lung.org/assets/documents/ research/lgbt-report.pdf Durso, L., & Meyer, I. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers

among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10, 35–42. doi:10.1007/ s13178-012-0105-2 Eliason, M. J., Dibble, S., & DeJoseph, J. (2010). Nursing’s silence on lesbian, gay, bisexual, and transgender issues: The need for emancipatory efforts. Advances in Nursing Science, 33, 206–218. doi:10.1097/ANS.0b013e3181e63e49 Garcia, M. (2014, February 16). Antigay communities lead to early LGB death. Retrieved from http://www .advocate.com/health/2014/02/16/study-antigaycommunities-lead-early-lgb-death Margolies, L. (2013). Issues the LGBT population faces when it comes to cancer [Audio podcast]. Retrieved from http://www.medicine.yale.edu/cancer/patient/ answers/programsbytopic.aspx Margolies, L., & Scout, N. (2013). LGBT patientcentered outcomes: Cancer survivors teach us how to improve care for all. Retrieved from http://www. cancer-network.org/downloads/lgbt-patient-centeredoutcomes.pdf National Cancer Institute. (n.d.). Alcohol and cancer risk. Retrieved from http://www.cancer.gov/about-cancer/ causes-prevention/risk/alcohol/alcohol-fact-sheet National Cancer Institute. (n.d.). Obesity and cancer risk. Retrieved from http://www.cancer.gov/cancertopics/ factsheet/Risk/obesity

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In navigating their careers, LGBTQ people must address concerns related to visibility and stigma. Understanding the issues and challenges that LGBTQ individuals navigate as they progress through their careers is important because it helps both persons and organizations to make decisions that will help them maximize career satisfaction and success. One way of achieving career success and satisfaction is to have a career that meets one’s needs. These needs can be psychological (e.g., experiencing autonomy and independence or acceptance and support at work) or economic (e.g., having a secure and stable employment situation). This entry discusses the career development and

Career Development and Trajectories

trajectories of LGBTQ workers as they manage the impact of the decision whether to disclose their sexual identity as they seek to achieve career success.

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passing in hopes of avoiding detection and becoming potential targets. By contrast, others will engage in the strategy of disclosure in hopes of finding a safe work context where they will have access to support.

Identity Disclosure and Employment Protections

Types of Careers

The careers of LGBTQ workers are significantly affected by their sexual identity and whether they choose to make their identity publicly known. Unlike race and sex, which are normally visual clues to a person’s identity, few people are directly identified as being LGBTQ, in part due to societal heterosexism (which treats heterosexuality as normative and therefore assumed). Consequently, selfidentification as LGBTQ is necessary, particularly in the employment context. Individuals who choose to be visible are considered to be out, whereas those who choose to remain invisible are referred to as closeted (i.e., in the closet, which is a metaphor for hiding). To maintain this closeted status, a person engages in passing, either actively (i.e., engages in behaviors to make people believe that they are not LGBTQ) or passively (i.e., not dissuading others of the assumptions of heterosexism). Therefore, the first critical career decision to be made is whether one wishes to be visibly and openly LGBTQ in one’s work life. The decision to disclose is consequential, particularly in employment, given the stigma often associated with being LGBTQ and the lack of legal protections for LGBTQ individuals. Being LGBTQ is considered by some to be deviant, and, depending on the source, immoral and/or dangerous. Business owners who hold these beliefs can feel justified in denying employment opportunities to LGBTQ people, and in the majority of states such employer actions are legal. Currently, in the United States, only 21 states (plus Washington, D.C.) provide employment protections based on sexual orientation, of which 18 (plus D.C.) are inclusive of individuals who are transgender. While legislation may provide recourse, it does not necessarily prevent harassment or discrimination. Therefore, some LGBTQ people will pursue the strategy of

Regardless of whether an individual is out or closeted, he or she can have a successful career, but there are differences in how one is likely to manage and experience that career. This occurs because of different outcomes that result from the disclosure decision. Individuals who remain closeted need to be more self-reliant in managing and directing their careers because being closeted inhibits the ability to create developmental relationships within an organization while also making the individual vulnerable to discrimination if discovered. Of course, the potential for discrimination is a major career concern for someone who is visibly LGBTQ; however, LGBTQ workers manage this potential differently. Individuals who are out of the closet are expected to actively seek out and embed themselves in careers and organizations where it is safe to be LGBTQ. This promotes a better work–life balance as well as increasing the ability of the out individual to rely on an employer for career development and stability. Careers have both anchors and paths. Career anchors represent the foundation or basis that forms an individual’s career. It represents a person’s career identity and motivation. Careers also have paths based on the goals and decisions that people make. Greater consistency among these career anchors and paths with an individual’s psychological and economic priorities should promote career satisfaction and success. Therefore, recognizing one’s own priorities will facilitate making wiser career decisions. This is also true for employers seeking to advance the careers of their workers; however, the ability of organizations to do this will be greatest for those who are out because managers will have greater knowledge and understanding of the needs of those workers.

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Three categories of needs that have been identified as anchors/foundations from which careers emanate are autonomy and independence, lifestyle, and security and stability. Of these career anchors, autonomy and independence best meet the needs of individuals who are closeted. Autonomy and independence reflect the needs of closeted workers to manage their own careers as they are less able to depend on a specific organization for career security. While many individuals who are out of the closet will also manage their own careers, they are expected, as noted earlier, to seek organizations where it is safe to be LGBTQ, thus allowing them to experience greater support and a healthier work– life balance, which is consistent with a lifestyle anchor. The third option for a need-based career is security and stability. This alternative is found most among workers who are out of the closet but who place greater emphasis on economics than on identity integration and career self-management. From these career anchors, individuals experience different career trajectories. Further, certain trajectories are more consistent with specific career anchors than others. For example, traditional careers are most suitable for individuals who have a security and stability anchor. Traditional careers are based on the social contract where employees provide their effort and loyalty in return for job security. Another attribute of traditional careers is that they are based more on extrinsic than intrinsic factors. Understanding these characteristics is particularly important for organizations, since workers depend on their employers for career guidance and development. Reflecting changes in the social contract between workers and employers, two theories that have been developed as alternatives to traditional careers are those of protean and boundaryless careers. For both of these theories, how individuals take responsibility for their own career development is important because, increasingly, organizations are rewarding employability over simple loyalty. By way of distinction, individuals who follow a boundaryless path focus on career opportunities and are not tethered to a specific organization, whereas those on a protean career trajectory are more values-driven.

With regard to disclosure status and career anchor, a protean path is most congruent for “out” individuals with a lifestyle anchor. The intrinsic focus of a lifestyle anchor is more consistent with the emphasis on a values-driven career than the focus of those with security and stability anchors. Similarly, the decision to disclose one’s LGBTQ status is more consistent with a values-driven approach than the choice to remain closeted. Self-awareness of one’s anchor facilitates making appropriate career decisions. Further, it is valuable for employers to recognize this intrinsic focus to properly create developmental opportunities and rewards for these workers. As for pursuing a boundaryless career path, this trajectory is most congruent for individuals with autonomy and independence anchors who have chosen to remain closeted. Boundaryless individuals are psychologically the most open to changes in employment. Because closeted individuals are expected to have weaker social ties to an organization, mobility for them is easier and potentially more necessary (in the event of discovery); they are therefore expected to be more boundaryless in their career orientation. These factors emphasize remaining autonomous and independent, which explains why that anchor is the most congruent. A further consequence of this combination of disclosure, anchor, and trajectory is that employers are likely to have the least knowledge of, and influence on, the career development of these employees.

Developmental Networks Because being protean or boundaryless involves actively directing one’s career, it is useful to seek the advice of others and develop mentoring relationships. Individuals who have mentors tend to experience greater career success and satisfaction. This success and satisfaction results from a variety of psychosocial and career-planning functions that mentors provide, not the least of which is becoming part of a mentor’s network. Although traditionally mentoring has been discussed as a simple dyadic relationship between a more senior individual and a protégé, research has shown that people tend to have these types of developmental

Career Development and Trajectories

relationships with more than one mentor. Having multiple mentors is particularly beneficial for those individuals who might want to be paired with different people for the career planning and psychosocial functions of mentoring. There are several reasons for wanting to separate these functions, particularly if the person has a formal (organizationally assigned) mentor. Protégés are paired with formal organizational mentors for a variety of reasons, but sexual identity is not likely to be among them. Therefore, an LGBTQ person may want an additional developmental relationship with someone who is also LGBTQ and who can provide understanding and guidance for how one’s sexual identity intersects with his or her organizational and career experiences. For example, serving as a role model is one of the important functions that mentors fulfill. Having an LGBTQ mentor who can model such behaviors as how to handle social situations and personal needs is important. If closeted, a mentor can help a protégé get the support that he or she needs without requiring the individual to disclose his or her LGBTQ status. Even if someone is out of the closet, the decision whether to bring a partner/ spouse to a social function when new to an organization or early in one’s career can be stress inducing. Informal mentors do not need to be in the same organization, which may be particularly important for closeted workers. Also, individuals who have other salient identity issues (e.g., race, sex, or religion) in addition to being LGBTQ may want additional mentors who can speak to those facets of their identity. Even when just focusing on professional issues, having additional mentors, both within and outside one’s organization, provides benefits to a protégé beyond what can be found in a traditional dyadic mentoring relationship.

Conclusion The social and legal environment in which LGBTQ individuals live and work continues to evolve. Distinct progress has been made in terms of the laws recognizing same-sex relationships and protecting LGBTQ workers from discrimination.

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Eventually, these will exist at the federal level. Does that mean that all stigma and discrimination will be eliminated? Unfortunately, there is ample evidence from other groups who currently enjoy full marriage recognition and employment protections that this will not be the case. Therefore, the needs discussed in this entry are likely to continue to exist and drive the career development and trajectories of LGBTQ individuals. Understanding these will help LGBTQ workers and their employers make decisions that foster career satisfaction and success. David M. Kaplan See also Coming Out, Disclosure, and Passing; Domestic Partnership; Employment Non-Discrimination Act (ENDA); Mentoring; Work Environments; Work–Family Interface, LGBQ Parents; Workplace Discrimination

Further Readings Briscoe, J. P., & Hall, D. T. (2006). The interplay of boundaryless and protean careers: Combinations and implications. Journal of Vocational Behavior, 69, 4–18. doi:10.1016/j.jvb.2005.09.002 Higgins, M. C., & Kram, K. E. (2001). Reconceptualizing mentoring at work: A developmental network perspective. Academy of Management Review, 26, 264–288. doi:10.5465/AMR.2001.4378023 Human Rights Campaign. (n.d.). Maps of state laws & policies. Retrieved from http://www.hrc.org/resources/ entry/maps-of-state-laws-policies Kaplan, D. M. (2014). Career anchors and paths: The case of gay, lesbian, & bisexual workers. Human Resource Management Review, 24, 119–130. doi:10.1016/j.hrmr.2013.10.002 O’Ryan, L. W., & McFarland, W. P. (2010). A phenomenological exploration of the experiences of dual-career lesbian and gay couples. Journal of Counseling & Development, 88(1), 71–79. doi:10.1002/j.1556-6678.2010.tb00153.x Pichler, S., & Ruggs, E. (2015). LGBT workers. In A. Collela & E. King (Eds.), The Oxford handbook of workplace discrimination [Online]. Retrieved from http://www.oxfordhandbooks.com/view/10.1093/ oxfordhb/9780199363643.001.0001/oxfordhb9780199363643-e-13

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Schein, E. H. (1990). Career anchors: Discovering your real values. San Diego, CA: Pfeiffer & Company. Trau, R. N. C., & Härtel, C. E. J. (2004). One career, two identities: An assessment of gay men’s career trajectory. Career Development International, 9, 627–637. http://dx.doi.org/10.1108/13620430410570338 Tuten, T. L., & August, R. A. (2006). Work-family conflict: A study of lesbian mothers. Women in Management Review, 21, 578–597. http://dx.doi .org/10.1108/09649420610692525

CAREGIVING Although their experiences have not been well represented in the research literature, lesbian, gay, bisexual, transgendered, and queer (LGBTQ) persons have long been involved in providing care to partners and loved ones in need. This entry provides basic information on caregiving, including definitions of caregiving roles and duties and descriptions of the positive and negative outcomes of care provision. It also offers much-needed insight into the unique experiences of LGBTQ caregivers.

Caregiving for Adults, Children, and Elders Caregiving is the practice of providing assistance to another individual as well as finding and managing supplemental care in the community. Caregiving roles can be either formal or informal. Formal caregivers include paid professionals, such as home health aides and visiting nurses. Informal caregivers are often parents, spouses, partners, family, and friends, who provide care to individuals who are ill or disabled or cannot perform activities of daily living (ADL). Among LGBTQ persons, families of choice consist of persons or groups of people who may be from their family of origin, extended family, or significant members of their social network who are not biologically related. Often, one person assumes the majority of caregiving tasks, and this person is considered the primary caregiver. Secondary caregivers are also common and typically assist the primary caregiver(s). Spouses and adult children have traditionally been

called to become primary caregivers for aging loved ones. Research continues to identify females as the primary caregivers across groups and throughout the life span. The majority of care recipients are given care in their home or in the home of a loved one. As our global population ages and lives longer, demographers acknowledge that there will be fewer adult children to care for our elder population, placing a heavy burden on both informal and formal care providers.

Outcomes of Providing Care Caregivers are called upon to assist in a variety of activities of daily living, including bathing, dressing, and toileting a care receiver. They may also pay bills, prepare meals, dispense medications, and provide transportation for these individuals. Providing emotional support for and sharing social activities with their friend or loved one is also part of the caregiving role. Caregivers may also coordinate external care providers and health professionals, manage schedules, and arrange for service provision, including respite care, therapy, and other social services. Several negative outcomes have been identified as a result of the caregiving experience. These may include physical strain, including injury or illness, from providing hands-on care for extended periods of time. Many caregivers also experience emotional stress and even depression. Financial difficulties as a result of caregiving responsibilities can also occur because providing care can be costly and time intensive. Because caregiving can involve long hours over long periods of time, it can also cause strain with an individual’s other responsibilities and relationships. For example, an individual providing care to an older parent may be unable to spend as much time as usual with a spouse, partner, or child. Caregiving may also cause conflicts with employment, as a caregiver may need to take time off from work to provide assistance to a loved one. These negative outcomes of providing care have been described variously as caregiver stress, caregiver burden, and caregiver strain. Although not as well researched, care recipients also experience negative outcomes, including feelings of guilt

Caregiving

and fears of being a burden on the caregiver(s). Care recipients are frequently aware of their disabilities and/or declining capacity to perform their ADLs and may become emotionally distressed, frustrated, and/or angry. These reactions may prevent or hinder their ability to access necessary support. Despite such negative outcomes, caregiving also has positive aspects, and providing care to friends and family members has been identified as a rewarding experience. Caregivers often benefit because they feel good about themselves and the care that they provide. They may also enjoy the satisfaction of returning care to a loved one who once provided care to them or fulfilling a responsibility to a partner or family member. Many individuals also experience personal growth during the caregiving process, reporting that they learned about themselves and their capacity to give and be strong while caregiving. Caregivers and care recipients may also have the benefit of increased closeness, connection, and commitment to each other. Care recipients also acknowledge changes in important interpersonal connections when receiving care from loved ones, deepening relationships and forging stronger attachments.

Caregiving Among LGBTQ Individuals Overall, the caregiving literature has grown since the 1970s, although the majority of these studies are based on the experiences of heterosexual persons and couples. Far fewer studies exist on the unique caregiving experiences of lesbian, gay, bisexual, transgendered, and queer persons. The voices of transgender persons are almost nonexistent in the caregiving literature. The studies that have been conducted have focused on providing care to spouses/partners and other loved ones/ friends in need, and have shown that LGBTQ caregivers experience many of the same stressors as those identified in the traditional caregiving literature. These similarities include financial strains, physical and emotional problems, employment-related stressors, and relationship strains. Recent studies of LGBTQ persons have also identified unique issues and challenges experienced by

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both the LGBTQ caregiver and LGBTQ care recipient. LGBTQ persons are more likely to live alone, have fewer children, be ill-informed of supportive resources, face institutional and social discrimination, and cope with social policies that prevent access and negatively impact their care experience. The historic discrimination and oppression of LGBTQ persons has implications in the caregiving experience of both care providers and recipients. Although advancements in marriage equality legislation have been made in the United States and abroad, the lack of legal recognition of same-sex couples has historically been (and remains, in many areas of the world) a challenge, and has profound consequences for both caregivers and care recipients. Formally, care provision for LGBTQ persons has been compromised due to the lack of understanding of the needs of LGBTQ persons, professional constraints that do not recognize informal family-of-choice networks or non-kin relationships, and the omission of non-kin caregiving in social policies such as the Family Medical Leave Act of 1993. Contextually, LGBTQ persons have varied experiences with the “coming out” process, and many do not share their sexual orientation with family members, friends, places of employment, and health care providers. This may be the result of fear of discrimination, fear of the denial of services, and/or the lack of acceptance of their sexual orientation by friends and family members. Studies consistently demonstrate that informal care is preferred over formal care and the hierarchy of care frequently falls to families of choice within the LGBTQ community. LGBTQ family-of-choice caregivers may carry a heavier burden due to this lack of formal and informal awareness, recognition, or legal rights. Transgender caregivers and receivers are thought to experience even greater difficulties, often being estranged from family and faced with insensitive professionals. It is equally important to note that there are ingroup differences among LGBTQ persons that also impact the caregiving and care-receiving experience. For example, the experience of females as predominant caregivers, with fewer financial supports, suggests a heavier burden is carried.

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Lesbians may be impacted by having a small family-of-choice network. Further, gay men’s higher incidence of health issues related to HIV can impact the availability of informal care networks, which may be compounded by continued discrimination and stigma. Additionally, the pervasive lack of understanding or acceptance of transgender/ transsexual people among health care providers and family members, as reflected in discriminatory institutional mechanisms and policies, has the potential of limiting access to informal supports. Research studies continue to highlight the lack of knowledge among health care providers about meeting the needs of LGBTQ persons. The lack of training for health care providers and the discriminatory language of medical records and intake forms are examples of this common problem. Faced with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that often does not recognize non-kin relationships, LGBTQ care recipients and providers are frequently required to “out” themselves or their loved ones in an effort to receive care and make decisions. Finally, research studies continue to demonstrate the strong aversion to institutionalized care, and this finding is also true for LGBTQ persons. Disagreements between families of choice and biological families privilege biological family members, creating the potential for additional negative care experiences.

Conclusion Caregiving has complex features for the provider and receiver, particularly among LGBTQ persons. The rewards and challenges of caregiving are similar across groups; however, the unique experiences and challenges facing LGBTQ persons in need of care and those providing care to LGBTQ persons must be recognized and addressed. Fear of discrimination, lack of knowledge of the particular needs of LGBTQ individuals, and the omission of alternative care networks in formal care provision are just a few of the unique issues affecting LGBTQ care. Continued research, policy and program development, and education of health care providers are

important activities for the improvement of LGBTQ-care provision. Access to and knowledge of legal and other supportive resources for LGBTQ care providers and recipients are fundamental to enhancing the overall quality of care for this population. Kristina M. Hash and Marianne Mankowski See also Advance Health Care Planning; Aging, Social Relationships, and Support; Cancer and Social Support; Coming Out, Disclosure, and Passing; Dementia; Depression; Discrimination on the Basis of HIV/AIDS in Health Care; Families of Choice; Families of Origin, Relationships With; Health Care Plans; Health Care Providers, Disclosure of Sexual Identity to; Health Care System; Health Insurance Coverage for Transgender People, Access to; HIV and Treatment; HIV/AIDS and Aging; HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to; Hospital Visitation; LGBQ Parents and the Health Care System; Transgender Health Care

Further Readings Brotman, S., Ryan, B., Collins, S., Chamberland, L., Cormier, R., Julien, D., . . . Richard, B. (2007). Coming out to care: Caregivers of gay and lesbian seniors in Canada. Gerontologist, 47, 490–503. Cohen, H. L., & Murray, Y. (2006). Older lesbian and gay caregivers: Caring for families of choice and caring for families of origin. Journal of Human Behavior in the Social Environment, 14, 275–298. doi:10.1300/J137v14n01_.14 Coon, D. W. (2005). Exploring interventions for LGBT caregivers: Issues and examples. Journal of Gay & Lesbian Social Services, 18(3/4), 109–128. doi:10.1300/J041v18n03_07 Fredriksen-Goldsen, K. I., Kim, H.-J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., . . . Petry, H. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health. doi:10.2105/AJPH.2012 .301110 Grossman, A. H., D’Augelli, A. R., & Dragowski, E. A. (2005). Caregiving and care receiving among older lesbian, gay, and bisexual adults. Journal of

Catholic LGBTQ People Gay & Lesbian Social Services, 18(3/4), 15–38. doi:10.1300/J041v18n03_02 Hash, K. M. (2006). Caregiving and post-caregiving experiences of midlife and older gay men and lesbians. Journal of Gerontological Social Work, 47(3/4), 121–138. doi:10.1300/J083v47n03_08 Metlife Mature Market Institute. (2010). Still out, still aging: The Metlife study of lesbian, gay, bisexual, and transgendered baby boomers. Westport, CT: Author. Muraco, A., & Fredriksen-Goldsen, K. I. (2014). The highs and lows of caregiving for chronically ill lesbian, gay, and bisexual elders. Journal of Gerontological Social Work, 57, 251–272. doi:10.1080/01634372.201 3.860652 Williams, M. E., & Freeman, P. A. (2005). Transgender health: Implications for aging and caregiving. Journal of Gay & Lesbian Social Services, 18(3/4), 93–108. doi:10.1300/J041v18n03_06

CATHOLIC LGBTQ PEOPLE This entry examines the official position of the Roman Catholic Church regarding homosexuality and transgenderism, as well as its potential effects on the relationship between the gender and/or sexual identities of Catholic LGBTQ people and their confessional or religious identities. Next, it shows how the relationship of Catholic LGBTQ people with their faith may lead to a conflict between those identities. The main psychological effects of this conflict, as well as the ways identity contradictions are managed and/or resolved, are also examined. Finally, the influence of the wider sociocultural context and of the specific characteristics of the Catholic confession on that process is highlighted.

The Position of the Roman Catholic Church on Homosexuality and Transgenderism The official position of the Roman Catholic Church on human sexuality stems from a dichotomous and essentialist notion of gender. Men and women are seen as fundamentally different, but also complementary in regard to sexuality, which

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is valued essentially for its procreative potential within a monogamous and stable relationship. Against this backdrop, a number of rights claimed by the modern LGBTQ movement (same-sex marriage, adoption rights, identity recognition of transgender people and transsexuals, among others) have been the subject of clear and public opposition from the Catholic Church. As such, on a personal level, the relationship of Catholic LGBTQ people with their faith can be highly problematic. The position of the Catholic Church on homosexuality rests on six passages of the Old and New Testaments (Genesis 19:1–28; Leviticus 18:22, 20:13; Romans 1:26–27; 1 Corinthians 6:9; 1 Timothy 1:10). The Church’s position was first vaguely articulated in the encyclical Persona Humana: Declaration on certain questions concerning sexual ethics, released in 1975, and more explicitly in the 1986 Letter to the bishops of the Catholic Church on the pastoral care of homosexual persons. Homosexuality is classified in the Letter as an “objective disorder” and same-sex acts as contrary to “natural law” and “morally disordered.” Although homosexuality itself is not considered a sin, involvement in homosexual practices is because it represents a transgression of the divine order. Even though transgenderism has not been the focus of identical consideration, in an internal letter released in 2000 that was meant to be confidential, the Catholic Church instructed its bishops to refuse any requests for sex-change registration in parish records. This means that the administration of the sacraments of matrimony and ordination to transsexuals is also prohibited. Transsexuality is labeled as a psychic disorder, and the Church asserts that a person’s gender cannot be changed through surgery.

Confessional Identity, Religious Identity, and Identity Conflict Research on Catholic LGBTQ people’s relationship with their faith is scarce, and focuses mainly on Anglo-Saxon, as well as on some western European, societies. Overall, scientific literature highlights the

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conflict between the system of beliefs and values of Catholic LGBTQ people and their feelings and practices. Such conflict is usually equated with cognitive dissonance (a concept originally proposed by Leon Festinger) between one’s confessional/religious identity and one’s gender identity and/or sexual orientation. The person is torn between the possibility of self-fulfillment and the need to abide by religious precepts and of being socially integrated in the religious community he or she is part of. Difficulties in reconciling the two identities lead to variable degrees of psychological tension linked to feelings of guilt, shame, self-invalidation, depression, internalized homophobia and/or transphobia, self-hatred, and suicidal ideation, among others. The conflict also tends to be heightened when the person’s immediate context (family, friends, and community) is highly religious and conforms to confessional precepts. It is, nevertheless, important to notice that not all Catholic LGBTQ people feel that their confessional/ religious identity and their gender identity and/or sexual orientation are conflicting. One explanation for this seems to be the way people live and see their relationship with their faith. There is, in fact, a difference between confessional identity and religious identity. Confessional identity refers to understanding and living a religious faith in full conformity and identification with the specific precepts of a religious denomination. Religious identity refers to a form of understanding and living the principles of a given religious denomination in a relative way; that is, identification with the latter is only partial and often rests on the acceptance of some precepts and the rejection of others. In other words, religious feeling can be partially, or even completely, autonomous from particular religious confessions.

Conflict Resolution and the Sociocultural Context There are several ways to minimize—or even eliminate—the dissonance between a person’s confessional/religious identity and his or her transgender identity and/or homosexuality or bisexuality. One possible solution is to reject one identity and

preserve the other. For example, one could reject one’s LGBTQ identity through sexual abstinence or heterosexual marriage. Confessional identity could be rejected by abandoning one’s faith. Both identities may also be preserved, however, through compartmentalization. For example, one could avoid contexts or situations that bring to light dissonance between both (for example, not attending religious services), or by concealing one of them (for example, hiding one’s LGBTQ identity from one’s religious community and leading a double life). Finally, it is also possible to integrate both identities, for example by becoming a member of an inclusive congregation, or by turning to individualized forms of religion (for example, refusing the Catholic exegesis of biblical texts and/or creating a personal religion, often referred to in terms of “spirituality”). The same person can go through more than one of these situations, and conflict tends to be solved as he or she ages. Among the variables that interfere in this process are the search for information regarding different religious confessions and philosophies, and the reading of holy texts and the sharing of doubts with other persons, be these members of the same religious denomination or not. There are, however, some fundamental differences between Anglo-Saxon societies, especially the United States and western European countries, that mediate the process of conflict resolution. On one hand, the religiosity of North American society contrasts with that of many European societies, especially regarding the centrality and relevancy ascribed by North Americans to religion as a guide to life. On the other hand, unlike the United States, one cannot find a “religious market” in Europe. Particularly in Catholic western European countries, in spite of the constitutional separation between church and state, the presence of other confessions and churches tends to be residual. Additionally, the Catholic faith is organized around a central institution—the Catholic Church itself— with its diverse organs and its exegesis, which, unlike Protestantism, prevents the recognition of other churches within the Catholic confession. This means that not only departing from the

Child Support After LGBQ Divorce/Separation

Catholic Church to enter the so-called “inclusive congregations” is not equally possible for European Catholic LGBTQ people, but also that this would be objectively equivalent to a religious conversion that most of them refuse. Research suggests that the most common solution to the conflict between religious/confessional identity and sexual and/or transgender identity, when it exists, is the individualization of religious practice. In fact, this is in keeping with a broad trend toward secularization and the decline of institutionalized religious practice among economically developed western European societies. This does not necessarily mean rejecting the Catholic faith. What is usually rejected is the Catholic Church’s reading of homosexuality and transgenderism, not the Church itself. In fact, the Catholic Church can be differently understood—for example, as the community of believers, not as the formal organization itself. Also, many Catholic LGBTQ people are active members of their parishes, even though they acknowledge the conflict between their practices and/or identities and their confession. Remaining in the Church and actively taking part in its activities are considered necessary to their personal well-being and are often associated with the will to change the Catholic Church from the inside. An example of this kind of mission was the creation, in October 2014, of the World Organization of the Homosexual Catholic Associations (WOHCA). WOHCA joins Catholic LGBTQ associations from Argentina, Brazil, France, Italy, Mexico, Peru, Poland, Portugal, the United Kingdom, and the United States. Ana Maria Brandão See also Christian LGBTQ People; Jewish LGBTQ People; Muslim LGB People; Religion and Spirituality, Youth; Religion/Spirituality and LGBTQ People; Religious Identity and Sexuality, Reconciliation of; Religious LGBTQ Youth; Transgender People and Religion/Spirituality

Further Readings Festinger, L. (1957). A theory of cognitive dissonance. Stanford, CA: Stanford University Press.

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Gross, M. (2008). Etre chrétien et homosexuel en France [Being a Christian and a homosexual in France]. Sociétés Contemporaines, 71, 67–93. Levy, D. L., & Lo, J. R. (2013). Transgender, transsexual, and gender queer individuals with a Christian upbringing: The process of resolving conflict between gender identity and faith. Journal of Religion & Spirituality in Social Work: Social Thought, 32, 60–83. Pérez-Agote, A. (2014). The notion of secularization: Drawing the boundaries of its contemporary scientific validity. Current Sociology Review, 62(6), 886–904. Sacred Congregation for the Doctrine of the Faith. (1975). Persona humana: Declaration on certain questions concerning sexual ethics. Retrieved October 25, 2014, from http://www.vatican.va/roman curia/ congregations/cfaith/documents/rc_con_cfaith_doc_ 19751229_persona-humana_en.html Sacred Congregation for the Doctrine of the Faith. (1986). Letter to the bishops of the Catholic Church on the pastoral care of the homosexual persons. Retrieved October 25, 2014, from http://www.vatican.va/roman_ curia/congregations/cfaith/documents/rc_con_cfaith_ doc_19861001_homosexual-persons_en.htmlv Yip, A. K. T. (1997). Dare to differ: Gay and lesbian Catholics’ assessment of official Catholic positions on sexuality. Sociology of Religion, 58(2), 165–180. Yip, A. K. T. (2003). The self as the basis of religious faith: Spirituality of gay, lesbian and bisexual Christians. In G. Davie, P. Heelas, & L. Woodhead (Eds.), Predicting religion: Christian, secular and alternative futures (pp. 135–146). Aldershot, England: Ashgate.

CAUSES

OF

SEXUAL ORIENTATION

See Essentialist–Constructionist Debate on the Origins of Sexual Orientation

CHILD SUPPORT AFTER LGBQ DIVORCE/SEPARATION Child support is the financial sum provided by noncustodial parents in the aftermath of a divorce. This financial award, typically court mandated, covers basic living costs such as food, clothing,

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health, and education while the child is under the age of 18. In cases of lesbian, gay, bisexual, and queer (LGBQ) divorce or separation, child support has often been decided through informal discussions, outside of a courtroom, although over the last 20 years it has become an emerging legal issue tied to same-sex marriage. The courts continue to rely on biological relatedness in acknowledging parental rights and obligations, and LGBQ divorce highlights the ways in which diverse family forms complicate divorce proceedings. This entry discusses child support, paying particular attention to the court’s distinct definitions of parenthood. The average amount of child support is determined on a case-by-case basis and considers the noncustodial parent’s income, the child’s needs, and the quality of life the child would have experienced had the two parents stayed together. For many families, child support is a lifeline—ensuring the economic safety and well-being of children. Different from child custody, child support is not always tied to custody or contact, and these terms are considered separate issues in divorce proceedings (i.e., noncustodial parents who do not wish to have contact with the child are still required to provide child support). In the United States, establishing parent–child connections is complex. Most children raised in same-sex couple households come from a previous heterosexual relationship and are biologically tied to only one parent. Moreover, in most cases of in vitro fertilization or surrogacy, only one parent has a direct biological connection to the child. In these families, establishing a legal parent–child tie for the nonbiological parent depends on access to same-sex marriage, civil unions, and secondparent adoption. In the absence of legal ties, samesex couples have often used creative means, such as establishing legal guardianship and adopting the nonbiological parent’s last name. Despite many potential difficulties, same-sex couples have completed private and public adoptions of children of all ages. With no biological parent–child ties, both parents must rely on access to legal ties. Joint adoption, in which both parents have legal claim to the child, is ideal but not available in all states. Often, one partner will adopt the

child in order to circumvent state laws or adoption policies that bar same-sex couples from jointly adopting children. In families where parent–child ties cannot be or are not accessed, same-sex couples have few alternatives. A few states recognize “de facto,” “psychological parent” (i.e., acting in a parental role), or equitable estoppel (i.e., intention to parent) rights. In de facto or psychological parent cases, the court recognizes that the noncustodial and nonbiological parent performed and continues to perform parental duties at a similar (and sometimes higher) level as the custodial or biological parent and grants him or her parental rights and obligations. These de facto parents become responsible for child support, and in a few cases, the court awards custody and visitation. The burden of proof for de facto parenthood is the responsibility of the nonbiological parent, and, if this parent does not want to assume parental rights, he or she often does not. There are cases in which biological parents have filed for retroactive child support and have won. Courts required child support from nonbiological parents on the basis of intention to parent (equitable estoppel) or presumption of parentage for a sufficient amount of time (“holding out”). There is, however, no universal standard for holding out or intention to parent, and therefore courts often vary in child support obligations for nonbiological parents. In cases of unmarried, same-sex relationship dissolution, where one parent has no legal or biological ties to the child(ren), the nonbiological or nonlegal parent has no legal obligation under the law to provide child support. As discussed above, courts vary in requiring child support for nonbiological parents, but often de facto or psychological parents petition the courts in order to maintain a connection to the child(ren) and in hopes of gaining visitation or custody. They are willing to take on child support, in order to continue their parental tie. In instances where the biological or legal parent has sought out child support, the courts have rarely awarded it but are increasingly considering the obligations of nonbiological or nonlegal parents, especially where they were intended parents. Instead, custodial parents have relied on the

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goodwill of noncustodial parents, and child support has largely been the result of informal agreements between ex-partners outside of a court of law. In marriage and most civil unions, both spouses or partners have parental rights when the child is born during the relationship. Subsequently, in same-sex divorce, the courts can obligate the nonbiological, nonadoptive, or noncustodial parent to provide child support. Since the introduction of same-sex marriage in 2003, more custodial parents are able to demand child support after a divorce, fulfilling the original intent of child support. Access to divorce, however, can be restricted, as the ability to divorce depends on the state of residence and, in some instances, the state in which the couple’s union was celebrated. Child support not only provides economic benefit to families but also improves quality of life. With child support, children of divorced same-sex parents experience more financial stability and sometimes more positive family relationships. Child support does not guarantee parent–child contact or visitation but does help ensure the child(ren)’s well-being. Emma C. Potter and Katherine R. Allen See also Coparenting; Custody and Litigation, LGBQ Parents; Divorce, Legal Issues in; Legal Recognition of Nonmarital Same-Sex Relationships; Legal Rights of Nonbiological Parents; Living Arrangements of Children After LGBQ Divorce/Separation; Marriage, Reasons for and Against; Relationships With Former Spouses

Further Readings Allen, K. R. (2007). Ambiguous loss after lesbian couples with children break up: A case for same-gender divorce. Family Relations, 56, 174–182. doi:10.1111/j.1741-3729.2007.00450.x Beekman, J. C. (2011). In search of parity: Child custody/ visitation and child support for lesbian couples under “companion” cases Debra H. and In Re H.M. (Paper No. 27). Retrieved from http://scholarship.law .cornell.edu/lps_papers/27 Gartrell, N., Bos, H., Peyser, H., Deck, A., & Rodas, C. (2011). Family characteristics, custody arrangements,

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and adolescent psychological well-being after lesbian mothers break up. Family Relations, 60, 572–585. Goldberg, A. E., & Allen, K. R. (2013). Same-sex relationship dissolution and LGB stepfamily formation: Perspectives of young adults with LGB parents. Family Relations, 62, 529–544. doi:10.1111/ fare.12024

CHILDREN WITH LGBQ PARENTS, ACADEMIC OUTCOMES In describing the academic outcomes of children with lesbian, gay, bisexual, and queer (LGBQ) parents, this entry provides an overview of studies on lesbian mothers and, to a lesser extent, gay fathers; very little research has been conducted on bisexual parents. First, research is described that summarizes LGBQ parents’ involvement in school, which has been established (in prior work with heterosexual-parent families) as an important predictor of academic outcomes for children, whereby greater parental school involvement is linked to better academic outcomes. Next, the entry reviews evidence about the amount and types of bullying that children with LGBQ parents face at school from their peers (and sometimes other adults), which can contribute to school disengagement and poorer academic outcomes. Then, having described several factors that affect academic outcomes of children, the entry presents evidence on children’s academic achievement, looking at both the acquisition of academic skills and school performance, as well as normal grade progression through the education system. The entry ends with a brief discussion of limitations faced by studies on this subject, and suggestions for future research.

Factors Shaping the Academic Outcomes of Children With LGBQ Parents Parental School Involvement

Researchers have long studied the contribution that parents make to their children’s academic outcomes. One parenting practice that has gained considerable attention is parents’ involvement

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with their children’s schools. Having parents that are involved with their children’s schooling (e.g., doing such things as volunteering in the classroom, being an active member of parent–teacher organizations and associations, and developing lines of communication with teachers and school administrators) is typically associated with better academic outcomes for children. The reasons for this association are many, but evidence continues to support the importance of parents’ school involvement for children’s learning. This association is no different for LGBQ parents; however, the reactions received by lesbian mothers or gay fathers when interacting with schools can vary dramatically. School attitudes toward LGBQ parents can be broadly classified into three categories: acceptance, tolerance, or ignorance. Acceptance is characterized by schools that strive to create an awareness of diversity within their building(s), often including a multitude of family structures in their public displays (e.g., bulletin boards), standard curriculum (e.g., types of families present in classroom books), and classroom presentations (e.g., discussions of what families can look like). Tolerance is characterized by schools in which both parents are able to openly participate and engage in their children’s schooling experiences, but the type of proactive efforts toward diversity described above (e.g., different family structures depicted in public displays) are generally lacking. Ignorance is characterized by schools that actively discourage or prohibit LGBQ parents from being involved in their children’s schooling. In some cases, this includes schools prohibiting one parent from participating in school activities or events (e.g., in states that do not allow same-sex parent adoption, disallowing the nonbiological parent from being an active member of parent–teacher associations or being able to serve as a legal guardian of the child), which may contribute to a general sense of hostility to that parent’s presence at meetings or assemblies. Parental school involvement is important for children’s academic outcomes, and when parents are discouraged from participating, this takes away from children’s opportunities for academic success.

Experiences With Bullying

As children get older, one of the leading contributors to student disengagement from school is the experience of bullying. When students are bullied at school, they are less likely to want to be there, they are more likely to associate school with negative experiences and emotions, and the end result is increased risk for dropping out and poorer academic performance in general. Bullying is typically thought of as taking place between similaraged individuals, in the form of student-to-student interactions, but it can also take the form of student-to-adult interactions, involving teachers, school officials, and other parents. Much of the early research on the experiences of bullying for children with LGBQ parents sought to determine whether these children experienced more bullying than their peers. Some smaller-scale studies suggested that, indeed, children with lesbian mothers or gay fathers were more likely to be bullied, but this finding has more recently been challenged. Increasingly, it is believed that children with LGBQ parents do not experience more bullying than their peers, but, rather, that the bullying they experience is often more targeted. That is, children with LGBQ parents tend to be bullied with similar frequency as their peers with heterosexual parents, but while other children are bullied for varying reasons, children with LGBQ parents often are repeatedly targeted because of their family structure. The persistent focus on the family structure has led some researchers to conclude that the bullying of children with LGBQ parents may not be more frequent, but it is more intense. In addition, the bullying faced at school by children with LGBQ parents is not simply limited to actions by their similar-aged peers; instead, these children sometimes face similar albeit more covert victimization from adults. Related to the extent to which schools encourage LGBQ parents to be involved, their children sometimes face ridicule at school and pressure to keep their family structure secret, and they are chastised when they attempt to talk about their families in public spaces. Many studies have documented young children with LGBQ parents describing their family structure to

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a class, only to have the teacher dismiss them as being confused about their family structure, actively rejecting the possibility of their family structure, or, when learning of the family situation, asking the children to refrain from discussing it in class. Older students are often less open about their family structure because of earlier experiences with peer or teacher disapproval, but are still faced with bullying from adults (e.g., when they hear derogatory gay slang used by other students go uncorrected by teachers, and on occasion hear teachers themselves use derogatory speech). Together, these types of experiences at school can remove a child’s sense of safety and security, which are essential for learning and healthy development.

Research Findings Over the last half century, studies have repeatedly demonstrated the central role that academic performance and educational attainment play in explaining social inequality. Individuals who do better in school tend to stay in school longer, attend better colleges and universities, attain more advanced degrees, and work in more prestigious jobs. The importance of education for getting ahead is why understanding differences in academic outcomes is so essential. As described above, children with LGBQ parents are faced with many unique challenges and difficulties related to their schooling experiences, which could be expected to contribute to poorer academic outcomes for these children. Despite such expectations, most studies have found no evidence of difference in the performance and progression through school of these children relative to their peers from two-biological-parent (mother and father) households. In fact, children with LGBQ parents tend to score as well as their peers on standardized tests, get similar grades as their peers, and remain as academically engaged and motivated as their peers. Recent findings also indicate that children with LGBQ parents are no more likely to be retained in a grade than their peers, suggesting that normal grade progression is not

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different across family forms. In addition to evidence of no difference between children with LGBQ parents and children living in other family forms (e.g., two-biological-parent, stepparent, and single-parent forms), there is some evidence to suggest that children adopted into LGBQ-parented families do better academically than their peers remaining in group-home or foster-care settings. Whereas most studies have found that no difference exists in the academic outcomes of children with LGBQ parents, authors often reported different reasons for arriving at this conclusion. Some authors have suggested that living with LGBQ parents is simply not related to academic outcomes (i.e., there is not even a baseline difference between families). Others have pointed out that many LGBQ-parented families are the by-product of dissolved different-sex-parent families (compared with LGBQ-parented families in which the child was adopted at birth), and that differences may exist in the academic outcomes of children with LGBQ parents, but these differences are not a reflection of the family structure but the changes and fluctuations in family form often involved in the creation of the family. Regardless of the explanation, most authors generally agree that children with LGBQ parents have relatively similar academic outcomes to their peers from other family types.

Limitations to Current Research The LGBQ-parented family is a novel family form in recent history, and as such has received a lot of attention from researchers interested in understanding the implications of this family structure on children’s outcomes. Despite the interest in and increasing number of LGBQ-parented families, the body of research on these households continues to be largely plagued by relatively small, typically unrepresentative samples that severely hinder the opportunity for inference and generalizability. Studies on LGBQ-parent school involvement have often relied on in-depth interviews of parents describing their experience with their children’s schools, so it remains unclear whether these patterns are true for this population more generally.

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Similarly, evidence of children’s experience with bullying often comes from retrospective accounts or qualitative interviews that offer very detailed insight into the hardships—some of which are extreme—that children face at school, but cannot definitively say whether these are the experiences of all children with LGBQ parents. Research on the actual academic outcomes of children with LGBQ parents has historically faced similar criticism related to small sample sizes and problems with generalizability, though recently evidence has emerged based on larger and increasingly representative samples. Still, definitive evidence remains elusive, while studies in the field continue to improve in quality and rigor. Finally, more work is needed to highlight the experiences of children growing up in single-LGBQparent households. Studies often identify gayfather or lesbian-mother households based on the family structure (i.e., two unrelated adult women or two unrelated adult men in the household), and not necessarily on the self-reported sexuality of the parent. As a result, very little is known about the academic outcomes of children living in singleparent households in which the parent is gay or lesbian. Similarly, as mentioned earlier, research on children whose parents identify as bisexual is severely limited. As asking about sexual orientation becomes less taboo, more will be learned about the importance (or lack thereof) of parents’ sexual orientation for shaping and influencing the academic outcomes of their children. Daniel Potter See also Adults With LGBQ Parents; Bullying, Rates and Effects of; Children With LGBQ Parents, Gender Development and Identity; Children With LGBQ Parents, Psychosocial Outcomes; Education; Home– School Partnerships in LGBTQ-Parent Families; LGBTQ-Parent Involvement and Advocacy in Schools; School Choice in LGBTQ-Parent Families

Further Readings Biblarz, T. J., & Stacey, J. (2010). How does the gender of parents matter? Journal of Marriage and Family, 72, 3–22.

Kosciw, J. G., & Diaz, E. M. (2008). Involved, invisible, ignored: The experience of lesbian, gay, bisexual, and transgender parents and their children in our nation’s K–12 schools. New York, NY: Gay, Lesbian & Straight Education Network. MacCallum, F., & Golombok, S. (2004). Children raised in fatherless families from infancy: A follow-up on children of lesbian and single heterosexual mothers at early adolescence. Journal of Psychology and Psychiatry, 45, 1407–1419. Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. C. (2010). Counted out: Same-sex relations and Americans’ definition of family. New York, NY: Russell Sage. Rosenfeld, M. J. (2010). Nontraditional families and childhood progress through school. Demography, 47(3), 755–775. Tasker, F. (2005). Lesbian mothers, gay fathers, and their children: A review. Developmental and Behavioral Pediatrics, 26(3), 224–240. Wainright, J. L., Russell, S. T., & Patterson, C. J. (2004). Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Child Development, 75(6), 1886–1898.

CHILDREN WITH LGBQ PARENTS, FEMALE/MALE ROLE MODELS This entry describes the female and male role models of children with parents who are not heterosexual. Beginning with a review of the processes by which role models influence children’s social and identity development, the entry continues with a description of the role models that exist in the lives of children with LGBQ parents. Finally, the entry addresses the possibility that heterosexism is at the root of concern about male/female role models for children with LGBQ parents. Suggesting that children with same-sex parents need a model of the other gender is a reflection of the heterosexual family as the standard that other families must emulate. Under this model, nonheterosexual parents are expected to find ways to compensate for differences in family structure. The entry also discusses an alternative view; namely, that LGBQ

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parents can construct families free of the expectations and social roles embedded in the heterosexual family model.

Role Models Social learning theory and later, social cognitive theory, both developed by Albert Bandura, argue that children imitate, or model, people in their environment. According to social learning theory, children are passive receivers of information and learn as they observe the behaviors of others in their environment, known as models. Children often use their parents as models, but may also model other important adults, siblings, peers, or even television or storybook characters. Children can observe models showing novel behaviors that children have not seen or performed before. Later, children are likely to show these behaviors themselves. Observing a model can also serve to increase or decrease children’s inhibitions surrounding such behaviors. If a child was nervous about a task, observing a model succeed at the task may prompt the child to try it. Models also work to draw children’s attention to certain objects and increase children’s use of these objects or tools. Finally, observing models’ positive emotional reactions to objects or during tasks increases children’s interest in and experiences with such objects or tasks. Under social cognitive theory, children are seen as more active in their development as they carefully select from people in their environment whom they want to model. When children observe a model complete a task, they build feelings of efficacy for that task. With efficacy children are more likely to report interest in, as well as to persist in and seek out, activities that involve such tasks. One key component in children’s selections of models is the model’s gender; children are more likely to choose a model of their own gender.

Role Models and Gender Development According to Kay Bussey and Albert Bandura’s social cognitive theory of gender development, children choose models according to their gender.

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As children model primarily people of their own gender, they become more interested in activities and objects associated with that gender. Children build efficacy for gendered tasks as they watch models perform such tasks. With increased efficacy, children begin to choose to participate in and practice tasks that are seen as typical for their gender. Additionally, children will not have the opportunity to build efficacy in domains that are not performed by their models. For example, a boy may choose to model men who never perform feminine tasks. Later, he will be less likely to choose activities that involve feminine tasks and less likely to persist if such tasks seem frustrating. It is this process of model selection, efficacy-building, and activity choices that explain children’s differential abilities in gendered tasks. If this process continues throughout development, boys will build efficacy and capabilities in masculine skills, and girls will increase their efficacy and skills in feminine domains. Therefore, according to the social learning theory, children need models of their gender in order to perform the gender-based social roles expected by society. However, when children select models who behave in less gendered ways, they can build efficacy for tasks regardless of the stereotypicality of such behaviors. Indeed, when children observe more egalitarian division of labor between their parents, they report more efficacy for nontraditional tasks.

Role Models in Lives of Children With LGBQ Parents Early public and legal concerns about lesbian and gay parents focused on the role models available to their children. It was suggested that these children would not have exposure to or relationships with adult models of each gender. Concerns were often raised about children whose gender was different from their same-sex parents (daughters of gay parents and sons of lesbian parents). In particular, judges in early court decisions voiced concerns for sons being raised by lesbian mothers. People were concerned that without a male parent in the home, sons would not be able to perform masculine tasks and would be overly feminized.

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As a result of such concerns, research on families headed by lesbian and gay parents has been focused on available role models for children. In a study of planned lesbian families by Abbie Goldberg and Katherine Allen, more than two thirds of mothers reported concerns about the impact that having no male role model might have on their children. These women had actively searched for men who could serve as models for their children. A significant body of research indicates that these concerns were unwarranted; children with parents who are not heterosexual are likely to have contact and relationships with close relatives from their extended family. This research finds that sons of lesbian parents are often in regular contact with grandfathers and uncles. Similarly, daughters of gay fathers have important and regular contact with grandmothers and aunts. Both gay and lesbian parents report having wide networks of friends of diverse genders and sexual orientations who serve as models for children in the family. Parents also report that children have neighbors, coaches, teachers, and parents of the children’s friends who may serve as same-sex models for the children. It seems that the concern that children of gay or lesbian parents would not have exposure to samesex models is based on the heterosexist assumption that parents who are not heterosexual isolate themselves from the wider network of adult supporters of children. Instead, research demonstrates that gay and lesbian parents and their children are embedded in a large community of family, friends, educators, and peers who serve as important role models for children.

Are Male/Female Role Models Necessary? It is also important to reflect on the premise of the question itself. Do children need a model of their same sex to develop into happy, healthy, and competent adults? The question arises because the culture’s definition of family has historically included both a man and a woman. If lesbian- and gay-parented families are compared with this heteronormative family model it will appear as if these families need to compensate for the missing

father or mother. When nonheterosexual parents are asked to replicate a traditional family model, an opportunity to rethink our notions of families is missed. If instead new family models were investigated without heteronormative standards, evidence for important family processes may begin to emerge.

Other-Sex Parents as Models for Children It has been assumed that, insomuch as heterosexual parents are presumed to specialize their family roles and labor by gender, it is therefore important to children’s adjustment to have a parent of each gender. A close look at the literature on single mothers and fathers, primary caregiving fathers and working mothers, and gay and lesbian parents reveals that men and women are both capable of parenting children and are able to model for children all of the important characteristics of healthy adulthood, regardless of their gender. Men can and do perform nurturing and expressive tasks typically performed by mothers in heterosexualparented families. Similarly, women can model instrumental behaviors in the domains stereotypically attributed to men (e.g., the work domain). In an investigation of children with lesbian parents, Henny Bos and her colleagues studied a sample of 78 adolescents in which half reported having male role models and half reported not having male role models. There was no difference in these children’s masculinity or femininity scores as a function of having a male role model. Additionally, there was no difference in children’s psychological adjustment according to their own and their mothers’ reports. This study is just one of many that suggests that children do not need significant interaction with a model of a particular gender to display gendered behaviors and to show healthy development.

Gender Role Adherence, Psychological Adjustment, and Child Well-Being The concern for children’s exposure to same-gender models is also premised on the assumption that building skills in gender-typical domains is associated

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with children’s well-being and psychological adjustment. However, research indicates that children and adults who show competence in both stereotypically masculine and feminine domains are well-adjusted and healthy. Gender role flexibility allows men to create and sustain warm connections with children, family, and friends. Such flexibility also allows women to succeed in leadership and career domains traditionally reserved for men. Thus, research suggests that children do not need to develop gender-specific skills for well-being and adjustment. Under the heteronormative family model, men and women are responsible for different tasks inside and outside the home and children require same-sex models in order to learn the skills to fulfill these gendered roles. Less traditional family organizations, like those of gay and lesbian parents, have parents who can serve as models for more flexible roles and a wider range of behaviors for children to model. When children use more gender-flexible models, they build efficacy for skills and tasks that are less tied to gender. Models are an important component of child development, and men and women can serve as influential models to either boys or girls. Megan Fulcher See also Children With LGBQ Parents, Gender Development and Identity; Children With LGBQ Parents, Psychosocial Outcomes; Division of Labor in LGBTQ-Parent Families; Heteronormativity; Heterosexism

Further Readings Bos, H., Goldberg, N., Van Gelderen, L., & Gartrell, N. (2012). Adolescents of the U.S. National Longitudinal Family Study: Male gender role traits and psychological adjustment. Gender & Society, 26, 603–638. Clarke, V., & Kitinger, C. (2005). “We’re not living on planet lesbian”: Constructions of male role models in debates about lesbian families. Sexualities, 8, 137–152. Fulcher, M., Chan, R. W., Raboy, B., & Patterson, C. J. (2002). Contact with grandparents among children conceived via donor insemination by lesbian and heterosexual mothers. Parenting: Science and Practice, 2, 61–76.

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Goldberg, A. E., & Allen, K. R. (2007). Imagining men: Lesbian mothers’ perceptions of male involvement during the transition to parenthood. Journal of Marriage and Family, 69, 352–365.

CHILDREN WITH LGBQ PARENTS, GENDER DEVELOPMENT AND IDENTITY Does parental sexual orientation affect children’s gender development? And if so, how and to what degree? These questions have been widely discussed in legal and policy debates, such as those focused on marriage, child custody, and adoption by LGBQ adults. They have also been the subject of considerable social science research. This entry provides an overview of research findings that address these questions, focusing chiefly on “lesbian and gay” parents because comparatively little research has been conducted on self-identified bisexual or queer parents. Gender development is often considered to have three aspects. The first is gender identity, a person’s internal sense of being male or female. This is generally discussed in binary terms—male or female— but gender identity can also fall outside of or between the typical binary categories. The second aspect of gender development is gender role behavior and attitudes: namely, the extent to which a person’s activities and preferences conform to conventional gender norms. The third aspect is sexual orientation, which concerns the sex of those to whom a person feels sexually attracted. In the discussion below, results of research relevant to each of these three aspects of gender development are discussed.

Gender Identity Gender identity has been studied using both direct and indirect assessment techniques. Early studies employed indirect or projective techniques, such as the Rorschach test, and reported that children’s gender identities were not associated in any systematic way with parental sexual orientation. More recent studies using direct assessments, such

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as questionnaire methods, have come to the same conclusion. In short, and regardless of assessment techniques, results of research have revealed that development of gender identity is not related to parental sexual orientation.

Gender Role Behavior and Attitudes The greatest amount of research on gender development among children of lesbian and gay parents has explored development of gender role behavior and attitudes. Many studies have reported that the gender role behavior of children with lesbian and gay parents is similar to that of children with heterosexual parents. For instance, one study examined children’s toy preferences, activities, interests, and occupational choices, and found no differences between children of lesbian versus heterosexual mothers. More recently, Anne Brewaeys and her colleagues assessed gender role behavior among 4- to 8-year-old children who had been conceived via donor insemination by lesbian couples, and compared it with that of same-aged children who had been conceived via donor insemination by heterosexual couples, and with that of same-aged children who had been naturally conceived by heterosexual couples. They used the Preschool Activities Inventory, a maternal report instrument designed to differentiate between masculine and feminine behavior among unselected samples of children in schools. They found no significant differences between children of lesbian mothers and children of heterosexual parents on preferences for gendered toys, games, and activities. Similar findings were reported by a number of other investigators. Two subsequent studies also reported no significant differences in gender role preferences or activities between children of gay fathers and children of heterosexual parents. Thus, results of studies using the Preschool Activities Inventory have been consistent in revealing no differences in gender role behavior as a function of parental sexual orientation. One early study by Richard Green and his colleagues reported some isolated differences in gender role development as a function of parental

sexual orientation. In interviews with children, the researchers reported no differences between children of lesbian mothers and those of heterosexual parents with respect to favorite television programs, favorite television characters, favorite games, or favorite toys. There was some indication in interviews with children themselves that those with lesbian mothers had less conventionally sextyped preferences for activities at school and in their neighborhoods than did those with heterosexual mothers. Consistent with that result, lesbian mothers were also more likely than heterosexual mothers to report that their daughters often participated in rough-and-tumble play or occasionally played with conventionally masculine toys such as trucks or guns, but they reported no differences in these areas for sons. Lesbian mothers were found to be no more and no less likely than heterosexual mothers to report that their children often played with conventionally feminine toys such as dolls. Thus, while there were some differences among girls as a function of parental sexual orientation, these investigators found no differences among boys. In a more recent study by Fiona MacCallum and Susan Golombok, the Children’s Sex Role Inventory was used to study gender role development among young adolescent offspring of lesbian and heterosexual mothers. These researchers found that boys of lesbian mothers reported more feminine (but not less masculine) gender role preferences compared with boys of heterosexual mothers. They reported no differences as a function of parental sexual orientation among girls. Thus, while one earlier study reported some differences among girls but not among boys, this one found some differences among boys, but not among girls. Studies by Megan Fulcher and her colleagues and Erin Sutfin and her colleagues both examined 4- to 6-year-old children of lesbian or heterosexual couples, using the Sex Role Learning Index and also a Gender Transgression questionnaire. They reported that parental sexual orientation was unrelated to children’s knowledge of gender stereotypes, and also unrelated to children’s stated preferences among current activities or future adult occupations. On the other hand, the researchers also

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reported that lesbian mothers had more liberal attitudes about gender role behavior and that lesbian mothers also provided more egalitarian models with regard to division of labor in their households than did heterosexual parents. Results also showed that lesbian mothers even decorated their children’s bedrooms in less gender stereotypic ways than did heterosexual mothers. Thus, it was not surprising that children reported feeling less pressure from their parents to conform to conventional gender roles and that they also reported feeling less concerned about other children’s violations of gendered norms (e.g., a boy wearing brightly colored fingernail polish). Henny Bos and Theo Sandfort recently reported a study of gender role development among 8- to 12-year-old Dutch children with lesbian or heterosexual parents. These investigators studied children’s conceptions of their own gender typicality (i.e., the sense that one is a “typical girl” or a “typical boy”). They also studied gender contentedness, which was the degree to which children reported feeling happy or contented in their gender identities. These investigators found no significant differences as a function of parental sexual orientation for children’s reports of their own gender typicality, for children’s gender contentedness, or for children’s reports of pressure from peers to conform to conventional gender norms. Children of lesbian mothers did, however, report feeling less pressure from their parents to conform to gender norms, and more inclination to question their own heterosexual attractions than did children of heterosexual parents. Considered together, the results of research on gender role attitudes and behavior suggest that, although children with lesbian and gay parents may receive different input (such as parental division of labor and parental decoration of their homes), and hence that they may develop more liberal attitudes, their gender-relevant behavior is nevertheless very similar to that of children with heterosexual parents. There is more research-based information about younger than older children and more on children with lesbian mothers than on children with gay fathers. Overall, however, while gender-related attitudes may be more liberal

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among children of lesbian and gay parents than among children of heterosexual parents, the research suggests that gender-role behavior is remarkably similar in the two groups.

Sexual Orientation The third component of gender development, sexual orientation, has been a matter of interest to many observers. A number of early studies compared the sexual orientation of the adolescent or young adult offspring of lesbian and gay parents with that of youngsters of heterosexual parents. Several studies reported similar proportions of nonheterosexual offspring in the two groups, regardless of parental sexual orientation. Other investigators compared proportions of nonheterosexual offspring of lesbian and gay parents in a small sample of research participants with rates of nonheterosexual orientation in the general population. Owing to methodological issues, results of these studies can be difficult to interpret. In all the studies, however, findings showed that an overwhelming majority of people with lesbian or gay parents grew up to identify themselves as heterosexual. Thus, existing data do not support the conclusion that the sexual orientations of daughters or sons are related to those of their parents. The data relevant to this issue are, however, still relatively sparse. A study that employs a very large representative sample of families and uses standardized assessments of sexual orientation has yet to be reported. Thus, questions about possible linkages between sexual orientation among parents and their children have not yet been resolved. If there is an association, however, the available findings make it clear that it must be small or even very small in size.

Conclusion In conclusion, and insofar as the research literature is informative on the question, gender development appears to proceed in very similar ways overall, regardless of parental sexual orientation. The data are especially clear with regard to the

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development of gender identity; there is no credible evidence to suggest that gender identity varies as a function of parental sexual orientation. The findings are also relatively consistent with regard to gender role behavior; most studies report that gender role behavior is highly similar among children of lesbian, gay, and heterosexual parents. There are data to suggest that attitudes about conventional gender roles are more liberal among children of lesbian mothers than among children of heterosexual parents; no data on this point among children of gay fathers are yet available. Finally, studies have consistently reported that, regardless of parental sexual orientation, the great majority of children grow up to be heterosexual. In short, the clearest conclusion suggested by research to date is that parental sexual orientation may be associated with children’s attitudes about gender-related topics, but not with children’s gender identities or gender-role behavior. Charlotte J. Patterson and Jason Sumontha See also Adults With LGBQ Parents; Children With LGBQ Parents, Academic Outcomes; Children With LGBQ Parents, Psychosocial Outcomes; Children With LGBQ Parents, Sexual Identity; Parent–Child Relationships

Further Readings Bos, H., & Sandfort, T. G. M. (2010). Children’s gender identity in lesbian and heterosexual two-parent families. Sex Roles, 62, 114–126. Brewaeys, A., Ponjaert, I., Van Hall, E. V., & Golombok, S. (1997). Donor insemination: Child development and family functioning in lesbian mother families. Human Reproduction, 12, 1349–1359. Brodzinsky, D., & Pertman, A. (Eds.). (2010). Adoption by lesbians and gay men: A new dimension in family diversity. New York, NY: Oxford University Press. Fulcher, M., Sutfin, E. L., & Patterson, C. J. (2008). Individual differences in gender development: Associations with parental sexual orientation, attitudes, and division of labor. Sex Roles, 58, 330–341. Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association.

Goldberg, A. E., & Allen, K. R. (Eds.). (2013). LGBTparent families: Innovations in research and implications for practice. New York, NY: Springer. Golombok, S., & Tasker, F. (2010). Gay fathers. In M. Lamb (Ed.), The role of the father in child development. Hoboken, NJ: Wiley. Green, R., Mandel, J. B., Hotvedt, M. E., Gray, J., & Smith, L. (1986). Lesbian mothers and their children: A comparison with solo parent heterosexual mothers and their children. Archives of Sexual Behavior, 15, 167–184. Halim, M. L., & Ruble, D. (2010). Gender identity and stereotyping in early and middle childhood. In J. Chrisler & D. McCreary (Eds.), Handbook of gender research in psychology (pp. 495–525). New York, NY: Springer. MacCallum, F., & Golombok, S. (2004). Children raised in fatherless families from infancy: A follow-up of children of lesbian and single heterosexual mothers at early adolescence. Journal of Child Psychology and Psychiatry, 45, 1407–1419. Patterson, C. J. (2009). Children of lesbian and gay parents: Psychology, law, and policy. American Psychologist, 64, 727–736. Sutfin, E. L., Fulcher, M., Bowles, R. P., & Patterson, C. J. (2008). How lesbian and heterosexual parents convey attitudes about gender to their children: The role of gendered environments. Sex Roles, 58, 501–513.

CHILDREN WITH LGBQ PARENTS, PSYCHOSOCIAL OUTCOMES Does parental sexual orientation affect children’s personal and social development? If so, how, and to what degree? These questions have been discussed in the context of legal and policy debates in the United States and abroad, particularly in those concerning marriage of same-sex couples, child custody, and adoption by nonheterosexual adults. These questions are also relevant to many theoretical issues about the role of gender and biological linkages in parent–child relations. A considerable research literature that is relevant to such questions has developed over the past three decades. This entry provides an overview of social science research findings that address these questions.

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The research has focused on a number of topics in the general area of psychosocial development. These include general adjustment and behavior, self-concept, and social relationships with peers and adults, all of which are discussed in the following sections. Considerable research has also focused on gender development and academic outcomes among children with lesbian and gay parents, but it is not described here. Very little research has focused on self-identified bisexual or queer parents, so this entry focuses mainly on research with lesbian and gay parents and their children. Families with lesbian and gay parents are themselves diverse in many ways. One type of diversity that is especially significant involves the mode of family formation. In some cases, children were born in the context of a heterosexual marriage that broke up when one or the other parent (or sometimes both parents) came out as lesbian or gay. In these cases, the children may be reared by a lesbian or gay parent after a divorce. In other cases, lesbian or gay adults may have had children in the context of pre-existing nonheterosexual identities. Children in these families, which are often called “planned lesbian- and gay-parent families,” have not necessarily experienced parental separation or divorce. Given the differences among these families, children’s experiences in them may vary in significant ways. As in other families, many additional kinds of diversity (such as differences attributable to variations in race, ethnicity, religion, education, etc.) also exist, but we focus here mainly on possible differences among children growing up in divorced and planned lesbian- and gay-parented homes.

Behavioral Adjustment Is the overall adjustment and behavior of children growing up with lesbian and gay parents any different from adjustment and behavior among children of heterosexual parents? Many investigators have studied this question, both in the United States and in Europe, over many years, and the research findings are remarkably consistent. Those with lesbian or gay parents have been found to be largely indistinguishable from those

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with heterosexual parents on the basis of their overall adjustment and behavior. In a well-known early study published more than 30 years ago, Susan Golombok and her colleagues studied a group of 10-year-old English children with divorced lesbian versus divorced heterosexual mothers. Using standardized measures of adjustment and behavior problems, Golombok and her colleagues compared results for children with lesbian mothers and those with heterosexual mothers. In reports of children’s behavior from mothers and also from the children’s teachers, no significant differences between the behavior of children with lesbian and heterosexual mothers were identified. Similar results have been reported by other researchers working in Europe and in the United States. Early data were collected from samples of volunteers that were not necessarily representative of the populations from which they were drawn. Later studies in the United States and in England were based on more representative samples. For example, Jennifer Wainright and her colleagues, using data that had been collected for a nationally representative study of adolescent health in the United States, identified youngsters living with parents who were same-sex couples and compared them with a matched group of youth living with parents who were other-sex couples. Using standardized survey instruments to assess behavior, the researchers found that the adjustment of those living with same- and different-sex couples was not reliably different. Thus, in representative samples, as well as in convenience samples, the overall adjustment and behavioral patterns of children and youth have not revealed any systematic variability as a function of parental sexual orientation. Many of the early studies compared behavior of those in families that conceived children in the context of heterosexual marriages. This raised a question about whether results would be the same for children whose parents had conceived them after assuming lesbian or gay identities (i.e., after coming out). Again, studies on both sides of the Atlantic led to similar conclusions. Raymond Chan and his colleagues studied the issue in the United States, comparing development among children

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who were conceived by lesbian or by heterosexual parents using the resources of a single sperm bank. Whether considering parent or teacher reports, Chan and his colleagues reported that there were no differences in overall adjustment or behavior as a function of parental sexual orientation. Studies conducted in Europe and by other American scholars yielded similar findings. More recently, studies of gay fathers and their children have reported similar findings and have come to the same conclusions. An area of behavioral adjustment that has received particular study is that of the use of substances such as tobacco, alcohol, and other drugs. In the Netherlands, Henny Bos and her colleagues compared self-reported substance use among adolescents of lesbian mothers versus those of heterosexual parents. They reported no significant differences between reports of any type of substance use in these two groups. Similar results have been reported in other parts of Europe and in the United States. Overall, there is no evidence of differences in adjustment or behavior as a function of parental sexual orientation.

Self-Concept Researchers have also studied the extent to which self-concepts of children and adolescents may vary as a function of parental sexual orientation. Using a six-item scale that required adolescents to respond to items such as “feeling loved and wanted” or “feeling socially accepted,” Jennifer Wainright and her colleagues compared self-esteem among adolescents (drawn from a national sample in the United States) living with parents who were same-sex versus different-sex couples. Their results revealed no differences between youth living with same-sex versus different-sex parents. In studies of lesbian mothers and their children, similar findings have been reported by other American and European scholars. More recently, similar findings have also been reported with regard to the children of gay fathers. In short, after 30 years of research, no differences in self-concepts between youth reared by lesbian or gay couples and those reared by heterosexual couples have been identified.

Social Relationships Many observers have predicted differences in the social relationships of children and adolescents growing up with lesbian or gay versus heterosexual parents. If only because of the existence of stigma and discrimination, some observers have anticipated that children of lesbian and gay parents might encounter difficulties in their relationships with peers. In the early study of English children of divorced lesbian and divorced heterosexual mothers by Susan Golombok and her colleagues, the authors studied peer relationships in middle childhood. Regardless of maternal sexual orientation, parents reported typical patterns of peer relationships among their children. As one might expect, most of the children were described as having same-sex best friends and predominantly same-sex peer groups. The quality of children’s relationships with peers was described in positive terms by their mothers, regardless of maternal sexual orientation. Similar results were reported by investigators in the United States. A 2008 study by Jennifer Wainright and Charlotte Patterson compared peer relations among adolescents (drawn from a nationally representative sample in the United States) whose parents were same-sex versus different-sex couples. Some assessments were drawn from reports by the adolescents themselves, and others were drawn from their peers at school. Teenagers with same-sex parents reported the same number of friends and the same overall relationship quality with friends as did youth with different-sex parents; they also described their networks of friends in similar terms. According to reports from classmates, youth with same-sex parents did not differ from those with different-sex parents in their centrality in peer networks or in their overall popularity among peers. Like friendships, the romantic relationship experiences of children with same-sex parents have been of great interest to many observers. Several studies in the United States, including those based on nationally representative samples, have indicated that adolescents and young adults with

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same-sex parents report the same number of romantic partners, and the same overall quality of romantic relationships as do their heterosexually parented peers. In addition, in two studies that assessed this, the likelihood of adolescents reporting that they were sexually active was unrelated to family type. Overall, the findings suggest that parental sexual orientation is not associated with romantic experiences or sexual attractions among adolescent or young adult offspring. A number of studies have examined the extent to which children and adolescents with nonheterosexual parents are teased or bullied by peers. Many researchers have reported that, especially in early adolescence, youth with lesbian or gay parents report hearing negative comments about their families, about lesbian/gay people, and/or about lesbian/gay parenting. Those who report having heard such comments agree that it was an unpleasant experience. A number of studies have revealed, however, that offspring of lesbian and gay parents are not more likely than other children to be teased or bullied. If a child of lesbian or gay parents is teased or bullied, it is more likely than it is for other children to focus in some way on their parents’ sexual identity. The evidence does not, however, suggest that children or adolescents with lesbian or gay parents are overwhelmed or traumatized by whatever teasing or bullying they may experience. On the contrary, studies in the United States and in Europe have failed to uncover any lasting impact on child and adolescent mental health or overall adjustment as a result of any teasing or bullying they have experienced. Research has also examined qualities of children’s relationships with adults, as a function of parental sexual orientation. Early studies on both sides of the Atlantic showed that lesbian and heterosexual mothers described their children’s contact with adults outside the family in very similar terms. Relationships with parents have also been described as equally supportive regardless of parental sexual orientation. Two studies of children’s relationships with grandparents, both conducted in the United States, have reported that these relationships are equally warm and supportive, regardless of parental sexual orientation. Thus, the possibility

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that parental sexual orientation is related to children’s relationships with adults appears to be without empirical foundation.

Individual Differences What predicts positive development among children of lesbian and gay parents? Are the predictors of healthy development the same or different as a function of parental sexual orientation? Considerable research has examined this question. By and large, findings have revealed that many factors known to be important to the development of children with heterosexual parents also seem to be relevant to development among children with lesbian and gay parents. Thus, when children live in stable, harmonious homes with the resources they require in order to meet basic needs, they seem to do better than in unstable, conflict-ridden, or impoverished homes. Warm, supportive relationships with parents are associated with healthy development for children in all types of families. In addition to variables relevant to all families, specific contextual factors may be particularly important for lesbian- and gay-parented families. When lesbian- and gay-parented families live in areas populated by relatively high proportions of other lesbian and gay people, have strong social support from friends and relatives, and enjoy legal recognition for their family relationships, researchers have found that overall outcomes among children and adolescents are most likely to be favorable.

Conclusion In conclusion, psychosocial development appears to proceed in very similar ways overall, regardless of parental sexual orientation. The largest amount of research has been conducted in the United States and in Europe, but increasingly, research is being reported from other parts of the world, as well. The findings with regard to overall behavioral adjustment, self-concept, and social relationships with peers are clear, and they show that psychosocial development is not related to parental sexual orientation. Many determinants of development appear to be similar, regardless of parental sexual

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orientation, though some contextual issues may be particularly important for families with nonheterosexual parents. In short, research to date reveals that psychosocial development of children is not associated with parental sexual orientation. Charlotte J. Patterson and Bernadette Blanchfield See also Adults With LGBQ Parents; Children With LGBQ Parents, Academic Outcomes; Children With LGBQ Parents, Female/Male Role Models; Children With LGBQ Parents, Gender Development and Identity; Children With LGBQ Parents, Sexual Identity; Parent–Child Relationships

Further Readings Farr, R. H., Forssell, S. L., & Patterson, C. J. (2010). Parenting and child development in adoptive families: Does parental sexual orientation matter? Applied Developmental Science, 10, 164–178. Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Goldberg, A. E., & Allen, K. R. (Eds.). (2013). LGBTparent families: Innovations in research and implications for practice. Hoboken, NJ: Wiley. Golombok, S., & Tasker, F. (2010). Gay fathers. In M. E. Lamb (Ed.), The role of the father in child development. Hoboken, NJ: Wiley. Lick, D. J., Patterson, C. J., & Schmidt, K. M. (2013). Recalled social experiences and current psychological adjustment among adults reared by lesbian and gay parents. Journal of GLBT Family Studies, 9, 230–253. Palewski, J. G., Perrin, E. C., Foy, J. M., Allen, C. E., Crawford, J. E., Del Monte, M., . . . Vickers, D. L. (2006). The effects of marriage, civil union, and domestic partnership laws on the health and wellbeing of children. Pediatrics, 118, 349–364. Patterson, C. J. (2009). Children of lesbian and gay parents: Psychology, law, and policy. American Psychologist, 64, 727–736. Patterson, C. J., Riskind, R. G., & Tornello, S. L. (2014). Sexual orientation and parenting: A global perspective. In A. Abela & J. Walker (Eds.), Contemporary issues in family studies: Global perspectives on partnerships, parenting, and support in a changing world (pp. 189–202). New York, NY: Wiley/Blackwell.

Tornello, S. L., Riskind, R. G., & Farr, R. H. (2011). Sexual minority parenting. In Oxford Bibliographies. Retrieved from http://www.oxfordbibliographies .com/view/document/obo-9780199828340/ obo-9780199828340-0028.xml Wainright, J. L., Russell, S. T., & Patterson, C. J. (2004). Psychosocial adjustment, school outcomes, and romantic relationships of adolescents with same-sex parents. Child Development, 75, 1886–1898.

CHILDREN WITH LGBQ PARENTS, SEXUAL IDENTITY One of the primary functions of family is the socialization of its members, including socialization of sexuality. Sexuality is a multidimensional concept referring to behaviors, desire and attraction, knowledge, thoughts, and identities. Socialization of sexuality is thought to occur explicitly through purposeful conversations, as well as implicitly through conscious and unconscious verbal and nonverbal communication of attitudes and values. Parents and other caregivers play an important role in the sexual socialization of their children, sending implicit and explicit messages about behaviors, feelings, and identities that are deemed appropriate or inappropriate to the family. The majority of parents represented in the youth sexual socialization literature are heterosexual, as few studies have examined the sexual socialization of youth with lesbian, gay, bisexual, and queer (LGBQ) parents. Yet, according to some child development theories, parental sexual orientation may have an influence on children’s notions about sexuality and, in turn, children’s own sexual orientation identity development.

Review of Research Some researchers who have explored sexual orientation identification of youth and adults with LGBQ parents often have done so in the interest of determining whether these individuals are more likely to identify as nonheterosexual than individuals with heterosexual parents. This line of inquiry

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seems to suggest that it is “bad” if children turn out to be nonheterosexual; indeed, according to the heteronormative cultural ideal, healthy (i.e., “normal”) sexuality development is equated with heterosexuality. Until studies utilizing large, representative samples are conducted, the question of whether children of LGBQ parents are more likely to identify as LGBQ than children of heterosexual parents will remain unanswered. That said, most studies on this topic have reported that the vast majority of youth and adults with LGBQ parents identify as heterosexual and are similar to the offspring of heterosexual parents in regard to same-sex attraction. Some studies, however, have revealed nuanced findings: Groundbreaking work by psychologists Fiona Tasker and Susan Golombok, published in the mid-1990s, found that young adults with lesbian mothers were more open than young adults with heterosexual mothers to the idea of entering into same-sex relationships. A 2010 study by Henny Bos, a social and behavioral scientist, and Theo Sandfort, a social psychologist, reported that school-age children of lesbian mothers were more likely to question their future heterosexual romantic involvement than children of heterosexual parents. Similarly, a 2007 qualitative study of adults with lesbian, gay, and bisexual (LGB) parents by psychologist Abbie Goldberg relayed that some participants felt that growing up with a nonheterosexual parent led them to develop less rigid ideas about sexuality. In 2011, psychiatrist Nanette Gartrell and her colleagues reported from their longitudinal study of lesbian-parent families that the teenage daughters of lesbian mothers were more likely than daughters of heterosexual parents to identify as bisexual and to have engaged in same-sex sexual behavior. Scholars have posited that growing up in a familial environment where same-sex relationships and LGBQ identities are modeled and, perhaps, not stigmatized, might lead children to be more open to the possibility of such relationships and identities for themselves. Relatively little research exists on the sexual socialization of youth in LGBQ-parent families, likely because the topic is politically sensitive. Researchers may worry that findings from studies

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that explore how being raised with nonheterosexual parents might influence children’s sexual identity and behavior could fuel heterosexist criticisms of LGBQ-parent families. For example, findings that some LGBQ parents intentionally aim to teach their children that there are options beyond heterosexuality may be interpreted as LGBQ parents trying to pressure their children toward samesex sexual behaviors and relationships. However, by failing to move forward with such studies, researchers not only succumb to heterosexist pressures but also miss an opportunity to learn more about sexual-identity development in general. There may be important lessons to be learned from examining sexual socialization within LGBQparent families, such that all families may benefit from the knowledge gained. Although it is important to avoid a reductionist perspective that assumes all LGBQ parents raise their children in the same way, a handful of studies have explored what LGB parents teach their children about sexual orientation and found that many lesbian mothers purposefully teach diverse notions of sexuality beyond just heterosexuality. Notably, these findings seem to be distinct from research on heterosexual parents. Although any parent could teach their children diverse notions of sexuality, LGBQ parents’ experiences of having a nonheterosexual sexual identity could influence their intentions. LGBQ parents may have experienced stigmatization tied to their nonheterosexual identity; as a result, some LGBQ parents might want their children to learn about sexual orientation in a more positive and accepting way, devoid of shame and stigma. A few studies have investigated LGBQ parents’ expectations and preferences for their children’s sexual orientations and found that these parents hold diverse perspectives. In a study conducted by psychiatrist Ghazala Javaid in the early 1990s, 7 out of 13 lesbian mothers expressed an acceptance of, but not preference for, their children to be LGBQ, while 3 reported homosexuality to be more acceptable for their daughters than for their sons, and 3 preferred that their children be heterosexual. A study published in 1997 by sociologist Cary Costello reported that 13 of 18 LGBQ

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parents expected their children to be heterosexual, while four were unsure, and one expected his child to be bisexual; all said they would accept their children’s eventual sexual orientation regardless, “while four went on to state a preference for their children to be nonheterosexual, and four preferred heterosexuality.” Study participants who preferred heterosexuality for their children referred to the homophobia that LGBQ individuals face as the reason for their preference. Early reports (1999 and 2000) from Nanette Gartrell and colleagues’ longitudinal study documented changes in 150 lesbian mothers’ hopes over time. When their children were 2 years old, 50% of the mothers did not report a preference for their children’s future sexual orientation, while 28% wanted their children to be heterosexual to avoid struggles with homophobia. Those mothers who did hope that their children would be lesbian or gay “did not see homophobia as a deterrent to happiness.” By the time the children were 5 years old, 65% did not report a preference, while 21% hoped their children would be heterosexual. When these same children were 10 years old, over half of the mothers said they could not predict their children’s sexual orientations, while more than one third anticipated their children being heterosexual, and 10% predicted their children would identify as LGBQ.

“Second-Generation” Youth Few studies have explored the experiences of sexual-minority youth with LGBQ parents. In the early 1990s, as a result of his experiences as a gay man with a lesbian mother, Dan Cherubin created an organization for LGBTQ youth and adults with LGBTQ parents and named it “Second Generation.” Soon afterward, he partnered with COLAGE, a national organization run by and for individuals with at least one LGBTQ parent. Cherubin’s and others’ experiences as second-generation LGBTQ individuals are shared in the groundbreaking book by writer and queer family activist Abigail Garner, titled Families Like Mine: Children of Gay Parents Tell It Like It Is (2004). For her book, Garner

interviewed more than 50 young adults with LGBTQ parents, some of whom also identified as LGBTQ. In her chapter called “Second Generation: Queer Kids of LGBT Parents,” Garner highlights the diversity of experiences among this group: Although “second generation” is an umbrella term for all LGBT kids with LGBT parents, there is no definitive second generation family experience that represents them all. . . . A lesbian daughter of politically active lesbian mothers, for example, will have a different second generation experience than a daughter raised by a closeted gay dad. (p. 179)

Thus, the term second generation refers to all nonheterosexual and/or gender-nonconforming individuals with a nonheterosexual and/or gendernonconforming parent. Following Garner’s work, in 2009, Katherine Kuvalanka and Abbie Goldberg, two scholars who study LGBQ-parent families, conducted the first in-depth study of second-generation individuals documented in the social science literature: Namely, they examined the experiences of 18 LGBTQ young adults with lesbian and bisexual mothers. Many of Kuvalanka and Goldberg’s findings echoed and extended those of Garner, lending credence to her pioneering discussion of the diverse experiences of the second generation. Both Garner’s and Kuvalanka and Goldberg’s research revealed that having nonheterosexual parents when one identifies as LGBTQ may be experienced as potentially beneficial, in that some participants felt that the coming-out process was less arduous than it might have been with heterosexual parents. Some of Kuvalanka and Goldberg’s participants said that having a nonheterosexual parent allowed them to explore and question their sexual/gender identities at a younger age than other youth. As such, participants believed that having LGBTQ parents allowed them to conceptualize broader notions of acceptable sexual and gender identity options for themselves. Furthermore, many participants did not worry about rejection upon disclosure of their identities to their LGBTQ

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parents. For some second-generation individuals, their parents’ identification, support, and acceptance may neutralize society’s powerful homonegative messages and foster greater self-acceptance and self-esteem. Indeed, for some participants, their uniquely supportive familial environments led them to construct their own emergent identities as normal and acceptable. Further, having a strong connection to the LGBTQ community from a young age may deepen understanding of LGBTQ history and culture. Garner posited that it is beneficial for second-generation individuals to grow up with “out” and “proud” parents, who can serve as positive role models, thus lessening the development of internalized homophobia among these youth. Several participants in both Garner’s and Kuvalanka and Goldberg’s research discussed unique challenges they faced as second-generation youth. Some participants felt pressure from their LGBTQ parents to be heterosexual and gender conforming, and some delayed coming out as LGBTQ due to fears of fulfilling critics’ assertions that “gay parents raise gay kids.” Some participants also expressed annoyance and feelings of disempowerment as a result of the assumption that their sexual/gender identities were caused by their parents. Other participants reported concerns related to being LGBTQ, including initially not wanting to be LGBTQ after witnessing the prejudice and discrimination that their parents endured. Second-generation youth are inevitably confronted with the heterosexism their parents have faced and understand they may face similar struggles, which may cause ambivalence or fear about coming out as LGBTQ. These experiences reveal that having a nonheterosexual parent is not guaranteed protection against the influence of societal heteronormativity. Interestingly, Kuvalanka and Goldberg found that some participants did not turn to their lesbian/ bisexual mothers for support during their sexual and gender identity formation. In particular, sons of lesbian/bisexual mothers tended to look elsewhere for support. In addition to the obvious gender difference between mothers and sons, sons may also be hesitant to discuss their emerging

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sexualities with their mothers because of their perception that aspects of gay male culture (e.g., pornography) may clash with their mothers’ political/ lesbian/feminist ideologies. Additionally, a “queer generation gap”—stemming from differences in social norms and experiences between the first and second generations—also seemed to play a role. Some of the youth/young adults and their parents disagreed about how “out” to be in their communities and also utilized different language (e.g., queer as opposed to lesbian or gay) to describe their own identities. Last, some participants in Garner’s and Kuvalanka and Goldberg’s research discussed disappointment upon disclosing their LGBTQ identities to their LGBQ parents, especially when parents remained closeted about their own identities. According to these participants, their LGBQ parents had fears about heterosexist discrimination that their children might face or worried that others would “blame” them for their children’s LGBTQ identity. More research is needed that investigates the sexual-identity development of all youth—heterosexual and LGBTQ—with heterosexual and nonheterosexual parents. Research findings from the Family Acceptance Project have begun to reveal the powerful influence of familial acceptance and rejection of youth’s sexual identities on young people’s well-being. Indeed, there is still much to learn about all individuals’ sexual socialization across the life span. Katherine A. Kuvalanka and Katie M. Barrow See also Adults With LGBQ Parents; Children With LGBQ Parents, Female/Male Role Models; Children With LGBQ Parents, Gender Development and Identity; Children With LGBQ Parents, Psychosocial Outcomes; Children With LGBQ Parents, Stigmatization; COLAGE

Further Readings Cohen, R., & Kuvalanka, K. A. (2011). Sexual socialization in lesbian-parent families: An exploratory analysis. American Journal of Orthopsychiatry, 81, 293–305. doi:10.1111/j.1939-0025.2011.01098.x

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Family Acceptance Project. familyproject/sfsu.edu Gabb, J. (2004). Sexuality education: How children of lesbian mothers “learn” about sex/uality. Sex Education, 4, 19–34. doi:10.1080/1468181042000176515 Kuvalanka, K. A. (2013). The “second generation”: LGBTQ children of LGBTQ parents. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 163–175). New York, NY: Springer. doi:10.1007/978-1-4614-4556-2_11 Mitchell, V. (1998). The birds, the bees . . . and the sperm banks: How lesbian mothers talk with their children about sex and reproduction. American Journal of Orthopsychiatry, 68, 400–409. doi:10.1037/h0080349

CHILDREN WITH LGBQ PARENTS, STIGMATIZATION Children with LGBQ parents may encounter stigmatization related to their parents’ sexual orientation. Such experiences have implications for their psychological adjustment. This entry describes stigmatization that children with LGBQ parents experience as a result of their parents’ sexual orientation. It defines stigmatization, explains who is stigmatized, and when and where stigmatization is more likely to occur. The entry discusses children’s responses to stigmatization, and concludes with ways to limit stigmatization and its negative effects.

What Is Stigmatization? Stigmatization is the experience of being teased, harassed, bullied, excluded, disapproved of, devalued, ostracized, or discriminated against. The degree of stigmatization can vary: Teasing, for instance, occurs when someone makes fun of or attempts to provoke another person, while bullying refers to a pattern of behavior that has a negative impact on the victim, where the victims feel threatened and unable to protect themselves because of the imbalance of power. Bullying tends to be composed of a large number of seemingly trivial instances that occur over a long period of time. In contrast to bullying, harassment is

systematic or unwanted aggressive pressure or intimidation, whereby an unpleasant or hostile situation is created through verbal or physical conduct. LGBQ-parent families are formed in the context of a society that favors opposite-sex sexuality and relationships, and as a result, are more likely to experience stigmatization. Erving Goffman’s theory of social stigma defines stigma as an attitude, behavior, or reputation that is socially discrediting in a particular way. An individual is mentally classified by others as an undesirable, rejected stereotype. Goffman describes several categories of stigma, including (a) those who bear the stigma and (b) those who do not bear the stigma but risk being affiliated with the stigmatized (i.e., children of LGBQ parents). Children of LGBQ parents both bear stigmas and are affiliated with the stigmatized. Because of their parents’ sexual orientation, they are at risk of facing discrimination and harassment.

Who Are the Stigmatized? In spite of changing laws protecting LGBQ rights, a substantial number of people still hold negative views about homosexuality and bisexuality. Many people still view LGBQ parents as unfit parents despite the lack of empirical evidence to support this belief. Other people worry that the development of sexual and gender identity in children of LGBQ parents will be impaired. Still others fear that children of LGBQ parents will experience adjustment difficulties and exhibit behavioral problems. Gay fathers in particular are evaluated more negatively as parents than heterosexuals because of gender and sexual orientation biases: Men in general are not expected to be adequate parents, and if they are gay, they are not expected to be suited for parenthood. In contrast, lesbian women face only sexual orientation bias: They are thought to be poor parents because of their sexual orientation, not because they are women. Those who are prejudiced vary by age and by range of support (or lack thereof) for LGBQ parents. Older adults, for instance, tend to have stronger prejudice against LGBQ parents than younger adults. The range of support for equal marriage rights and

Children With LGBQ Parents, Stigmatization

equal parenting rights varies by geography. In Europe, for instance, people are less likely to support equal parenting rights, while in the United States, people are less likely to support equal marriage rights. These prejudices are often justified through explanations of concern for children’s welfare. For example, parental sexual orientation is frequently considered by judges when deciding child custody outcomes. LGBQ parents therefore are directly affected by stigmatization. By extension, children may face discrimination, harassment, and bullying because of their parents’ sexual orientation. Family members can also be the source of stigmatization for many LGBQ-parent families. Some LGBQ parents report receiving less support from family members, such as their parents and siblings, when they announce their intention to have children. Nonbiological parents in particular tend to receive less support from family members when they decide to have children, particularly when coparent adoptions are not available, because family members are concerned that contact with the nonbiological children is not legally protected in the event that the same-sex couple’s relationship ends. In states where same-sex, second-parent adoption is available, family members tend to be more supportive. Family members may react negatively for a variety of reasons. For instance, they may have religious or moral oppositions to the idea of LGBQ parents having children. The process of adoption may be something family members do not support, particularly if it is a transracial adoption. Family members might be concerned that life will be difficult for the LGBQ parents and their children. The disapproval of family members is another way that LGBQ-parent families are stigmatized. Thus, from the very beginning, children of LGBQ parents may feel devalued by their own extended family members.

When and Where Does Stigmatization Happen? Children raised by LGBQ parents tend to be remarkably resilient, both socially and psychologically, even in the face of stigmatization. There are many other factors that bolster healthy

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development and that protect against the effects of bullying, such as having a strong relationship with one’s parents, having parents with a strong sense of competence, and being in a family that has social and economic support. These factors can outweigh the effects of stigmatization. Children with LGBQ parents may have strong social skills and good relationships with friends, but at the same time may also experience bullying because of their family structure. Studies that compare the experiences of stigmatization with children of LGBQ parents and children of different-sex parents are mixed. Some suggest that children of LGBQ parents are stigmatized more, while other studies suggest that there is no difference in the amount of stigmatization. However, even if the rates of stigmatization are the same, the content likely differs for children of LGBQ parents versus heterosexual parents. For instance, children of LGBQ parents are more likely to be teased for having two mothers, for not having a father, or for having a lesbian mother. Boys in particular are likely to be teased about being gay themselves, whether true or not. Although the frequency of teasing may be the same for children of heterosexual parents and children of LGBQ parents, the content of the teasing is likely to be different between these groups, with children of LGBQ parents experiencing teasing around their parents’ sexual orientation. Additionally, there are differences in reaction by gender: Boys tend to be excluded more than girls because of their family structure and to be more hyperactive, while girls tend to experience more gossip about them and to have lower self-esteem. As children of LGBQ parents grow older, they may be more likely to experience teasing at certain developmental stages. For instance, preschool-aged children are unlikely to experience teasing related to their parents’ sexual orientation, but as children grow older and move into formal schooling, such teasing becomes more frequent. Middle school in particular is where many children experience stigmatization more intensely. If children of LGBQ parents feel unsafe due to perceived stigmatization, they may be more likely to skip school in an attempt to avoid potential harassment.

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The intensity of stigmatization depends on the geographic region and neighborhood in which LGBQ-parent families live. For instance, families that live in more liberal areas may not experience as much stigmatization as families who live in conservative locations. Children in families who are able to attend progressive or private schools may not face as much peer discrimination as children of LGBQ-parent families in public schools. However, not all families are able to afford to send their children to private schools, and not all families are able to move to more progressive neighborhoods.

Children’s Responses to Stigmatization Confronted with teasing and bullying because of their parents’ sexual orientation, children of LGBQ parents tend to respond in several ways. First, children may directly address the teasing through confronting the perpetrator. They may tell the perpetrator that their comments are unacceptable or unwanted, asserting themselves through confronting the bully. Second, they may also solicit help from teachers, peers, or other supportive people in an effort to stop the teasing. Third, they may try to defend their parents against bullies, which can lead to further conflict. In spite of the fact that they may be teased because of their parents’ sexual orientation, children of LGBQ parents are unlikely to hide their family’s status. While it might be easier to mask their family status through using terms such as “parents” instead of “fathers,” most children are direct and honest about the structure of their family. They often opt to disclose the fact that they have two moms or two dads to whoever asks. However, some children try to control how much information they give to their friends and peers concerning their family, particularly as they get older. Some children might be more open with close friends about their families, and might avoid discussing that part of their lives with acquaintances and peers. By regulating how much information is given to peers and controlling how “out” they are about their family structure, children of LGBQ parents are sometimes able to limit teasing related to their parents’ sexual orientation.

Interestingly, as children and adolescents with LGBQ parents become college-aged, some have found that their parents’ sexual orientation is met with more positive reactions. Their peers, for example, may think that it is “cool” that they have two mothers or two fathers. As children mature into adulthood, they become more accepting of diversity, including diversity associated with sexual orientation and family structure. This acceptance of sexual orientation and family structure as children grow older has limitations. As children of LGBQ parents grow older and romantic relationships become important, they sometimes find that potential partners are not interested in being in a relationship with someone who has two moms or two dads. Men are less accepting of being in relationships with children of lesbians. The potential partners may be afraid of what others might think about their partner’s family and may be unwilling to risk facing stigmatization through association with the LGBQ family. As a result of stigmatization, children of LGBQ parents may have a heightened sensitivity to homophobia that they see in friends, peers, and strangers. These children may have more difficulty trusting others, feeling the need to be guarded and cautious, especially when forming new relationships.

Protective Factors Against Stigmatization The broader school context and family processes may help to offset some of the negative effects of stigmatization. Additionally, children from middleand upper-middle-class families may be more protected from the effects of bullying, as their parents would have more financial resources. Having more financial resources means that parents have more flexibility in what neighborhoods they choose to live in, what support groups they are able to access, and what schools they can afford to send their children to, all of which can protect the child from teasing. White LGBQ families tend to be more protected by class privilege than LGBQ families of color. Other protective factors against stigmatization include having friends with LGBQ parents, attending a school that uses LGBTQ-friendly

Children With Transgender Parents, Psychosocial Outcomes

curricula, and having strong parent–child relationships. These protective factors can help to limit the negative impact that stigma has on well-being. In spite of the stigmatization children of LGBQ parents may experience because of their parents’ sexual orientation, these children are remarkably resilient. They tend to be socially competent and have high-quality relationships with their friends. Academically, they perform as well as children of non-LGBQ parents. They also tend to be more empathetic toward groups that are marginalized, likely as a result of having experienced stigmatization themselves. Even in the face of stigmatization, with the right support, children of LGBQ parents can thrive.

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CHILDREN WITH TRANSGENDER PARENTS, PSYCHOSOCIAL OUTCOMES Between one quarter and one half of transgender people identify as parents among studies of various transgender populations. Based on current population estimates, this finding indicates that there are roughly 175,000 to 350,000 transgender people parenting children in the United States. This entry describes current research on transgender parents, the process of disclosing transgender identity to children, and the documented developmental, social, and identity development of children with transgender parents.

Kaitlin A. Black and Abbie E. Goldberg

Parenting Characteristics See also Adults With LGBQ Parents; Children With LGBQ Parents, Psychosocial Outcomes; Children With Transgender Parents, Psychosocial Outcomes; Division of Labor in LGBTQ-Parent Families; Nonheterosexual Children of LGBTQ Parents; Resilience and Protective Factors, Youth

Further Readings Gartrell, N. K., & Bos, H. M. W. (2010). US National Longitudinal Lesbian Family Study: Psychological adjustment of 17-year-old adolescents. Pediatrics, 126, 28–36. doi:10.1542/peds.2009-3153 Goldberg, A. E. (2007). (How) does it make a difference? Perspectives of adults with lesbian, gay, and bisexual parents. American Journal of Orthopsychiatry, 77, 550–562. doi:10.1037/0002-9432.77.4.550 Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Goldberg, A. E., Gartrell, N. K., & Gates, G. (2014). Research report on LGB-parent families. Los Angeles, CA: Williams Institute. Retrieved from http:// williamsinstitute.law.ucla.edu/wp-content/uploads/ lgb-parent-families-july-2014.pdf Golombok, S., Perry, B., Burston, A., Murray, C., Mooney-Somers, J., Stevens, M., & Golding, J. (2003). Children with lesbian parents: A community study. Developmental Psychology, 39, 20–33. doi:10.1037/0012-1649.39.1.20

Parenting rates among transgender people may be related to a variety of characteristics, including gender, cohort, and race/ethnicity. In the majority of studies, a higher percentage of trans women report being parents as compared with trans men. Other gender-nonconforming people, such as people who cross-dress or people who identify as androgynous or gender blended, have demonstrated greater variation in responses to questions about parenting, making estimates of parenting rates by trans people a challenge. Older transgender people are more likely to report being parents than younger transgender people. This is often due to having children with different-sex partners prior to coming out as transgender. However, with the increased opportunity to use fertilityrelated medical technologies, there is evidence that more recent cohorts of self-identified transgender people are opting to become parents at younger ages. Transgender people who report being parents also report parenting similar numbers of children as compared with lesbian, gay, or bisexual people, or non-transgender siblings. The number of transgender people who report living with children is lower than the number of those who report being parents. This is due in part to having adult children, but evidence also suggests that discrimination in custody decisions or partners informally

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attempting to control access to children may be contributing to transgender people not living with their children. In regard to parenting styles, qualitative research suggests that many transgender parents emphasize the strengths they bring as parents without focusing on gendered expectations around the behaviors of “mothers” or “fathers.” Qualitative studies have also emphasized that transgender parents frequently teach their children from early ages about the fluidity of gender, and attempt to break down the gender binary for their children. How this parenting approach may impact children’s conceptualization of gender in the long term has yet to be studied. Transgender parents have also described preparing their children for the challenges their transgender status may pose, such as being bullied, or seeing people treating their transgender parent disrespectfully. Similar to other vulnerable groups, transgender parents report having explicit strategies to prepare their children for encountering stigma and to help their children cope with negative experiences related to having a transgender parent.

Parental Disclosure The majority of existing research has focused on transgender parents who disclose to their partners and children later in life. The majority of transgender people report that they became parents with a current or past heterosexual partner. Often, this occurs before transgender parents have disclosed their gender identity to others. Little is known about transgender people who choose to become parents after their identification as transgender and/or following transition. In particular, more research is needed on those people who identify as androgynous or gender blended and/or choose not to transition at all while occupying a more liminal space between genders. Current theories suggest that, similar to other types of stress brought on by changes in a family (e.g., a relocation, a remarriage), when parents come out to their children as transgender, a period of challenging family dynamics is introduced as the children try to process this change. Frequent

questions raised by children in qualitative studies include what they should call their parent (e.g., does “mom” become “dad”) and how their relationship with that parent might change. Following a period of transition for the entire family, as family dynamics are renegotiated and reconfigured, the majority of transgender parents and children report relationships are as strong as, if not stronger than, prior to the parent’s disclosure. Some parents do report being rejected by children, particularly when they disclosed to those children when they were teenagers or adults. However, the majority of transgender parents and their children report maintaining positive relationships with one another. Many transgender parents report waiting to reveal their transgender identity or to begin any transition process until their children are older, due to fears about harming them or causing them difficulties in school or public. However, most research suggests that younger children cope better with a parent’s disclosure than older children or adult children. Younger children have been found to be more accepting of the disclosure and more easily adapt to changes in pronoun and name usage. The majority of transgender parents who report difficulties with their children also report that this difficulty was with teenagers or adult children. Relationship dissolution after disclosing transgender identity has been found to be a larger problem for the children of transgender people than the parent’s transgender status itself. In particular, some transgender people report that ex-partners have tried to formally exclude the transgender parent from custody rights or have informally blocked the transgender parent from seeing their children. This finding suggests that addressing discrimination in custody decisions and assisting both parents to come to fair custody arrangements will further help transgender people maintain relationships with their children.

Outcomes for Children of Transgender Parents The few studies that have examined psychosocial characteristics of the children of transgender parents

Christian LGBTQ People

have found them to be no different from those of children of cisgender (non-transgender) parents. For example, there is no evidence that the children of transgender parents are more or less likely than children with cisgender parents to identify as lesbian, gay, bisexual, or transgender. Most studies that have asked about children’s experiences of bullying found that one third or less reported having these types of experiences because of their parent’s transgender status. As stated, the children of transgender people can experience family and relationship stress that is related to tension between transgender and cisgender parents and issues in their relationship. In multiple samples of children referred to clinics, assessments of child well-being and mental health were often part of court proceedings trying to establish custody orders because cisgender partners were claiming that the transgender parent’s gender identity was harmful to their child(ren). Although high levels of family tension brought these children to mental health professionals, they have not been documented to have experienced any long-term consequences to their overall wellbeing due to having a transgender parent. Specifically, they have not been found to be at elevated risk for depression, gender identity concerns, unhappiness, or abnormal psychosocial development; further, only short-term impacts on academic performance as children process this change have been reported. Instead, termination of contact with a transgender parent has been proposed to have the most significant negative impacts upon children. Short-term therapeutic intervention for children who showed any signs of difficulties with either their transgender parent’s transition or the relationship stress between their parents have been shown to be effective in resolving any of these difficulties. Short-term intervention helped children process the changes in their families. In addition, protective factors that allow transgender parents to transition more smoothly in their relationship with their child(ren) have been found, including having a strong parent–child relationship before transition, taking care with how the transition is framed for the child, having a cisgender parent

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who is not opposed to the transition, and having parents who cooperate with one another effectively. A few studies have suggested that transgender parents may have unique positive impacts on their children in terms of valuing diversity and being open-minded about difference. Studies of the adult children of transgender parents have found that the experience of having a transgender parent has helped them to be less judgmental about others. Also, some children of transgender parents have said that seeing their parent braving a world where they face discrimination based on their gender identity has helped them to be more true to themselves and authentic with others. Rebecca L. Stotzer See also Children With LGBQ Parents, Gender Development and Identity; Parent Gender Transition and Intimate Relationship Changes; Parent–Child Relationships; Transgender Parents and Well-Being

Further Readings Pyne, J. (2012). Transforming family: Trans parents and their struggles, strategies, and strengths. Toronto, Ontario, Canada: LGBTQ Parenting Network, Sherbourne Health Clinic. Ryan, M. (2009). Beyond Thomas Beatie: Trans men and the new parenthood. In R. Epstein (Ed.), Who’s your daddy? And other writing on queer parenting (pp. 139–150). Toronto, Ontario, Canada: Sumach Press. Stotzer, R. L., Herman, J., & Hasenbush, A. (2014). Transgender parenting: A review of existing research. Los Angeles, CA: Williams Institute. Veldorale-Griffin, A. (2014). Transgender parents and their adult children’s experiences of disclosure and transition. Journal of GLBT Family Studies, 10(5), 475–501. doi:10.1080/1550428X.2013.866063

CHRISTIAN LGBTQ PEOPLE According to the Pew Research Center, Christianity is one of the most common religions on Earth, with 31.5% of all people identifying as Christian. Regardless of denominational or political viewpoint, there

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are certain consistent, foundational characteristics of Christianity that distinguish it from other monotheistic religions such as Islam and Judaism. Christians believe in Jesus Christ as the only son of God, who was born of the Virgin Mary and who taught, suffered on the cross, died, and was then resurrected. Christians believe that Jesus, who was Jewish, died to save all humans from their sins. This topic is relevant to LGBTQ lives because Christians from more conservative denominations have used six specific passages from the Bible (Genesis 19:1–28; Leviticus 18:22 and 20:13; Romans 1:26–27; 1 Corinthians 6:9–10; and 1 Timothy 1:10) to condemn sexual and gender minorities as sinners who will be punished by God. This attitude is one of the driving forces behind many of the 21st century’s cultural battles in the West, including debates over LGBTQ civil rights, same-sex marriage, and adoption across Europe and North America. While many LBGTQ individuals flee from established Christian denominations because of prejudice and discrimination, many others still adhere to their Christian faith and do not believe that being a sexual or gender minority goes against the teachings of Jesus. In the social sciences, there is a recent paradigm shift (within the last 15 to 20 years) that views LGBTQ individuals not just as nonreligious/nonspiritual beings needing to be compared and contrasted with religious others, but instead as religious and spiritual beings in their own right. How do sexual and gender minorities thus manage to reconcile their sexual orientation while participating in a religion that contains such strong anti-LGBTQ sentiments? This entry addresses such questions by illustrating how religiously active LGBTQ Christians leave more politically conservative denominations for more liberal ones, reinterpret scripture, argue against perceived Christian hypocrisy, and do their best to live by the simple message of Jesus Christ.

Bisexual and Transgender Christians Historically, social scientific studies of LGBTQ Christians have focused predominantly on gay men and lesbians, with little research conducted

from bisexual or transgender perspectives. Social and personality psychologist Eric Rodriguez makes two relevant points regarding bisexual and transgender Christians: (1) Christianity is more concerned with same-sex sexual behavior than with sexual orientation; thus bisexuality tends to get subsumed by conservative Christian aversion to men having sex with men alongside Western society’s tendency to eroticize women having sex with women; and (2) spiritual journeys of transgender individuals can be viewed as variations on gay male or lesbian female experience—those who view themselves as outsiders (in this case because of the discriminatory male/female gender binary predominant in the Bible and Christian culture) trying to understand how both their gender identity and their sexual orientation fit with their religious beliefs. There is solidarity among Christian sexual and gender minorities in how such individuals, regardless of sexual identity or nonbinary gender status, manage to integrate their Christian beliefs into their LGBTQ lives.

The Political Spectrum of Christianity Christian attitudes toward sexual and gender minorities are generally determined by the political slant of the denomination, with conservativeleaning churches holding more negative and exclusionary attitudes and doctrines, while more liberal-leaning churches hold more positive and inclusive views. This issue of how Christians should engage with sexual and gender minorities (to condemn them as sinful “others,” or to love and accept them fully into the life of the church) has created schisms within many of the large Christian denominations worldwide, including the Anglican, Episcopalian, Lutheran, and Methodist churches. Politically conservative Christian denominations that continue to condemn homosexuality as the gravest of sins include Baptists (and Southern Baptists), Evangelicals, Fundamentalists, Jehovah’s Witnesses, Pentecostals, and Seventh-Day Adventists. Most of these churches do not allow genderor sexual-minority members, will not ordain LGBTQ clergy, do not permit LGBTQ individuals

Christian LGBTQ People

to serve in congregational leadership roles, do not support same-sex relationships, and will not recognize or perform same-sex weddings. Politically moderate Christian denominations include Missouri and Wisconsin Synod Lutherans and Roman Catholics, as well as some Anglicans/ Episcopalians, Methodists, and Mormons. Many of those closer to the political middle make the argument that a distinction needs to be made between LGBTQ identity/orientation versus samesex sexual behavior. Within this standpoint the sin is in the behavior, not the identity, thus the creation of the idea “love the sinner, hate the sin” as a driving factor in how to approach sexual and gender minorities. Within this perspective, LGBTQ individuals are to be shown Christian love and compassion as individuals, while at the same time encouraged to repent and turn away from their sinful sexual lifestyle. Many of these churches also encourage active LGBTQ participation in the church to give such individuals an opportunity to repent the sin of homosexuality. However, such churches do not ordain LGBTQ clergy, do not support same-sex relationships, and do not recognize or perform same-sex weddings. Alternatively, liberal Christian denominations that welcome LGBTQ people as equals include the Evangelical Lutheran Church of America (ELCA), the United Church of Christ, the United Federation of Metropolitan Community Churches (UFMCC), and the United Universalists, as well as many Anglicans/Episcopalians, Methodists, and Presbyterians. The liberal perspective can be further broken down into “gay-positive” versus “gay-friendly” congregations. A “gay-positive” church (e.g., the UFMCC) is a denomination that was either founded by, and/or ministers specifically to, the LGBTQ community. A “gay-friendly” church (e.g., the ELCA), however, represents a predominantly heterosexual religious denomination that is inclusive of LGBTQ individuals— welcoming them as full and active members of the church community. Gay-positive and gay-friendly churches allow gender- or sexual-minority members, ordain LGBTQ clergy, support samesex relationships, and recognize and perform same-sex marriages.

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Scriptural Interpretation One of the critical issues relating to how sexual and gender minorities practice their Christianity without conflict between their sexual/gender identity and religious beliefs is the interpretation of scripture. There are two basic ways of interpreting the Bible: fundamentalist or historical critical. From a fundamentalist perspective, the Bible is the inerrant word of God and everything written there should be taken at face value without question or reservation. Through the fundamentalist lens, the Bible clearly states in the previously mentioned six passages that same-sex attraction and behavior is an egregious sin and is thus unnatural and an abomination in the eyes of God. In contrast, the historical critical (i.e., historical contextual) interpretation of scripture argues that the Bible was inspired by God but written by fallible human beings. Within this perspective, the Bible should be viewed in light of the historical and cultural context in which it was written. Thus, rules and regulations meant to guide individuals in the 1st century are not necessarily germane to 21st-century life. Furthermore, those using the historical critical method of interpretation argue that the most important parts of the Bible are the four Gospels from the New Testament (Matthew, Mark, Luke, and John) detailing the life, teachings, death, and resurrection of Jesus Christ. Emphasizing these passages means that individuals are encouraged to view scripture through the lens of God’s grace; the idea that we are saved not because of our actions or identities, but rather because Jesus Christ was crucified, died, and was resurrected for the sins of all. This message is particularly compelling for LGBTQ Christians who point out that Jesus never explicitly spoke for or against same-sex sexual behavior or gender variations. A major offshoot of this line of thought is what sociologist Andrew Yip has labeled the ontogeneric argument—since all sexual and gender variations argument were created by God, they are all blessed by God.

Sodom and Gomorrah The story of the destruction of the cities of Sodom and Gomorrah in the Old Testament book of

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Genesis provides an excellent illustration of the differences between these two contrasting methods of interpreting scripture. One key disparity centers on the origins, and underlying meaning, of the term sodomite. Fundamentalists argue that in this story, God clearly demolished these two cities because of the sin of homosexuality and thus a sodomite is a man who engages in sexual behavior with another man. Historical contextualists argue, however, that the original Greek and Hebrew writings have been mistranslated and that the sin in question was actually that of showing a lack of hospitality toward guests—hospitality being a cultural more, or norm, that was strong in the Middle East during that time. Thus, from the historical critical perspective, a sodomite is actually someone who refuses to show hospitality toward a guest in his home. Relying on the historical critical approach, LGBTQ Christians argue that the concept of sexual orientation, as we understand it today, did not exist over 2,000 years ago, and thus prohibitions against homosexuality do not pertain to same-sex couples in loving, committed relationships.

Charges of Christian Hypocrisy One of the key tenets of Christianity is to love your neighbor as yourself, an idea that rejects any type of discrimination toward other people for any reason. This inherent inconsistency drives the theological battles between LGBTQ people and conservative Christians. Fundamentalist Christians argue that the Bible is clear that homosexuality is an unnatural abomination and a sin, while LGBTQ Christians counterargue that singling out sexual and gender minorities as somehow being more sinful than everyone else goes against—indeed outright contradicts—Jesus’s actual teachings of peace and tolerance toward others. LGBTQ Christians further contend that those who use the Bible against them are guilty of selective morality or “cherry-picking” Bible verses to support the case against LGBTQ individuals while ignoring other Biblical prohibitions that many view as no longer applicable in 21st-century Christian society (e.g., not eating pork and shellfish, menstruating women being forbidden to attend worship services).

This juxtaposition of clashing religious ideals is one of the main reasons why many Christian denominations struggle in their interactions with the LGBTQ community. This is where “love the sinner, hate the sin” came from as a form of compromise between these two competing Christian viewpoints. One conservative Christian’s compromise, however, is often an LGBTQ Christian’s hypocrisy (and vice versa). Many LGBTQ Christians argue that singling out same-sex sexual behavior as somehow being a greater sin than many of the others mentioned in both the Old and New Testaments of the Bible (adultery, bearing false witness, divorce, greed, pride, thou shall not kill, etc.) is the height of hypocrisy because Jesus actually had very harsh words to say about anyone who would presume to sit in judgment against anyone else (Matthew 7:1–5): Do not judge, so that you may not be judged. For with the judgment you make you will be judged, and the measure you give will be the measure you get. Why do you see the speck in your neighbor’s eye, but do not notice the log in your own eye? . . . You hypocrite, first take the log out of your own eye, and then you will see clearly to take the speck out of your neighbor’s eye.

Jesus’s Simple Message Theologians have argued that while Jesus never spoke directly for or against sexual or gender minorities, he did speak explicitly regarding his two greatest commandments—love your God with all of your heart and soul and love your neighbor as yourself (Matthew 22:36–40). Perhaps the most powerful and persuasive argument that LGBTQ Christians use to reconcile their sexual, and/or nonbinary gender identities with their religious beliefs is that Jesus would not approve of the way fundamentalist and Christian conservatives treat sexual and gender minorities, as such prejudice and discrimination violates his central teachings for all Christians to care for all human beings. Rather, Jesus conducted his ministry by focusing on the plight of the downtrodden and dispossessed— his message was not one of exclusion and bigotry

Chronic Illness

but instead one of love and support for all people. It should come as no surprise, therefore, that many who identity as both LGBTQ and Christian find spiritual shelter beneath such a simple yet powerful, and all-inclusive, message. Eric M. Rodriguez and Chana Etengoff See also Religion/Spirituality and LGBTQ People; Religious Identity and Sexuality, Reconciliation of; Sexual Orientation Conversion Therapy; Transgender People and Religion/Spirituality

Further Readings Barton, B. (2010). “Abomination”—Life as a Bible Belt gay. Journal of Homosexuality, 57(4), 465–484. Gay Christian Network. https://www.gaychristian.net/ Meeks, W. A. (Ed.). (1989). The HarperCollins study Bible: New revised standard version. New York, NY: HarperCollins. Pew Research Center, Religion and Public Life Project. http://www.pewforum.org/ Rodriguez, E. M. (2010). At the intersection of church and gay: A review of the psychological research on gay and lesbian Christians. Journal of Homosexuality, 57(1), 39–53. Rodriguez, E. M., & Follins, L. D. (2012). Did God make me this way? Expanding psychological research on queer religiosity and spirituality to include intersex and transgender individuals. Psychology & Sexuality, 3(3), 214–225. Rodriguez, E. M., Lytle, M. C., & Vaughan, M. D. (2013). Exploring the intersectionality of bisexual, religious/spiritual, and political identities from a feminist perspective. Journal of Bisexuality, 13, 285–309. Scanzoni, L. D., & Mollenkott, V. R. (1994). Is the homosexual my neighbor? A positive Christian response, revised and updated. San Francisco, CA: HarperOne. Transgender Christians. http://www.transchristians.org/ Yip, A. K. T. (1997). Attacking the attacker: Gay Christians talk back. British Journal of Sociology, 48(1), 113–127. Yip, A. K. T. (1997). Dare to differ: Gay and lesbian Catholics’ assessment of official Catholic positions on sexuality. Sociology of Religion, 58(2), 165–180.

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CHRONIC ILLNESS Chronic illness refers to long-term conditions that are rarely completely cured and are often characterized by uncertain outcomes, unpredictable episodes of intrusive symptoms, and intermittent or progressive physical and/or mental impairment. Examples include cardiovascular disease, arthritis, respiratory problems, diabetes, epilepsy, and cancer. This entry provides a brief overview of how chronic illness may impact people’s lives generally; it then goes on to consider how chronic illness intersects with LGBTQ lives more specifically. Over the course of the 20th century, there was a dramatic shift from acute to chronic diseases as the leading cause of mortality in industrialized nations. Improved sanitation, public health surveillance, routine immunizations, and improvements in health care more broadly have led to aging populations and a rise in the number of people living with chronic health conditions. Advances in medicine have also seen a number of diseases transformed from terminal to chronic conditions; for example, with the development of antiviral therapies, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has become a chronic rather than an acutely fatal condition in many parts of the world. Chronic conditions may lead to a loss of physical and/or mental functioning and may result in reduced life expectancy and poorer quality of life. Although the term illness is often preferred in the social sciences over the more medical term disease, in many cases those with chronic conditions may not feel, nor consider themselves to be, “ill” most of the time and, in some circumstances, those living with well-managed chronic conditions (e.g., type 1 diabetes) may lead a long and relatively healthy life. For those who were neither born with a medical condition nor developed the condition in early childhood, receiving a diagnosis of a life-changing illness can come as a shock and be difficult to accept. A key concept within the social scientific literature on chronic illness is that of “biographical disruption”: the disruption of taken-for-granted

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assumptions about life and an associated crisis of one’s sense of self. Life with many chronic conditions is characterized by uncertainty and involves a process of considerable psychological adjustment. Many chronic illnesses require lifelong treatment or self-management, sometimes in the form of complex medical regimens that may call for lifestyle adjustments (dietary adjustment, monitoring of blood glucose levels, etc.). There is often a negative impact on a person’s quality of life; for instance, people with chronic illness are more likely to experience stress, depression, sexual dysfunction, and disrupted personal relationships. A diagnosis of chronic illness also often confers a level of stigma. Those conditions that have physical manifestations (e.g., deformities, scars), are transmittable (e.g., HIV), or are viewed as the result of unhealthy lifestyles (e.g., type 2 diabetes, lung cancer) are often particularly stigmatizing.

The Legacy of HIV/AIDS on LGBTQ Health Studies While the notion of HIV/AIDS as a “gay disease” has long been criticized by LGBTQ and AIDS activists, it continues to be considered by many as a “gay health issue,” a disease that disproportionately affects gay men with risk factors that are particularly pertinent to men who have sex with men (e.g., unprotected anal intercourse). Many other chronic illnesses, however, are typically not considered in relation to sexual and gender minorities and, as a result, there is a paucity of research examining LGBTQ people’s experiences of living with other chronic illnesses. It is unclear what the legacy of the HIV/AIDS epidemic has been for scholarly literature on chronic illness more broadly. On the one hand, it could be considered to have narrowed the field of LGBTQ health, making it difficult for other chronic conditions to be considered and recognized, while on the other hand, HIV has made gay men’s health and LGBTQ health more broadly a legitimate focus of academic work and public health policy. AIDS and the queer politics surrounding it have also provided LGBTQ health scholars with political and theoretical

frames of reference for examining and studying other forms of illness.

LGBTQ Experiences of Chronic Illness Gay and bisexual men with HIV/AIDS are more likely to develop other chronic conditions as comorbidities in the form of diabetes and some forms of cancer. However, with the exception of rates of HIV/AIDS among gay men, there is currently very little data about the prevalence of chronic health conditions among LGBTQ populations as data on sexual and cis/transgender identity are rarely collected in epidemiological studies. There is some evidence that risk factors associated with certain chronic conditions are higher among some sexual minorities. For example, populationbased surveys have consistently found that nonheterosexuals are more likely to smoke tobacco than heterosexuals, which significantly increases the risk of developing a wide range of chronic conditions such as cardiovascular disease, chronic obstructive pulmonary disease, stroke, emphysema, and various forms of cancer. There is also some evidence to suggest that lesbians are more likely to be overweight or obese than heterosexual women, which also increases the risk of chronic conditions such as type 2 diabetes. The fact that lesbians are less likely to have children and more likely to delay childbirth beyond the age of 30 may also increase their risk of some conditions such as breast cancer and endometrial cancer, which breastfeeding is thought to offer some protection against. To date, only a handful of populationbased surveys have directly examined differing rates of chronic conditions in relation to sexual orientation. There have been some findings to suggest that lesbians report higher rates of breast cancer, and higher rates of asthma have been found consistently among sexual-minority women; however, there is little conclusive evidence that LGBTQ people are disproportionately affected by many other conditions. For the most part, those illnesses that the literature has focused on in relation to lesbians and gay men have been gendered illnesses that affect sexualized (and gendered) parts of the anatomy,

Chronic Illness

such as breast cancer among lesbians and prostate cancer among gay men. Much of the literature on LGBTQ experiences of chronic illness has focused on how such conditions disrupt sexual relationships and also on experiences of homophobia and transphobia within health care. Studies have found that mainstream health care organizations are often poorly equipped to provide support that is sensitive to LGBTQ individuals. Although the importance of cultural competence within health care is well recognized in relation to ethnic diversity, the importance of training that raises awareness of LGBTQ issues and encourages practitioners to carefully reflect on their own attitudes toward gender and sexual minorities is yet to be fully recognized. LGBTQ people have been reported to be less likely to be “out” to their health professionals than in other spheres of their lives, for fear that it might affect their ongoing care. This can be problematic, particularly when the condition may affect sexual functioning; for example, erectile dysfunction may be the first symptom of a chronic condition (e.g., diabetes), while for those already diagnosed it may be a sign of a progression or complications of their condition, such as heart disease. It is therefore critically important that LGBTQ people feel comfortable enough to freely discuss their sexual functioning and practices with their health practitioner. LGBTQ people may also receive less social support from their families of origin due to family members’ failure to accept their sexual or gender identity. LGBTQ people living with chronic illness may be considered to be living with multiple forms of stigmatization based on both their sexual/gender identity and their illness. In addition to passing as heterosexual or cisgendered to avoid stigma in certain situations, LGBTQ people may also conceal their chronic illness to avoid being stigmatized by others, including within LGBTQ communities. Studies have found that gay male cultures in particular are often perceived to be highly sexualized and to emphasize bodily perfection, idolizing young, slim, fit, and able bodies. Although this is a stereotyped portrayal of gay culture that does not reflect the diverse communities of gay men, this understanding of gay culture may nonetheless influence

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the way that gay men living with chronic illness feel about themselves and their bodies. The stigma of living with a chronic health condition may also add to the minority stress already experienced by LGBTQ individuals, which in turn may affect their ability to cope with and manage their condition.

Queering Chronic Illness In addition to efforts to make LGBTQ experiences of chronic illness more visible through documenting their narratives, LGBTQ scholars have also drawn on queer theory to provide a critical examination of how gender is inscribed in the culture surrounding medical conditions and how chronic illness and its treatment relate to the politics of gender and sexuality. Culturally available illness narratives, for instance those available in published autobiographies, are predominantly heterosexual narratives that often display heteronormative concerns. Audre Lorde’s book Cancer Journals is a notable exception not only because it was written by a lesbian, but also because it is written explicitly from a Black lesbian feminist position that examines the intersections of illness, race, gender, and sexuality within a political context. Lorde writes, for instance, about a distressing experience while visiting her surgeon’s office postmastectomy, when she was chastised in front of the other patients for not wearing the pale pink prosthesis she had been given. For Lorde, this was a direct assault on her right to own and embrace her body despite its not conforming to normative standards of female appearance. Queer scholars have also sought to forge theoretical links between queer theory and cultural studies of health and illness by examining the way in which gender and sexual identity are constituted in cultural representations of chronic conditions such as breast cancer and HIV/AIDS. Some scholars, for instance, have examined the way that the language and imagery used within self-help and health care literatures heterosexualize health conditions in ways that can be experienced as marginalizing for LGBTQ people. For example, sources of information for the partners of men with prostate cancer often assume that such partners are women.

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The scholarly literature, both on chronic illness and on LGBTQ studies, has tended to reflect the dominant narratives of privileged social groups (e.g., White, middle class). The literature on chronic illness has tended to reflect heterosexual, cisgender narratives of illness, while LGBTQ studies has yet to fully explore the intersections that exist in the lives of sexual and gender minorities living with a wide range of chronic illnesses. As intersectional forms of analysis continue to develop in LGBTQ studies, it is likely that a wider range of health conditions will be examined and that additional insights from queer theory will be applied to the study of health and illness. Adam Jowett See also Advance Health Care Planning; Cancer and Social Support; Cancer in the LGBTQ Community; Disabilities Among LGBTQ Elders; Discrimination on the Basis of HIV/AIDS in Health Care; Health Care Providers, Disclosure of Sexual Identity to; Health Care System; Health Disparities; Intellectual Disabilities; Physical Disabilities

Further Readings Axtell, S. (1999). Disability and chronic illness identity: Interviews with lesbians and bisexual women and their partners. Journal of Gay, Lesbian, and Bisexual Identity, 4, 53–72. doi:10.1023/A:1023254408084 Dibble, S., Eliason, M., & Christiansen, M. (2007). Chronic illness care for lesbian, gay, & bisexual individuals. Nursing Clinics of North America, 42, 655–674. doi:10.1016/j.cnur.2007.08.002 Jain, S. L. (2007). Cancer butch. Cultural Anthropology, 22, 501–538. doi:10.1525/can.2007.22.4.501 Jowett, A., & Peel, E. (2009). Chronic illness in nonheterosexual contexts: An online survey of experiences. Feminism & Psychology, 19, 454–474. doi:10.1177/0959353509342770 Lipton, B. (Ed.). (2004). Gay men living with chronic illnesses and disabilities: From crisis to crossroads. Binghamton, NY: Harrington Park Press. Lorde, A. (1980). The cancer journals. Argyle, NY: Spinsters Ink. Walden, E. L. (2009). An exploration of the experience of lesbians with chronic illness. Journal of Homosexuality, 56, 548–574. doi:10.1080/00918360903005220

Wilkerson, A. (2003). Memoirs of the sick and the queer: Genre and the possibility of oppositional subjectivity. In R. N. Fiore & H. L. Nelson (Eds.), Recognition, responsibility, and rights: Feminist ethics and social theory (pp. 105–117). Lanham, MD: Rowman & Littlefield.

CISGENDERISM Cisgenderism refers to the ideology that delegitimizes people’s own understanding of their genders and bodies. The term cisgenderism comes from the Latin cis (“on the same side”) and genus (“kind” or “type,” later gender). Cisgenderism can manifest in distinct forms, such as pathologizing (constructing or treating people’s genders, bodies, and experiences associated with their genders and bodies as disordered, e.g., gender dysphoria, gender identity disorder, and disorders of sex development) and misgendering (misclassifying people’s genders and bodies, e.g., referring to a man who was assigned female at birth as “she” or “female”). Cisgenderism was initially used interchangeably with the term cisgender to describe people who are “not transgender.” In the cisgenderism framework first proposed by psychologist Y. Gavriel Ansara and first empirically researched by Ansara and Peter Hegarty, the term cisgenderism has been used to critique the recent transgender/cisgender binary for assuming that all people can be neatly categorized as either cisgender or transgender people.

Key Components of the Cisgenderism Framework Cisgenderism theory contrasts with approaches that treat these two categories (transgender and cisgender) as essentially distinct classes of people, regarding this gender binary as an essentialist form of cisgenderism. Cisgenderism theory provides a critique of the cis/trans gender binary on multiple grounds, including but not limited to the following: • The label transgender is often imposed on people who consider trans a descriptor of their life experience and not their identity, such as people

Cisgenderism

who consider themselves to be simply women or men and not transwomen or transmen. • The cis/trans binary excludes people who cannot be neatly classified as transgender or cisgender. Some of the many people excluded by this binary include intersex people, people who would be classified as cisgender yet experience misgendering due to their physical characteristics (e.g., women who were assigned female and who have some stereotypically “male” physical characteristics due to polycystic ovary syndrome), people who ordinarily live in their assigned gender but do drag for work and/or fun, and people whose nonbinary genders are part of a recognized, culturally specific gender system within their society (e.g., Bissu, fa’afafine, Yimpininni). • The cis/trans binary is an ethnocentric lens through which to approach the topic of gender.

As sociologist Oyèrónkẹ́ Oyěwùmí has argued, the category of gender cannot be assumed to be universally meaningful and applicable to all societies; in some African societies, gender does not necessarily function as the central organizing category for social stratification. Some societies around the world do not determine authentic gender based on categories assigned by external authorities. In some societies, one’s official gender is self-determined and/or can be changed through ritual acts that are viewed as normative coming-ofage rites (e.g., Kaska society in some parts of British Columbia and the Yukon Territory, Canada; Bugis society in South Sulawesi, Indonesia). Anthropologist Ifi Amadiume has documented how, in some societal contexts, one’s gender may shift over the course of a day and is determined by the specific activities in which one is engaged rather than on physical characteristics or formal documentation.

Cisgenderism Versus Transphobia Older frameworks such as transphobia have focused on negative individual attitudes and hostile acts. In contrast, cisgenderism can describe both systemic and individual acts, whether hostile or benevolent, in a variety of social contexts. Thus

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transphobia could be classified as a type of hostile cisgenderism that targets people who are perceived as “trans” by others. The cisgenderism framework does not conflate all people who experience gender or body delegitimization as being a distinct group of people, nor does it classify such people using a single grouping label. Moreover, cisgenderism theory is concerned with influences broader than behavior or self-reported attitudes; cisgenderism is an ideology that influences people’s views of their societies and which attributes they consider culturally normative. In addition to affecting individual actions and perceptions of others, cisgenderism can be expressed in subtle and structurally embedded ways.

Theoretical Influences on Cisgenderism Theory The field of cisgenderism studies examines forms of this delegitimizing ideology in distinct cultural contexts. Primary influences on the initial development of cisgenderism theory were the two social science fields of critical disability studies and ethnocentrism studies. These two fields share with cisgenderism studies a critique of the external imposition of identity labels that the people being described can experience as stigmatizing, inaccurate, or othering. Cisgenderism theory also incorporates the critique in ethnocentrism studies that categories, terms, and methods developed in one cultural context are automatically applicable to another cultural context in the absence of direct evidence to support this adaptation. For example, the concept of trans stems from a set of problematic colonial U.S. and European cultural assumptions that are similar to the “natural facts” of gender critiqued by sociologist and ethnomethodologist Harold Garfinkel. Chief among these assumptions are the beliefs that all people have a single gender as either women or men; that a person’s gender can be determined reliably by their physical appearance and/or their voice; that gender always maps onto physical characteristics in the same way (e.g., all people who identify as men must have, or want to have, a penis and testicles, and all people who have a clitoris and

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breasts that they wish to retain will necessarily identify as women); that the visual appearance of a person’s external genitals at birth is a reliable indicator of their gender; that all people’s genders remain fixed and static through their life span; that “trans” people “change sex” from one binary category to another rather than affirming a gender they already understand as their own prior to medical intervention; and that no valid genders exist beyond the binary options of woman and man. Such assumptions can motivate expressions of cisgenderism such as retroactive misgendering (in which a person’s past is described using language that disregards or contrasts with their current designation of their gender) and coercive queering (in which self-identified heterosexual people with “trans” life experiences or intersex bodies are inaccurately assumed to have a gay, lesbian, bisexual, or queer sexuality and assumed to share the same needs and experiences as these populations). Informed by the conceptual insights of Julia Serano, who is credited with having coined the term misgendering, Ansara and Hegarty modified Serano’s definition to transcend the cis/trans binary and develop an operational definition of misgendering for research applications.

Research in the Field of Cisgenderism Studies The first empirical research on cisgenderism consisted of a quantitative content analysis that assessed claims that views about children’s genders were becoming more accepting and less cisgenderist over time. Journal articles on children’s genders or gender expression were evaluated as to whether they reflected or contrasted with the stated aims of the American Psychological Association’s nondiscrimination statement on “transgender” and “gender variant” people through an analysis of pathologizing and misgendering in empirical research on children. Pathologizing was found more frequently than misgendering. Although cisgenderism remained stable over time, articles on children’s genders and gender-associated expression had increasing professional influence over time, and language used by mental health

professionals was more cisgenderist (in degree) than that used by authors from other professions. This pioneering study found that the most highly cisgenderist research on children’s genders or gender expression was authored by an invisible college (a network of collaborating authors) centered around the most prolific author in the field. More recently, other scholars have examined how authors associated with this invisible college have been pivotal figures in the dissemination and perpetuation of pathologizing and discriminatory approaches to people whose genders, characteristics, or behaviors do not match stereotypical gender norms. More recent work in the field of cisgenderism studies has explored cisgenderism in specific fields, provided recommendations for reducing cisgenderism in research and professional practice, and/ or integrated the cisgenderism framework with existing mental health approaches. Recent work has examined how everyday practices in the field of family therapy enacted and perpetuated cisgenderism and developing a cisgenderism reduction checklist for reflective therapeutic practice. Other work has evaluated the most widely cited Englishlanguage papers in the field of sexist language research for cisgenderism and published guidelines aimed to reduce cisgenderism in psychological research. Still other scholars have applied a model that integrated decompensation theory and cisgenderism theory to existing Australian research evidence on the mental health needs and experiences of people whom Australian research describes as “trans” or “gender diverse.”

Guidelines for Reducing Cisgenderism in Research and Data Collection In addition to exploring everyday cisgenderism in diverse cultural contexts, a primary goal of cisgenderism studies is to reduce cisgenderism in research and professional practice. Ansara and Hegarty produced guidelines in 2013 that advocated for the development of research practices that can reduce misgendering. They advise researchers to refrain from assuming participant gender based on people’s names, voices, and visual appearance, in

Cisgenderism

recognition that these are culturally variable “clues” that can be misleading. They also recommend that researchers distinguish between the administrative “sex” categories to which people have been assigned and those people’s physical attributes; when researchers make assumptions about people’s bodies and their related medical needs, this practice can lead to unintentional exclusions and access barriers to health services. The guidelines stress the need to consider the myriad physical characteristics that can be associated with the same gender self-designation and the absence of a universal template to define which gender selfdesignation is associated with particular physical characteristics. They recommend that those involved in research design consider the potential distinction between assigned administrative “sex” category and self-designated gender, the existence of people with multiple and/or nonbinary genders, and the cultural variations in the number of recognized gender categories. The guidelines highlight the need for authors to document clearly how participant gender was determined; to consider methodological concerns regarding the coding of gender as a single dichotomous variable; to avoid misgendering people, particularly those with nonbinary genders who may wish to be described using only nonbinary pronouns and descriptors; and to ensure that research anticipates the possible range of gender diversity among participants, so that discriminatory research practices such as excluding all people who do not identify clearly as women or men as “outliers” will be unnecessary. Although these guidelines focused primarily on research practices, their approach contains elements that can also help to reduce cisgenderism in other forms of professional communication and practice. In his work on cisgenderism in medical contexts, Ansara explored how techniques used to support community engagement and inclusive practice can perpetuate marginalization and exclusion. This work focused on three widely used methods: feedback forms, consultation with community leaders, and the use of “evidence-based medicine.” Ansara asserted that feedback forms typically focus on questions related to individual staff behavior and overlook important structural

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and policy components of health care experiences. His work also explored the extent to which people with negative evaluations of their health care experiences will disclose their evaluations on these forms. The widespread preference for Likert-type scales over narrative responses on feedback forms may also limit open disclosure on feedback forms. This work documented that “community consultation” is often limited to contact with designated community leaders who cannot adequately reflect the needs of the most marginalized individuals within that particular community. Definitions of “evidence” are not neutral or objective, but determine whose input and experiences will be used to create knowledge, evaluate existing views, and determine policy. Critical feedback about systemic gaps and structural barriers needs to be incorporated into existing definitions of evidence to enable improvement in health care contexts. Y. Gavriel Ansara and Israel Berger See also Gender Binaries; Gender Clinics; Gender Nonconformity, Youth; Genderqueer; Health Disparities; History of Transgender Medicine in the United States; Intersections Between Sex, Gender, and Sexual Identity; Naming Practices; Nonbinary Genders; Sexual-Identity Labels; Sexual Orientation Among Transgender People; Therapy With Transgender Individuals: Mental Health Considerations; Transgender Identities; Transgender Sexualities; Transphobia

Further Readings Ansara, Y. G. (2010). Beyond cisgenderism: Counselling people with non-assigned gender identities. In L. Moon (Ed.), Counseling ideologies: Queer challenges to heteronormativity (pp. 167–200). Farnham, England: Ashgate. Ansara, Y. G. (2012). Cisgenderism in medical settings: How collaborative partnerships can challenge structural violence. In I. Rivers & R. Ward (Eds.), Out of the ordinary: LGBT lives (pp. 102–122). Cambridge, England: Cambridge Scholars Publishing. Ansara, Y. G., & Hegarty, P. (2012). Cisgenderism in psychology: Pathologising and misgendering children from 1999 to 2008. Psychology & Sexuality, 3(2), 137–160.

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Ansara, Y. G., & Hegarty, P. (2013). Misgendering in English language contexts: Applying non-cisgenderist methods to feminist research. International Journal of Multiple Research Approaches, 7(2), 160–177. Ansara, Y. G., & Hegarty, P. (2014). Methodologies of misgendering: Recommendations for reducing cisgenderism in psychological research. Feminism & Psychology, 24(2), 259–270. Blumer, M. L., Gavriel Ansara, Y., & Watson, C. M. (2013). Cisgenderism in family therapy: How everyday clinical practices can delegitimize people’s gender selfdesignations. Journal of Family Psychotherapy, 24(4), 267–285. Davy, Z. (2013). The construction of gender dysphoria at “Classifying Sex: Debating DSM-5.” Psychology of Women Section Review, 15(2), 63–67. Pyne, J. (2014). The governance of gender nonconforming children: A dangerous enclosure. Annual Review of Critical Psychology, 11, 79–96.

CLOSET, THE In order to understand the “the closet” in relation to sexual orientation, it is necessary to first define the term. In general use, the closet refers to a space for hiding private objects from public view. According to the Oxford English Dictionary (OED), a closet can be a “room for privacy,” an “inner chamber,” a “private repository of valuables,” or the “den or lair of a wild beast.” A person may also have a “skeleton in the closet”—a “private or concealed trouble in one’s circumstances, ever present, and ever liable to come into view.” These definitions of the closet make the act of “coming out of the closet” possible. To come out means to make hidden, private, and possibly valuable information public; to reveal one’s “inner chamber” to others; to expose the living quarters of a “wild beast” or a concealed, troubling “skeleton”; and/or to “admit (something) openly, to cease to conceal” information, especially same-sex attraction (“homosexuality”). The person who does not disclose same-sex attraction may risk being considered a “closet queen” (a person who only comes out to other queer people yet avoids

frequent association with these people out of a fear of stigmatization) or a “closet case” (a slang term for “a homosexual who conceals or denies his or her sexuality”; see “closet” [OED]). While these definitions offer a sense of the closet and coming out, there are five additional characteristics of the closet and its relationship to same-sex attraction that are worth addressing. First, the closet is applicable to, and coming out is necessary in, contexts in which a person’s same-sex attraction is hidden and not known— heteronormative contexts that, by default, frame a person as heterosexual. In these contexts, a person must disclose her or his same-sex attraction or engage in a nonheterosexual act (e.g., being intimate with a person of the same sex) in order to disrupt ascriptions of heterosexuality. Persons who identify as bisexual or pansexual would experience this characteristic of the closet if they worry about revealing same-sex attraction or about revealing their bisexuality or pansexuality. Second, the closet is a relational construct; it exists primarily in relation to other people, specifically what others do and do not know about a person’s same-sex attraction. For example, a brother may not know about his sister’s same-sex attraction, which may then make her “closeted” in relation to him. Or an employee may assume that his boss does not know about his same-sex attraction, and may thus feel closeted in relation to her. Or a woman may be out (of the closet) to her cousin, but not out to her mother; out to co-workers, but not out to the server at a restaurant; and out to her therapist but not to her dentist. In these situations, the closet exists based on (assumptions about) information that has not been revealed in particular relationships. The closet could also exist when other people deny or pretend not to know about a person’s same-sex attraction, even though the person has told these others about her/his attraction numerous times. Third, the relevance of same-sex attraction and the closet depends on whether this attraction is considered to be important information for a relationship. For example, a mother may ask her son if he finds a particular woman (intimately,

Closet, The

relationally) attractive. The mother may even try to get this son to marry this woman and encourage the (heterosexual) couple to (biologically) reproduce in order to, by way of patriarchal custom, “carry on the family name.” But if the son does not find women attractive or does not want to marry a woman, and instead finds men attractive and may even want to marry a man, then his private and concealed (closeted) same-sex attraction would be relevant information for his mother/their relationship. If the son could disclose (come out) to his mother, she might no longer have such expectations about her son and might not pressure him into a relationship that he does not find to be satisfying or important. Fourth, coming out can be risky and dangerous, as a person might reveal information that others will condemn. There are many accounts of parents reacting negatively to their children’s coming out, and some colleges and employers can dismiss a student or employee for disclosing same-sex attraction. In some places (e.g., Russia, Uganda), a person can be fined, imprisoned, or even killed because of same-sex attraction. As such, a person who comes out can lose access to important resources and may experience emotional stress and physical harm; a person who stays closeted—that is, who does not come out—may maintain safety and protection, at least in relation to others. However, as many queer activists have argued, coming out is important for recognition, pride, and honesty; even though coming out may be risky and dangerous, not coming out—staying in the closet—can perpetuate the assumption that same-sex attraction is unimportant, inappropriate, and/or abnormal. Fifth, for a person with same-sex attraction, the closet can be an enduring construct, as coming out can become a perpetual, lifelong process. If coming out means to reveal private or concealed information to others, then a person may be closeted when immersed in new (heteronormative) contexts with unfamiliar others. Every new work environment, every trip to the grocery store, every new venture into social life—the closet does not disappear with one act or utterance; new audiences make for new times to disclose.

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While “the closet” and “coming out (of the closet)” are constructs often used to understand disclosures of same-sex attraction, these constructs can also be used to understand any disclosure that reveals hidden and possibly taboo information. For example, depending on context and audience, a person may need to come out as someone who struggles with gender identity or as transgender, as pregnant, as an undocumented citizen, as a military veteran, as a particular religious identity (e.g., Muslim, atheist, Jewish), or as having a (nonvisible) medical condition (e.g., cancer, diabetes, colorblindness). The need to and the importance of understanding the closet will thus exist as long as the revelation of hidden information to others is perceived to be an important yet dangerous act. Tony E. Adams See also Coming Out, Disclosure, and Passing; Cultural Dissemblance (of African Americans); Don’t Ask, Don’t Tell and Public Opinion; Down Low; Gaydar; Heteronormativity; Homonormativity; Minority Stress; Queer Politics; Stealth (Transgender Passing); Strategic Disclosure

Further Readings Adams, T. E. (2011). Narrating the closet: An autoethnography of same-sex attraction. Walnut Creek, CA: Left Coast Press. Barton, B. (2012). Pray the gay away: The extraordinary lives of Bible Belt gays. New York, NY: New York University Press. Closet. (n.d.). In Oxford English dictionary. Retrieved July 20, 2014, from http://www.oed.com Cowell, A. (2014, February 24). Uganda’s president signs antigay bill. New York Times. Retrieved October 1, 2014, from http://www.nytimes.com/2014/02/25/ world/africa/ugandan-president-to-sign-antigay-law .html Kramer, A. E. (2013, June 11). Russia passes bill targeting some discussions of homosexuality. New York Times. Retrieved October 1, 2014, from http://www .nytimes.com/2013/06/12/world/europe/russia-passesbill-targeting-some-discussions-of-homosexuality.html Sedgwick, E. K. (1990). Epistemology of the closet. Berkeley: University of California Press.

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COLAGE

COLAGE COLAGE is a national nonprofit organization for individuals with at least one lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) parent. According to the COLAGE website, the organization’s mission is to unite people with LGBTQ parents “into a network of peers” and to support them “as they nurture and empower each other to be skilled, self-confident, and just leaders” in their communities. COLAGE, which previously stood for Children of Lesbians and Gays Everywhere, expanded its mission in 1996 to explicitly include children of bisexual and transgender parents. The organization has sought to break down the social isolation and discrimination that individuals with LGBTQ parents face by offering peer support, education, leadership, and advocacy programs. COLAGE has local chapters throughout the United States led by youth and young adults with LGBTQ parents and provides online forums and communities for people across the world to connect around their unique experiences. COLAGE staff and volunteers also provide workshops for youth and adults with LGBTQ parents and networking events for parents in various locations around the country. Perhaps most notably, COLAGE partners with the Family Equality Council each summer to provide youth programming at Family Week in Provincetown, Massachusetts. The COLAGE website also offers several written resources for individuals with LGBTQ parents, as well as for parents, researchers, and educators. This entry provides a history of the organization’s founding and programming and concludes by discussing the importance and significance of COLAGE in the context of social science research. COLAGE was founded in the early 1990s by a small group of young people with lesbian and gay parents, who had grown up in the 1960s and 1970s when there were few networks or resources for LGBTQ-parent families. These founders grew up thinking there were no other children like them, as the majority of LGBTQ parents at the time came out after the birth of their children but remained largely closeted. Many of these parents

kept their sexual and gender identities secret for fear of losing custody of their children. Some of these parents (primarily middle-class, White fathers in major metropolitan areas) began to organize family social activities that brought their children an opportunity to connect with other youth in similar circumstances. In 1979, at the first National March on Washington for Gay and Lesbian Rights, several local gay fathers’ groups formed a national network called the Gay Fathers Coalition. In 1986, the Gay Fathers Coalition was renamed the Gay and Lesbian Parents Coalition International (GLPCI). COLAGE grew out of an early GLPCI annual conference, where several parents in attendance organized activities for their children who had come to the conference with them. These youth quickly recognized that they—rather than their parents—were the experts on growing up in lesbianand gay-parent families and, as such, should be organizing their own supportive and educational activities. They also wanted other children with lesbian and gay parents to have the opportunity to connect with one another in this way. In 1990, under the name Just for Us, this small group of young people began putting out a periodic newsletter and running local chapters. In 1993, the group adopted the name Children of Lesbians and Gays Everywhere (COLAGE). In 1995, COLAGE opened a volunteer-run national office in San Francisco. The organization hired its first paid director in 1997 and became an independent 501(c)(3) in 1999. During the late 1990s and early 2000s, COLAGE began to respond to the needs of a new generation of COLAGErs: Children of the “gayby boom,” whose parents had chosen to form families after coming out, often through adoption or reproductive technology. Although these children still had much in common with previous generations of COLAGErs, they also experienced different benefits and challenges. COLAGE has continued to develop its programs to address the shifting demographics of its membership and to reach historically underserved constituents. COLAGE has designed workshops specifically for youth of color with LGBTQ parents that focus on racism,

College Athletes

interracial adoption, and the intersectionality of race and sexual orientation, as well as workshops that teach White youth about racism and White privilege. Further, even though COLAGE was started by children of queer parents, these leaders were not exempt from the pervasive internal and external heteronormativity that is socially carried. Thus, it took COLAGE time and work to accept bisexual and transgender people as their own and to more fully achieve inclusion of all queer families. Since 2010, COLAGE has developed programming for Kids of Trans (KOT) parents that addresses specific needs of the KOT community. In the past decade, social science researchers have begun to investigate the importance of peer support for youth with LGBTQ parents. Social support from peers, especially other youth with LGBTQ parents, is thought to buffer the negative influences of heterosexism and homophobia that these youth encounter. COLAGE has been cited in several studies in which youth and young adults with LGBTQ parents have shared the critical role the organization has played in their social and personal growth and development. Findings from these studies provide evidence of the importance of organizations such as COLAGE that provide opportunities for individuals with LGBTQ parents—especially children and youth in isolated social and geographic contexts—to connect with one another and realize that they are not alone. Katherine A. Kuvalanka, Anna Heller, and Robin Marquis See also Adults With LGBQ Parents; Children With LGBQ Parents, Psychosocial Outcomes; Children With LGBQ Parents, Stigmatization; Multiracial LGBTQParent Families; Support Groups and Resources

Further Readings COLAGE. http://www.colage.org Fakhrid-Deen, T., & COLAGE. (2010). Let’s get this straight: The ultimate handbook for youth with LGBTQ parents. Berkeley, CA: Seal Press. Family Equality Council. http://www.familyequality.org/ Garner, A. (2004). Families like mine: Children of gay parents tell it like it is. New York, NY: HarperCollins.

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Kuvalanka, K. A., Leslie, L. A., & Radina, R. (2014). Coping with sexual stigma: Emerging adults with lesbian parents reflect on the impact of heterosexism and homophobia during their adolescence. Journal of Adolescent Research, 29, 241–270. Kuvalanka, K. A., Teper, B., & Morrison, O. A. (2006). COLAGE: Providing community, education, leadership, and advocacy by and for children of gay, lesbian, bisexual, and transgender parents. Journal of GLBT Family Studies, 2(3/4), 71–92.

COLLEGE ATHLETES Within the university setting, collegiate athletics has historically been considered an area of extreme prejudice and discrimination related to sexual orientation. The climate that nonheterosexual college student-athletes experience is typically recognized as one of the most oppressive compared with other campus settings; some research has shown it to be the most oppressive. For nonheterosexual college athletes, such an environment can lead to identity compartmentalization, in which the individual focuses on one aspect of identity—typically, being a student-athlete—and minimizes other aspects, including sexual identity. Because of the suppression of aspects of one’s identity, the ability to develop into a healthy, complete individual—as one ideally should experience during late adolescence and early adulthood—is often challenging for college student-athletes. This entry provides an overview of the college studentathlete experience for nonheterosexuals, compares their experiences with other college studentathletes, and discusses efforts within one U.S. collegiate athletic governing body to address climate and policies regarding nonheterosexual and transgender student-athletes.

Experiences of LGBTQ College Athletes For men’s sports, the climate of hypermasculinity overshadows other considerations and creates an environment where those who are “less than real men” would not be found, and if they are, they

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are typically not welcome. For women’s sports, the assumption of prevalent lesbianism creates a culture that off the field emphasizes femininity and distancing oneself from even the possibility of nonheterosexuality. Within the college setting, these ideas often drive college coaches to implement rules and guidelines to reinforce gender norms and heterosexuality, such as feminine dress codes off the field to help combat the perception that players may be lesbian. Within female collegiate athletics, just the perception of nonheterosexuality can affect multiple aspects of the environment—from recruitment and playing time for the studentathletes, to recruitment and selection of female coaches. Very little research on the experience of transgender athletes has been completed in general; most of what is published focuses on the medical and physiological aspects of transgender issues in single-sex sports. The few studies that examine the experiences of transgender athletes do not focus on college student-athletes, so little is known about their experiences beyond personal stories shared in collegiate athletic reports and the media. Those stories discuss the challenges of transition, the support, and the harassment that transgender college student-athletes may experience. The limited comparison research available indicates that LGBTQ college student-athletes experience more harassment and a more negative climate than their straight and cisgender teammates. Not only do these experiences affect their ability to successfully perform their sport; they also affect their ability to succeed academically. At the same time, some research indicates that the generally decreasing level of homonegativism occurring in society is also occurring in the college athletic environment. Attitudes within both male and female sports are more accepting than in previous decades, and many student-athletes express direct and unequivocal support for queer individuals and the potential (or reality) of a gay or lesbian teammate. Within the United States, there have been collegiate athletes who have come out, with some doing so very publicly—such as Michael Sam, who became the first college football player

to come out as gay preceding his draft to the National Football League.

Policies Related to LGBTQ College Athletes Some collegiate athletic programs in the United States are governed by the National Collegiate Athletic Association (NCAA), which has a policy that prohibits discrimination based on sexual orientation. In 2011, the NCAA adopted a policy for transgender student-athletes. However, transgender individuals need to consider eligibility requirements for a system that is based on binary sexes. In the NCAA transgender policy, although student-athletes can modify their appearance and use different names and pronouns without any impact, hormone use changes their eligibility. A female-to-male student-athlete using testosterone can compete on a men’s team or a mixed-gender team but cannot compete on a female-only team. A male-to-female student-athlete who is taking testosterone-suppression medication may compete on a men’s team or a mixed team, and after one year of testosterone-suppression treatment is eligible to compete on a women-only team. While issues of transition are relevant for all transgender athletes, for college student-athletes who are receiving a scholarship or assistance for housing and expenses, the decision to transition may affect not only their ability to play athletics but also their ability to attend the university. Colleges and universities that are not members of the NCAA may or may not have policies that protect student-athletes based on sexual orientation, gender identity, or gender expression, or policies that guide the transition process for transgender student-athletes. This lack of structure and protection further challenges the student-athlete to feel comfortable coming out or to start transitioning because of the unknown response. One of the challenges in the collegiate setting is the generational differences between coaches and players. Younger individuals—like student-athletes— are typically more accepting of nonheterosexual and non-cisgender people than their coaches, who are

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often from an earlier generation and have been enmeshed in an athletic culture that is not supportive of nonheterosexual and non-cisgender people. The power differential in the relationship between student-athletes and coaches seldom allows for the education to flow in a direction from studentathlete to coach. For progress to be made in the collegiate athletic setting, the involvement of coaches and, similarly, athletic directors will be essential. To that end, in 2012 a subcommittee within the NCAA commissioned a best-practices document— Champions of Respect: Inclusion of LGBTQ Student-Athletes and Staff in NCAA Programs— Programs—that provides guidelines for coaches, athletic departments, and athletic directors. While directed toward NCAA-affiliated programs, the recommendations are applicable to any college athletic environment. Sara B. Oswalt See also Campus Climate; College Students; LGBTQ (In)Visibility Within College Contexts; Sports, SexualMinority Men in; Sports, Sexual-Minority Women in

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(e.g., race, ethnicity, social class, age, faith tradition, nationality), academic majors and interests, and academic experiences (e.g., transfer students, part-time and full-time status, student veterans). They also differ within the LGBTQ category by sexual orientation and gender identity; a growing number of students identify outside the categories represented in the LGBTQ acronym as, for example, pansexual, asexual, or genderqueer. Despite increased visibility of LGBTQ college students, only a handful of institutions ask students for their sexual orientation and gender identity in a way that makes it possible to determine with accuracy their number in postsecondary education. Estimates of the number of LGBTQ students range from 3% to 10% of the overall student population. This entry addresses (a) the history of LGBTQ students in U.S. higher education, (b) identities of LGBTQ college students, (c) campus climate for LGBTQ students, and (d) multiple identities of LGBTQ students.

History of LGBTQ College Students Further Readings Anderson, E. (2011). Updating the outcome: Gay athletes, straight teams, and coming out in educationally based sport teams. Gender & Society, 25, 250–268. doi:10.1177/0891243210396872 Griffin, P., & Carroll, H. (2011). NCAA inclusion of transgender student-athletes. Retrieved August 20, 2014, from http://www.ncaa.org/sites/default/files/ Transgender_Handbook_2011_Final.pdf Rankin, S., & Merson, D. (2012). Campus Pride 2012 LGBTQ national college athlete report. Charlotte, NC: Campus Pride.

COLLEGE STUDENTS LGBTQ students exist on every college campus regardless of institutional type (2- or 4-year, public or private, religiously affiliated or secular), region, or size. LGBTQ students are diverse across several dimensions, including demographics and identity

From the late 1800s through the mid-1900s, postsecondary approaches to LGBTQ students took a “deviance and disease” approach, which kept these students largely out of sight. The disease model was especially salient through the 1950s, when students with same-sex desire were seen as having a serious personality, medical, or psychological problem and same-sex sexuality was cast as “not normal.” Through the mid-20th century, students suspected of same-sex sexual activity were expelled from many campuses, individually or in larger “purges” of suspected homosexual social groups. The foundation of the college counseling and student affairs professions in the mid-1900s promoted a shift from this punishment orientation to one of “treating” students who expressed homosexual or unexpected gender tendencies. From the mid-1900s to 1974, when the American Psychiatric Association stopped classifying homosexuality as a mental disorder, campus officials and medical providers believed it was a treatable condition and could be cured or controlled

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through psychological and/or religious interventions. Expulsions continued, but treatment approaches overtook them as the primary means of dealing with students suspected of being sexual or gender minorities. There was also an increase in research about sexuality during this time, including same-sex sexualities, which made possible shifts in understanding, from same-sex desire as deviant toward conceiving of variations in sexuality as a part of human diversity. In addition to the landmark 1974 decision to remove homosexuality from the list of psychological diseases, social movements off campus in the late 1960s and early 1970s broke the silence and invisibility of LGBTQ students. The 1969 Stonewall riots, which represented interests of both sexual and gender minorities and catalyzed the gay and lesbian movement, occurred at the same time as early efforts to organize gay (then also lesbian, bisexual, queer, and transgender) students in higher education. Movements with names like the Student Homophile League and Gay Liberation Front spread to dozens of campuses in the early 1970s. These movements raised visibility of gay and lesbian students, and university administrators and educators noticed them. After 1974, a consensus emerged among student affairs professionals in higher education that sexual-minority students were not a threat to themselves or campus safety. Gay and lesbian (then also bisexual) activist movements on and off campus continued to bring attention and visibility to issues of sexual orientation. Among the earliest tasks of nascent student organizations was to press for permission to meet on campus and hold events. A number of lawsuits at public universities in the 1970s paved the way for the growth of student organizations and increased visibility for LGBTQ students in higher education. Unlike in the gay and lesbian rights movement (e.g., Queer Nation, ACT UP, Gay Liberation Front), the transsexual (later, transgender) rights movements (e.g., Transsexual Menace) outside higher education did not lead to the formation of campus groups (e.g., Student Homophile League). The first transgender student groups formed on campuses in the 1990s, often but not always aligned with student

organizations for sexual-orientation minorities. Around the same time, campus policies and local, state, and federal laws related to nondiscrimination on the basis of sexual orientation and gender identity provided further support for equitable treatment of LGBTQ students. Today more than 2,000 LGBTQ student organizations exist on college campuses, providing social, support, educational, and activist outlets.

LGBTQ Identities in College Students Some students enter higher education knowing that they are LGBTQ; other students become aware of their sexual orientation and/or gender identity while in college. Research about LGBTQ identity development represented an early step in empirical investigations about queer and trans college students. For lesbian, gay, bisexual, and queer (LGBQ) college students, stage-based models developed with nonstudent samples dominated the literature through the 1990s. These models focused on resolving internal conflict about one’s sexuality through the process of coming out to self and others. Movement through stages depended on interactions of the individual with family, friends, and other LGBQ individuals. Positive responses from others were believed to lead to further disclosure; negative responses could delay or halt identity development. Contemporary scholars take a different, nonlinear approach, presenting models of identity processes or of patterns among similarly identified individuals. Some of these models share the “coming out” focus of the stage models, with an emphasis on the contexts in which individuals disclose their sexual orientation identity. Other models describe the ways that the environment influences situational identification as LGBQ. Emerging research points to the complexity of the concept of “sexual orientation identity” in the 21st century, when self-identification, ascribed identity, emotions, and behaviors may point to different definitions of sexuality. An asexual college student, for example, may also identify as heterosexual or as LGBQ, based on emotional attraction, yet not engage in behaviors that some

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people would consider essential to understanding one’s sexual identity. Given the historical classification of gender identity disorder as a mental illness, a medical/ psychiatric lens is often the base for considering transgender identity development. Relying solely on diagnostic criteria with respect to transgender students ignores identity processes and patterns of this population, as well as the interaction of the college experience with gender identity. While gender dysphoria (formerly gender identity disorder), listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (5th edition; DSM-5), remains a psychological condition in need of treatment, the propensity for higher education professionals to see trans students exclusively through a lens of deviance and disease is slowly abating. However, even with trans identities remaining classified within a disease model, access to competent medical and psychological services remains a challenge for many trans students. There are a number of nonclinical models of transgender identity development, most describing identity across the life span and not limited to the college experience. Some reflect the stagebased approach to sexual orientation identity development, in which the individual moves from self-discovery as not cisgender (parallel to selfdiscovery as not heterosexual) to disclosure of trans identity to an increasingly wide circle of family, friends, peers, coworkers, and transgender communities. Other models focus on key milestones that many transgender individuals reach, though not necessarily in a set order. For example, a milestone for transsexual individuals might be gender-reassignment surgery. Given the wide range of identities and experiences that fall under the umbrella of transgender identities, existing models may lack the ability to account for the complex processes that making sense of one’s gender identity often entails. There is some evidence that the postsecondary context provides opportunities to explore gender identity and expression; there is also evidence that postsecondary institutions are locations for the reinforcement of genderist assumptions related to fixed, binary gender

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categories that place masculinity and femininity at opposite poles that do not intersect.

Campus Climate for LGBTQ Students Studies of campus climate are performed on individual campuses and, occasionally, on the basis of a national sample. LGBTQ students report being harassed, threatened, and/or physically harmed, though evidence demonstrates that postsecondary campus climate is generally better than the secondary school climates from which students come. Transgender students report more negative incidents than do cisgender students of any sexual orientation. Campus climates are shifting in the 21st century as public policy relating to, and societal opinions about, LGBTQ people continue to evolve in a positive direction. Overt hostility, such as vandalism of LGBTQ student organization property or threats and violence against individuals, has declined, although anti-LGBTQ microaggressions continue to shape campus climates. While support has grown for same-sex marriage and for bans on sexual orientation and genderidentity discrimination in employment, and while anti-LGBTQ violence, harassment, and discrimination have decreased in frequency over time, less obvious forms of anti-LGBTQ bias persist in the lives of college students. Microaggressions are the everyday, sometimes unintentional, words and actions that invalidate, silence, and make invisible LGBTQ identities and experiences; examples include the use of the phrase “That’s so gay” as a universal put-down, the lack of gender-inclusive language on campus surveys, and refusal to use students’ chosen names and pronouns. Exposure to microaggressions in the college environment has a negative effect on LGBTQ students’ psychosocial, physical, and academic well-being. Recent research indicates, however, that LGBTQ students are resilient in the face of adversity. LGBTQ climate varies across institutions and institutional types. For example, many religiously affiliated institutions remain unwelcoming to LGBTQ college students; some continue to expel transgender students from campus housing and compel gay and lesbian students to take additional

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pledges of purity beyond those required of presumably heterosexual students. A few Catholic and other Christian institutions (e.g., Calvin College, Loyola University of Chicago) have made intentional and specific efforts to more fully support LGBTQ students on their campuses. Progressive public and private institutions provide gender-inclusive housing and public facilities (e.g., restrooms, locker rooms), straightforward processes to change one’s name in campus records, LGBTQ curriculum, an array of student organizations, and well-trained professionals across campus who implement LGBTQ-positive policies and programs. Some campuses (currently fewer than 200, but with more opening each year) have LGBTQ campus resource centers (CRCs) or provide partor full-time staff responsible for supporting the LGBTQ community.

Multiple Identities of LGBTQ College Students Although much of the existing research on LGBTQ college student experiences and identities ignores other identities—such as race, faith tradition, ability, and social class—that may be salient to those students, scholars are beginning to examine multiple and intersecting identities in college students. Research indicates that people of color who identify as LGBTQ, or other more culturally specific terms like same-gender-loving or two-spirit, may experience the negative effects of heterosexism and genderism as well as racism or combinations of these oppressive forces. They may face antiLGBTQ sentiment among peers of their racial or ethnic background and racism among mostly White groups of LGBTQ peers at predominantly White institutions (PWIs). However, research that takes an appreciative stance indicates that some LGBTQ students of color demonstrate resilience in the face of multiple and overlapping systems of oppression. For example, some biracial, bisexual students indicated that they developed their racial and sexual identities on parallel, but related, tracks and that the college environment provided unique opportunities for identity development in these domains.

A small body of evidence addresses intersections of LGBTQ and religious (sometimes called spiritual or faith) identities among college students, mainly addressing students with Judeo-Christian faith identities and experiences. A strong faith identity, particularly if that identity is rooted in a conservative tradition, may lead to feelings of guilt, shame, or confusion about an LGBTQ identity. Conversely, a strong LGBTQ identity may lead some students away from a religious tradition that they find constraining. An increasing body of research finds that some college students are able to reconcile and integrate their sexual, gender, and religious selves. Other LGBTQ students may leave organized religious traditions to explore dimensions of spirituality and faith outside formal religion. Studies suggest that creating spaces for LGBTQ students of faith to discuss their identities is particularly important in the development and maintenance of a positive self-concept. In another area of multiple identities, LGBTQ college students with disabilities may find communities among supportive peers, staff, and faculty. LGBTQ deaf students network on their own campuses and through national organizations that are facilitated primarily through online communities and regular in-person conferences. The academic areas of disability studies and queer studies share some theoretical assumptions about embodied identities and the medicalization of the so-called abnormal in society. LGBTQ college students and faculty with disabilities have been leaders in both academic areas. Social class remains an understudied area of higher education in general and of LGBTQ student experiences and identities in particular. The ways that social class identities interact with and mutually cocreate sexual orientation and gender identities are understudied. It is also not clear how a socioeconomic analysis of LGBTQ college student outcome (such as graduation rates, selection of majors, sense of belonging on campus) might reveal differences across economic quartiles. Presumably LGBTQ students are distributed evenly across the quartiles and their outcomes would mirror those of their socioeconomic peers. But studies of LGBTQ youth show that they are more likely

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than heterosexual and cisgender youth to be homeless or in foster care; how their overrepresentation in the lower-income quartiles might appear in college data is unclear.

LGBTQ Students at Colleges and Universities With Specialized Missions The majority of U.S. colleges and universities have missions that are not specific to religion, race, or gender. Several hundred, however, are affiliated with religious denominations (mainly Catholic and Christian, with a few Jewish, Muslim, and Hindu) and have missions to promote the values and/or practice of those denominations; 106 public and private institutions were designated in 1964 as historically Black colleges and universities (HBCUs) and maintain strong commitments to educating African American and Black students; and there are about four dozen private women’s colleges remaining (down from a high of more than 200 in the mid-1900s). There are LGBTQ students at all of these institutional types, and sometimes the mission of the institution creates different conditions for identities, experiences, and climate from those that exist at public and secular private PWIs and at coeducational institutions of all types. The history of U.S. higher education is inextricably bound to the establishment and spread of (mostly Christian) religious denominations across the North American continent. Hundreds of colleges founded by religious denominations persisted to become private colleges and universities of varying degrees of religiosity in the 21st century; many dropped their denominational ties entirely, while others retain strong affiliations with religious traditions and require students, faculty, and other employees to sign a document that defines codes of beliefs and behavior. Some students may identify as LGBTQ before entering these faith-based institutions, but others may come to understand themselves as LGBTQ after beginning college. In both cases, LGBTQ students are in a position that may compromise their continued enrollment if their identities become known. Navigating institutional enactment of doctrinal teachings about homosexuality (hate the sin, love the sinner) may become part

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of their college lives. Catholic institutions are unlikely to compel students to sign a faith-statement, and LGBTQ students are a visible presence on many Catholic campuses, though they may not be allowed to create formally recognized student organizations. HBCUs on the whole lack institutionalized support for LGBTQ students. Few HBCUs have professionally staffed LGBTQ resource centers, their library holdings have limited LGBTQ materials, and the area of queer studies is not visible in their curricula. About two dozen HBCUs, one quarter of the institutions in this sector, have LGBTQ student organizations. Paul Quinn College and Morehouse College have articulated dress-code policies that strictly forbid gender nonconformity; students at all-male Morehouse, for example, are not to dress in women’s clothing. Research demonstrates that while there are a number of openly LGBTQ students at HBCUs, they typically experience conflicting messages about embracing racial pride in themselves while carefully monitoring their gender and sexual orientation expression to avoid violating stated and tacit norms about what it means to be an educated Black man or woman. Although a number of prominent Black queer intellectuals do work in the intellectual area of gender and sexuality within African American communities, HBCUs generally have not reflected progressive views on LGBTQ issues or embraced progressive approaches to their queer students. Women’s colleges are in a unique situation among these special mission institutions, in that gender identity has been built into them from their beginnings in the early 1800s when they were the only option for female students aspiring to education past secondary school. Evidence indicates that women’s colleges have, from their early days, been the location of romantic friendships and sexual activity between students. Concern that they would be considered “hotbeds” of lesbian activity led some women’s colleges to react with extremely vigorous campaigns to eradicate any signs of “particular friendships” on their campuses; other colleges became sanctuaries of a sort for women who found themselves attracted to other women. By the 1990s, most secular women’s colleges

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settled into their reputations as tolerant—but not promoting—of lesbian and bisexual identities on campus. In the 21st century, an influx of trans students has challenged women’s colleges to clarify their admissions and continuing enrollment standards. Most women’s colleges admit students who are legally female at the time of application, regardless of their gender identity; the result is a visible population of trans masculine spectrum students and transgender men on some women’s college campuses. Trans feminine spectrum individuals and transgender women who are legally male, however, are not welcome to apply to most women’s colleges. Given the low likelihood that students in the traditional applicant pool for women’s colleges—first-time, first-year students just out of high school—have had the opportunity to attain hormone therapy and/or surgery necessary to change their legal sex (or gender in some states), the number of transgender women attending women’s colleges is likely to remain low until institutional policies or civil statutes regarding gender assignment change. In 2014, two women’s colleges (Mills and Mount Holyoke) articulated admissions policies that are inclusive of transgender students; Mount Holyoke will consider applications from qualified applicants who are biologically female and any gender identity, or who are biologically male and any gender identity other than cisgender male. Kristen A. Renn and Erich N. Pitcher See also Activists in College; Campus Climate; College Athletes; Education; Historically Black Colleges and Universities, LGBTQ Students at; Transgender Inclusion on College Campuses

Further Readings Dugan, J. P., Kusel, M. L., & Simounet, D. M. (2012). Transgender college students: An exploratory study of perceptions, engagement, and educational outcomes. Journal of College Student Development, 53(5), 719–736. doi:10.1353/csd.2012.0067 Dugan, J. P., & Yurman, L. (2011). Commonalities and differences among lesbian, gay, and bisexual college

students: Considerations for research and practice. Journal of College Student Development, 52(2), 201–216. doi:10.1353/csd.2011.0027 Marine, S. (2011). Stonewall’s legacy—bisexual, gay, lesbian, and transgender students in higher education [Special issue]. ASHE Higher Education Report, 37(4). Spade, D. (2011). Some very basic tips for making higher education more accessible to trans students and rethinking how we talk about gendered bodies. Radical Teacher, 92, 57–62.

COLORADO DESIGNATED BENEFICIARY A designated beneficiary agreement (DBA) is a legal document available only in Colorado that allows any two unmarried individuals to designate each other for one or more important purposes, such as medical decision making and inheritance. The two people do not need to live together or be in an intimate relationship. Although it is not limited to same-sex couples, the 2009 act creating designated beneficiaries was the first Colorado law that did extend a limited set of legal rights to samesex couples. Both parties to a DBA must be 18 years or older, competent to contract, unmarried, and not already a party to a DBA. The parties must sign the agreement voluntarily. There are 16 possible legal rights that the parties to a DBA may select. The parties need not select all 16. In addition, the parties may select different legal consequences for each other. The agreement must be signed and notarized and must be filed with the county clerk and recorder in a county in which one party resides. Some of the most important rights and protections that two people may choose in their DBA are the right to visit in a hospital, nursing home, hospice, or similar facility; to make complaints about the patient’s treatment at a nursing home facility; to make health care decisions when the patient cannot make his or her own decisions; to inherit if the other party dies and has not written a will; to obtain survivor’s benefits if the other party dies on the job, or to sue for wrongful death; and to determine the disposition of the other party’s remains

Colorado Designated Beneficiary

upon death. These go into effect immediately upon signing the DBA and filing it in the office of the county clerk and recorder where one of the designated beneficiaries lives. Either party can revoke the DBA by filing a notarized revocation with the county clerk’s office where the DBA was recorded. The subsequent marriage of one of the parties also automatically revokes the DBA. In addition, either party can execute other documents, including a will, medical power of attorney, or advance directive concerning medical treatment and disposition of remains, and those documents supersede a DBA. The law creating DBAs was enacted in 2009 at the urging of Equal Rights Colorado, the state’s LGBT-rights legislative advocacy organization. In 2006, Coloradans had voted to define marriage as between a man and a woman in the state constitution and had defeated a proposal to create a statewide domestic partnership status. In 2009, unable to get the legislature to pass either civil unions or marriage for same-sex couples, LGBT-rights advocates and their allies saw enactment of the statute authorizing DBAs as a stepping-stone toward greater rights in the future. Opponents of greater recognition for same-sex couples also understood this legislation as an incremental step toward same-sex marriage and resisted it for that reason. In 2010, One Colorado Education Fund, an education and research organization dedicated to LGBT equality, conducted a survey of 4,600 LGBT Coloradans. Over 30% of the respondents were unaware of the law that had created DBAs. Over half of all respondents were in committed relationships, and, of those, 34% had a DBA. The Colorado LGBT community had additional legislative success in 2013, when a vote of the legislature created civil unions, available to both same-sex and different-sex couples. That law provided that “a party to a civil union has the rights, benefits, protections, duties, obligations, responsibilities, and other incidents under law as are granted to or imposed upon spouses.” In October 2014, as a result of a ruling, binding in Colorado, by the U.S. Court of Appeals for the 10th Circuit, the state began allowing same-sex couples to marry.

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Colorado’s designated beneficiary status is unique. It most closely resembles the status of reciprocal beneficiaries created in Hawaii in 1997, the first U.S. law with the explicit purpose of providing some legal rights to same-sex couples. Colorado’s DBA differs from that status in two important ways, however. Hawaii made its status available only to two people who could not marry each other, thereby excluding heterosexual couples. The Hawaii status also confers identical, enumerated rights on the two parties. In Colorado, the parties to a DBA select for themselves which of the 16 legal consequences they wish, and they need not select the same ones. This flexibility allows the two parties to tailor their DBA to their individual circumstances. The DBA legislation remains in effect. Because LGBT advocates saw DBAs as a stepping-stone to greater rights, some might question the purpose of retaining the DBA option. The value of this alternative, however, is its availability to couples who do not choose to marry and to any two unmarried individuals who wish a way to give an unrelated person a status that resembles that of next of kin. For example, when an unmarried person who has not drafted power of attorney documents is incapacitated and cannot make health care decisions or manage his or her affairs, the law generally gives decision-making power to relatives such as parents, adult children, siblings, or more distant relatives. When an unmarried person dies without a will, the law names some of those same relatives to inherit the deceased’s estate. When a person marries, any rights those relatives would have automatically become secondary to the spouse, who becomes the legal next of kin. A DBA allows a person who is unmarried to name someone who would become his or her next of kin for the specific purposes identified in the DBA. This is an especially important option for unmarried LGBT individuals who have chosen family and may be estranged from their relatives. The marriage-equality movement has faced criticism from some within the LGBT community for assimilating to a heterosexual norm. A DBA is an example of a mechanism that can be used creatively to confer limited legal consequences on

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relationships that do not mirror marriage. In the wake of nationwide marriage equality, LGBT advocates may use Colorado’s DBA statute as a starting point for developing similar legal structures in other states. Nancy D. Polikoff See also Hospital Visitation; Legal Recognition of Nonmarital Same-Sex Relationships; Marriage, Reasons for and Against; Powers of Attorney; Wills and Trusts

Further Readings Berg, N. C. (2011). Designated beneficiary agreements: A step in the right direction for unmarried couples. University of Illinois Law Review, 2011(1), 267–307. Colorado Bar Association. (2012). Colorado’s Designated Beneficiary Agreement Act. Retrieved from https://www.cobar.org/index.cfm/ID/21614 Feinberg, J. R. (2013). Avoiding marriage tunnel vision. Tulane Law Review, 88, 257–315. Trageser, C. (2009, July 1). Designated beneficiary rules grant unmarried pairs decision-making power: Partners in life, by law. Denver Post, p. B-01. Retrieved from http://www.denverpost.com/ci_12727790

COMING OUT, DISCLOSURE, AND PASSING Coming out is a commonly used trope in LGBTQ life, literature, media, and research. Coming out is behind the scenes, often assumed by scholars as a process occurring but seldom defined. Colloquially, coming out refers to the disclosure of sexual identity, but the metaphor has grown to encompass the disclosure of any LGBTQ identity to others, or even the claiming of nonqueer identities to further a social movement, such as “coming out as fat.” Coming out can refer to the internal claim to an identity—“coming out to myself”—as well as the disclosure of that identity to others. Conversely, people are passing when others assume them to be heterosexual or straight in a given situation. Because of the history of the

concept, coming out is often seen as a one-time event: “When did you come out?” However, scholars today see coming out as an ongoing process of managing one’s identity, which can involve disclosing to some people and passing with others. In the context of research, the concept of coming out has had a tangled and convoluted history, emerging from folk meanings about the public embrace of a gay identity to the ongoing struggle of regulating knowledge of one’s LGBTQ identity within a society that assumes heterosexuality. This entry first covers the development of the concept of coming out and continues with a discussion of research on the strategies, motivations, and future of coming out.

The History of Coming Out The metaphor “coming out of the closet,” although common today, was not the original use of the term. Rather, the term referred to coming out into queer society, meaning that people were revealing themselves to be gay to other gay people, in a manner akin to the “coming out” of debutantes at a high-society ball. Later, however, the term was combined with the metaphor of the closet, implying the oppressive, shameful existence of “living a lie.” Coming out in this metaphor, then, is not about the acceptance of a gay identity but the disclosure of that identity to straight people. Researchers began discussing coming out in earnest as psychologists attempted to understand patients who were struggling with integrating their homosexual identity, often within communities that stigmatized homosexuality. Building on Erik Erikson’s stage model of psychological development over the life course, Vivienne Cass’s stage model of homosexual identity development is perhaps the single most influential study on coming out from this period, given that these stages influenced a generation of research on gay people and her assumptions about the nature of coming out linger to this day. In Cass’s model, coming out was a feature of the “identity tolerance stage” in which gay men, having realized and accepted their attraction to other

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men, begin to live a double life. With other gay people, they were publicly gay, whereas with straight people, like their families, they continued to pass as straight. Coming out, then, was the disclosure of their identity such that they no longer had to live a double life, but were beginning to synthesize the two identities into a single, integrated identity in the next stage. Later theorists continued to rely on Cass’s model, but began to see the stages as too rigid to aptly describe real life. Instead, researchers adapted these stages into a more fluid “coming out process.” In this definition, coming out was a process of disclosing identity to more people over time, thus indicating a commitment to a gay identity. Milestone events in the process were coming out to family members or friends. Conceptions of coming out as a process, though, still retain a stagelike linearity, as though one simply accumulates disclosures until one is “out.” During the social constructionist turn in LGBTQ studies, scholars began to move away from essentialist notions that gay identity developed in the same way for everyone; in turn, there was an explosion of new research into coming out. However, while many researchers between 1990 and 2004 introduced new definitions of coming out, these definitions did not engage with one another, leading to more confusion. Largely, coming out was seen as an individual matter, with different researchers emphasizing different aspects, such as emotional connection, the family life cycle, or using their own lives as models to define coming out. Coming out in this era was seen as an act of disclosure to specific people at specific times, rather than part of an overarching process. Although coming-out researchers proposed these changes, other scholars applying the concept in studies continued to refer to coming out as a one-time event, primarily involving an emotionally charged verbal disclosure of identity. Most research was within a psychology frame, focusing on the mental health outcomes of gay people, and so viewed these disclosures, or instances of passing, as reflecting internal states of identity, rather than contextual social interaction in the long-term

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management of identity. One way to think of the difference between these two perspectives is to think about “coming out to oneself” versus “coming out to others.” Scholars today see coming out as an ongoing process of identity management, focused on how and why people come out to others, not just their identity development. LGBTQ people make decisions about which contexts and people warrant disclosure versus passing. Of course, it is impossible for truly everyone to know about someone’s gay identity within a society that assumes heterosexuality. There will always be strangers that do not know about one’s LGBTQ identity. Therefore, the possibility of coming out is always there. Different scholars use different metaphors to describe this situation, but they are similar in describing an ongoing contextual social process of managing identity. Some use the metaphor of “being out,” although this has grown out of favor since it implies an essential situation in which everyone knows one’s sexual identity. Other scholars discuss coming out as a “revolving door,” in which people are constantly coming in and out of the closet as they move through different situations. Others use the metaphor of a “career.” This metaphor also emphasizes that coming out is always happening in one’s life. Others consider LGBTQ people to have a “strategic outness.” This perspective views coming out as continual and contextual. People can never completely disclose their identity to everyone. Rather, LGBTQ people continually make strategic decisions about what identity they will disclose to others and the methods they will use.

Methods of Coming Out and Staying In: Disclosure and Passing Although coming out is often discussed as though it is a moment of revelation, a public disclosure, and/or an emotional announcement, there are many ways that people come out, or manage who knows about their LGBTQ identity. This stereotypical coming out is the “direct disclosure” strategy. This is the “Mom, Dad, I’m gay” of coming out strategies.

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However, people can come out more subtly, without explicitly referencing their identity, by presenting clues. Often people use stereotypes of the group to indicate membership in it. The other person in the interaction, the person being come out to, infers group membership on the basis of such clues. Of course, the person has to understand the clue! If the other person doesn’t get the reference, or doesn’t associate it with the group, then that person might not receive the message because coming out is contextual. A woman who puts on a plaid flannel shirt might be giving a clue to indicate her lesbian identity, but it might not work as a clue in a midwestern rural town, where such clothing is more common among women. Clues depend on the social contexts the other person moves through, and the groups to which the person belongs. Coming out with an affinity is closely related to this category. In this case, the person comes out with a statement, such as “likes guys,” that the other person takes to mean that the person coming out is queer. Essentially, the person is coming out as “not straight,” or as LGBTQ, but it’s harder to pin down the exact identity term. Tailoring involves coming out using a different identity than the one that a person identifies with, but one that is also stigmatized. For instance, a bisexual man might tell someone that he is gay, such that this will be less remarkable to the person, or otherwise minimize questions or interaction in the coming-out encounter. In this way, tailoring takes us into the types of coming out that involve preventing someone from knowing a person’s identity. Passing is one such method: coming out by “staying in,” so to speak. It is coming out in the sense discussed throughout this entry, as an ongoing management of identity. Passing involves using the heterosexual assumption to stay under the radar, to pass as straight in the situation despite identifying otherwise. Concealment, on the other hand, refers to explicitly preventing others from finding out. Covering is also similar in that it is about minimizing clues to identity. However, in covering, people consider themselves to be “out” in the situation, but are merely trying to make their identity less salient by monitoring their behavior for stereotypical clues or other things that people might use to “clock” them as LGBTQ.

Last, speculating is the strategic abdication of a decision, a nonmethod method of coming out. If people leave observers to “speculate” about their identity, they are essentially saying that they don’t want to make a choice. They want other people to figure it out and ask them if necessary. Overall, coming out is accomplished in multiple ways, sometimes with multiple methods with the same person or context. LGBTQ people use different methods of coming out not only to manage knowledge of their identity, but also to regulate their distance from others in their life.

Motivations to Disclose or Pass The reasons for coming out are as diverse as the methods people use to accomplish it. Some people come out because they feel the need to be “true to themselves” or that they are “living a lie.” That is coming out as viewed as essential and mandatory. People must tell others because there will be negative impacts in their own lives if they do not. The reasoning is that honest people will disclose to others, since passing often involves covering or concealing aspects of their lives that would be clues to their LGBTQ identity. This motivation, however, cannot be divorced from the political context, in which coming out has been used as a tool of social change. The gay liberation movement encouraged coming out as a political strategy, because public visibility of LGBTQ people was thought to erode discrimination and secure rights. Harvey Milk, the slain gay civil rights leader, for instance, commanded in a speech: “Gay brothers and sisters, you must come out!” Research shows that LGBTQ people sometimes intentionally come out to people who they believe will react negatively so that they might educate these people, perhaps correcting stereotypes or stigma before others can be discriminated against. Coming out can also be dangerous. Some LGBTQ people refer to it as “explosive knowledge,” in that it could blow up in their faces if revealed to the wrong people. Even if it doesn’t provoke discrimination or violence, coming out can damage social relationships in which people thought they deserved to be told earlier or in a different manner.

Coming Out, Disclosure, and Passing

Thus, coming out can be exhausting emotional work. Unknowing people might ask personal questions or begin to apply stereotypes to someone who has come out to them. Since coming out is ongoing and never-ending, some LGBTQ people find it draining, preferring to minimize instances in which they will have to come out to new people. These different motivations for coming out (e.g., desire to live fully out, open lives; desire to educate others; desire to decrease stigma through visibility) work in concert. Research shows that people consider various factors, including the closeness of their relationships with individuals, to determine whether coming out is worth the risk and reward.

Differences in Coming Out Between Groups Scholars disagree about whether there are meaningful differences between groups in how and why people come out. Some researchers contend that the coming out process looks different for gay men than it does for lesbian, bisexual, transgender, and queer people. They argue that gay men have an easier time coming out than members of other groups, because the social privilege attached to being men often enables them to be financially independent from their families or stigmatizing communities. In this line of thinking, because women are subject to sexism, which lowers their economic potential, their ability to form lives separate from heterosexual marriage is hampered. Other researchers disagree, arguing that although the contexts in which gay men and lesbians might come out and have difficulty are different, they use similar methods and are motivated by similar reasons to come out. Coming out for bisexuals has an added dimension in that their relationships with the other sex fit societal expectations of heterosexuality. If a bisexual man introduces his wife to someone, that person—because of the heterosexual presumption— will assume that he is straight. In this case, is he passing, covering, speculating, or concealing? As discussed in the previous section, the interpretation depends on one’s political stance, with those

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advocating for bisexual visibility likely arguing that this man would have a “disclosure imperative” to reveal his sexuality to prevent others from assuming heterosexuality. There has been little research on whether the methods of coming out, the motivations for doing so, or how one would define coming out are different across racial groups. Initial indications from some research suggest that, again, the methods and motivations are similar, but the contextual considerations change. Much of the research in this area has focused on a case of passing within the Black community known as the “down low,” which has its own identity and social politics and is addressed in its own entry in this volume. Similarly, passing within the transgender community is sometimes called “going stealth,” which also has its own dynamics, identity, and political motivations, and is also addressed in a separate entry. Other factors influence the context that people use to manage who knows about their identity or if others accept that identity as legitimate. For example, research has shown that people who are perceived as conventionally attractive are more likely to receive feedback when coming out to the effect that their identity is not real, or that they are not truly LGBTQ. As an ongoing social process, coming out develops in concert with other social dynamics.

The Continuing Relevance of Coming Out When people come out, what are they coming out with? The identity that they reveal when they come out is just as important a factor as the methods and motivations for coming out. The diversity of identity labels today means that people can come out with identity labels beyond the traditional gay, lesbian, bisexual, and transgender. Coming out with a different label (i.e., one that most people are less familiar with) may mean that people will have more questions, and, in turn, create more emotional work for the person coming out. Furthermore, a number of scholars consider LGBTQ people today to be “beyond the closet” or “post-gay.” They believe that, with the growing acceptance of LGBTQ people in society, LGBTQ

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people no longer go through a “coming out experience.” Coming out is seen as an older model in which people identify with the gay social group and then disclose this to others. Today, it is thought in this movement that young people do not need to come out, because their sexual identity is public as they are discovering it. They believe young people tend not to identify as sexual minorities, but see themselves as “normal people.” Other scholars dispute the validity of this “post-gay” model for several reasons. First, this model relies on a definition of coming out that is linear, developmental, and stagelike, rather than an ongoing social process. Second, today’s young people continue to use traditional sexual identity labels, although perhaps concurrently with unique labels or affinity labeling. Third, people might have to come out multiple times over the course of their lives, since sexuality is fluid, and people’s identifier might change as they develop. Thus, coming out continues to be an important metaphor and process to understand how LGBTQ people manage their identities. Jason Orne See also Developmental Aspects of Sexuality; Down Low; Sexual-Identity Labels; Stealth (Transgender Passing); Strategic Disclosure

Further Readings Cass, V. (1979). Homosexuality identity formation. Journal of Homosexuality, 4, 219–235. Cox, S., & Gallois, C. (1996). Gay and lesbian identity development. Journal of Homosexuality, 30, 1–30. Evans, N., & Broido, E. (1999). Coming out in college residence halls: Negotiation, meaning making, challenges, supports. Journal of College Student Development, 40, 658–668. Guittar, N. (2013). Coming out: The new dynamics. Boulder, CO: FirstForumPress. Kaufman, J. M., & Johnson, C. (2004). Stigmatized individuals and the process of identity. The Sociological Quarterly, 45, 807–833. Mclean, K. (2007). Hiding in the closet? Bisexuals, coming out and the disclosure imperative. Journal of Sociology, 43, 151–166.

Mosher, C. M. (2001). The social implications of sexual identity formation and the coming-out process: A review of the theoretical and empirical literature. The Family Journal, 9, 164–173. Orne, J. (2011). “You will always have to ‘out’ yourself”: Reconsidering coming out through strategic outness. Sexualities, 14, 681–703. Orne, J. (2013). Queers in the line of fire: Goffman’s stigma revisited. The Sociological Quarterly, 54, 229–253. Oswald, R. F. (2000). Family and friendship relationships after young women come out as bisexual or lesbian. Journal of Homosexuality, 38, 65–83. Troiden, R. (1989). The formation of homosexual identities. Journal of Homosexuality, 17, 43–73.

COMMITMENT CEREMONIES Commitment ceremonies are rituals that celebrate romantic relationships. They may be held to recognize and celebrate the romantic relationship (or relationships) between individuals in same-sex, different-sex, and gender-complicated couples or polyamorous groups. Commitment ceremonies do not provide legal recognition of the relationship being celebrated and thus should not be equated with weddings or marriage. This entry describes commitment ceremonies, summarizes the benefits of having one, and suggests that these rituals hold continued relevance even as same-sex marriage becomes more common. In the United States, marriage is a contract written by individual states. Those who enter into marriage are beholden to its legal rules. These rules vary by each individual state, but all marriage statutes require the “solemnization” of a marriage license. Weddings are rituals that provide the solemnization that validates a marriage license. Weddings may be secular or religious, but they must be officiated by someone who is sanctioned by the state to perform the ritual (e.g., a clergyperson or judge). Also, only two spouses are allowed; all states currently ban polygamy. Although there is room for personalization in wedding ceremonies, certain elements must be included (e.g., vows, witnesses, signing the license). Upon filing a

Commitment Ceremonies

solemnized marriage license, spouses may have the option to change their last name with no fee or application. Once obtained, the marriage license entitles spouses to more than a thousand state and federal benefits. By contrast, commitment ceremonies are scripted by those involved and provide no legal standing. Commitment ceremonies may look exactly like traditional weddings, but they may also be completely different and contain no recognizable “wedding” elements. Commitment ceremonies may be officiated by anyone who is chosen by those getting committed. Any number of people may be joined in a commitment ceremony—there is no requirement that it be limited to couples. Although people who have a commitment ceremony may apply to change their legal names, they must do so as individuals and always pay the required fee for name changes. Having a commitment ceremony does not establish any legal rights or obligations between partners. Commitment ceremonies are nonetheless seen as important rituals. Rituals are meaningful events used to mark important social transitions. Their meaning may be drawn from deeply personal sources, and/or from social norms and institutional expectations. Rituals move people from one status to another by creating boundaries around the ritual that distinguish it from everyday life, by employing multiple symbols that invoke the core meaning of the event, by including people who conform to the expectations of the event, and by scripting closure that marks a transition back into everyday life but with a new status. Commitment ceremonies are events by which couples or groups declare their intention to remain in the relationship. They mark the change from a casual or dating relationship to one that recognizes obligations between partners. The partners involved may consider it extremely important that they replicate the symbols and customs of a traditional wedding; although their ceremony does not provide any legal standing, the enactment of a traditional wedding ritual may provide social legitimacy in the eyes of family or friends. If the ceremony has religious

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content, then it may provide important religious validation even if other religious sources are rejecting. Unlike weddings, commitment ceremonies may be completely idiosyncratic to the partners involved. Because there is no legal mandate for witnesses, the ceremony may be private or even secret. The vows, or statements of commitment, may take any form. Rings may be used to symbolize commitment, but other symbols may be instead of, or in addition to, rings. What is essential is that those involved believe that the event has solidified their commitment to each other. As some observers have pointed out, the commitment ceremony is a valuable ritual form that should not be overlooked despite the increasing availability of same-sex legal marriage. Quite simply, not all couples wish to be legally married, and polyamorous groups do not have access to legal marriage. Polyamorous relationships are those that involve three or more partners; all partners may be involved with one another, or they may be structured such that one person is in multiple relationships. Commitment ceremonies for these relationships would involve rites of commitment between each set of partners, and possibly among the entire group. Reasons for avoiding legal marriage include a belief that the state should not regulate personal relationships, as well as the avoidance of tax or social security penalties that may accrue if one is divorced and then remarries. Furthermore, commitment ceremonies demonstrate the creativity, beauty, and tenacity that may arise when people are marginalized and excluded from social norms, or consciously choose to reject those norms. Indeed, the LGBTQ community has always involved tensions between normativity and “queering”—between the stance that gender and sexual minorities want to be “just like everyone else,” and the stance that marginalization from social conventionality allows for the creation of alternative models for love and commitment. Prior to legal same-sex marriage, commitment ceremonies were the only option for same-sex couples. Now that legal same-sex marriage is increasingly possible, it is easy to overlook the fact

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that not everyone desires it. Commitment ceremonies can continue to provide deeply meaningful recognition of relationships. Ramona Faith Oswald See also Domestic Partnership; Families of Choice; LongTerm Same-Sex Couples; Marriage, Reasons for and Against; Polyamory; Romantic Friendships; Same-Sex Weddings

Further Readings Lewin, E. (1998). Recognizing ourselves: Ceremonies of lesbian and gay commitment. New York, NY: Columbia University Press. Reczek, C., Sinikka, E., & Umberson, D. (2009). Commitment without marriage: Union formation among long-term same-sex couples. Journal of Family Issues, 30, 738–756. doi:10.1177/0192513X09331574 Unmarried Equality. http://www.unmarried.org

COMMUNITY CLIMATE This entry describes the concept of residential community climate—what it is, how it is measured, and how it affects LGBTQ people. Although community can be defined in various ways, for the purposes of understanding community climate, a community refers to a geographical region—a town, city, or municipality—bounded by shared local laws, government offices, and political representatives. The community represents the contextual piece of an LGBTQ person’s experiences in a residential district. The sections that follow explore ways to think about community climate for LGBTQ people and the importance of considering community climate as an indicator of context. After defining and illustrating the idea of community climate, the entry highlights the ways that community climate has been measured in LGBTQ research and summarizes the literature connecting community climate and LGBTQ individuals’ well-being. The entry concludes with additional points of consideration

when thinking about community climate for LGBTQ people.

What Is Community Climate? Community climate is the overall level of support or hostility toward LGBTQ people that is present in a geographical region (e.g., a municipality, city, town, suburb, county). It describes the societallevel conditions of support for LGBTQ issues, rather than the individual experiences or interpersonal interactions that occur at the micro level. Thus, community climate refers to a macro-level understanding of the social environment. It addresses this question: “Is the general attitude of a region one of acceptance or stigma?” Community climate is also pervasive in that it is constantly present and reinforces the beliefs about what types of individuals and interpersonal interactions are acceptable. For example, a singular act of antiLGBTQ victimization or harassment may be a symptom of a larger hostile community climate in an area. This community-level support, or lack thereof, is reflected in local institutions, laws, and political stances, as well as the social norms and attitudes of the community’s residents.

How Has Community Climate Been Studied? Since the concept of community climate describes the general attitudes of a region, scholars have used both subjective and objective measures to capture the presence of supportive or hostile attitudes. Subjectively, researchers have asked LGBTQ people specifically as well as the general population of an area, “How gay friendly is your neighborhood?” or “Do you consider this community to be supportive, tolerant, or hostile toward LGBTQ people?” These perceptions can offer insight into what it feels like to be a sexual-minority or transgender person in this community, regardless of what resources are or are not available. To an outsider, a municipal region may appear to provide adequate resources to support this marginalized group, but insiders within the community may still

Community Climate

report an overarching sense of stigmatization in their day-to-day lived experiences. These types of climate measures provide valuable information regarding salient aspects of support or hostility in the community. Some scholars, however, have suggested that asking LGBTQ individuals to rate both the community climate (a predictor variable) and their own well-being (often the outcome variable) leads to inherent biases in the data. In order to reduce this “same source” bias, scholars have turned to also measuring community climate with objective indicators, by calculating scores based on the presence or absence of LGBTQ-supportive policies and resources. The Human Rights Campaign, for example, created an itemized “scorecard” known as the Municipal Equality Index (MEI) in order to rank the community climate of hundreds of U.S. cities. The MEI evaluates a city’s laws and policies based on the protection of and support for LGBTQ rights and inclusiveness of local LGBTQ leaders. A city scores higher—arguably a more supportive community climate—for the presence of nondiscrimination laws, having same-sex relationship recognition in the form of marriage or civil unions, providing same-sex partner benefits to municipal employees, and having an LGBTQ liaison in the mayor’s office or police department. Bonus points are awarded to cities that elect openly LGBTQ officials or provide services to vulnerable LGBTQ subpopulations (e.g., LGBTQ homeless youth). All of these indicators show the city’s commitment to providing a safe and affirming climate for LGBTQ people. A failure to enact such policies and procedures can indicate a more hostile atmosphere, where an LGBTQ person does not feel recognized, valued, or even protected. Other characteristics of the municipality may also contribute to this sense of acceptance or disregard for LGBTQ people. Ramona Oswald and her colleagues suggest that in addition to an examination of the legal climate, the political and religious climates of a region can also serve as indicators of community climate. Data are publicly available reporting the number of Republican versus Democratic votes in presidential elections, or the number

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of religious adherents per denomination. Again, both of these measures are taken to represent the general tone of a geographical region toward LGBTQ people. For instance, a community with an overrepresentation of a politically conservative opinion or a theological stance that homosexuality is a sin may be interpreted as a less supportive community climate. These factors contribute to the overall social attitudes toward LGBTQ issues, but also interact with and influence the laws and policies of a municipality. Taken together, these items can be seen as an objective summation of community climate.

How Does Community Climate Affect LGBTQ People? Community climate, as the backdrop of support or hostility, sets the stage for LGBTQ people to feel valued or further stigmatized in a particular city. A hostile community climate, one where the majority of the population holds a general attitude or tone that LGBTQ people are not tolerated, allows opportunities for discriminatory interpersonal interactions to occur. For instance, if a city lacks a punitive law against LGBTQ discrimination, and the majority of residents support laws that remove rights from LGBTQ individuals and believe homosexuality is a sin, residents may feel it is more acceptable to shout derogatory comments at presumed LGBTQ people or shun someone based on sexual orientation. A hostile community climate essentially reinforces individuals’ decisions to discriminate; the community climate can guide what interpersonal behaviors are or are not deemed acceptable. In addition to acting as the moral compass for beliefs about LGBTQ people and therefore individuals’ behavior, community climate can directly impact LGBTQ individuals’ sense of worth and well-being. LGBTQ people in the community receive the societal messages, cultural beliefs and expectations, and attitudes of others just as everyone else in the town does. In fact, they may be more attuned to assessing these attitudes and the community climate because these messages are

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about them. The internalization of negative messages about a part of someone’s identity can truly be damaging to their emotional and psychological health. Mark Hatzenbuehler has done extensive research on structural discrimination and the social factors leading to mental health disparities for LGBTQ people. He and his colleagues have found that a hostile community climate, aside from direct experiences with discrimination, has a negative impact on LGBTQ individuals’ wellbeing. Individuals living in a hostile community climate show higher rates of depression and anxiety, as well as increased mortality risks (e.g., homicide, suicide, and cardiovascular disease). These effects do not hold true for heterosexual people living in the same community, indicating that LGBTQ people are uniquely impacted by the negative climate.

Additional Points of Considerations Community climate is an important contextual factor to consider when looking at LGBTQ people’s experiences. The messages present at the societal level can have great implications not only for how individuals are viewed by their neighbors, but also for how those individuals view and understand themselves. Some additional aspects of the concept of community climate that are worth considering include the changeable nature of climate, the non-insular nature of communities, and how the perceptions of community climate can vary by individual identity characteristics. Community climate is a sociohistorical phenomenon. That is, scholars cannot assign rankings to a community and assume that the climate will remain static across time. Laws are amended and society’s attitudes shift, yet the interplay between changing legal and social climate in a community is not always immediately apparent. Often, social attitudes shift and subsequent legal change feels long overdue; alternatively, legal amendments may occur before the overall community climate has swung in the direction of support for that law. Although laws, in theory, reflect the beliefs and desires of the constituents in that jurisdiction, legal

changes do not inherently shift social attitudes or vice versa. Therefore, it is important to recognize the unique contributions of subjective and objective measures to the understanding of community climate for a given place in a given historical period. Additionally, community climate and the residents of those communities are not wholly insulated by the geographical boundaries of the region. Rather, individuals are mobile and may experience multiple community climates depending on where they work and live. For example, an LGBTQ person may live in a less-than-tolerant community but work and socialize in a neighboring, relatively more-supportive town. Having access to other types of climates could potentially change residents’ perspectives of their own community or buffer the effects of their own residential climate. Further, individuals may live in a state with an overall hostile climate toward LGBTQ people, but feel supported by the local community climate of their particular town. Thus, consideration should be given not only to the geographical bounds of individuals’ communities, but additionally reach the many climates that those individuals may also experience. Finally, it is not enough simply to study the community climate as a context for LGBTQ people’s experiences. Scholars should also aim to understand the interaction between the individual person and the contextual climate. For example, Abbie Goldberg and JuliAnna Smith found that LGBTQ people with high levels of internalized homophobia showed significantly greater negative effects in a hostile community climate than individuals who were more comfortable with their sexual orientation. Moreover, consideration must be given to an individual’s multiple and intersecting identities. That is, subpopulations within the LGBTQ demographic may be affected by a regional community climate differently than others. Scholars need to consider how the climate for transgender individuals differs from that of other sexual minorities, or how the local climate is different for LGBTQ people of color. Feeling extremely attached to one’s residential community may make one more perceptive of, and perhaps more vulnerable

Coparenting

to, the messages embedded in the community climate. Parents who interact with local school policies may recognize different aspects of the community climate that LGBTQ people without children do not directly experience. Therefore, understanding the ways that diverse individuals interact with and understand their environment can lead to a more comprehensive understanding of the effects of community climate for LGBTQ people. Elizabeth G. Holman See also Antigay Ballot Initiatives (and LGBTQ Activism); Discrimination Against LGBTQ People in the Public Sector; Nondiscrimination Protections, State and Local; Rural and Urban Communities; School Climate; Work Environments

Further Readings Goldberg, A. E., & Smith, J. (2011). Stigma, social context, and mental health: Lesbian and gay couples across the transition to adoptive parenthood. Journal of Counseling Psychology, 58, 139–150. doi:10.1037/ a0021684 Hatzenbuehler, M. L. (2011). The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics, 127, 896–903. doi:10.1542/ peds.2010-3020 Hatzenbuehler, M. L., Keyes, K. M., & Hasin, D. S. (2009). State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health, 99, 2275–2281. doi:10.2105/AJPH.2008.153510 Human Rights Campaign. (2013). Municipal equality index: A nationwide evaluation of municipal law. Retrieved from http://www.hrc.org/mei Lick, D. J., Tornello, S. L., Riskind, R. G., Schmidt, K. M., & Patterson, C. J. (2012). Social climate for sexual minorities predicts well-being among heterosexual offspring of lesbian and gay parents. Sexuality Research and Social Policy, 9, 99–112. doi:10.1007/ s13178-012-0081-6 Oswald, R. F., Cuthbertson, C., Lazarevic, V., & Goldberg, A. E. (2010). New developments in the field: Measuring community climate. Journal of GLBT Family Studies, 6, 214–228. doi:10.1080/ 15504281003709230

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Oswald, R. F., & Holman, E. G. (2013). Place matters: LGB families in community context. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families (pp. 193–208). New York, NY: Springer. doi:10.1007/978-1-46144556-2_13

COPARENTING Regardless of sexual orientation, two adults who parent together must manage the many tasks associated with rearing children. Thus, coparenting involves coordination between the two adults in order to complete such tasks. Coparenting involves how couples divide child care labor (and whether there are discrepancies in involvement) and any parental behaviors (overt or covert) that are supportive or undermining of each other. In addition, coparenting has been found to be more strongly tied to child adjustment than other aspects of the couple relationship or individual parent–child relationships. Indeed, linkages between coparenting and child development are well established in heterosexual-parent families with biological children, particularly young children. Coparenting has been more commonly studied among heterosexual couples and their biological children than among lesbian and gay parents, yet increasing numbers of families in the United States are not composed of a heterosexual mother and father rearing biological children, and thus it is imperative to understand parenting and child development in the context of other family systems. This entry centers on coparenting, or the dynamics of two adults working together to raise a child, among sexual-minority couples. It attends to the extent to which coparenting dynamics are influenced by parent gender and sexual orientation, and on the relationship between coparenting behaviors and child outcomes among families with lesbian and gay parents.

Traditional and Gendered Divisions of Family Labor Research on coparenting among lesbian and gay couples has largely focused on divisions of family

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labor, often comparing patterns of how same-sex and heterosexual couples make decisions about sharing and specializing in housework and child care. Traditional patterns of dividing labor denote that the father specializes in paid employment (usually outside the home) and the mother specializes in unpaid employment at home (such as household chores and child care tasks). This gendered specialization of division of labor, while well established, has become less common in recent years. Specialization appears to be most pronounced among families in which the mother does not work in paid employment, and it is least pronounced in families where both mother and father work full time. Even so, most heterosexual couples adhere to specialized divisions of family labor. Many observers seem to expect that even same-sex couples will show these traditional, gendered patterns. Same-sex parenting couples often report being asked questions such as “Which of you is the mother?” or “Which one of you is the husband?” Such questions are based on traditional notions about division of labor, and assume that same-sex couples must also specialize, with one partner in the “husband/father role” and the other in the “wife/mother role.”

Shared Versus Specialized Patterns of Dividing Family Labor Findings from numerous studies, however, demonstrate that divisions of labor among lesbian and gay couples often differ from those among heterosexual couples. Rather than specializing, same-sex couples are more likely than heterosexual couples to share the labor involved in parenting and in maintaining other aspects of their household and life together via a relatively equal distribution of tasks. In studies of families formed through a variety of pathways (e.g., donor insemination, adoption), results have consistently demonstrated that same-sex couples tend to report shared or egalitarian divisions of labor, and heterosexual couples tend to report specialized divisions, with mothers often doing more child care (e.g., bathing, feeding, dressing the child) than fathers in these families. Thus, divisions of family labor are often

characterized by shared patterns among lesbian and gay couples and specialized patterns among heterosexual couples, particularly with regard to child care tasks. When the actual number of hours spent in paid employment per week is considered, research suggests that lesbian and heterosexual couples spend the same overall time in paid work each week. The difference, however, lies in how the hours of paid work are allocated between the two members of the couple. In heterosexual couples, fathers work more hours in paid employment than mothers, but in lesbian couples, both mothers tend to work approximately equal numbers of hours per week. Similarly, discrepancies in occupational prestige (which describes the relative worth or social class associated with a particular job) between partners in heterosexual couples are generally greater than among those in same-sex couples, a further indication of greater specialization among heterosexual couples compared with same-sex couples.

Consequences of Specialized Child Care Divisions In studies focusing specifically on lesbian couples in which one parent is the biological mother (e.g., families formed via donor insemination, or DI), it is sometimes the case that biological mothers report doing more child care than nonbiological (or “social”) mothers. Perhaps this is related to biological mothers having the experience of pregnancy and then breastfeeding when the child is an infant, setting in motion a pattern of completing more child care tasks. Indeed, lesbian couples who adopt children (where there is no discrepancy in biological connectedness between the mothers) tend to report more shared divisions of labor than lesbian couples with biological children. Some studies suggest that lesbian couples who use DI (and one mother is known to be the biological mother) may experience more maternal jealousy than lesbian couples who use in vitro fertilization in a way such that one partner contributes the egg(s) to be fertilized and the other partner is inseminated and carries out the pregnancy. In these ways, discrepancies in biological relatedness to the

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child can sometimes facilitate tensions among the parenting couple and/or differences in divisions of family labor. It should be noted, however, that comparisons with heterosexual couples reveal that different types of lesbian-headed families (e.g., adoptive, DI) still show less-specialized patterns of labor than do heterosexual couples. Moreover, lesbian social mothers in couples who pursue DI often report qualitatively different experiences than heterosexual fathers, such as greater feelings of satisfaction with their partner as a coparent, need to justify their role as a parent, and parental concern toward their child, as well as lesser feelings of need to use power-assertive methods of discipline and control with their child.

Perceived Parenting Competence and Child Care Labor Divisions Research has also investigated parents’ feelings of competence in performing tasks associated with child care, which has revealed no differences among heterosexual and same-sex couples. Rather, when comparing individual parent groups, heterosexual fathers have been found to feel significantly less competent as compared with gay fathers, lesbian mothers, and heterosexual mothers. This finding could be explained by the fact that heterosexual fathers tend to do the least amount of child care relative to these other parent groups. Regardless, most parents describe themselves as very competent in completing tasks related to child care.

Satisfaction With Divisions of Family Labor Data from these studies of division of labor indicate that same-sex couples not only report dividing child care and household chores relatively evenly but are also likely to prefer these arrangements; lesbian mothers in particular report that they ideally want an equal distribution of child care with each couple member doing about half. In contrast, heterosexual mothers typically report that, ideally, they would like to do somewhat more than half of the child care, while heterosexual fathers report that, ideally, they would like to do somewhat less than half of the child care. Indeed, many same-sex

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couples particularly emphasize egalitarian values and the purposeful, conscious decisions surrounding sharing labor. Contrary to actual patterns of dividing labor, how satisfied couples are with their particular arrangements is linked to children’s behavior problems. Lesbian and gay parents who report being more satisfied with their divisions of labor and with their partner as a coparent also report that their children enjoy better overall behavioral adjustment. Interestingly, regardless of parental sexual orientation, there is some indication that greater specialization is related to less overall satisfaction with division-of-labor arrangements. Thus, it is possible that sharing family labor offers some advantages to parents and children alike across different family types.

Observations of Coparenting Dynamics Some research on coparenting among lesbian and gay couples has focused on the emotional and relational dynamics of coparental interactions and how these are related to child outcomes. Findings suggest that lesbian, gay, and heterosexual parenting couples may have different styles of coparenting during observed family interactions. Lesbian couples appear to be the most warm, interactive, and supportive, as compared with heterosexual and gay male couples. On the other hand, heterosexual couples are more likely to exhibit competitive behavior and undermining behavior than are lesbian and gay male couples. Across all family types, couples that show supportive behaviors toward each other have children with fewer behavior problems. When couples are undermining of each other, children are especially at risk for externalizing problems (e.g., aggression, acting out, etc.). Importantly, across all families, parents are more likely to act in a supportive rather than in an undermining way in coparenting behaviors.

Directions for Future Study Future research could expand much more on the dynamics of relational and emotional interaction between same-sex parenting couples, and how

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these are relevant to their child’s development over time. Further research would benefit from the inclusion of more diverse samples (e.g., increased attention to bisexual and transgender parents). The roles of biological relatedness, legal parenting and couple relationship status, and decisions surrounding routes to family formation would be important to consider in future studies about coparenting among lesbian and gay couples. In conclusion, same-sex and heterosexual couples show both similarities and differences in coparenting styles. While couples differ in reports of dividing family labor and even in observations of coparenting behaviors, it appears that satisfaction with arrangements and supportive interactions are consistently linked with better child outcomes across all families. Thus, aligned with broader literature about lesbian- and gay-parent family systems, it seems that parental sexual orientation is connected more with qualitative differences in family experiences than with differences in outcomes for children. Rachel H. Farr See also Couples Therapy; Division of Labor in LGBTQParent Families; LGB Parenting Styles and Values; Long-Term Same-Sex Couples; Parent Relationship Quality; Therapy With LGBTQ Parents; Transition to Parenthood and Parental Roles; Transition to Parenthood for LGBTQ People

Further Readings Bos, H. M., van Balen, F., & van den Boom, D. C. (2007). Child adjustment and parenting in planned lesbianparent families. American Journal of Orthopsychiatry, 77(1), 38–48. Carrington, C. (1999). No place like home: Relationships and family life among lesbians and gay men. Chicago, IL: University of Chicago Press. Chan, R., Brooks, R., Raboy, B., & Patterson, C. (1998). Division of labor among lesbian and heterosexual parents: Associations with children’s adjustment. Journal of Family Psychology, 12, 402–409. Farr, R. H., & Patterson, C. J. (2013). Coparenting among lesbian, gay, and heterosexual couples: Associations with adopted children’s outcomes. Child Development, 84, 1226–1240.

Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Goldberg, A. E., & Perry-Jenkins, M. (2007). The division of labor and perceptions of parental roles: Lesbian couples across the transition to parenthood. Journal of Social and Personal Relationships, 24(2), 297–318. Johnson, S. M., & O’Connor, E. (2002). The gay baby boom: The psychology of gay parenthood. New York: New York University Press. Patterson, C. J., & Farr, R. H. (2011). Coparenting among lesbian and gay couples. In J. McHale & K. Lindahl (Eds.), Coparenting: Theory, research, and clinical applications. Washington, DC: American Psychological Association. Patterson, C. J., Sutfin, E. L., & Fulcher, M. (2004). Division of labor among lesbian and heterosexual parenting couples: Correlates of specialized versus shared patterns. Journal of Adult Development, 11(3), 179–189. Pelka, S. (2009). Sharing motherhood: Maternal jealousy among lesbian co-mothers. Journal of Homosexuality, 56(2), 195–217. Schacher, S. J., Auerbach, C. F., & Silverstein, L. B. (2005). Gay fathers expanding the possibilities for us all. Journal of GLBT Family Studies, 1(3), 31–52.

CORRECTIVE RAPE In many cultures across the globe, individuals believe that being heterosexual and cisgender (i.e., the assigned sex at birth aligns with an individual’s gender identity) are the only normal and acceptable expressions of sexual orientation and gender identity. Often these heterosexist and cisgenderist cultural mores are strengthened by gender role expectations, especially in patriarchal societies, where men hold more power than women. For instance, feminine gender role expectations may include having long hair, wearing feminine clothing, and behaving in a certain manner (e.g., submissive, caretakers) whereas masculine gender role expectations tend to be equated with strength, financial responsibility, and being the primary decision maker. Moreover, heterosexism is often coupled with homonegativity (i.e., bias and

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prejudice toward lesbian, gay, and bisexual individuals) and transnegativity (i.e., negative attitudes and feelings toward transgender individuals); therefore, lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals may be perceived to be threating since they challenge traditional cultural expectations about family, religion, and legal policies. In some cultures, this discrimination is fueled by the belief that LGBTQ individuals are a Western issue or a White phenomenon. Increasingly, policies that used to enable legalized discrimination against LGBTQ individuals are being overturned. In some countries, LGBTQ individuals are legally protected from discrimination in terms of marriage, housing, and employment. However, in some parts of the world, social stigma remains strong and LGBTQ individuals are often the targets of hate crimes. Specifically, verbal harassment and sexual assault are among the different types of victimization used in hate crimes. The term corrective rape is frequently used to describe when girls and women who identify as or are perceived as lesbians are raped by one or more heterosexual men under the faulty assumption that this will change their sexual orientation, punish them, or turn them into “real women.” Often the assailants tell the individual during the attack that they are doing this to “cure” them or “teach them a lesson.” Despite the fact that corrective rape is a global issue and reports of this crime have been made in Jamaica, Thailand, the United Sates, and Zimbabwe, the majority of research and literature about this topic comes from South Africa (the country with the highest prevalence of rape). Aside from not trusting the police and fear of additional discrimination, many LGBTQ individuals do not report incidents of corrective rape because the perpetrators are often family members, friends, and/or acquaintances. In 2008, the issue of corrective rape became widely known about when Eudy Simelane, a South African soccer player, was raped and murdered for being open about her sexual orientation. Although multiple perpetrators attacked her, only one conviction was obtained during the original trial. In fact, between 1998 and 2008, out of the 31 reports of lesbian women who were murdered in South

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Africa, the conviction in the Simelane case was the first of its kind. By the same token, less than 5% of the men accused of rape in South Africa are sentenced, with more than 95% being acquitted or never charged for their crime(s). Evidence suggests that Black lesbian women are more likely to be targets of this hate crime than White lesbian women. However, this discrepancy may be due to the remnants of apartheid since White women in South Africa are more likely to live in better-protected neighborhoods while there tends to be a lack of police presence in Black neighborhoods. Regardless of race, ethnicity, gender, gender identity, or sexual orientation, the issue of rape, in general, is a significant problem across the globe that often goes unreported due to barriers that prevent individuals from seeking justice (e.g., police harassment, limited support systems, and flawed legal systems that place the victim on trial). Although rape is usually believed to be a crime against women, victims of rape can be of any gender. Research conducted by Out LGBT WellBeing (a South African organization that specializes in LGBT health care, research, and advocacy) suggests that at least among lesbian women and gay men, the prevalence of sexual assault was almost identical. Therefore, the issue of corrective rape impacts the broader LGBTQ community and has many individuals living in fear. It should also be noted that the term corrective rape, like much other nomenclature, should be used with caution, if at all. Some authors have cautioned that when language is sensationalized by media or misinterpreted by the reader, it could minimize the experience of the victims, promote stereotypes, and take away from the broader issue at hand. For instance, this term not only ignores the progress that has been made toward depathologizing the experiences of LGBTQ individuals but also erroneously suggests that diverse sexual orientations and gender identities can be cured. Thus, the aim of this entry is to increase awareness that rape, like many other forms of victimization, can be used in hate crimes, especially when individuals are targeted because of their gender identity and/or sexual orientation. In addition to raising awareness of this global problem, readers are encouraged

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to be mindful of how this term is used and that, over time, the language used to discuss this specific type of hate crime may evolve. Regardless of how this offense is labeled, additional research about this type of hate crime is needed from within South Africa, as well as across the globe, to better understand this issue and facilitate preventive efforts. Megan C. Lytle See also Criminal Legal System and LGBTQ People; Discrimination Against LGBTQ People by Law Enforcement; LGBTQ Health in Non-Western Contexts

Further Readings Di Silvio, L. (2010). Correcting corrective rape: Carmichele and developing South Africa’s affirmative obligations to prevent violence against women. The Georgetown Law Journal, 99, 1469–1515. Hames, M. (2011). Violence against Black lesbians: Minding our language. Agenda, 25(4), 87–91. Mieses, A. (2009, December). Gender inequality and corrective rape of women who have sex with women. GMHC Treatment Issues, 1–5. Retrieved from http:// www.gmhc.org/files/editor/file/ti-1209.pdf Wells, H., & Polders, L. (2006). Anti-gay hate crimes in South Africa: Prevalence, reporting practices, and experiences of the police. Agenda, 20(67), 20–28.

COUPLES THERAPY Couples therapy is a format of psychotherapy aimed at assisting individuals in addressing problems they feel unable to solve on their own. Couples in which one or both partners hold a minority sexual or gender identity or who are seeking to address issues related to sexuality or gender identity may seek LGBTQ couples therapy. Since the removal of homosexuality from the list of psychiatric disorders in 1974, scholarly articles and mainstream psychotherapy texts focusing on LGBTQ couples in therapy have steadily increased in visibility. Informed by this literature, this entry will describe some of the most common concerns

that LGBTQ couples address in therapy, as well as provide information about accessing LGBTQ couples therapy.

What Brings LGBTQ Couples Into Therapy? LGBTQ couples seek therapy for many of the same reasons as heterosexual couples, such as issues related to communication, conflict, feeling appreciated or loved, division of labor, parenting, sex, or the effects of one or both partners living with mental illness or substance use. Furthermore, the literature suggests that LGBTQ couples are more likely to seek therapy for these reasons than issues that are directly related to their sexual orientation or gender identity. Unfortunately, societal heteronomativity, cisgenderism, and experiences as a result of homophobia and transphobia play a role in issues faced by LGBTQ couples. Heteronormativity refers to an ideology that upholds the monogamous, heterosexual couple as the only legitimate intimate partnership. Cisgenderism refers to prejudice that denies, ignores, denigrates, or stigmatizes nonbinary (i.e., male/female) forms of gender identity or expression. Homophobia involves a range of negative attitudes and feelings toward individuals who are perceived to be lesbian, gay, bisexual, or otherwise not heterosexual. Transphobia involves a range of negative attitudes and feelings toward individuals who are perceived to be transgender or gender-nonconforming. These concepts help us to understand the often far-reaching effects of discrimination and prejudice for LGBTQ individuals and couples. Recent research has explored the concept of LGBTQ minority stress and how daily experiences of microaggressions (i.e., when a member of a dominant group sends a message to a member of a marginalized group, often unintentionally, that denigrates their experience) can impact emotional and physical health. In fact, individuals who identify as LGBTQ often have higher rates of anxiety, depression, suicide ideation, and substance use, as compared with those who identify as heterosexual. When individuals hold an additional minority status, such as an identity as a racial or ethnic

Couples Therapy

minority, they may experience even more minority stress. Because LGBTQ couples often have these experiences in common, it can strengthen the couple relationship, resulting in resilience. Conversely, these experiences often create additional strain on the couple system, complicating existing problems or generating more stress than the couple can handle without appropriate social support or professional assistance. LGBTQ couples may also present to therapy with issues that are specific to their minority sexual or gender identity and relationship status. As a direct result of a heteronormative society, there are few relationship scripts for LGBTQ couples. A lack of relationship scripts can result in ambiguity around relationship formation, family rituals (e.g., marriage ceremonies or baby showers), relationship maintenance, and even relationship dissolution. The lack of LGBTQ relationship scripts also may have implications for the extent of social support that is available to LGBTQ couples from their families, friends, and communities. Limited social support is one of the most difficult issues for LGBTQ couples. Often, LGBTQ couples are not fully accepted or embraced by one or both of the partners’ families of origin. Many LGBTQ couples create families of choice, composed of close friends who are supportive of the couple relationship. Most scholarly articles geared to increasing competence of therapists working with LGBTQ couples emphasize expanding the sources of social support that are available to the LGBTQ couple. The social, political, and legal context has an enormous impact on LGBTQ couples and the kinds of issues that they bring to therapy. There is much variation within the United States and internationally regarding rights and affirmative policies for LGBTQ individuals, couples, and families. Stress related to a lack of legal protection can complicate issues faced by LGBTQ couples. For example, if a couple is trying to decide if and when they want to have children, the absence of laws explicitly allowing second-parent adoption by same-sex partners in their area could make their decision even more difficult. Similarly, in some businesses and jurisdictions, sexual orientation

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and gender identity are not protected statuses, thereby leaving sexual-minority and transgender individuals vulnerable to unfair treatment (e.g., being fired for being gay). The lack of legal protections for sexual and gender minorities could become an important factor that couples bring to therapy. When partners have differing levels of “outness” to family, friends, and others, it often creates strain on the LGBTQ couple relationship, prompting the couple to seek therapy. Differences in the degree to which each partner is out can also be an invisible factor in many relationship conflicts that result from seemingly mundane disagreements, such as whether both partners will attend one partner’s work or community event or whether both partners will attend a family gathering. Differences in the degree to which each partner is out can also be an overlooked factor in larger relationships issues, such as deciding whether to legalize their partnership or hold a relationship ceremony. Discrepancies in outness or visibility can be even more complicated for couples in which one or both partners identify as bisexual or transgender, particularly if one partner disclosed his/her identity after the relationship formed or if the identity of one partner results in a perceived change of the identity of the other partner (e.g., in a same-sex female partnership and one partner discloses her transgender identity, transitions to a male identity, and then his female partner is now perceived as heterosexual but still identifies as lesbian). The least amount of scholarship on LGBTQ couples therapy exists for couples in which one or both partners identify as bisexual or transgender. These couples also experience stigma and isolation from both the mainstream heterosexual community and also the lesbian/gay community. The literature that does exist suggests that as individuals depart from a binary understanding of gender and sexuality, they are more likely to experience discrimination, negative internalized perceptions of self (e.g., biphobia or transphobia), and high levels of minority stress, which can burden the couple relationship, thus increasing the likelihood that such couples may seek therapy. Unpacking the

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complex ways their relationship is affected by gender and sexuality would likely be an important task for couples therapy.

What Should LGBTQ Couples Look for in a Therapist? There is a growing body of scholarship regarding therapy with LGBTQ couples. Mainstream couples therapy texts are increasingly including sections and examples of working with LGBTQ couples. While there are no known empirically validated LGBTQ couples therapy treatment approaches to date, there is a substantial literature describing how various couple or family therapy models can be used to work with LGBTQ couples. Moreover, there are a number of publications focused on building clinical competency working with LGBTQ couples. Given that most clinicians who work with couples will likely work with at least one LGBTQ couple over the course of their career, it is important for therapists to be competent in working with LGBTQ couples. There is some indication that individuals who identify as LGBTQ believe therapist competence is more important than the sexual orientation of the therapist. Unfortunately, research suggests that many therapists do not feel clinically competent to work with LGBTQ individuals, couples, and families and report a lack of training in this area. As a result, LGBTQ couples should be encouraged to seek out a couples’ therapist who has had specific training or experience working with LGBTQ couples. LGBTQ couples seeking a therapist should feel empowered to “shop around” for a therapist who can best meet their needs. It is not uncommon for couples to start therapy with a therapist, stop going or terminate, and then find another therapist who is a better fit. Seeking recommendations from other LGBTQ-identified individuals in their community, local LGBTQ-serving organizations, friends, primary care physicians, local community assistance or referral services, or online directories such as www.therapistlocator.net are common methods for finding a therapist. In many geographic locations, the local LGBTQ community has put together a list of affirmative resources, such as affirmative churches, health care practitioners, lawyers, and

psychotherapists. LGBTQ couples may find it useful to ask a prospective therapist in a phone consultation or during the initial session one or more of the following questions in order to gauge goodness of fit: (1) Describe your view of lesbian, gay, bisexual, and transgender people and their relationships. (2) How do you generally work with LGBTQ couples? (3) What kind of training have you had in working with the LGBTQ population? It should be noted that couples in rural areas or small towns may have limited access to any couples therapist, let alone one with specific training or experience working with LGBTQ couples. It is not uncommon for couples in these areas to travel to larger cities or metropolitan areas to obtain services. Consensus in the clinical literature emphasizes the necessity for clinicians to understand the implications of heteronormativity, homophobia, and more recently, cisgenderism and transphobia, in their work with LGBTQ couples. It is important for therapists to be actively aware of their own biases and to avoid inadvertently pathologizing the LGBTQ couple relationship. In addition, therapists should be cautious not to overemphasize the couple’s minority sexual or gender identity. As mentioned previously, it is more common for LGBTQ couples to seek therapy for reasons not directly related to their sexual orientation or gender identity. A therapist should be able to work appropriately with these couples and acknowledge their identities without making these identities a part of the presenting problem.

LGBTQ Affirmative Therapy LGBTQ affirmative therapy is an approach for working with LGBTQ individuals, couples, and families that embraces a positive view of individuals who express gender and sexual diversity and their relationships, while also addressing the adverse influences of heterosexism, cisgenderism, homophobia, and transphobia. Communicating an LGBTQ affirmative stance to all clients, regardless of their sexual orientation or gender identity, is important to the LGBTQ affirmative therapist. The literature on LGBTQ affirmative therapy provides several recommendations for creating a more

Criminal Legal System and LGBTQ People

inclusive therapy practice. For example, LGBTQ affirmative couples therapists should include affirming language on clinical paperwork and avoid heteronomative or cisgender assumptions (e.g., they should use the term partner instead of husband or wife for all couples, and ask clients their preferred gender pronouns). Many clinicians, but not all, who practice LGBTQ affirmative therapy draw heavily from feminist-informed therapy approaches, as well as narrative therapy and solution-focused therapy. In addition, emerging research with LGBTQ couples in therapy suggests that focusing on the emotional connection, such as the focus of Susan Johnson’s emotionally focused therapy (EFT), can be particularly beneficial to LGBTQ couples. However, much more empirical research is needed in order to provide recommendations for specific kinds of therapeutic approaches with LGBTQ couples. Individuals who study or work with LGBTQ couples should remain open and curious about how LGBTQ couples do family, as this has important implications for LGBTQ couples therapy. As our understanding of LGBTQ couples grows, scholars and clinicians will be able to better serve these remarkable families and utilize their strengths and accomplishments to create additional strategies, opportunities for change, and stories of hope and resilience for other LGBTQ couples seeking therapy. Erika L. Grafsky See also Affirmative Therapy; Mixed-Orientation Marriages; Therapists, Training of; Therapists’ Biases Regarding LGBTQ People; Therapy With LGBTQ Parents; Therapy With Transgender, Transsexual, and Gender-Nonconforming People

Further Readings Bepko, C., & Johnson, T. (2000). Gay and lesbian couples in therapy: Perspectives for the contemporary family therapist. Journal of Marital and Family Therapy, 26, 409–419. Bigner, J. J., & Wetchler, J. L. (Eds.). (2012). Handbook of LGBTQ-affirmative couple and family therapy. New York, NY: Routledge.

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Bigner, J. J., & Wetchler, J. L. (2014). Relationship therapy with same-sex couples. New York, NY: Routledge. Giammattei, S. V., & Green, R.-J. (2012). GLBTQ couple and family therapy: History and future directions. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBTQ-affirmative couple and family therapy (pp. 1–22). New York, NY: Taylor & Francis. Green, R. J. (2008). Gay and lesbian couples: Successful coping with minority stress. In M. McGoldrick & K. V. Hardy (Eds.), Re-visioning family therapy: Race, culture, and gender in clinical practice (pp. 300–310). New York, NY: Guilford Press. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender variant people and their families. Binghamton, NY: Haworth Press. McGeorge, C., & Stone Carlson, T. (2011). Deconstructing heterosexism: Becoming an LGB affirmative heterosexual couple and family therapist. Journal of Marital and Family Therapy, 37, 14–26.

CRIMINAL LEGAL SYSTEM LGBTQ PEOPLE

AND

From its inception, the U.S. criminal legal system has been a site of discrimination and violence for LGBTQ people, particularly those of color, who are disproportionately policed, prosecuted, and punished on the basis of their real or perceived sexual orientation and/or gender identity. It is also a system that many LGBTQ people have turned to in order to seek safety from violence motivated by homophobia and transphobia, only to be abandoned or further violated and traumatized by the very actors they believe are there to serve and protect them. This entry describes how LGBTQ people have been historically criminalized, and highlights the ways and contexts in which they continue to be targeted by police and punished in the courts on the basis of their sexual and gender nonconformity.

The Criminal Legal System The criminal legal system is composed of the laws enacted by federal, state, and municipal governments that proscribe actions deemed to be criminal

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or illegal, the law enforcement agents responsible for enforcing them (e.g., police officers, sheriffs, FBI agents, state and federal prosecutors), and the judges and penal officials who are responsible for adjudicating the law and meting out punishment. What conduct is deemed to be a crime and who is deemed to be criminal is largely socially constructed, and is influenced by enforcement of racial, class, gender, and sexual norms. For example, historically, criminal laws have explicitly criminalized certain conduct by Indigenous people, African-descended people, and immigrants, while exempting the same exact conduct when committed by White people (e.g., the slave codes and later the Black codes enacted after the Civil War). Similarly, whereas sodomy laws, which were enacted in colonial times, were originally designed to criminalize all acts of nonprocreative sex, they were later amended or enforced in ways to punish only people who engaged in same-sex sexual activity, a practice legitimized by the U.S. Supreme Court in the 1986 Bowers v. Hardwick decision. Although in the 21st century the vast majority of laws are now neutral on their face, they continue to be discriminatorily enforced, leading to the disproportionate criminalization of people of color, including LGBTQ people of color.

The History of Policing and Punishment of Sexual and Gender Nonconformity The policing and punishment of sexual and gender nonconformity was a central feature of the colonization of the Americas and enslavement of African-descended people in the United States. Native American scholar Andrea Smith and historian Brian Fone have documented that branding Indigenous people as “sodomites” and “perverts” served as justification for the genocide of Indigenous people and seizure of their land by European colonizers. Similarly, as legal scholar Dorothy Roberts points out, casting enslaved Africans as “hypersexual,” as well as “uncivilized,” “violent,” and “immoral,” served as a necessary pretext to countenance colonization of African people and the imposition of chattel slavery. Immigrants to the

United States from Asian, Latin American, and Middle Eastern countries were also framed as sexually deviant and promiscuous in order to justify sexual violence and laws used to exclude and control them. Laws punishing sodomy—defined as oral or anal sex—were enacted as capital offenses during the colonial era, without regard to the race, gender, or sexuality of the individuals involved. However, sodomy crimes were selectively enforced. According to historian Robert Oaks, those charged, convicted, and executed were often Black men, while wealthy White men were generally charged with lesser crimes of lewd behavior, if prosecuted at all. Sodomy laws were not always necessary or the sole means of criminalizing and punishing perceived sexual “deviance.” Legal scholar Ruthann Robson notes that some women alleged to have been sexually deviant were persecuted as witches, while others accused of same-sex activity faced charges of “unseemly practices” and lewd behavior. Crimes of fornication, prostitution, and vagrancy were also used to prosecute free women of color, immigrant women, and poor White women, sending many to prison or mental institutions. In the 1850s, criminalization of gender nonconformity was achieved through sumptuary laws requiring individuals to wear at least three pieces of clothing associated with their gender as defined by their genitalia. These laws, along with vagrancy laws, were designed to root out the alleged deception of appearing in a manner that did not strictly adhere to the norms of the gender binary. Law enforcement agencies used these laws to target and harass transgender and gender-nonconforming people, including many butch lesbians, in the early 20th century, prior to those laws being struck down as unconstitutional or rewritten in the late 1970s and early 1980s. During the Cold War era of the 1950s and 1960s, laws were passed outlawing the existence of gay bars, leading to the harassment, extortion, arrest, and brutalization of countless LGBTQ people, who not only faced criminal charges but were subject to public shame and humiliation when their names and photographs were published in newspapers upon their arrest.

Criminal Legal System and LGBTQ People

Present-Day Criminalization of LGBTQ People LGBTQ people, particularly LGBTQ people of color, continue to face discrimination in the criminal legal system in the 21st century. According to a national survey conducted by Lambda Legal, 73% of all LGBT people and people living with HIV have had face-to-face contact with police, and 5% reported having spent time in jail or prison, a rate markedly higher than the nearly 3% of the U.S. adult population who are under some form of penal control.

Policing of LGBTQ People LGBTQ people and communities report ongoing profiling, false arrests, physical violence, sexual harassment and assaults, and illegal searches by police officers, particularly in the context of enforcement of “quality-of-life” offenses, “stopand-frisk” practices, selective enforcement of sexrelated charges, and continual raids of LGBTQ establishments. Existing data show that LGBTQ people of color, transgender and gender-nonconforming people, and homeless and low-income LGBTQ people bear the brunt of police misconduct against LGBTQ people in the 21st century. Several reports tracking identity-based violence nationwide have documented that police officers are responsible for a significant amount of the homophobic and transphobic violence experienced by LGBTQ individuals. Lambda Legal found that 21% of survey respondents who had face-to-face contact with law enforcement officers experienced hostile attitudes from police officers, and LGBTQ people of color, transgender and gender-nonconforming people, LGBTQ youth, and low-income LGBTQ people all reported experiencing hostility at higher rates. Further, Black, Latina/o, and Native American respondents were also more likely to be searched during their encounters with the police. LGBTQ people of color, low-income LGBTQ people, and transgender or gender-nonconforming people also reported higher rates of false arrests. Similar trends were revealed by a 2011 study published by the National Gay and Lesbian Task

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Force and National Center for Transgender Law and Equality. One fifth of all transgender respondents who interacted with the police reported they were harassed, with Black, multiracial, and Asian transgender people reporting higher rates of harassment, physical assault, and sexual assault by police. The role played by the policing of “quality-oflife” offenses in the ongoing criminalization of LGBTQ people was documented by Amnesty International in a 2005 report. “Quality-of-life” regulations criminalize everyday activities, including standing or congregating in public spaces; eating, sleeping, drinking, urinating, or engaging in “lewd conduct” in public; being “disorderly”; or smoking too close to buildings. Of course, countless people engage in these behaviors on a daily basis, but “quality-of-life” laws are selectively enforced against certain populations. Police officers are given almost total discretion to decide when, where, and whom to charge and whether they will issue a warning, write a ticket, or arrest the person for these minor offenses. Enforcement of “quality-of-life” offenses often targets homeless people and youth of color, disproportionately affecting LGBTQ youth, who constitute 40% of all homeless youth. LGBTQ people are also targeted for selective and discriminatory enforcement of sex-related crimes (e.g., solicitation, prostitution, lewd conduct, or public indecency). Gay men and transgender women are frequently presumed to be engaged in such criminal activity simply by virtue of their presence in public spaces, leading to preemptive arrests. The profiling of transgender women of color for prostitution-related offenses occurs so often it has become a well-known phenomenon dubbed “walking while trans.” Transgender women, and particularly transgender women of color, report that regardless of whether they are hailing a cab, greeting a friend, going to the store, or simply traveling to and from home, school, or work, they are profiled by police and arrested for solicitation or prostitution without any concrete evidence indicating an intent to trade sex for money. Research by organizations such as Amnesty International and Human Rights Watch shows

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that police often engage in transphobic and homophobic verbal harassment, physical violence, sexual assault, and extortion of sexual acts in exchange for leniency during such encounters, and frequently use mere possession of one or more condoms as evidence of intent to engage in prostitution-related offenses. “Stop-and-frisk” and other discriminatory policing practices targeting communities of color have also disproportionately impacted young LGBTQ people of color. While the U.S. Supreme Court has authorized police officers to stop individuals whom they have reasonable suspicion to believe have committed or are about to commit a crime, and to conduct a brief pat-down if they have a reasonable belief the person is armed, in many cities “stop and frisk” is being used to stop people solely on the basis of their skin color. For example, in New York City from 2012 to 2013, almost 9 out of 10 stops were of African American or Latina/o people, and half were aged 14 to 21. Police failed to find a basis to even issue a summons in almost 90% of stops, indicating that the stops were motivated by profiling rather than concrete evidence of criminal activity. Research conducted by the City University of New York during the same time frame found that LGB youth experienced more negative police encounters than their heterosexual peers, and reported twice as many instances of sexual harassment and assault. Gay men also continue to be targeted by police in entrapment schemes seeking to root out alleged public sex activity in locations such as parks and public restrooms. These schemes often result in the arrests of large numbers of gay and heterosexual men, regardless of whether or not they are engaging in or about to engage in sex. Fabricated boilerplate assertions are then used to justify these schemes in criminal court complaints and reports. Shame and embarrassment cause many to simply plead guilty to the charge rather than face ongoing court proceedings. Raids of LGBTQ establishments also continue to take place with alarming frequency. For instance, in 2003, the Power Plant, a private club in Detroit frequented by Black LGBTQ people, was raided by local sheriffs claiming to be investigating

complaints by neighbors. Approximately 350 people were cuffed and forced to lie on the floor for hours without access to bathroom facilities while being brutalized and called homophobic epithets and subsequently charged with “loitering inside a building.” In 2009, the Rainbow Lounge, a gay bar in Fort Worth, Texas, was raided by local law enforcement officials for alleged liquor violations, during which several patrons were physically brutalized, with one person suffering a brain injury. A few were subsequently arrested for “public intoxication.” In November 2009, officers from the “Red Dog” unit of the Atlanta Police Department raided the Eagle Bar, forcing all those present to lie down on the ground, some lying in beer and broken glass, as police conducted background checks while subjecting many to antigay slurs. Transgender and gender-nonconforming people also frequently report that they are addressed using the wrong names and pronouns and subjected to routine harassment during stops, as well as humiliating and unlawful searches during which officers physically grope or demand to view their chest area and/or genitalia, often accompanied by ridicule and transphobic abuse. They are also held in dangerous conditions in police custody when housed with people who do not share their gender identity, and humiliated by being forced to remove their wigs and items of clothing consistent with their gender identity such as bras and binding.

Criminal Courts and LGBTQ People in the 21st Century Once a person is arrested and charged, prosecutors, like police, have virtually unfettered discretion to decide what charges to bring against the accused, whether the accused will get a favorable or stiff plea deal, and what sentences they will seek. Discriminatory bias against LGBTQ people continues to seep into charging decisions, and such notions continue to influence the perceptions and decisions of judges and jurors regarding innocence, guilt, credibility, and the necessary punishment of LGBTQ people. Present-day civil and criminal courts remain hostile environments for many LGBTQ people. A

Criminal Legal System and LGBTQ People

2013 study by Lambda Legal found that one fifth of respondents who appeared in court heard a judge, attorney, or court employee make a negative comment about a person’s sexual orientation or gender identity or expression. Sixteen percent of respondents reported that their LGBTQ identity was raised in court when it was irrelevant to the proceedings, and 11% reported the release of this information was against their will, with LGBTQ people of color or those with mental or physical disabilities reporting nonconsensual disclosure at higher rates. LGBTQ defendants, as well as attorneys representing them, report that LGBTQ people are routinely ridiculed, harassed, dehumanized, and treated with a lack of respect and dignity by court personnel, sheriff’s deputies, lawyers, and judges. Many report that transgender people continue to face overt bigotry and are referred to as “it” by judges. LGBTQ people who stand accused of crimes, particularly sex-related crimes, continue to face often unconscious perceptions that they are inherently not credible or deceptive and predisposed to engage in “sexually deviant” behavior. Prosecutors often take advantage of such prejudice against LGBTQ people, arguing, for instance, that transgender people cannot be believed because they tell the world they are one gender, but they are really another. In light of these circumstances, LGBTQ people often plead guilty to avoid suffering the humiliation of defending themselves against such charges and the harsher punishments they risk if convicted after a trial. LGBTQ people also receive disproportionate or excessive sentences. For instance, as documented by a 2009 study by the National Center for Lesbian Rights (NCLR), the National Juvenile Defender Center, and Legal Services for Children, LGBTQ youth are disproportionately charged with sex offenses, and are often sentenced to sex-offender programs, even in cases that do not involve sex-related charges. In a number of capital cases, prosecutors improperly injected irrelevant evidence of a person’s sexual orientation or gender identity into the proceedings, arguing on the basis of stereotypical and pathologizing perceptions of LGBTQ people

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that they are guilty of the crime or were worthy of greater punishment, successfully prejudicing juries to both convict and deliver death sentences. Examples of this pattern of prosecutorial misconduct include the cases of Calvin Burdine, sentenced to die in Texas in 1994; Bernina Mata, sentenced to die in Illinois in 1998; Stanley Lingar, executed in Missouri in 2001; Wanda Gene Allen, executed in Oklahoma in 2001; Jay Wesley Neill, executed in Oklahoma in 2002; and Eddie Hartman, executed in North Carolina in 2003. Finally, LGBTQ people are often denied competent, effective, and professional legal services by attorneys who represent them. Too often, publicly funded or private counsel lack information and knowledge about their client’s lived realities necessary to effectively represent them in criminal proceedings. Frequently, attorneys fail to refer to their clients by their preferred name or pronouns, and are unaware or lack the courage to ask judges and prosecutors to do the same. Attorneys also fail to advocate for appropriate enrollment in diversionary programs such as drug treatment facilities, which are often sex segregated, and they may fail to ask necessary questions of potential jurors or elicit mitigating evidence.

Anti-LGBTQ Hate Crimes and Alternatives to the Criminal Legal System LGBTQ people also encounter the criminal legal system as victims of crimes, including victims of bias-motivated violence and harassment. In 2013, more than 2,000 instances of anti-LGBTQ hate violence were reported to the National Coalition of Anti-Violence Programs (NCAVP). A disproportionate number of victims of homophobic and transphobic violence are LGBTQ people of color, and of those who were murdered, over half were transgender women of color. Many LGBTQ victims assert that when they report hate violence to the police, the police do not take their claims seriously and fail to classify these incidents as hate crimes. LGBTQ victims also report that they are often blamed for the violence they experience, or are further harmed and traumatized by homophobia or transphobia

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on the part of law enforcement officials when seeking safety and protection. In response to this violence and police misconduct, many mainstream LGBTQ organizations have demanded that politicians and players in the criminal legal system take violence against LGBTQ people seriously, seeking the passage of hate-crime legislation in Congress and in state legislatures. Such legislation generally requires that law enforcement agencies track and document incidents involving bias-motivated violence and enact enhanced sentences for those convicted of a hatemotivated crime. Mainstream LGBTQ organizations have also demanded that law enforcement officers and judges receive sensitivity training regarding LGBTQ issues, and that law enforcement agencies hire more LGBTQ officers and community liaisons. Other LGBTQ organizations and advocates, however, oppose hate-crime penalty enhancements and the use of the criminal legal system as a vehicle to address violence altogether, believing the system is fatally and inextricably flawed and violent, inherently biased against LGBTQ people, particularly those of color, and incapable of providing protection, safety, and justice to marginalized communities. Some of these organizations are investigating and creating new ways to address the violence faced by LGBTQ and other marginalized individuals. Looking to restorative and transformative justice frameworks, they are developing community-based programs to provide safety to individuals while holding perpetrators of violence accountable in ways that are independent of the criminal legal system. The Audre Lorde Project in New York City, Project NIA in Chicago, and Creative Interventions, based in California, are just a few of the organizations investing in these alternatives to the criminal legal system, and the trend in seeking such solutions is growing nationwide. Joey L. Mogul See also Bias in the Criminal Justice System; Discrimination Against LGBT People by Law Enforcement; Gender Binaries; Incarceration; Sex Work and Criminalization

Further Readings Alexander, M. (2012). The new Jim Crow: Mass incarceration in the age of colorblindness. New York, NY: New Press. Bronski, M. (2011). A queer history of the United States. Boston, MA: Beacon Press. Capers, B. (2008). Cross dressing and the criminal. Yale Journal of Law and the Humanities, 20, 1–30. Davis, A. (2003). Are prisons obsolete? New York, NY: Seven Stories Press. Hanssens, C., Moodie-Mills, A., Ritchie, A., Spade, D., & Vaid, U. (2014). A roadmap for change: Federal policy recommendations for addressing the criminalization of LGBT people and people living with HIV. Retrieved November 10, 2015, from https://web.law.columbia .edu/sites/default/files/microsites/gender-sexuality/files/ roadmap_for_change_full_report.pdf Mogul, J., Richie, A., & Whitlock, K. (2011). Queer (in) justice: The criminalization of LGBT people in the United States. Boston, MA: Beacon Press. Oaks, R. (1978). “Things fearful to name”: Sodomy and buggery in seventeenth-century New England. Journal of Social History, 12(2), 268–281. Richie, B. (2012). Arrested justice: Black women, violence, and America’s prison nation. New York, NY: New York University Press. Robson, R. (1992). Lesbian (out)law: Survival under the rule of law. Ithaca, NY: Firebrand. Smith, A. (2005). Conquest: Sexual violence and American Indian genocide. Cambridge, MA: South End Press. Stanley, E., & Smith, N. (2011). Captive genders: Trans embodiment and the prison industrial complex. Oakland, CA: AK Press.

CROSS-CATEGORY FRIENDSHIPS Friendships are widely believed to be organized around the principle of homophily—the idea that relationships form between individuals who are similar. Under this principle, individuals are most likely to form friendships with others who are similar to themselves in terms of age, gender, race, socioeconomic status, or identity. Friendships between individuals with different social identities

Cross-Category Friendships

are considered cross-category friendships. By definition, cross-category friendships form across social identities in which one identity is privileged and the other disadvantaged. Thus, in order to maintain cross-category friendships, friends are required to negotiate their own identities across social inequalities. Cross-category friendships are considered the exception rather than the rule in the general population. Within minority communities, however, cross-category friendships are more common. Friendships are understood as unique interpersonal relationships that are voluntary, reciprocal, and equitable in nature. The study of cross-category friendships illuminates how identity differences impact friendship patterns and dynamics. Understanding the unique experience of minority individuals in cross-category friendships provides insight into how members of these communities negotiate their minority status within an interpersonal context. For lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals in cross-category friendships, such negotiation occurs across sexual- and gender-minority status. This entry explores patterns and characteristics of cross-category friendships within the LGBTQ community across sexual orientation, sex/gender, and race.

Patterns of Cross-Category Friendship Within the LGBTQ Community By and large, individuals in the LGBTQ community conform to the principle of homophily; they are more likely to report friendship dyads of similar identities. Namely, LGBTQ individuals report more same-sex and same-race friendships than friendships with individuals of different sex and race. However, these patterns differ across racial identity. LGBTQ people of color are more likely than their White counterparts to report cross-race friendships. Although LGBTQ individuals primarily form samesex and same-race friendships, cross-orientation friendships are fairly common, occurring more often than same-orientation friendships. Patterns of these cross-orientation friendships differ across sexual-orientation identity; bisexual men and

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women are more likely than lesbians and gay men to report cross-orientation friendships. These patterns suggest that, overall, those individuals with the most marginalized identities are the most likely to form cross-category friendships. Cross-orientation friendship patterns may be unsurprising, as there are far more heterosexual individuals than there are sexual and gender minorities. These patterns of friendships, however, are not simply reflections of population demographics. They are shaped by larger sociopolitical attitudes. For LGBTQ individuals, the acquisition and maintenance of cross-category friendships is complicated by their minority status. More specifically, dominant attitudes toward sexual and gender minorities impact cross-orientation and cross-gender identity friendship choices. Examination of the characteristics of these friendships reveals prevailing heterosexist, biphobic, and transphobic ideology.

Characteristics of Friendships Across Orientation and Gender Identity For LGBTQ individuals, the importance of friendships is contextualized by the relative lack of social support for sexual and gender minorities in the larger culture. LGBTQ individuals often rely on friendships within the LGBTQ community to provide support (both emotional and material) that is less available in their natal homes and peer groups. However, friendships across sexual orientation and gender identity can also provide LGBTQ individuals with a supportive personal relationship independent of their connection to the LGBTQ community. The literature on cross-orientation and cross-gender identity friendships has largely focused on the barriers and benefits of such friendships. Friendships Across Sexual Orientation

Barriers to cross-orientation friendships are often cited by heterosexual and LGBQ individuals alike. Both heterosexual and LGBQ individuals may feel discomfort discussing differences in

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sexual orientation, may perceive their lives to be different as a function of sexual orientation, and/ or may worry about potential sexual tension within their friendships. Heterosexual individuals in particular may avoid friendships with LGBQ individuals because of the associated stigma and because of their discomfort with, or lack of familiarity with, LGBQ individuals or culture. When cross-orientation friendships do form, how friends negotiate the difference in sexual orientation may present additional barriers to closeness. For example, the difference in sexual orientation may become a focal point where sexual-minority identity becomes tokenized or overemphasized. Alternatively, sexual-minority individuals may feel that their sexual orientation is not acknowledged in the friendship or that their friend does not understand their experiences of being a sexual minority. Many sexual-minority individuals in cross-orientation friendships report feeling as if they cannot fully express their sexual identity in such friendships. Still others report that tolerating unintentional discrimination, judgment, and/or invalidation of their sexual identity is required to maintain such friendships. Bisexual women in cross-orientation friendships with heterosexual women, for example, report that their bisexual identity may be invalidated as their friendship focuses on the friends’ shared interest in men. In their friendships with heterosexual men, gay and bisexual men often need to negotiate the traditional link between masculinity and homophobia. Despite these barriers, sexual-minority individuals report several benefits to cross-orientation friendships. Cross-orientation friendships may allow LGBQ individuals to find acceptance from heterosexuals that is otherwise unavailable from friendships in other contexts. Friendships with heterosexual individuals can potentially serve to increase a sense of self-acceptance and self-esteem among sexual minorities, challenge stereotypes about heterosexuals, and allow an understanding that acceptance outside the LGBTQ community is possible. There are also benefits to cross-orientation friendships that are experienced by both individuals

in the friendship. Both sexual-minority and heterosexual individuals experience closer and more trusting cross-orientation relationships predicated upon the disclosure of sexual-minority identity. Furthermore, such friendships allow sexual-minority and heterosexual individuals to cultivate an appreciation for similarities between themselves and their cross-orientation friend while also allowing for an objective perspective in their lives. Heterosexual individuals uniquely report experiencing increased sensitivity to sexual-minority experience and an increased reflection and understanding of their own sexual-orientation identity as a result of friendships with LGBTQ individuals. Friendships Across Gender Identity

The friendship experiences of transgender individuals have received far less attention in the research literature than those of other sexual minorities. To date, research has described the important role of friendships formed among transgender individuals. In addition to fulfilling a familial role, friendships with other transgender individuals often provide mentoring and support specific to the transgender experience that is perceived as unavailable from counseling and health care professionals. Barriers to friendship across gender identity exist both outside and within the larger LGBTQ community. Although sexual (LGBQ) and gender (T) minorities are often considered a unified community, transgender individuals experience increased stigma and a unique type of discrimination or transphobia. Transphobia can come from heterosexual or LGBQ individuals and can impact friendship development and support. Transgender individuals also report benefits of friendship with cisgender (non-transgender) individuals, including feeling supported in their gender identity and experience. Specifically, friendships across gender identity may contribute to a feeling of normality for the transgender friend while also allowing them to be perceived by others as their identified gender. Transgender individuals report that friendships with cisgender individuals may allow for diverse perspectives and opinions,

Cross-Category Friendships

potentially serving as a platform for educating others about their experiences as a transgender person.

Cross-Category Friendships: Reflections on Dominant Sociopolitical Attitudes As previously discussed, lesbians and gay men are more likely to develop same-orientation than crossorientation friendships. These same-orientation friendships buffer sexual minorities from the social isolation and stigma experienced in society at large. It is the predominant culture of heterosexism that functions to marginalize sexual-minority identity, which in turn necessitates the use of sameorientation friendships as a refuge from alienation within the larger culture. However, lesbians and gay men are still likely to report some cross-orientation friendships in which their sexual identity may be viewed as a barrier that must be addressed to further develop the friendship. It is again because of heterosexist attitudes that sexualminority identity becomes something to be “dealt with” in the context of cross-orientation friendships. Thus, heterosexism impacts the experience of friendship for sexual-minority individuals as well as heterosexual individuals who maintain cross-orientation friendships. Cross-orientation friendships are more common for bisexual individuals than for their lesbian and gay peers. Thus, bisexual individuals may be less likely than other sexual minorities to experience the type of buffer from societal heterosexism that sameorientation friendships offer. These friendships may also be influenced by biphobia, a unique form of sexual prejudice toward bisexual individuals that can be experienced from both heterosexual and sexualminority (LGBQ) individuals. Cross-orientation friendships between bisexual and heterosexual individuals may develop without an explicit acknowledgment of the bisexual individual’s sexual orientation. Among bisexual women in particular, friendships with lesbian women may be marred by biphobic attitudes that bisexual women are untrustworthy or some other misunderstanding of bisexuality. Similar research regarding friendships between bisexual and gay men is underdeveloped.

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Although research on friendships across gender identity is in its infancy, there is evidence that these friendships are also subject to dominant sociopolitical attitudes regarding transgender identity. Specifically, friendships for transgender individuals function not only in the context of heterosexism toward the LGBTQ community in general, but transphobic prejudice toward transgender individuals in particular. Like heterosexism for communities of sexual minorities, transphobia also leads to a sense of social isolation and rejection among transgender individuals. Transphobia has the added harm, however, of creating a general lack of professional support and services for transgender individuals. Thus, transphobia plays a significant role in the experience of friendships for transgender individuals. While friendships between transgender individuals may fill the gap in support services experienced in society at large, friendships across gender identity may improve feelings of connectedness to mainstream society. Thus both same- and cross-gender identity friendships may buffer the isolation experienced by transgender individuals as a result of dominant discourses of transphobia and heterosexism.

Changing Attitudes: Friends as Allies Cross-orientation and cross-gender identity friendships within the LGBTQ community have the added benefit of working to change dominant discourses surrounding normative (i.e., heterosexual and cisgender) and non-normative (i.e., LGBTQ) identities. Friendships with LGBTQ individuals have long been associated with more positive attitudes toward the LGBTQ community. In fact, both sexual and gender minorities report an added benefit of cross-category friendships is their use as an educational platform for issues related to sex, gender, and privilege. Furthermore, cross-category friendships are generally associated with increased cognitive flexibility and self-reported breaking down of stereotypes. Friendships with LGBTQ individuals have more recently been implicated in the development of allies to the LGBTQ community. Thus, LGBTQ individuals are not wrong when they associate

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cross-category friendships as educational opportunities. The aforementioned benefits of cross-category friendships may be instrumental in fostering the support of LGBTQ individuals, both at the individual and at the cultural level.

Conclusion Cross-category friendships by their nature occur across identities of varying levels of social power and marginalization. Patterns of cross-category friendships among LGBTQ individuals suggest that those who are more marginalized in the dominant culture are less likely to form friendships with others who share their marginalized identity. Further qualitative research has revealed significant benefits and barriers to LGBTQ cross-category friendships stemming from dominant sociopolitical discourses of heterosexism, biphobia, and transphobia. It is these discourses that shape crosscategory friendships by creating a context of social isolation and rejection for members of the LGBTQ community. Thus, benefits of cross-category friendships for LGBTQ individuals are intimately linked to the marginalization of LGBTQ individuals within society at large. Furthermore, such benefits are experienced only after overcoming barriers related to the negotiation of sexual- and genderminority identity within a broader culture of stigma, prejudice, and discrimination against the LGBTQ community. Renae C. Mitchell and M. Paz Galupo See also Ally Experience; Families of Choice; Friendships; Romantic Friendships; Workplace Friendships

Further Readings Galupo, M. P. (2009). Cross-category friendship patterns: Comparison of heterosexual and sexual minority adults. Journal of Social and Personal Relationships, 26(6–7), 811–831. Galupo, M. P., Bauerband, L. A., Gonzalez, K. A., Hagen, D. B., Hether, S. D., & Krum, T. E. (2014). Transgender friendship experiences: Benefits and barriers of friendships across gender identity and sexual orientation. Feminism & Psychology, 24(2), 193–215.

Galupo, M. P., & Gonzalez, K. A. (2013). Friendship values and cross-category friendships: Understanding adult friendship patterns across gender, sexual orientation, and race. Sex Roles, 68(11–12), 779–790. Galupo, M. P., & St. John, S. (2001). Benefits of crosssexual orientation friendships among adolescent females. Journal of Adolescence, 24(1), 83–93. Hall, R., & Rose, S. (1996). Friendships between African-American and White lesbians. In J. S. Weinstock & E. D. Rothblum (Eds.), Lesbian friendships (pp. 165–191). New York, NY: New York University Press. Muraco, A. (2012). Odd couples: Friendships at the intersection of gender and sexual orientation. Durham, NC: Duke University Press. Price, J. (1999). Navigating differences: Friendships between gay and straight men. New York, NY: Harrington Park Press. Ueno, K., Wright, E. R., Gayman, M. D., & McCabe, J. M. (2012). Segregation in gay, lesbian and bisexual youth’s personal networks: Testing structural constraint, choice homophily and compartmentalization hypotheses. Social Forces, 90, 971–991.

CULTURAL DISSEMBLANCE (OF AFRICAN AMERICANS) Cultural dissemblance occurs when a person takes on characteristics they believe to be opposite of those expected of their cultural or social group. In essence, cultural dissemblance is a coping strategy used to actively reject negative, offensive, or stereotypical characteristics. The cultural dissemblance of African Americans speaks rather heavily to their experiences in the United States. Historian Darlene Clark Hine theorized that cultural dissemblance served as a survival strategy to help protect African Americans, and in particular, African American women, from the onslaught of Whites and the threat of sexual exploitation. At its root, cultural dissemblance can serve as a response to institutional racism, or a systematic disadvantage based on race-specific discrimination. In the United States, this form of institutional racism was brought about by forces such as slavery and the continued socioeconomic subordination of African Americans,

Cultural Dissemblance (of African Americans)

which permeates various aspects of African American social life. One arena where cultural dissemblance can be seen as a coping strategy for African Americans is in response to stereotypes concerning African American sexuality.

Slavery Setting the Cultural Stage Various sexually based African American archetypes emerged during slavery. For African American women, these archetypes are rooted in the sexualization of the Black body. The two most prominent sexualized African American female archetypes are the “Jezebel” and the “Hottentot Venus.” During slavery, sexual relations between Whites and African Americans were illegal and seen as morally reprehensible. Nonetheless, this did not prevent White male slave owners and employers from sexually assaulting African American women. To shift the blame for these sexual assaults from White men to African American women, the stereotypical image of African American women as lustful and oversexed, or the Jezebel, emerged. In addition to the Jezebel, depictions of the late 19th-century South African sideshow performer Saartjie Baartman, otherwise known as the Hottentot Venus, further sexualized the Black female body. At the time, Whites often displayed Baartman in the nude (often with “jungle” paraphernalia) and highlighted areas of her body, such as her breasts and buttocks. Although Baartman primarily traveled throughout Europe, her notoriety and images of her naked body reached the Americas and helped influence the perception of the “wild” Black female body. Both the Jezebel and Hottentot Venus images partially developed in reaction to depictions of White femininity, whereby White women were portrayed as civilized, frail, docile, and submissive beings. Under similar historical and cultural conditions, African American men were also categorized under gender-specific stereotypes. Given a similar underpinning of illegal sexual relations between Whites and African Americans, African American men were also hypersexualized. Treated as “bucks,” African American men were stereotyped as having large genitalia, and therefore were portrayed as lustful predators.

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Consequently, many individual African Americans and, most notably, African American cultural stereotypes have reacted against negative depictions of African American sexuality by taking a conservative stance on issues pertaining to “deviant” forms of sexuality. This is most often found within African American religious institutions.

Political and Social Consequences of Cultural Dissemblance Given African Americans’ conservative stance on alternative sexualities, African American communities often denounce sexual relations that fall outside the purview of procreative monogamy and heterosexual matrimony. This view is closely linked to the values espoused by the “Black Church.” The Black Church (a religious institution made up of Protestant churches with predominantly African American congregations and leadership) served as a major cultural institution in African American communities. The Black Church is not only a religious institution but a social one as well, which has given comfort and support to African Americans since slavery. Current estimates indicate that African Americans are the most religious racial/ethnic group in the United States, and most African Americans belong to Black churches. Research also notes the important role that religion and spirituality have in the lives of African Americans. In response to negative depictions of African American sexuality, Black church leaders and members, many of them middle class, worked to separate themselves as much as possible from deviant forms of sexuality. As within White communities, African American religious institutions, often made up of the middle class, emphasized support for “conventional” heteronormative relationships that support “traditional” family norms, such as a mother and father giving birth to a child in wedlock. This has resulted in the marginalization of LGBTQ members of African American communities and has impacted issues such as responses to HIV/AIDS within African American communities and support for same-sex marriage. Cultural dissemblance can also be used to examine responses to same-sex marriage among

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African American religious and community leadership. Although African Americans are more likely to support laws that maintain equal treatment for same-sex couples and are even more likely than other racial or ethnic groups to acknowledge the discrimination LGBTQ community members experience, they are less likely to support same-sex marriage. For many African Americans within the Black Church, support of same-sex marriage would equate to acceptance of deviant forms of sexuality. This has resulted in politically and socially conservative and predominantly White organizations targeting African American religious institutions and leadership in an effort to support homophobic and anti-LGBT laws, such as bans against samesex marriage. Similar to how African Americans engage in cultural dissemblance, the broader LGBT community also shifts in reaction against negative stereotypes. Using the Bible as their directive, conservatives have painted the LGBT community as wanton and lustful. This includes sanctioning heterosexuality as representing monogamy and morality, while demonizing relationships that involve same-sex sexuality. The institution of marriage solidifies the tie between heterosexuality and monogamy. Additionally, as a result of the HIV/AIDS crisis in the 1980s, members of the LGBT community were further stigmatized as deviant and wanton. As a reaction to Christian conservatives and the AIDS crisis, many LGBT political organizations began to focus on assimilationist political strategies. These strategies involved creating campaigns that attempted to reverse negative stereotypes. This included developing campaigns that involved portraying the LGBT community as family and marriage oriented. During the 1990s and early 2000s, gay marriage became a mainstream political goal and continues to redefine how members of the LGBT community negotiate their sexualities. Angelique Harris and Omar Mushtaq See also HIV/AIDS and Racial/Ethnic Disparities; Homophobia; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ People of Color; Religious Identity and Sexuality, Reconciliation of

Further Readings Harris, A. C. (2010). AIDS, sexuality, and the Black Church: Making the wounded whole. New York, NY: Peter Lang.  Harris, A. C. (2010). Sex, stigma, and the Holy Ghost: The Black Church and the construction of AIDS in New York City. Journal of African American Studies, 14(1), 21–43.  Harris, L. M. (2004). In the shadow of slavery: African Americans in New York City, 1626–1863. Chicago, IL: University of Chicago Press. Hine, D. C. (1995). Rape and the inner lives of Black women in the Middle West: Preliminary thoughts on the culture of dissemblance. In B. Guy-Shetfall (Ed.), Unequal sisters: A multi-cultural reader in US women’s history (pp. 380–388). New York, NY: Routledge.

CUSTODY AND LITIGATION, LGBQ PARENTS When legal parents of minor children separate, whether they were married or not, provision must be made for continuing care of those children. From a legal point of view, there are two separate aspects of the child’s life that must be considered: Decision-making authority (also known as “legal custody”) must be allocated between the separating parents, and there must be a plan for where the child will live and how much time the child will spend with each parent—for “physical custody.” (The modern trend is toward use of the terms decision-making authority and residential provisions in place of “legal custody” and “physical custody,” respectively.) In addition, provision must be made for the financial support of the children. Ideally, allocation of decision-making authority and the determination of residential provisions can be made through agreement of the parties. (Because the state takes an interest in minor children, any agreement must be reviewed by a court, but most agreements are approved.) Agreement, however, is not always possible. If the parties cannot reach

Custody and Litigation, LGBQ Parents

agreement, then they must resort to the court system and to litigation. While most family court systems encourage mediation, if all else fails, a trial will be held and a judge will determine the allocation of decision-making responsibility and the residential arrangements for the child. Details of custody procedures vary from state to state, but some generalizations can be made. Custody proceedings are adversary proceedings in which each of the opposing parties advocates for her or his own preferred outcome, ideally with the assistance of a lawyer. The opposing parties in a custody case are the parents. The child is not a formal party to the proceedings. While this may seem curious, the general understanding is that parents are the best representatives for their children’s interests and since each parent is entitled to present arguments, the child’s interests should be presented through them. Indeed, contested custody proceedings typically turn on competing visions of the child’s interests. The judge ultimately resolves the issues in a custody case. In virtually all cases, the law directs the judge to consider the “best interests of the child” in reaching her or his conclusion. As is readily apparent, the “best interests” test is hardly a clear-cut one. It allows the judge to consider all of the circumstances as well as the particular needs of the child. This can be seen as both a strength—in that it directs the judge to make an individualized determination particular to the facts of each case— and a weakness—in that it opens the door to consideration of an enormous range of factors, some of which may not be properly before the court. Historically, lesbian, gay, and bisexual parents separating from heterosexual coparents as part of a coming-out process often suffered severe discrimination in custody cases. Some jurisdictions held that being LGBQ automatically disqualified a parent as custodian. Many judges imposed strict conditions on visitation, limiting the LGBQ parent’s activities while the child was in their care. With time the formal law has largely evolved. Generally, states require that a nexus—a causal link—between sexuality and harm to the child be shown before sexuality can be taken into account

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in a custody case. However, the indeterminacy of a “best interests of the child” analysis can still allow particular judges to discriminate, so long as they do not explicitly take sexuality into account. With the rise of LGBQ families where both parents are lesbian or gay, a new category of custody case has arisen; namely, cases where each of the contesting parties is LGBQ. While there are certainly individual jurisdictions where anti-LGBQ discrimination may be found, it is less predictable how this might play out in a situation in which both parents identify as LGBQ. As is noted above, in a custody case the judge determines what is in the best interests of the child, guided by the arguments from the parties. Depending on the jurisdiction, the court may appoint some sort of representative for the child, either to make an independent evaluation or to consult with the child directly. If the child is of appropriate age and maturity, the judge may meet directly with the child to discuss the child’s wishes and perceived needs. Ultimately the ruling of the court will specify both allocation of decision-making responsibility and residential provisions for the child. With regard to allocation of decision-making, there is a general preference for both parents remaining involved in the major decisions in a child’s life— decisions regarding nonemergency medical care, education, and religion, for example. Minor decisions are typically entrusted to the parent with whom the child is residing at the moment the decision arises. Often some procedure for dispute resolution is identified. With regard to residential provisions, much will depend on the particular circumstances. The age of a child and the geographical distance between the parents’ new homes will figure into the division of the child’s time. There is a significant presumption that both parents will have residential time with the child. Julie Shapiro See also Custody Issues in Transgender Parenting; Joint Adoption; Legal Rights of Nonbiological Parents; Second-Parent Adoption; Surrogacy, Legal Considerations of

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Further Readings Joslin, C. G., Minter, S. P., & Sakimura, C. (2014). Lesbian, gay, bisexual and transgender family law. Eagen, MN: Thomson Reuters.

CUSTODY ISSUES PARENTING

IN

TRANSGENDER

In child custody cases, judges make decisions based on several factors relating to the practical, emotional, and psychological needs of the child(ren) in question, as well as the ability of the parents to meet those needs; often a subjective interpretation of a parent’s morality is part of the criteria in making this decision. The abstract nature of what is in the “best interest of the child” allows judges expansive discretionary freedom, allowing potential biases to be part of their ruling. Further, the ruling is one of rather high stakes because custody decisions are rarely reviewed, and are not overturned unless there is considerable evidence of court error. There is a rulings precedent that a parent’s race or religion is beyond the scope of the court’s opinion as it relates to child custody. Case studies suggest, however, that courts are currently divided on the bearing of a parent’s sexual orientation in custody cases. While some courts operate under a “nexus test,” where a parent’s homosexuality would be used as negative evidence only if it is found to have specific unfavorable consequences for the child, other courts still operate under a “per se ban,” where homosexuality is seen as intrinsically harmful to children. Although the latter was more frequently used against gay and lesbian parents in the past than it is today, transgender individuals are still likely to experience their gender identity being used as evidence that they are fundamentally unfit as parents. Although there are some defining judicial moments in the arena of transgender custody, precedents rulings are relatively absent from family law jurisprudence, partially because most transgender custody decisions are settled outside of court. However, case studies do suggest that

judges are more hostile to parents who transition from male to female, whereas parents who transition from female to male, and individuals who do not plan to transition publicly, hold more favor with the courts. This is likely due to two interrelated social issues. First, transmisogyny describes the intersection of discrimination against gendernonconforming individuals with the cultural hatred of femininity in a male-dominated society. In other words, trans women may hold less favor with the courts because transitioning to female is perceived as more deviant than transitioning to male. Second, this may be a form of cis-sexism, where non-transgender people still perceive trans individuals as their assigned birth sex rather than their current gender identity. In this case, courts may perceive trans men as “mothers” to their children, rather than fathers, and follow patterns of awarding primary custody to mothers. Generally speaking, if there is a custody case between a biological parent and a nonbiological parent, the court will award custody to the biological parent unless he or she is proven to be unfit. However, judicial decisions in this area have shifted due to the rising patterns of surrogacy and same–same parenting, sometimes granting custody to nonbiological parents who expressly planned for and intended the birth of the child. However, relating to transgender custody cases, courts have denied biological and legal parents custody of, as well as visitation rights to, their children specifically due to a parent being transgender. At least one court, in the 1981 Nevada Supreme Court case of Daly v. Daly, has terminated the parent–child relationship due to the parent’s gender identity. In the 1993 Missouri case of J.L.S. v. D.K.S., a custody case ensued after a wife (J.L.S.) sought divorce from her spouse of nine years (D.K.S.) because of the spouse’s decision to transition from male to female. D.K.S. requested that she be granted custody of her children as “Aunt Sharon,” rather than as her children’s father, but was denied custody under the guise of “best interest of the child.” The first high-profile custody case involving a transgender parent occurred in 2003, surrounding the custodial rights of a female-to-male

Custody Issues in Transgender Parenting

transgender man, Michael Kantaras. This case was also a “case of first impression” in Florida, a case with no binding precedent that would set guidelines for similar cases in the future. Michael and Linda Forsythe had legally married as a heterosexual couple in the state of Florida in 1988, with Linda’s knowledge that he was a transsexual man. They were married for nine years, raising two children together: Linda’s biological son conceived with a former partner who never acted as a parent to the child, and Linda’s biological daughter conceived with a sperm donation from Michael’s brother. Although Michael was not the biological father of his children, he had been their social father since their births (marrying Linda six weeks after the birth of their first child), and he had legally adopted them. However, when the couple divorced, Linda asked that their marriage be invalidated and Michael’s parental rights rescinded, solely based on his transgender status. The court relied on a court-appointed psychologist as well as an independent court-appointed therapist who were tasked with assessing the parenting abilities of Michael and Linda, and making a recommendation about the best interest of their two children. In the therapist’s report to the court, Michael’s transgenderism is not noted, and he is recommended as the preferable choice for custody. It is noteworthy that Linda’s mental health issues and attempts to manipulate their children’s opinion of Michael were part of the decision against her custodial rights. The two were granted a divorce, and Michael was granted full custody of the children. In 2004, the Second District Court of Appeal of Florida invalidated their marriage on the grounds that Michael was not “male” by their definition, and that same-sex marriage was banned in the state; it had no effect on the custody decision. There have been subsequent court decisions on gay- or lesbian-parent custody that are positive signs for future transgender-parent custody cases, particularly as they pertain to the court’s responsibility to provide evidence of harm to a child, rather than a presumption of harm. For example, in 2006 a Georgia court (Moses v. King) found “a parent’s cohabitation with someone, regardless of that person’s gender, is not a basis for denying custody

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or visitation absent evidence that the child was harmed or exposed to inappropriate conduct.” Similarly, in 2007 a Tennessee court (Marlow v. Parkinson) found that “a parent should not have restrictions imposed on how she interacts or spends time with her child unless those restrictions are necessary to protect against a demonstrated harm.” Although both of these cases were about a parent’s right to have a same-sex partner involved in their child(ren)’s lives, legal scholars believe it can be extrapolated to include a transgender parent’s right to express their gender around their child(ren). Although most studies that have investigated the outcomes of children raised by LGBTQ parents have focused on lesbian and gay parents, studies that have included transgender parents similarly report that there are no significant negative differences between them and non-transgender parents that would impact the wellness of children. As with gay and lesbian parents, the greatest detriment to transgender parents’ ability to adequately parent their children is their lack of legal protection as parents, and widespread institutional and social discrimination. One of the oldest recognized court interpretations of constitutional liberty, protected by the due process clause, is the right to parent one’s children. Many legal scholars point out that when courts impose their own moral interpretation of a parent’s worth, related to issues like gender identity or gender expression, it is not only a matter of transgender discrimination, but one of denying basic constitutional rights. Maura Ryan See also Transgender and Gender-Nonconforming Youth and the Legal System; Transgender Parents and Well-Being; Transition to Parenthood and Parental Roles; Transphobia

Further Readings Carter, K. J. (2006). Best interest test and child custody: Why transgender should not be a factor in custody determinations. Health Matrix, 16(1), 209–236. Chang, H. Y. (2002). My father is a woman, oh no: The failure of the courts to uphold individual substantive

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due process rights for transgender parents under the guise of the best interest of the child. Santa Clara Law Review, 43(3), 649–698. Cooper, L., & American Civil Liberties Union. (2013). Protecting the rights of transgender parents and their children: A guide for parents and lawyers. New York, NY: American Civil Liberties Union and National Center for Transgender Equality.

Perez, S. S. (2009). Is it a boy or a girl—not the baby, the parent: Transgender parties in custody battles and the benefit of promoting a truer understanding of gender. Whittier Journal of Child and Family Advocacy, 9(2), 367–403. Tye, M. C. (2003). Lesbian, gay, bisexual, and transgender parents. Family Court Review, 41(1), 92–103.

D Defining Dating

DADT

Dating can be difficult to research, as it is often difficult to define. Individual definitions of dating vary from person to person—and this is no exception among sexual-minority men. Broadly speaking, dating can be defined as practices that one engages in to explore intimacy, emotions, and sexual desires with another person or persons. However, among sexual-minority males, this can range from nonsexual, casual meetings with different people, to long-term, committed, monogamous relationships. Sexual-minority men define their varying relationships according to different factors. Two of the most common factors used to define a relationship are level of commitment to a partner and level of emotional attachment to a partner. Generally, categories of relationships include hooking up, friends with benefits, casual dating, and open or monogamous romantic relationships. These categories tend to define the relationship on both level of commitment and emotional attachment—with hooking up, or a purely sexual engagement, being the least committed.

See Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell

DATING, SEXUAL-MINORITY MEN This entry describes issues surrounding same-sex dating among sexual-minority men. Although there are many shared issues and experiences between cisgender (those who identify with the gender assigned to them at birth) and transgender (those who do not identify with their assigned gender) sexual-minority males, there are unique experiences faced by trans individuals that must be considered. To clarify the scope, this entry focuses on cisgendered males. The first section explains how relationships are broadly defined, in general, and discusses their importance to male youth development. Next, issues regarding dating, including complications, sexual agreements, and implications for physical and mental health, are described. Emphasized throughout is what is known on this topic based on the research, while drawing attention to the fact that overall, the research is somewhat limited.

Dating and Development Romantic relationships provide a unique relational context—apart from parental and peer relationships— for men to explore their sexual, gender, and relational

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identities. Among young men, same-sex relationships may serve to help them develop relationship scripts and may help to guide their future relationship behaviors. Learning to develop intimaterelationship scripts is especially crucial for young sexual-minority males, as they do not have many societal scripts for same-sex relationships available to them. For example, compared with their heterosexual peers, sexual-minority young men have limited knowledge of how to go about the basic process of dating someone of the same gender, given that society portrays heterosexual relationships as the norm in media, legislation, and cultural practices. Compared with their heterosexual counterparts, men may also be less likely to receive support and advice from family, peer, religious, and school systems on how to date and seek out samesex partners. Therefore, it is crucial that young men have the opportunity to develop their own relationship scripts in safe environments and settings. Many sexual-minority men explore dating in unique venues—such as community organizations and events, or LGBTQ-friendly bars and clubs. Increasingly, many men use technology (e.g., websites, geospatial phone apps) to seek partners. These online sites are often advertised as dating websites, yet also serve as sites to meet other men for friendship and/or casual sex. These resources allow men the opportunity to seek out dating partners and explore their sexuality through casual sex or commence a romantic relationship. Online dating allows men to meet potential partners without having to go to bars or clubs (particularly in regions where there may not be a gay bar or club nearby) and to vet potential partners in a cost-effective and convenient way before agreeing to meet in public. Although most of the literature on online dating has examined men’s sex-driven partner-seeking behaviors (i.e., hookups, transient pleasure, and sexual sensation seeking), a growing body of literature is also examining men’s pursuit of romantic relationships (i.e., dating) online, highlighting the importance of acknowledging that men also desire closeness, intimacy, and companionship. In exploring their sexuality, men may use the Internet to pursue one type of partner

(i.e., romantic or casual) more actively than the other, or may pursue both partner types to the same extent. In some instances, a casual partner may become a romantic interest (or vice versa). Consequently, rather than assuming that dating behaviors are mutually exclusive across partner types, it is vital to acknowledge that men may pursue casual and romantic partnerships concurrently. During the dating process, men may discuss the terms and agreements of their relationships with these different types of partners. Acknowledging the dynamic exchanges that emerge during the dating process, for example, there is a growing body of literature focusing on the relationships’ sexual agreements—within and outside of the relationships—and their implications for HIV/ AIDS. A sexual agreement is usually defined as an explicit, mutual understanding between two partners regarding which sexual and extra-dyadic behaviors they deem acceptable to engage in— including with whom they are appropriate—while in the relationship. From the available data, there seems to be no difference in relationship satisfaction derived from open versus monogamous relationships.

Implications for Health It is widely thought that dating and romantic relationships are beneficial for sexual-minority men’s mental health. Relationships can provide minority males with opportunities to solidify their sexual identity, refine the characteristics they seek out in partners, and give rise to opportunities to form intimate relationships that may provide social support. Research studies have found that participation in same-sex relationships may result in improved self-esteem and social support among men. Researchers have also found that men in same-sex relationships experience lower levels of anxiety and depressive symptoms than those not involved in a relationship. However, there are some potential risks for sexual-minority males’ mental health when dating. For example, some men may experience limerence (i.e., the pursuit of an overidealized form of a romantic relationship).

Dating, Sexual-Minority Men

At present, however, little is known about how developmental transitions (e.g., the coming-out process) and social and environmental contexts (e.g., growing up in homophobic areas) may predispose or exacerbate these outcomes among men. Due to the disproportionate burden of HIV/ AIDS and sexually transmitted infections (STIs) among sexual-minority men, researchers have examined whether the type of sexual and relationship practices that men engage in while dating are associated with negative health outcomes. For example, researchers have noted that some men may forgo condom use during anal intercourse as a way of developing an emotional bond with a new partner, which can lead to an increased risk of HIV and other STI exposure. Other reasons for males forgoing condom use include a desire to show commitment or develop intimacy with a partner, limerence, believing that one is participating in a monogamous relationship, a desire for increased physical pleasure, or a minimalized perception of one’s personal risk of acquiring HIV/ STIs. Conversely, researchers have noted that single men are less likely to engage in HIV/STI risk behaviors if they indicate greater relationship ideation and greater self-efficacy to negotiate safer sex with partners. Similarly, researchers have sought to examine how male couples develop and maintain their sexual agreements given their potential for HIV prevention interventions. Researchers have characterized open sexual agreements by types of allowed behavior (e.g., safe anonymous sex, “play together” couples, no clearly set rules); by partner understanding (concurringly open or monogamous, versus discrepant); or by HIV serostatus of the couple (sero-concordant–negative/ positive, or sero-discordant). Many investigators have looked at serostatus, as some believe that engaging in extradyadic, unprotected anal intercourse could put both men in the couple at greater risk for HIV infection. Condom use is not the only important behavior to prevent and manage HIV or STI risk. Sexualminority males also get tested for HIV and STIs and negotiate testing with their partners—by asking their partners to get tested, testing with their

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partners, or asking a sexual partner’s status before pursuing physical activities. That being said, different males are comfortable with different levels of these strategies, and some feel that knowing or disclosing status is only important for certain activities (e.g., disclose for anal sex but not oral). Beyond STIs, there is a growing body of literature focused on intimate partner violence. Psychological dating violence can include, but is not limited to, a partner trying to socially or behaviorally control the other partner, scaring the other partner, and emotional abuse. The mental harm of dating violence for minority men—exacerbated by the effects of stigmatization—not only may increase one’s levels of anxiety and depression, as well as lower self-esteem, but can also develop unhealthy relationship scripts regarding future relationship expectations. There are physical risks also linked to intimate partner violence (e.g., physical harm or sexual abuse). The extent of dating violence among sexual-minority men, as well as how it compares with the prevalence experienced by heterosexual men, requires further study. This work will require some cultural adaptation given that sexualminority males may also experience dating violence issues unique to them, such as undesired “outing” of their sexuality, and difficulty coping or finding support for lack of social scripts or fear of stigmatization. Peter J. D. Ceglarek and José A. Bauermeister See also Men Who Have Sex With Men (MSM); Transgender Youth and Well-Being; Youth and Dating

Further Readings Adam, B. D. (2006). Relationship innovation in male couples. Sexualities, 9(1), 5–26. Bauermeister, J. A., Leslie-Santana, M., Johns, M. M., Pingel, E., & Eisenberg, A. (2011). Mr. Right and Mr. Right Now: Romantic and casual partner-seeking online among young men who have sex with men. AIDS and Behavior, 15(2), 261–272. Darbes, L. A., Chakravarty, D., Neilands, T. B., Beougher, S. C., & Hoff, C. C. (2014). Sexual risk for HIV among gay male couples: A longitudinal study of the

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impact of relationship dynamics. Archives of Sexual Behavior, 43(1), 47–60. DeHaan, S., Kuper, L. E., Magee, J. C., Bigelow, L., & Mustanski, B. S. (2013). The interplay between online and offline explorations of identity, relationships, and sex: A mixed-methods study with LGBT youth. Journal of Sex Research, 50(5), 421–434. Gottman, J. M., Levenson, R. W., Gross, J., Frederickson, B. L., McCoy, K., Rosenthal, L., et al. (2003). Correlates of gay and lesbian couples’ relationship satisfaction and relationship dissolution. Journal of Homosexuality, 45(1), 23–43. Hoff, C. C., Beougher, S. C., Chakravarty, D., Darbes, L. A., & Neilands, T. (2010). Relationship characteristics and motivations behind agreements among gay male couples: Differences by agreement type and couple serostatus. AIDS Care, 22(7), 827–835. LaSala, M. C. (2004). Monogamy of the heart: Extradyadic sex and gay male couples. Journal of Gay & Lesbian Social Services, 17(3), 1–24. Mitchell, J. W. (2014). Characteristics and allowed behaviors of gay male couples’ sexual agreements. Journal of Sex Research, 51(3), 316–328.

DATING, SEXUAL-MINORITY WOMEN Dating is one of the most common ways for two individuals to develop a romantic relationship in the United States, as well as many other countries. It typically refers to a trial phase of getting to know one another to explore each other’s romantic potential but with no specific goal. A series of dates is often the first step to a serious commitment. The purpose of this entry is to describe same-sex dating among sexual-minority women, including lesbians and bisexual and transgendered women, and to summarize popular alternatives to dating. The majority of research on dating, however, has been done with lesbians; at present, comparatively little is known about the same-sex dating experiences of bisexual and transgendered women. Sexual-minority women tend to prefer dating partners that are fun, intelligent, kind, and supportive and have a sense of humor. In personal ads and

online dating, sexual-minority women frequently emphasize hobbies and interests more than their own or the prospective partner’s physical or sexual attributes. Some online dating services cater specifically to lesbians (e.g., Pinkwink.com); others are open to all couple types (e.g., Match.com). Online dating has become very popular; it is easier to find partners without having to guess the person’s sexual orientation, identity, or interest in a friendship versus a romantic relationship. Sexualminority women also are likely to meet partners through school, work, mutual friends, or recreational activities. These venues provide a pool of dating partners that are likely to be of similar social status, race/ethnicity, and age. The ambiguity about whether interactions with another woman are steps toward a friendship versus a romantic relationship appears to be one of the difficulties that sexual-minority women have when seeking partners. Sexual-minority women may also be tentative about approaching another woman if they are uncertain about her sexual orientation or are fearful that she will respond with prejudice or rejection if they come out to her. Nonverbal communication becomes very important in this context. Some common signals of romantic interest among sexual-minority women include nonverbal cues (e.g., touching, smiling, eye contact); attentiveness (e.g., listening to the partner, sexual energy); direct statements of interest; or outright asking for a date. Direct physical behaviors that lesbians say they use to signal attraction include briefly holding hands when talking, hugging tightly when greeting, and sustained eye contact. Research on online dating suggests that it works more effectively if individuals move fairly quickly from an online to a face-to-face interaction or date, where the two women can get a clearer sense of their attraction and relationship potential at the early stage of acquaintance. Appearance also may be used to send a sexual signal. For instance, many young lesbians make some changes in their appearance after coming out, including getting a shorter haircut, wearing more casual or androgynous clothes, no longer wearing makeup, getting a tattoo or body piercing, or wearing comfortable

Dating, Sexual-Minority Women

shoes. These changes signal their group membership, make them more visible to potential partners, and differentiate them from the dominant culture. The cultural script for heterosexual dating is well defined along gender roles, particularly for a first date, with the man being expected to ask for the date, pay expenses, and initiate sexual contact. For sexual-minority women, these roles typically are shared. In addition, unlike heterosexual women, sexual-minority women do not have to establish or guard a “good girl” reputation by limiting or rejecting sexual involvement. As a result, most sexualminority women report initiating some form of physical contact on a first date. Most individuals, including sexual-minority women, experience some anxiety before or during a first date due to the desire to create a good impression. Among lesbians who described their first-date experiences, most indicated being anxious before the date about their appearance or physical attractiveness. Even at this early stage, many also viewed the first date as a chance to evaluate a date’s potential as a committed relationship partner. Young bisexual women who are dating women have been found to follow a pattern similar to lesbians. Most were involved in same-sex dating and engaged in typical adolescent dating activities including going to the movies, “hanging out” with each other or with friends, and going out to eat. Other activities included going for coffee, shopping, attending cultural events, or engaging in outdoor activities such as hiking or swimming. Of note is that adolescent bisexual women who were steadily dating a woman were at heightened risk for verbal harassment from others if they were still in high school. Knowledge about the same-sex dating practices of transgender women is scarce and is based primarily on first-person accounts. Dating is likely to be very challenging for transgender teens, who face much higher levels of harassment and violence than lesbian, gay, and bisexual teens and often feel isolated and not part of the school community. Among adult transgender women, dating may be especially stressful during the transition phase, when the person is changing physically and

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seeking to develop comfort with a female public persona. In addition, lesbian transgender women face a constrained dating pool because many lesbians will not date a transgender woman. Transgender women may choose to come out immediately to any potential partners to avoid being rejected if they reveal their identity at a later stage of dating. Some bisexual women, or other transgendered women, may be more open to dating a transgender lesbian; there are a number of online transgender dating sites available. Emotional intimacy is highly valued by sexualminority women, and most seek to convey a positive emotional tone when dating. As dating progresses, research indicates that lesbians engage in long, intimate conversations with dating partners, partly to get acquainted but also to set the stage for a friendship. Sharing coming-out stories is a common conversational topic. Getting to know a partner’s sexual history also is used as a way to evaluate concerns about HIV/AIDS and other sexually transmitted diseases. When asked to describe a fifth date, lesbians typically reported being both sexually and emotionally involved. They expected their partner to be monogamous and viewed the relationship as moving toward a serious commitment. Little research has been done to assess sexual satisfaction during the dating phase of relationships for any couple type. However, sexual satisfaction tends to be high among established lesbian couples; presumably, this may also be the case for dating couples. Experience and age also may affect dating. The percentage of midlife sexual-minority women who are single is unknown. Those who are single may be dating one woman, more than one, or none. Midlife lesbians tend to be more purposive than younger lesbians in terms of evaluating a dating partner’s potential for a long-term relationship and therefore tend to value warmth, respect, and reciprocal liking from prospective partners more than physical attraction and sexual gratification. Midlife and older sexual-minority women may have an advantage over heterosexual women in terms of finding new romantic or sexual partners because the pool of women partners is greater than the

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pool of male partners in their age-groups. In addition, lesbians tend to be attracted to women their own age; this means midlife lesbians may have a better chance of finding a new partner than their heterosexual counterparts. Gender roles have been studied primarily using lesbian samples. Although most lesbians appear to reject gender roles when dating, a minority subscribe to butch–femme roles as a form of gender expression. A major function of butch–femme roles is as a sexual signaling system that is used to communicate attraction to others and to provide mutual validation of identities. Traditional gender patterns of power and subordination are not part of the roles among White or African American butch–femme lesbians. The roles do not parallel heterosexual masculinity and femininity. For instance, butch women are not the primary initiator of physical contact. Instead, either woman may initiate it. Furthermore, butch lesbians often place the femme’s sexual satisfaction above their own. The quality of dating relationships for sexualminority women may be affected by factors such as minority stress, defined as the chronic experience, expectation, or perception of prejudice or discrimination. Couples experience minority stress when they feel it necessary to conceal their attraction when in public, at work, or interacting with family. Transgender women have the added stress of coming out as transgendered to their prospective partners. Sexual-minority women often do not introduce their dating partner to parents until the relationship is fairly well established. Public displays of affection are less common than among heterosexuals. Many same-sex couples are reluctant to show affection in public due to fear of harassment or violence. Dating violence, including psychological, physical, sexual, and cyber (e.g., outing someone online), has been identified as an issue affecting the dating relationships of some sexual-minority women. Sexual-minority youth are significantly more likely than their heterosexual counterparts to experience dating violence (35% vs. 8%). However, findings about prevalence in women’s same-sex dating

relationships are inconclusive. Some research reports that young lesbians and gay men experience interpersonal violence at about the same rate (e.g., 44% and 45%, respectively); other findings indicate that gay men are more likely than lesbians to experience all forms of interpersonal violence except sexual violence. Bisexual women most often reported experiencing verbal or controlling interpersonal violence from a male partner. Although many lesbians and bisexual women engage in same-sex dating, others have never dated; instead, they describe becoming friends with someone, falling in love, and then making a commitment to their relationship. This is particularly true for lesbians who came out in the pre-Stonewall era and among those who came out in midlife. Bisexual women also frequently described becoming friends with a woman and then getting sexually involved without formally dating or identifying as being more than friends. Other more casual arrangements such as hookups, hangouts, and friends with benefits have been proposed as being more common than dating, particularly among emerging adults. A hookup refers to brief, uncommitted sexual encounters among individuals who are not romantic partners or dating each other; the degree of sexual interaction may range from kissing to intercourse. Hanging out refers to occasions when two people spend loosely organized, undefined time together without making their interest in one another explicit. Friends with benefits refers to two good friends who have casual sex without a monogamous relationship or any kind of commitment. Little is known about the extent to which sexual-minority women prefer or engage in dating compared with these alternatives. Many lesbians have had casual sex or a one-night stand on at least one occasion, and most were positive about the experience; however, most preferred a slower, more romantic progression to a relationship. The dating practices of sexual-minority women may change as same-sex marriage and other societal rights and recognitions become more prevalent. In the future, sexual-minority women may be more comfortable approaching another

Deciding Whether to Parent

woman directly to ask for a date, as well as to be seen as a dating couple with family, at work, and in public settings. Suzanna M. Rose See also Butch–Femme; Intimate Partner Violence, Female; Romantic Friendships; Sexual Norms and Practices

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socially constructed; that is, they develop out of and are embedded in social structures of race, class, gender, and sexuality that shape the decisionmaking process about whether or not to parent. The emphasis here, therefore, is on the personal, cultural, and structural reasons that LGBTQ people decide whether to parent.

Personal Factors Further Readings Fingerhut, A. W., & Peplau, L. A. (2013). Same-sex romantic relationships. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 165–178). New York, NY: Oxford University Press. Garcia, J. R., Reiber, C., Massey, S. G., & Merriwether, A. M. (2012). Sexual hookup culture: A review. Review of General Psychology, 16(2), 161–176. Messinger, A. M. (2011). Invisible victims: Same-sex intimate partner violence in the National Violence Against Women Survey. Journal of Interpersonal Violence, 26(11), 2228–2243. Moore, M. R. (2006). Lipstick or Timberlands? Meanings of gender presentation in black lesbian communities. Signs: Journal of Women in Culture and Society, 32, 113–139. Rose, S. M., & Eaton, A. A. (2012). Lesbian love, sex, and relationships. In D. Castaneda & M. Paludi (Eds.). An essential handbook of women’s sexuality: Vol. 2. Diversity, health and violence (pp. 3–28). New York, NY: Praeger.

DECIDING WHETHER

TO

PARENT

Most research examining LGBTQ parents studies them after they have children. This entry looks at the major factors embedded in the process that LGBTQ people go through when deciding whether or not to parent. These include personal factors, support networks, work-related issues, and intimate partner relationships. The sections that follow examine how these factors, while experienced by LGBTQ people on an individual level, are

The first type of factors that shape LGBTQ people’s parenting decisions (i.e., their decisions to become parents or remain child-free) are personal. Personal factors are those that include the desire to become a parent, internalized homophobia, and the ability and need to make public one’s sexual identity (i.e., come out) in order to negotiate multiple identities. The Desire to Parent

When LGBTQ people want to become parents, they often work to turn their desire into reality. People’s desires to parent tend to fall on a continuum, with those who really want to parent on one end, and those who want to remain child-free on the other. LGBTQ people who are White and middle class tend to follow their desires such that those who desire parenthood become parents and those who do not remain child-free. However, for those less privileged by race and social class, barriers can alter people’s parenting decisions regardless of their parenting desires. As discussed below, these barriers come in the form of a lack of family support; a lack of access to LGBTQ parent networks; inflexible jobs; financial instability; and a lack of access to fertility specialists (e.g., reproductive endocrinologists) who administer reproductive technologies, adoption agencies, and surrogacy options. Some LGBTQ people fall in between the two extremes of the parenting continuum and are therefore undecided as to whether or not they want to become parents. Ambivalent LGBTQ people are often swayed by the various factors discussed as follows.

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Internalized Homophobia

A second personal factor that shapes LGBTQ people’s decisions about whether to parent is internalized homophobia. Because of heterosexism and homophobia, which are pervasive throughout society, many LGBTQ people internalize negative social and cultural messages. Such messages portray LGBTQ people as being immoral, making unfit parents, and raising emotionally scarred children. Because of internalized homophobia, some LGBTQ people may question their own right and ability to parent. In addition, LGBTQ people who are considering parenthood may also be considering how their sexual identity may negatively impact their children’s experiences and opportunities. Such questioning can lead to personal doubt that presents a real barrier to becoming a parent. Owing to intersections of gender and sexuality, internalized homophobia affects gay and bisexual men differently from lesbian and bisexual women. For example, because definitions of hegemonic masculinity encourage heterosexual people to demean men who relinquish their sexual power over women, internalized homophobia is often particularly strong among male sexual minorities. In addition, gender norms discourage men from believing they can be good nurturers. Therefore, male sexual minorities are often more concerned than their female counterparts about how heterosexual people might view and treat them and their children. Regardless of the reason for internalized homophobia, if LGBTQ people are ambivalent about becoming parents, it can present a big enough barrier to prevent them from choosing parenthood. The Ability and Need to Come Out

Internalized homophobia often affects LGBTQ people’s ability to safely and comfortably reveal their identity to others (i.e., come out), and how comfortable one is to come out is shaped by larger structures of race and social class. Regarding race, historically, White people have stigmatized Black people by creating a myth of the oversexualized Black man whom Whites need to

fear, and a myth of the Black woman whose sexuality needs to be controlled lest she have too many children. Because of such racialized sexuality, Black people have often tried to follow puritan and homophobic sexual practices and beliefs so that White people will see them as being sexually “normal.” Furthermore, because Black families are often connected to religious communities that can be homophobic, coming out to family and community is often difficult for Black LGBTQ people. Similarly, in communities with heightened sexism, coming out can also be difficult. For example, in many upper-class Latino communities, the honor of the family rests in part on the sexual purity of their women, which means high levels of homophobia against lesbians or bisexual women. However, because of the value placed on the tightknit family in both Latino and Black communities, there is often a “don’t ask, don’t tell” tolerance for people who are willing to be in LGBTQ relationships without openly revealing or discussing those relationships. Social class also matters in how likely people are to come out. For example, because workingclass White families experience greater economic hardship than middle-class families, they rely on family relationships to help them through difficult economic times. Such reliance has led to the development of a strong belief in traditional notions of family that support a clear gender division of labor. As in Latino families, strong ideas about gender mean strict rules about sexuality for women and men. However, families with tight emotional ties are also disinclined to expel their children. Thus, similar to families of color, White workingclass families may adopt a “don’t ask, don’t tell” practice as well. Middle-class White LGBTQ people do not necessarily face the same problems in coming out. For example, because White middle-class LGBTQ people tend to come from families that are less connected to larger religious communities than are people of color, they are less likely than other groups to risk losing connection to communities outside their families if they come out. Such race and class privilege allows middle-class White

Deciding Whether to Parent

LGBTQ people to come out to their families more often and more easily than other racial/ethnic and class groups. Whether or not LGBTQ people can come out to their families is important because the more accepting families are of their members’ sexual identities, the easier it is for members to turn their parenting desires into parenting realities. Although there are many similarities among LGBTQ people in terms of coming out, there are some variations by gender. For example, for many lesbians, coming out is a necessary step to becoming a mother, particularly if they are planning on getting pregnant. However, for gay men, because of heightened internalized homophobia as discussed above, coming out may close the door on becoming a father. Therefore, for some gay men, coming out means that they are giving up the chance to be fathers.

Access to Support Networks, Information, and Resources In addition to personal issues, a second main factor that shapes LGBTQ people’s decisions to become parents is access to support networks, information, and resources. Support generally comes from two major sources: LGBTQ-parent networks, and legal and medical information and services. LGBTQ Parent Networks

Support from other LGBTQ people influences parenting decisions. LGBTQ people who live physically near to and know other LGBTQ parents have an easier time deciding to parent than those who are more isolated from LGBTQ-parent networks. This is because LGBTQ-parent networks help potential parents find reproductive specialists, adoption services, surrogacy agencies, and other parents who will support their decisions to parent and help turn desires into realities. Particularly in less urban areas, White middle-class LGBTQ people tend to have more access to other LGBTQ parents and support networks than do those less

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privileged by race and class. In short, meeting and interacting with other LGBTQ parents can give potential parents the confidence and knowledge they need to help them choose parenthood over remaining child-free. Access to Legal and Medical Information and Services

As stated earlier, finding LGBTQ parent networks is important because they provide potential LGBTQ parents with vital information about how to achieve that goal. While some LGBTQ people have become parents in previous heterosexual relationships, LGBTQ people who are considering parenthood within their current sexual and gender identities can do so through adoption, foster care, pregnancy, or surrogacy. Pregnancy often requires the use of reproductive technologies such as donor (i.e., alternative) insemination. If LGBTQ people want to use donor insemination or other medical techniques such as in vitro fertilization, they may need to access sperm through a sperm bank, which usually requires help from a physician. Some LGBTQ people use adoption or surrogacy services in order to become parents. Such services often require that LGBTQ people be able to access medical and/or legal services to become parents. Because LGBTQ relationships challenge some people’s definition of family, LGBTQ people who want to become parents may experience difficulty in finding a reproductive specialist or adoption agency willing to work with them. For example, some physicians or adoption agencies may only work with married couples. It remains to be seen if physicians and adoption agencies will change their practices, now that same-sex couples can marry (as of June 2015). In addition, some physicians will work only with the LGBTQ person who is being inseminated, and will ignore that person’s partner. When LGBTQ people receive insulting treatment from physicians or adoption agencies, or when they fear a general lack of legal protection for themselves and their children, they may decide to postpone or terminate their plans to become parents. In addition to insemination and adoption,

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surrogacy is an option for parenthood, but it is expensive, complicated, and not legal in all states. Therefore, knowing which physicians, adoption agencies, lawyers, or surrogacy agencies to access is key to helping LGBTQ people become parents if they so desire.

Work-Related Issues In addition to personal issues and LGBTQ parent networks, a third major factor that shapes parenting decision-making processes involves issues related to work. Work is important to how LGBTQ people decide whether to parent for a variety of reasons. First, unless LGBTQ people are using a known donor or have children from a previous relationship, they must be able to pay for reproductive technologies, adoption, or surrogacy. Jobs primarily occupied by middle-class people often come with a stable salary; flexible schedules; and comprehensive benefits such as sick leave, vacation time, and health insurance. Such benefits give middle-class LGBTQ people who want to become parents an advantage over working-class or poor LGBTQ people whose work does not afford them such benefits. Therefore, working-class LGBTQ people are often more concerned than middle-class LGBTQ people about how their work might hinder their opportunities to become parents. Indeed, the jobs that working-class LGBTQ people of color in particular hold often do not offer the same benefits as those occupied by middle-class—and particularly White middle-class—LGBTQ people. Thus, jobs with limited flexibility or career satisfaction, as well as inadequate health insurance, can create real barriers for LGBTQ people who want to parent. Similarly, when LGBTQ people who desire economic and personal freedom hold jobs with good salaries, flexible schedules, and good benefits, they might not want to give up their freedom to become parents. The result is that, regardless of whether LGBTQ people desire children or not, work can serve as a powerful barrier or incentive to parenting, depending on one’s race or class position.

Relationships With Intimate Partners A fourth major factor that influences LGBTQ people’s parenting decisions is whether someone has an intimate partner, and if so, the nature of that relationship. As with the previous three factors, the influence of intimate relationships is shaped by structures of race, class, and gender. When LGBTQ people want to become parents and also have a willing and supportive partner, the decision of whether to parent becomes easier. On the other hand, having a partner whose parenting desire differs from one’s own desire, or not having a partner at all, can make the decision-making process more challenging. Research has found that, in the case of lesbians, finding the “right” partner at the “right” time is critical to whether or not the couple become parents, and what constitutes the right partner or time varies by social class. “Right” for working-class lesbians means that their partner has to be both financially stable and emotionally ready to have children. “Right” for middle-class lesbians, on the other hand, means that the partner only has to be emotionally ready. Gay, bisexual, transgender, and queer (GBTQ) people might also face this same experience. However, similar research regarding GBTQ people has yet to be conducted.

Conclusion LGBTQ people make decisions on parenting based on personal factors, their access to social networks, the quality of their work, and their involvement or noninvolvement in an intimate partner relationship. Much of the research conducted to date has examined parenting decisions among lesbians and gay men. Few studies have looked specifically at transgender- or bisexual-parent families, and therefore more research is needed in these areas. However, what is clear is that personal, cultural, and social structural factors along lines of race, class, and gender shape LGBTQ people’s decisions to parent or remain child-free. Nancy J. Mezey

Defense of Marriage Act (DOMA) See also Adoption, Legal Considerations in; Assisted Reproductive Technologies (ARTs); Coming Out, Disclosure, and Passing; Health Care System; Masculinity and Pregnancy; Partners in (Gender) Transition; Transgender Health Care; Workplace Discrimination

Further Readings Bergman, K., Rubio, R. J., Green, R.-J., & Padron, E. (2010). Gay men who become fathers via surrogacy: The transition to parenthood. Journal of GLBT Family Studies, 6, 111–141. Eady, A., Ross, L. E., Epstein, R., & Anderson, S. (2009). To bi or not to bi: Bisexuality and disclosure in the adoption system. In R. Epstein (Ed.), Who’s your daddy? And other writings on queer parenting (pp. 124–132). Toronto, ON, Canada: Sumach Press. Goldberg, A. E., Downing, J. D., & Moyer, A. M. (2012). Why parenthood, and why now? Gay men’s motivations for pursuing parenthood. Family Relations, 61, 157–174. Hicks, S. (2006). Maternal men: Perverts and deviants? Making sense of gay men as foster carers and adopters. Journal of GLBT Family Studies, 2, 93–114. Hines, S. (2006). Intimate transitions: Transgender practices of partnering and parenting. Sociology, 40(2), 353–371. doi:10.1177/0038038506062037 Mallon, G. P. (2004). Gay men choosing parenthood. New York, NY: Columbia University Press. Mezey, N. J. (2008). New choices, new families: How lesbians decide about motherhood. Baltimore, MD: Johns Hopkins University Press. Mezey, N. J. (2015). LGBT families. Thousand Oaks, CA: Sage. Stacey, J. (2006). Gay parenthood and the decline of paternity as we knew it. Sexualities, 9, 27–55.

DEFENSE OF MARRIAGE ACT (DOMA) The Defense of Marriage Act (DOMA) is a United States statute enacted in 1996 that prohibited the recognition of same-sex marriage for all federal

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purposes and authorized states to refuse to recognize same-sex marriages performed in other jurisdictions. The landmark 2013 Supreme Court case, United States v. Windsor, invalidated the section of DOMA that established a federal definition of marriage and paved the way for the federal recognition of same-sex marriage. This entry outlines the history of DOMA and the circumstances surrounding its passage. It explains the range of disabilities DOMA imposed on married same-sex couples and concludes with a discussion of the rules governing the recognition of same-sex marriage at the federal level that were in place until the 2015 U.S. Supreme Court case Obergefell v. Hodges mandated nationwide marriage equality. In the United States, marriage had been traditionally governed by state law. Prior to DOMA, there was no federal definition of marriage. In questions involving federal law, such as taxes or federal benefits, the validity of a marriage was determined by reference to the definition of marriage in the state where the couple lived. DOMA was enacted to stop the spread of same-sex marriage after the Hawai’i State Supreme Court issued its 1993 ruling in Baehr v. Lewin, in which the court said that the prohibition on samesex marriage was discriminatory. Although it took almost 20 years for Hawai’i to then recognize same-sex marriage, the 1993 decision signaled the possibility that individual states could be required to recognize same-sex marriage under the protections afforded by their state constitutions. Without DOMA, the federal government would have been required to recognize all samesex marriages that were valid under state law. Moreover, the Full Faith and Credit Clause of the U.S. Constitution could have required states to recognize same-sex marriages performed in other jurisdictions. DOMA addressed both of these eventualities through two substantive provisions: It adopted a restrictive definition of marriage for all federal purposes, and it authorized states to refuse to recognize out-of-state same-sex marriages. Section 3 of DOMA amended the seldom-used federal

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Dictionary Act with the following definition of marriage: In determining the meaning of any Act of Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the word “marriage” means only a legal union between one man and one woman as husband and wife, and the word “spouse” refers only to a person of the opposite sex who is a husband or a wife.

Section 2 of DOMA spoke directly to Full Faith and Credit concerns: No State, territory, or possession of the United States, or Indian tribe, shall be required to give effect to any public act, record, or judicial proceeding of any other State, territory, possession, or tribe respecting a relationship between persons of the same sex that is treated as a marriage under the laws of such other State, territory, possession, or tribe, or a right or claim arising from such relationship.

DOMA was enacted with overwhelming bipartisan support. Introduced and passed in the months leading up to the 1996 presidential election, both presidential candidates supported the legislation. Republican presidential candidate Senator Bob Dole introduced DOMA in the U.S. Senate, where it passed by a vote of 85 to 14. DOMA passed the House of Representatives by a vote of 342 to 67. With veto-proof majorities in both houses of Congress, President Clinton, who was running for reelection, signed DOMA into law in September 1996. The Report of the U.S. House of Representatives Judiciary Committee explained that the legislation furthered four government interests: (1) defending and nurturing the institution of traditional marriage, (2) defending traditional notions of morality, (3) protecting states’ sovereignty and democratic selfgovernance, and (4) preserving scarce government resources. Focusing primarily on morality, the testimony in the Congressional Record reflects the heated rhetoric of the time. Members of Congress invoked images of the fall of ancient Rome and discussed same-sex marriage in alarmist and disparaging terms.

After DOMA was enacted, it was 8 years before Massachusetts became the first state to recognize same-sex marriage. Once same-sex couples could legally marry under state law, DOMA mandated that they were still considered unmarried for all federal purposes. For example, a same-sex couple who was legally married and lived in Massachusetts could file their state income taxes jointly, but had to file their federal taxes as if they were unmarried. The United States General Accountability Office identified 1,138 federal statutory provisions under which marital status is a factor in determining or receiving benefits, rights, and privileges. These provisions include favorable joint tax rates, Social Security spousal benefits, and pension rights. As more states adopted marriage equality, the inequities imposed by Section 3 of DOMA came increasingly under fire because legally married same-sex couples were being denied important federal benefits. In 2011, U.S. Attorney General Eric Holder announced that the U.S. Department of Justice (DOJ) would no longer defend Section 3 of DOMA because it violated the U.S. Constitution. The House of Representatives elected to defend the statute through its Bipartisan Legal Advisory Group (BLAG), and BLAG took the place of the DOJ in the pending federal lawsuits that were challenging the validity of DOMA. One of the lawsuits was United States v. Windsor, which was brought by Edie Windsor, an 83-year-old widow who had to pay over $363,000 in federal estate taxes on the death of her same-sex spouse because the federal government did not recognize her marriage. After lower courts ruled in favor of Windsor, the U.S. Supreme Court ruled in a 5-to-4 decision that Section 3 violated the Due Process Clause and Equal Protection guarantees of the Fifth Amendment of the U.S. Constitution. Although Windsor did not challenge Section 2 of DOMA, it was later invalidated by Obergefell v. Hodges. The invalidation of Section 3 of DOMA by Windsor allowed legally married same-sex couples to be considered married for all federal purposes, including federal spousal benefits. Because samesex marriage was not recognized in all states at the

Dementia

time of the decision, a complication arose when a same-sex couple was legally married in one state, but lived in a state that did not recognize same-sex marriage. To reach these marriages, the federal government adopted a “state of celebration” rule that recognized same-sex marriages, provided they were valid in the state where they were performed. However, this expansive rule did not apply in all instances because the laws authorizing certain benefit programs, such as Social Security, specifically imposed a requirement that a marriage must be valid in the couple’s state of residence. In these cases, a legally married same-sex couple who lived in a state where their marriage was not recognized would not be considered married for federal purposes. The resulting confusion further complicated the recognition of same-sex marriage at the federal level. The confusion was not resolved until the Supreme Court decided Obergefell v. Hodges in 2015 and mandated nationwide marriage equality. Nancy J. Knauer See also Domestic Partnership; Legal Recognition of Nonmarital Same-Sex Relationships; Marriage Equality, Landmark Court Decisions

Further Readings Baehr v. Lewin, 852 P.2d 44, 53 (Haw. 1993). Baehr v. Miike, No. 91-1394, 1996 WL 694235, at *21 (Haw. Cir. Ct. 1996), aff’d 950 P.2d 1234 (Haw. 1997). Chauncey, G. (2004). Why marriage? The history shaping today’s debate over gay equality. New York, NY: Basic Books. Cott, N. (2002). A history of marriage and the nation. Cambridge, MA: Harvard University Press. Defense of Marriage Act, Pub. L. No. 104-199, 110 Stat. 2419 (1996). Knauer, N. (2006). The recognition of same-sex relationships: Comparative institutional analysis, contested social goals, and strategic institutional choice. Hawai’i Law Review, 28, 23–83. Obergefell v. Hodges, 135 S. Ct. 2584 (2015). United States v. Windsor, 133 S. Ct. 2675 (2013).

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DEMENTIA Dementia has been referred to as a contemporary epidemic, and, while there has been a great deal of attention paid to the ways in which cognitive problems can affect those diagnosed (and the caregivers who support them), there remain a number of marginalized groups whose experience of cognitive loss remains little researched or understood. The onset and effects of dementia can have a profound and lasting impact on a person’s sense of identity. They can undermine a person’s carefully constructed coping mechanisms and can prove to be a barrier to effective communication and decision making. For LGBTQ people, these issues can be particularly profound, presenting additional obstacles and challenges that a non-LGBTQ person would be unlikely to face. It is these issues that are the focus of this entry. The reasons for the invisibility of LGBTQ people in the context of dementia are not clear but may relate to the historical silencing of LGBTQ voices in mainstream health and social care research and practice. Further, the fact is that LGBTQ people, who may have spent a lifetime concealing their sexual and gender orientation from service providers, are unlikely, in the event of difficulties in later life, to make themselves known. In addition, within the study of dementia itself, difficult issues are often marginalized, and the experience of dementia tends to be governed by a biomedical approach to both theory and practice. A biomedical perspective tends to merge issues of sexuality into the more obvious presenting needs of a person with dementia (again offsetting a need to address those issues that practitioners may find particularly challenging). There are, of course, a number of ways of conceptualizing dementia in an LGBTQ context. The first would suggest that “dementia is dementia” and that the experience of cognitive loss effectively subsumes one’s other personal and social identities. That is, one’s sexuality is seen as largely irrelevant to the experience of cognitive loss. On the other hand, it could be argued that issues of

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sexuality (which constitute part of the core of a person’s identity) inevitably affect, influence, and infuse all of a person’s other personal and social dimensions. That is, while the physiological effects of dementia may be broadly similar for all those who are diagnosed, the experience will depend upon a range of intersecting factors, one of which is a person’s sexuality. There is, however, little research that has focused specifically on LGBTQ people’s experiences of dementia, so it is difficult to determine which side of this conceptual coin is most persuasive. It is likely, however, that, as a result of the lack of knowledge about how dementia might be experienced by LGBTQ people, service providers may not feel confident in response to their needs. Nonetheless, research in dementia more broadly would suggest that people living with dementia (and their caregivers) fare best when they are able to continue their lives as they did prior to the diagnosis. Thus, it is important to be cognizant of the potential difficulties associated with living with dementia as part of a sexual minority. Dementia is a condition that has the potential to highlight and exacerbate existing social difficulties. LGBTQ people, all of whom, by virtue of their vulnerability to ongoing discrimination and marginalization, continue to live in uncertain social circumstances, may face the fears associated with dementia more intensively. Discrimination and prejudice remain potent forces and, for LGBTQ people with dementia, the associated stigma can serve to accompany and magnify the challenges associated with life as an LGBTQ person. One of the critical challenges these intersections of experience bring about focuses on the ways in which private matters can become more public when dementia becomes part of a person’s everyday experience. As dementia progresses, it may be necessary to invite service providers into one’s home—ordinarily a place of sanctuary but, for those who may not be comfortable with public knowledge of their sexuality, this sanctuary can be easily undermined and threatened when the outside world, by necessity, enters in.

The experience of dementia, like other critical life experiences, is underscored by heteronormative expectations and, in this context, LGBTQ people may have to decide whether or not to reveal their sexuality to the service providers who may be called upon to support them. The decision to come out (or not) to formal care providers can generate anxieties that they may be homophobic or unwilling to respect a person’s life choices. Indeed, the little existing research into the experiences of LGBTQ people living with dementia or caring for a person with dementia suggests that these anxieties are well founded. In response, LGBTQ people with dementia may feel it necessary to conceal their sexual identity to those people charged with supporting them, which may result in inappropriate (or at least insensitive) service provision. The anxiety this may generate can only further exacerbate the difficulties associated with living with dementia and, as cognitive losses accrue, the ability to effectively manage one’s public persona can be compromised. For service providers, a recognition and appreciation of these issues is essential to support LGBTQ people with dementia effectively. In addition, it is necessary to understand the particular ways in which LGBTQ people may construct their own support systems to purposefully include the family of choice. LGBTQ people may experience additional difficulties if their dementia becomes so challenging that they require long-term care. For example, they may need support and assistance to identify and access LGBTQ-friendly services. In this context, a person’s dementia may also be a barrier to making choices about whom to come out to and where it is safe to be open about issues of sexuality. Trans people, in particular, may face additional challenges that relate to the ways in which dementia, and its latent forgetting, has the potential to undermine the transition process and obfuscate the person’s true identity. This, in turn, might generate anxieties for service providers, who could be uncertain as to how best to respond. Dementia presents numerous, and sometimes insurmountable, challenges to those diagnosed and their caregivers. As this entry has demonstrated,

Demographics and the LGBTQ Population

these challenges can be particularly acute for people who are already marginalized. Nonetheless, there is a cohort of LGBTQ people now aging with the benefit of supportive legislation and social endorsement. They can reasonably expect dementia care service providers to have an informed understanding of their needs. Elizabeth Price See also Ageisms in LGBTQ Cultures; Aging, Sex, and Sexuality; Aging, Social Relationships, and Support; Aging and Gay Men; Aging and Lesbian Women; Aging and Transgender People; Discrimination Against LGBTQ Elders; Heterosexism

Further Readings Price, E. (2008). Pride or prejudice? Gay men, lesbians and dementia. British Journal of Social Work, 38, 1337–1352. doi:10.1093/bjsw/bcm027 Price, E. (2010). Coming out to care: Gay and lesbian carers’ experiences of dementia. Health and Social Care in the Community, 18, 160–168. doi:10.1111/j.1365–2524.2009.00884.x Price, E. (2011a). Caring for mum and dad: Lesbian women: Negotiating family and navigating care. British Journal of Social Work. doi:10.1093/bjsw/ bcr015 Price, E. (2011b). Gay and lesbian carers: Ageing in the shadow of dementia. Ageing and Society. doi:10.1017 /S0144686X11000560 Ward, R., Rivers, I., & Sutherland, M. (2012). Lesbian, gay, bisexual and transgender ageing: Biographical approaches for inclusive care and support. London, England: Jessica Kingsley.

DEMOGRAPHICS AND THE LGBTQ POPULATION Demography involves the study of population patterns and processes, traditionally concentrated on the fields of fertility, mortality, and migration. The discipline has expanded well beyond these core fields, however, and encompasses at least two

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dozen subfields, including areas such as race and ethnicity and gender. Over the past decade, population research has increasingly incorporated the demography of sexuality, including a focus on the demographics of the LGBTQ population. This entry discusses the importance of studying the demographics of the LGBTQ population and provides an overview of related key findings.

The Importance of Demography Population studies provide an opportunity to learn more about how many individuals identify as LGBTQ or engage in same-sex sexual behaviors, as well as how these sexual identities or practices affect their life outcomes. This type of information serves at least three purposes. First, as persons who fall outside of the heteronormative mainstream, LGBTQ individuals are often seeking information regarding the commonality of their identities, desires, and behaviors. This information can provide a sense of validation, as well as connectedness to other LGBTQ individuals. Demographic research on the prevalence of the LGBTQ population, therefore, has been frequently cited by individuals and LGBTQ organizations to bolster visibility and a sense of community. Second, knowledge about the demographics of the LGBTQ population has important policy implications. Most commonly, information gleaned from demographic analyses of sexual identity and behavior has been notable in terms of its relevance for population health and reproduction. LGBTQ individuals face different health needs and risks than do heterosexual individuals; accordingly, gaining an understanding of the prevalence of the population and its particular health requirements is important for health policy. In a data-driven society, there has also been a demand for demographic analyses to serve as support for policy initiatives for the LGBTQ population. For example, data on the geographic distribution of the LGBTQ population have been used in policyrelated work that explores the economic impact of same-sex marriage for states. Studies on economic outcomes for lesbian, gay, bisexual, and transgender

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(LGBT) persons have also been used to analyze the merit of the proposed Employment NonDiscrimination Act (ENDA). In addition, studies on the characteristics of same-sex couples as parents have served as fodder for those arguing both for and against same-sex marriage or gay adoption. Third and finally, demographic studies of the LGBTQ population have contributed toward unwrapping the concept of sexual orientation as an identity and a behavior. By studying the differences in prevalence between same-sex sexual behavior and LGBTQ identity, we are able to better understand whether behaviors versus identities have implications for other demographic outcomes. For example, a demographer might assess whether an individual who engages in same-sex sexual behavior, but does not identify as LGBTQ, would be exposed to the same risk of discrimination as someone who identifies.

Overview of Key Findings The Lesbian and Gay Male Population

Research on LGBTQ demographics has been largely driven by an interest in quantifying the size of the LGBTQ population. One of the first estimates of the prevalence of gay individuals in the population came from Alfred Kinsey. A biologist with a doctorate in entomology, Kinsey gained notoriety by encouraging the development of a methodical analysis of typical sexual behavior within the population. He conceived of sexual orientation as existing on a continuum, rather than in a simpler binary construction of heterosexual or nonheterosexual. Thus, when he presented estimates from his research of the prevalence of gay men in the population, he provided estimates of the percentage of men who might fall along a continuum of same-sex desires and behaviors. Despite this attempt to provide more nuanced prevalence estimates for gay men, a single estimate has been most cited from Kinsey’s work—that 10% of men in the U.S. population are gay. This figure became pervasive in the popular discourse, and remains the most-often cited estimate of the gay population among laypersons.

Given Kinsey’s heavy inclusion of student and prison populations within his study, questions arose regarding the representativeness of Kinsey’s sample. With the rising popularity of random sampling methods within the social sciences, researchers sought to gain a more accurate picture of the prevalence of lesbians and gay men within the population. Studies drawing on representative samples have produced estimates that range from 1.2% to 2.4% for gay men and 0.8% to 1.6% for lesbians. Some of the variation in estimates is attributed to whether researchers measured sexual orientation by sexual identity, behavior, or desire, with same-sex sexual behavior producing the highest estimates of the gay male and lesbian population. Even within each of these categories, however, variation in estimates is produced due to the reliance on measuring sexual orientation as a categorical rather than continuous variable. When measured as categorical, determining how much same-sex sexual behavior or desire renders one as nonheterosexual is subjective and varied across researchers. This practice contributes to differing prevalence estimates of the lesbian, gay, and bisexual (LGB) population, but is used out of convenience due to the lack of data collection and conceptualization of orientation as a continuous scale. In addition to prevalence estimates, researchers have attempted to describe the characteristics of the lesbian and gay male population. The U.S. Census Bureau data on same-sex unmarried partners have been one of the primary sources of information on the demographics of the gay and lesbian population, owing to the large sample size, which permits more detailed analysis of characteristics and geographic distribution. Overall, this research indicates that individuals who identify as being in same-sex relationships are more racially diverse and in more interracial and interethnic relationships than those individuals in different-sex relationships. Studies using the U.S. Census Bureau data have found that individuals identify as being in samesex unmarried partnerships within every county of the United States. Counties with the highest prevalence of men in same-sex partnerships are more

Demographics and the LGBTQ Population

urban, including San Francisco, California; Manhattan, New York; and the District of Columbia. Those counties with the highest prevalence of women in same-sex partnerships include less urban areas, such as Hampshire, Massachusetts; Franklin, Massachusetts; and Juneau, Alaska. Perhaps unexpectedly, same-sex couples with children are more prevalent in the politically and socially conservative areas of the southern United States than in the Northeast and West. In addition to geographic distribution, researchers have examined the prevalence of children within same-sex unmarried-partner households. Studies using Census Bureau data indicate that approximately 27% of female couples and 11% of male couples have a child within the household. The majority of these children are identified as a biological child of the head of household, with approximately 59% of children in female households and 66% of children in male households identified as biological. Same-sex couples with children are more racially diverse and earn lower household incomes than do those same-sex couples without children. Economic outcomes have also comprised a great deal of the demographic research on the gay and lesbian populations. In particular, researchers have attempted to determine whether a wage penalty exists for nonheterosexual individuals. The majority of studies have found that gay men experience a wage penalty when compared with married heterosexual men; in some studies, gay men’s earnings have been found to be comparable to those of men who are cohabiting with a different-sex partner. Overall, these findings suggest that marriage provides an important economic boost to heterosexual men, and that a portion of the wage penalty experienced by gay men is derived from lack of access to legal marriage or to differential returns on marriage. The economic picture is less clear for women, with some studies indicating that lesbians experience a wage penalty compared with married and partnered women, others indicating comparable wages, and still others indicating a lesbian wage advantage. The majority of studies utilizing recent, representative datasets support the finding of a

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lesbian wage advantage as compared with married and partnered women. Family researchers have found that married women do not experience the same income benefits from marriage as married men. This could provide a partial explanation for why lesbians do not appear to be affected by the same wage penalty as gay men. Some research suggests that lesbians might be less likely to experience an income penalty from motherhood as compared with heterosexual women. It is possible that a lower average household income for two women, as compared with a heterosexual household with a male earner, results in lesbians being less likely to enter and exit the labor force when having children. A more stable workforce trajectory for lesbians, as compared with heterosexual women, could produce a higher income over the course of a career. The Bisexual Population

There has been limited research on the demographics of the bisexual population. Due to small sample sizes of LGB individuals on most nationally representative samples, researchers have tended to group bisexual individuals with gay male or lesbian individuals in order to increase sample sizes. The existing data do, however, indicate that the prevalence of bisexual men is approximately 0.4% to 1.1% of the population, and that more women identify as bisexual at approximately 1% to 2% of the population. Some scholars suggest that there is greater fluidity allowed for women’s sexual identities, which permits a bisexual identity; in contrast, men face a strict binary of straight or gay, with any same-sex sexual desire or behavior rendering one “gay.” Greater examination of the characteristics of the bisexual population is needed in order to determine whether and how they vary from those who self-identity as gay men or lesbians. The Transgender Population

Little research has examined the prevalence or demographic characteristics of the transgender population. This is attributable in part to the fact that defining who is to be included or excluded from the

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population is problematic. Some individuals identify as transgendered, whereas others identify as their lived gender; in other words, an individual who was born female but lives as a male might identify as either transgendered or as male. These measurement challenges make collecting data about the prevalence of the transgendered population difficult. In addition, most of the information that has been collected about the population is derived from medical or psychological studies where individuals are recruited from the portion of the transgendered population that is seeking surgical or hormonal changes or psychological counseling. It is unknown, therefore, how prevalent the transgendered population might be if individuals outside of these groups were to be included. With these limitations in mind, the best estimates of the prevalence of the transgendered population are approximately 0.0077% to 0.034% for maleto-female transgendered individuals, and 0.0029% to 0.012% for female-to-male. Due to measurement challenges and limited sample sizes, little is known about other demographic characteristics of the transgendered population.

Conclusion Demographic analyses of the LGBTQ population have proven important within the LGBTQ community and for public policy. Many questions, however, remain unanswered about this population. Few surveys incorporate questions designed to capture sexual behaviors or identities, and there is a virtual absence of questions on gender identity in representative population surveys. For those surveys that do contain questions regarding sexual behavior or identity, many were not designed with the purpose of sexuality research in mind. For example, the U.S. Census data on same-sex unmarried partners are derived as a by-product of a variable that was developed to measure cohabitation. Gaining additional insight into LGBTQ demographics— particularly those for the bisexual and transgendered populations—thus requires future investments in survey design and data collection. Amanda K. Baumle

See also Methodological Decisions by Researchers of LGBTQ Populations; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity; Quantitative Research; Sampling; Sexual Attraction, Behavior, and Identity

Further Readings Baumle, A. K. (Ed.). (2013). International handbook on the demography of sexuality. Dordrecht, the Netherlands: Springer. Baumle, A. K., Compton, D. R., & Poston, D. L. (2009). Same-sex partners: The social demography of sexual orientation. Albany: State University of New York Press. Black, D., Gates, G. J., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography, 37, 139–154. Gates, G. J., & Ost, J. (2004). The gay and lesbian atlas. Washington, DC: Urban Institute Press. Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press.

DEPRESSION Elevated rates of clinical depression have been documented among LGBTQ populations when compared with cisgender and heterosexual peers. Depression is a mental health disorder with cognitive, physical, and affective symptoms marked by loss of interest and pleasure in activities. This entry discusses depression in the LGBTQ community using the minority stress theory model as an explanatory framework. Variations in prevalence (the percentage of the population affected at any one time) and symptom expression are described, as well as resilience and risk factors.

Depression

Prevalence Lifetime depression rates in LGBTQ populations are consistently higher than those in heterosexual and cisgender samples. LGBTQ populations are up to 4 times more likely to meet the criteria for major depressive disorder than peers. Rates of symptoms extreme enough to merit a diagnosis of major depression, also known as clinically significant symptoms, have ranged from 13% to 71%, underscoring the diversity of the LGBTQ population and the variations of risk within this group. Within lesbian, gay, and bisexual (LGB) samples, bisexuals often report the highest depression rates. However, this finding is not always substantiated. Competing research has found depression rates in bisexuals to be comparable with those of lesbians and gay men, indicating no elevated risk. While the reason for this disparity in findings is unclear, it is possible that bisexuals experience stigma in both LGBTQ and straight communities, increasing isolation and distress. Compared with LGB people, however, transgender-identified people are twice as likely to develop depression. Estimated prevalence rates for this group are consistently higher than rates reported for cisgender LGB samples; an estimated 44% to 60% of the transgender population have reported clinically significant depressive symptoms at some point in their life. Little research has been conducted concerning nonbinary or genderqueer transgender people. However, one study estimates major depression prevalence rates in this group to be 53%, comparable to findings in the larger transgender population. Depression rates may be particularly high for transgender-identified women, who are almost twice as likely as transgender men to meet the criteria for major depressive disorder. This reflects studies of general populations, where women are commonly found to have higher rates of depression than men. Similarly, studies of wide samples of the LGBTQ community often find lesbians to be at an elevated risk for depression compared with gay men. However, this relationship is complicated by the higher risk of violence for gay men, as discussed in the following section. In studies that have shown elevated depression rates for

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bisexuals, bisexual women tend to report higher levels of depressive symptoms than bisexual men.

Psychosocial Risk Correlates The behavioral consequences of depression among LGBTQ populations are varied. The documented relationship between LGBTQ identity and suicidal thoughts and attempts seems to implicate a link between LGBTQ depression and suicide. The evidence for a causal relationship between depression and attempted or committed suicide is unclear— no direct link has been found between suicide attempts and clinically significant depression among LGBTQ people. The uncertain relationship between depression and suicide, however, does not mean that LGBTQ people are not at risk for injury; self-harm, as distinct from attempted suicide, is still a concern. Research has found a link between depression and self-harm, with one study of LGBTQ youth finding that those exhibiting depressive symptoms were up to 3 times more likely to engage in cutting behavior. Furthermore, depression appears to predict high-risk sexual activity. The relationship between mental and physical health, especially as influenced by discrimination, may be particularly salient for LGBTQ individuals. LGBTQ individuals with depressive symptoms are at a greater risk for alcohol and drug abuse. Furthermore, LGBTQ older adults report engaging in unhealthy behaviors such as missing doctor appointments out of fear of discrimination by health care providers. This suggests a link between depression and poor physical health among LGBTQ populations. For youth, depression particularly impacts home and school life. Bullying, assault, and otherwise hostile school environments may be particularly difficult for LGBTQ students with clinical depression, increasing their risk for absenteeism. One study of youth with depressive symptoms found that those who identified as a sexual minority had a significantly larger number of unexcused school absences than straight peers, implying that the relationship between depression and absenteeism

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is particularly strong for LGBTQ students. Furthermore, studies of homeless youth have found elevated rates of depression among those who identify as LGBTQ.

Minority Stress and Stigma A central framework used to understand elevated rates of depression in LGBTQ populations is the minority stress model, which has been adapted for transgender populations as the gender minority stress model. This theory proposes a model of stress unique to LGBTQ individuals as a result of their stigmatized social category. Discriminatory social institutions uniquely and constantly place the burden of stigma on LGBTQ people. The stressors associated with this stigma exceed those stressors encountered in everyday life and thus explain differences in distress, including depression, between LGBTQ and non-LGBTQ populations. Members of minority groups respond to these stressors with both individual resiliency and group-level coping skills. This model commonly identifies three types of minority stress: stressful events, anticipation of prejudice, and internalized homophobia and transphobia. All three types of stressors have been linked with depression, providing strong evidence for the utility of this model. Incidences of physical attack, especially when related to gender or sexual-minority status such as hate crimes, have been found to significantly increase depressive symptoms in LGBTQ people. In youth, victimization and bullying in school are correlated with higher rates of depression. Furthermore, nonviolent incidents such as workplace discrimination have also been found to correlate with increased depressive symptoms. It is important to note that minority stressors impact individuals differently. Gay men and transgenderidentified people experience the highest rates of violence, and thus are particularly impacted by this type of minority stressor. The effects of anticipation of prejudice and stigma are more difficult to measure. Nonetheless, evidence suggests that the stress of constant vigilance against potential stigma, also known as anticipatory stigma, is related to depressive

symptoms. Studies with samples of gay men have found that the anticipation of stigma may be an even better predictor of psychological distress in general than actual instances of victimization. Furthermore, some tests of the minority stress model have found expectation of rejection or prejudice to have the largest impact on depression levels compared with the other two stress processes discussed. Anticipation of stigma particularly impacts the well-being of LGBTQ elders. Studies have shown that LGBTQ elders are more concerned about discrimination from health care providers than straight elders. Thus, long-term health care, such as nursing homes or hospice, is especially stressful for this population. The internalization of societal views about LGBTQ people has been related to depression. In a study looking at many different measures of internalized homophobia, the presence of internalized homophobia was significantly related to an increase in depression scores. For transgender people specifically, internalized transphobia has been linked with increased general psychological distress and suicide attempts, implying a similar impact. Thus, internalized homophobia and transphobia have a demonstrated impact on the development of depression in LGBTQ people.

Protective Factors and Resilience LGBTQ people demonstrate unique resilience and coping in the face of minority stress at both the individual and group levels, ameliorating the effects of stigma on depression. Group-level coping mechanisms are utilized through access to the wider LGBTQ community, garnering social support from peers and the formation of a positive LGBTQ identity. For example, studies of transgender samples have found that support from other transgender-identified people is associated with lower levels of depression. These resources might include Gay–Straight Alliances (GSAs), social media, LGBTQ support groups, and involvement in LGBTQ activism. Connection with a group identity increases resiliency and protects against LGBTQ-related depression. Through these connections with peers,

Depression

LGBTQ people have access to the development of an in-group identity. The development of an affirmative LGBTQ identity acts as a further buffer against minority stress. Those who endorse a strong level of identity pride have been found to exhibit lower levels of psychological distress. In addition, LGBTQ-identified people who report a sense of belonging to the wider LGBTQ community report fewer depressive symptoms than those who do not feel connected to the LGBTQ community. Resilience is sustained through the use of specific coping strategies. There is modest evidence to suggest that some types of coping strategies are more effective than others. Active coping skills that focus on problem solving are modestly beneficial. For transgender people, the use of coping strategies has been seen to change throughout the process of transition, with more active skills being used during and after transition. These changes in coping behavior may account for differences in psychological distress during various stages of transition; more psychological distress is generally reported in the early stages of transition. LGBTQ people with active coping styles have lower rates of depression, and behaviors associated with active coping predict lower levels of depressive symptoms. Increased social support has also been associated with a decrease in depression among LGBTQ individuals. Some studies have found that LGBTQ adolescents’ depression is most strongly impacted by familial social support. Among gay and lesbian adults, social support from gay friends has been found to be most impactful. In general, relationships providing support for an individual’s LGBTQ status can act as a protective factor against the development of depressive symptoms. There is only limited research into the personality characteristics that may boost resiliency in the face of minority stress. Some researchers have found the trait of optimism in particular to be negatively associated with depression among gay and bisexual men. High levels of optimism have been found to minimize or eliminate the negative impact of discrimination and victimization on mental health especially. Research has also explored the resilience factor of self-esteem in LGBTQ

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samples. In two studies of LGBTQ youth, selfesteem levels predicted depression levels among gay, lesbian, and transgender participants. Thus, high baseline levels of self-esteem may act as a buffer against the development of depression. Despite representations of religious institutions as homophobic and transphobic, religious or spiritual beliefs have been found to increase resiliency for LGBTQ people. Notably, many LGBTQ individuals experience stigma in their religious communities, which adds stress, while at other times religious communities may offer social support that enhances resilience. In some studies, religious and spiritually based coping has been mildly linked to lower levels of depression in lesbians and gay men. Religious coping behaviors are also highly associated with active styles of coping, indicating that religiosity is protective only insofar as it enables other coping behaviors such as social support.

Risk Factors While the use of adaptive coping strategies can boost resiliency, some coping strategies can pose risk factors to depression. Avoidant coping is an emotion-based coping strategy that involves evading emotional pain, rather than actively dealing with problems. The use of avoidant coping has been linked to negative mental health outcomes such as anxiety and depression. In fact, evidence suggests that facilitative or problem-based coping is helpful mainly in that it replaces avoidant coping. The absence of avoidant coping behavior is likely more important for positive mental health outcomes than the use of facilitative coping. Furthermore, the use of emotion-based coping as a primary coping skill may prevent LGBTQ individuals from accessing other sources of resiliency. For example, high levels of avoidant coping are associated with decreased social support, especially from LGBTQ peers. Concealment of LGBTQ identity, a risk factor implicated in minority stress, is also strongly associated with avoidant coping; individuals who engage in high levels of concealment also tend to rely on avoidant coping strategies.

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Identity concealment, or being “in the closet,” has also been associated with increased rates of depression. One study found that concealment of sexual identity among gay men predicted higher levels of depressive symptoms. Conversely, disclosure of one’s sexual identity has been linked to a decrease in depressive symptoms. This phenomenon is sometimes described as a type of hypervigilance involving anticipatory stigma. Social support can at least partially explain the relationship between concealment and increased depression; those who are more highly concealed may receive less support. In social contexts that are unsupportive or hostile to LGBTQ people, the beneficial effects of coming out are demonstrably weakened, and concealment might be necessary for safety. LGBTQ-identified youths are at increased risk for depression. Adolescents and youths who come out publicly have particularly high rates of depression. However, risk of LGBTQ depression appears to decline with age. In studies of adult gay men and lesbians, older age is associated with lower incidence of depression. Furthermore, studies have shown that the risk associated with LGBTQrelated physical and verbal abuse declines as age increases. While LGBTQ status disclosure has overwhelmingly positive effects on LGBTQ mental health, increased identifiability as LGBTQ raises the risk of minority stress. The hostility or acceptance of one’s social context can drastically curtail the positive effects of coming out; evidence suggests that the benefits of coming out in unsupportive families, schools, or workplaces are negligible. In youth, the number of years one is publicly “out” have been found to correlate with increased level of depression by increasing experiences of school victimization. This suggests that coming out earlier increases rates of depression in some contexts. The number of people one has disclosed to is similarly related to depression; being out to an entire school increases depressive symptoms more drastically than being out to one or two friends, underscoring the importance of considering social context when examining depression.

Similarly, gender nonconformity may act to identify LGBTQ individuals, even when they have not come out. Although gender nonconformity and LGBTQ identity are separate constructs, gender nonconformity is more often seen in LGBTQ people. Both self-reported and observer-rated gender nonconformity in lesbians and gay men have a relationship to depression, although this relationship is stronger for gay men. Furthermore, while negative effects of “outness” are tempered by the benefits of disclosure, this is not true for gender nonconformity. Both forms of identifiability and gender nonconformity increase depression through minority stress victimization. The high rates of HIV infection within the LGBTQ population, particularly for gay and bisexual men, are a concern for mental as well as physical health. Studies of HIV-positive gay and bisexual men have routinely found that HIV symptoms are associated with depression as related to increases in symptom numbers and severity. However, HIV status appears to have no relation to depression except as mediated through physical symptoms.

Conclusion The high rate of depression among LGBTQ populations is impacted by such factors as victimization, internalized homophobia and transphobia, and anticipatory stigma. Minority stress largely accounts for the elevated rates of depression among LGBTQ individuals. Minority stress does not affect all individuals equally, as this experience disproportionately impacts transgender-identified people and women. Furthermore, other risk factors may interact with LGBTQ minority stress, such as age or health. While LGBTQ identity poses a risk for minority stress, this identification also creates opportunity for accessing group-level coping mechanisms that enhance resiliency and life meaning. These coping resources and resilience factors further enhance the ability to cope with minority stress. Research on LGBTQ individuals with depression should focus on expanding the accessibility of group coping and encouraging

Developmental Aspects of Sexuality

active coping styles. Political and social change is also needed to reduce overall minority stigmatization in order to eliminate the source of minority stress and reduce depression rates. Mallory Merryman and Lauren Mizock See also Homophobia; Resilience and Protective Factors, Youth; Suicide, Risk Factors for and Prevention of; Transphobia; Violence and Victimization of Youth

Further Readings Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Consulting and Clinical Psychology, 81(3), 545–557. Budge, S. L., Rossman, H. K., & Howard, K. A. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of social support. Journal of LGBT Issues in Counseling, 8(1), 95–117. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53–61. Fergusson, D. M., Horwood, L., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56(10), 876–880. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. McLaren, S., Gibbs, P. M., & Watts, E. (2013). The interrelations between age, sense of belonging, and depressive symptoms among Australian gay men and lesbians. Journal of Homosexuality, 60(1), 1–15. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Wright, A. J., & Wegner, R. T. (2012). Homonegative microaggressions and their impact on LGB individuals: A measure validity study. Journal of LGBT Issues in Counseling, 6(1), 34–54.

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DEVELOPMENTAL ASPECTS OF SEXUALITY Sexuality, defined as physical, emotional, and cognitive aspects of sexual development, undergoes many changes during the life cycle. Understanding these changes in the context of lesbian, gay, bisexual, and queer (LGBQ) individuals is of interest because the dominant understanding of sexuality has tended to be heteronormative. This entry describes the developmental aspects of sexuality, beginning with infancy and closing with old age. Sexuality in general will be discussed, with emphasis on the sexuality and sexual orientation of individuals who identify as LGBQ.

Sexuality: Infancy Through Adulthood Sexuality in Infancy (Ages 0–2)

Many people find it difficult to imagine that the development of sexuality begins as early as infancy. However, children at this age are curious about their bodies. They explore their bodies through touch; this includes their genitals. Infants and toddlers also have no knowledge of the social norms that determine when nudity is appropriate or inappropriate. Sexuality in Toddlers/Preschool Children (Ages 2–5)

As children grow, they find new ways to explore their own and others’ bodies. During the ages of 2 to 5, most children become aware of their gender and how it is similar to and different from others’. They also may begin to pay more attention to societal gender roles. In addition, they begin to play games with other children (e.g., doctor) that may involve showing their genitalia or touching each other’s bodies, motivated by curiosity. Some children explore their genitalia via masturbation at this stage, which may occur in public or in private, because they may not yet be aware of social norms and expectations regarding public nudity or masturbation. Masturbation is conducted primarily

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out of curiosity about their bodies, but children may also experience physical pleasure associated with masturbation. Sexuality in Middle Childhood (Ages 5–8)

Knowledge of gender roles becomes more solidified during middle childhood. For example, children may express desire to conform to such gender roles through clothing, friendships, and extracurricular activities. Masturbation becomes more private at this age, as children begin to understand the societal view of masturbation as a private activity. At this stage, children also may begin to ask more questions regarding gender and sexuality, displaying their continued curiosity. Sexuality in Late Childhood (Ages 9–12)

During the preadolescent/early adolescent stage, children’s experiences with puberty begin to impact their developing sexuality. Children at this age experience physical changes in their bodies, including changes in genitalia and reproductive organs as well as secondary sexual characteristics (i.e., changes that are not directly related to reproduction, such as breast development and hair growth). They may be more self-conscious of their bodies and become more private with nudity. Masturbation at this age is likely entirely private, and their curiosity about sexuality may lead children to explore media with sexual content (e.g., television, Internet, film). Children at this age also may show desires to have more intimate relationships with peers (e.g., socializing outside of school, exploring kissing, talking about sexuality), and most begin to think more about sexual orientation than during their younger years. Sexuality in Adolescence (Ages 13–18)

Although puberty may begin prior to age 13 and may not always conclude by age 18, most adolescents experience puberty between these ages. During this period, their bodies become physically capable of reproduction. Adolescents

typically continue their explorations of sexuality via intimate and increasingly sexual encounters with others. They also continue to engage in masturbation, sexual orientation exploration, and exploration of gender and gender roles. Adolescents also become more emotionally attached to their intimate and/or sexual partners than in younger years. Sexuality in Early Adulthood (Ages 18–25)

Most young adults are sexually active. In addition, many in early adulthood have romantic relationships that continue to become increasingly emotionally involved, and some begin to consider marriage or starting a family. Now capable of reproduction, some young adults engage in sexual intercourse that leads to decisions regarding pregnancy, childbirth, and parenthood. Sexuality in Adulthood (Ages 25 and older)

As adults age, they continue to engage in sexual activity. Around the age of 50, most women experience menopause and are no longer capable of birthing children, though most continue to have sex with others. Men do not experience as abrupt a change in their sexual development, since they are capable of fathering children for most of their lives. However, over time, it becomes more difficult for men to sustain an erection, and both men and women may experience age-related health problems that interfere with sexual motivation and activity. Adults with children begin to experience the responsibility of educating their children about sexual development and answering their questions about sexuality. They may also experience grandparenthood. In addition, adults who are married/committed to another (or others) may experience the death of their emotional and sexual partner(s).

Sexuality Development for LGBQ Youth Sexual orientation can be described as an emotional, cognitive, and sexual attraction that an

Disabilities Among LGBTQ Elders

individual feels toward another person and that exists on a continuum. Individuals can experience attractions to another gender, the same gender, some genders, all genders, or no gender. Initial identification with a sexual orientation occurs at various developmental stages. It has been shown to occur as early as young childhood and can fluctuate over time. The developmental stages of sexuality have not been shown to significantly depend on sexual orientation. However, LGBQ youth face distinct challenges, given that they experience the development of their sexuality within a society that assumes the value and universality of heterosexuality. For example, as LGBQ youth develop and explore their sexuality, they may confront misunderstanding of their sexuality from family members, peers, and schools, and especially if they engage in heterosexual experiences, which is common. Due to the stigmatization of same-sex sexuality, LGBQ youth face an increased risk of bullying and are more at risk for suicide than their heterosexual peers. It is important for schools, families, and the community at large to support the LGBQ youth who likely struggle with society’s assumptions that only heterosexuality is healthy and normative. April M. Moyer and Abbie E. Goldberg See also Aging, Sex, and Sexuality; Asexuality; Sexual Fluidity; Youth and Dating

Further Readings Diamond, L. M. (2000). Sexual identity, attractions, and behavior among young sexual-minority women over a 2-year period. Developmental Psychology, 36, 241–250. Diamond, L. M. (2003). What does sexual orientation orient? A biobehavioral model distinguishing love and sexual desire. Psychological Review, 110, 173–192. Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 47, 205–213.

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DEVELOPMENTAL DISABILITIES See Intellectual Disabilities

DISABILITIES AMONG LGBTQ ELDERS LGBTQ elders with disabilities represent a growing number of persons among the elderly and include those with physical, psychological, and sensory disorders. These disorders may be due to the developmental stages of the aging process, may be acquired as a result of an accident, or may be congenital and the person is growing older with the disability. In any case, LGBTQ elders are among the most stigmatized groups because of their sexual orientation and gender identity and one of the most marginalized because of age and disability. In general, a disability is a recognized condition that imposes limitations on a person’s ability to adequately perform major life activities. To perform such activities, persons with disabilities typically need some type of modification. Although far from homogeneous, older adults are often categorized as old (ages 65–74), middle-old (ages 75–84), and oldest-old (ages 85 and over). Understanding disability-related issues that have implications for LGBTQ elders is increasingly important for several reasons. First, people are living longer. Second, older individuals are staying in the workforce longer out of necessity, and LGBTQ elders, especially women, are among the poorest of the poor. Third, quality of life is compounded by the intersection of age, sexual orientation or gender identity, and disability. Fourth, many LGBTQ elders have a lack of access to health care services or culturally sensitive and appropriate services, and LGBTQ elders have higher rates of health disparities. Fifth, LGBTQ elders are at high risk of victimization. Finally, until recently, older LGBTQ adults have been essentially ignored in gerontological and multidisciplinary research.

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Disabilities Among LGBTQ Elders

The following section presents an overview of research on LGBTQ elders and describes a range of disabilities common to this population. The entry then explores the experience of aging and living with a disability and concludes with a discussion of implications for service providers.

LGBTQ Elders LGBTQ elders are diverse and heterogeneous. Today’s LGBTQ elders grew up in the pre–gay pride era, initiated in the 1970s. Their lives were marked by secrecy because of the potential for violence and imprisonment and a lack of legal protection from legislation. Today, the often “closeted” (that is, nondisclosure of sexual orientation or gender identity) nature of older LGBTQ adults means that service providers are unaware that they are serving LGBTQ seniors, which further relegates them to a status of invisibility. In the past, much of the existence of LGBTQ elders was characterized by an extremely phobic culture in which homosexuality or gender variance was overtly and profoundly admonished. The Diagnostic and Statistical Manual of Mental Disorders classified homosexuality as a mental disorder until 1973 and first mentioned gender identity disorder in 1980, a diagnosis that remains to date. Often, bisexual persons find themselves not fitting into either the gay or heterosexual community. Transgender persons face unique challenges apart from lesbian, gay, or bisexual persons, especially if transitioning is done later in life, because of widespread transphobia in the medical and health care communities. In addition, LGBTQ elders face discrimination and, in some instances, safety concerns in nursing homes and residential facilities. In the aging process, LGBTQ elders are confronted with the typical challenges and concerns related to health status, disability, financial stability, loss of a spouse or partner, and a host of issues because of ageism. Many LGBTQ elders face isolation as a result of not having built social networks, as well as poor health, mental health concerns, substance abuse, insufficient income, transportation and mobility challenges, and being more likely to live alone.

Although negative experiences can lead to a host of problems for LGBTQ elders, researchers have found that despite the barriers and risks, these elders have developed unique skill sets, strengths, and resiliency that their non-LGBTQ counterparts do not necessarily benefit from as they age. Older lesbians tend to have more social networks composed of lesbians across the age spectrum, and LGBTQ elders of color demonstrate a high level of resiliency resulting from coping strategies developed to deal with racism. Many LGBTQ elders are well adjusted and do not present with mental health problems or psychological dysfunction. As with anyone, numerous factors must be considered in determining psychosocial adjustment of older LGBTQ adults including preexisting conditions, propensity for certain types of illness, family history, where they are along the development continuum, and issues related to self-identity.

The Presence of Disability The rate of disability is higher in the elderly population compared with that of the general population and disproportionately higher in LGBTQ elders than non-LGBTQ elders. For LGBTQ elders, one adverse effect of stigma, discrimination, and homo/trans/biphobia is a delay in seeking care, including social and health-related services. In addition, these elders have high levels of mistrust of health care providers and are less likely to reveal their sexual orientation for fear of being denied services or receiving inferior services. A lack of disclosure prevents discussion about risk factors for certain kinds of health conditions and increases the risk of acquiring chronic conditions or disabilities. The occurrence of mental health issues in LGBTQ populations is the result of dealing with stress related to stigma, discrimination, multiple minority statuses (e.g., being gay, a person of color, female), lower educational level, and lower socioeconomic status. Mental health plays a key role in physical health, and poor mental health can increase the risk of developing chronic health conditions or aggravate existing conditions. For LGBTQ elders, a lifetime of victimization and

Disabilities Among LGBTQ Elders

internalized stigma seem to increase the risk for depression in addition to increasing the risk of poor general health and disability. In addition, LGBTQ elders who are closeted live with the constant stress of fear that their sexual orientation or gender identity will be discovered. Older adults may have certain age-related disabilities such as chronic conditions (e.g., cardiovascular diseases, hypertension, arthritis, osteoporosis), obesity, injuries (e.g., falls), malnutrition, and mental health conditions (e.g., dementia, depression). Certain chronic conditions are particularly related to disability, including visual impairment, diabetes, stroke, and cognitive impairment. Other disabilities that are prevalent in LGBTQ elders are (a) alcohol and drug addictions, which occur disproportionately because of isolation and societal attitudes and bias; (b) pulmonary disease, usually resulting from smoking, which is disproportionately high among LGBTQ persons; and (c) HIV/ AIDS because people are living longer with improvement in the management of the condition. Vulnerability to disease and disability is associated with health-related behaviors earlier in life. Among all populations living with HIV, older LGBTQ adults are at heightened risk of hepatitis, anxiety, visual impairment, some cancers, and suicidal ideation. The prevalence of disability is higher among LGBTQ ethnic-minority populations than in their White counterparts, which is attributed to decades of disparity in health care services, poverty, and discrimination. For non-English-speaking LGBTQ elders, a language or communication barrier is another obstacle to effectively addressing chronic conditions and disability. The rates of disability among LGBTQ elders are also distinguishable by gender, with women’s physical health being significantly lower than men’s. A study of aging and health of LGBTQ elders found that women have higher rates of disability, arthritis, asthma, obesity, and osteoporosis, and men have higher rates of HIV disease, high blood pressure, high serum cholesterol, cardiovascular disease, diabetes, cancer, and hearing impairments. The presence of disabilities among LGBTQ elders is usually different from that of their

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non-LGBTQ counterparts because many older LGBTQ adults live alone and lack social networks to assist them, adversely impacting their quality of life. It is unknown if the rate of Alzheimer’s disease among LGBTQ elders differs from that of the general elderly population.

Aging and Living With a Disability Depending on the age of onset, over the course of a lifetime, LGBTQ elders who have a disability might experience substantial decline in health, mobility, self-care, and independence. The way in which LGBTQ elders must face living with a disability is challenging because they must deal with heterosexism on the part of service providers, and in many segments of society. LGBTQ elders may experience pain and fatigue secondary to their disability, which may worsen over time resulting in secondary functional limitations and disabilities. For many LGBTQ elders, the question of where they will live as their disability becomes worse is of great concern, as are end-of-life issues. Living itself becomes stressful. Individuals with developmental disabilities experience differences in the onset and progression of aging because of genetic, environmental, and lifestyle factors. These factors in tandem with LGBTQ status add to the complexity of aging and the continuous adaptation to changes across the lifespan.

Implications for Service Providers Professionals who work with LGBTQ elders with disabilities need to consider ways to provide comprehensive and integrated services with interdisciplinary intervention protocols. LGBTQ elders may need to have multiple facets of their lives addressed (e.g., housing, multiple medical conditions, financial and safety issues) at any given time. Because of the high likelihood that older LGBTQ adults are living alone, it is critically important that services are targeted for those without appropriate services or adequate support. Older LGBTQ adults will also have distinctive needs depending on their geographic location (urban vs. rural).

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Today, there is consensus within the professional literature that service providers need to be trained in understanding and addressing the needs of LGBTQ elders. Furthermore, as research on aging with disability continues to emerge, a focus on LGBTQ elders is becoming increasingly important. Debra A. Harley See also Ageisms in LGBTQ Cultures; Aging and Bisexuality; Aging and Gay Men; Aging and Lesbian Women; Aging and Transgender People; Intellectual Disabilities; Physical Disabilities

Further Readings American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. Crisp, C., Wayland, S., & Gordon, T. (2008). Older gay, lesbian, and bisexual adults: Tools for age-competent and gay affirmative practice. Journal of Gay & Lesbian Social Services, 20(1–2), 5–29. doi:10.1080/10538720802178890 Dibble, S. L., Eliason, M. J., & Crawford, B. (2012). Correlates of wellbeing among African American lesbians. Journal of Homosexuality, 59, 820–838. doi:10.1080/00918369.2012.694 Fredriksen-Goldsen, K. I., Kim, H. J., & Barkan, S. E. (2011). Disability among lesbians, gay men, and bisexuals: Disparities in prevalence and risk. American Journal of Public Health, 102, 616–621. doi:10.2105/ AJPH.2011.300379 Fredriksen-Goldsen, K. I., Kim, H. J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., et al. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health. Hash, K. M., & Rogers, A. (2013). Clinical practice with older LGBT clients: Overcoming lifelong stigma through strength and resilience. Clinical Social Work Journal, 41, 249–257. doi:10.1007/s10615-0130437-2 Hunter, S. (2005). Midlife and older LGBT adults: Knowledge and affirmative practice for the social services. Binghamton, New York, NY: Haworth Press.

Kimmel, D., Rose, T., & David, S. (Eds.). (2006). Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives. New York, NY: Columbia University Press. Muraco, A., & Fredriksen-Goldsen, K. (2011). “That’s what friends do”: Informal caregiving for chronically ill lesbian, gay, and bisexual elders. Journal of Social and Personal Relationships, 28, 1073–1092. doi:10.1177/0265407511402418 Services & Advocacy for GLBT Elders (SAGE) and Movement Advancement Project (MAP). (2010, March). Improving the lives of LGBT older adults. New York, NY: Author. Szymanski, D. M., & Gupta, A. (2009). Examining the relationship between multiple internalized oppression and African American lesbian, gay, bisexual, and questioning persons’ self-esteem and psychological distress. Journal of Counseling Psychology, 56, 110–118. doi:10.1037/a0013317

DISCIPLINARY TENSIONS LGBTQ POPULATIONS

IN

STUDYING

In many ways, questions of how best to do research about LGBTQ people mirror broader questions about research: What counts as evidence? Is value-neutral research possible or even desirable given social inequities? What role does advocacy play in research? In addition to these common concerns, researchers must also address unique issues in a homophobic, transphobic, and erotophobic (i.e., sex-phobic) culture. Sexuality is generally considered a private matter that should not be discussed publicly. In addition, despite improved legal rights and recognition in recent years, LGBTQ people still experience discrimination in many public and private settings, and people who transgress widely accepted gender norms experience particularly oppressive treatment. Moreover, as intersectional analysis has demonstrated, gender and sexuality don’t exist in isolation. Rather, they interact in dynamic ways with race, class, disability, and other social identities. These realities not only make research about LGBTQ people all the more pressing, but also raise

Disciplinary Tensions in Studying LGBTQ Populations

crucial ethical questions that researchers working in and between different disciplines (e.g., sociology, psychology, criminology, anthropology) and interdisciplinary fields (e.g., women’s and gender studies, queer studies, ethnic studies, disability studies, cultural studies) respond to in divergent ways. Following an overview of overarching ethical concerns, this entry briefly explores social scientific, humanistic, creative, and interpretive approaches to LGBTQ scholarship.

Epistemological Concerns Regarding Research Feminist and antiracist researchers have long questioned positivist approaches to research that assume that facts exist free from social context. Some have sought ways to be objective that are free from patriarchal and racist assumptions and ways to use quantitative data that don’t replicate masculinist and racist assumptions in older research. Others have posited that particular standpoints, generally of people most affected by various forms of discrimination, provide the best perspectives from which to view social issues. For example, a poor woman of color working as a live-in domestic worker must understand her employer’s perspective as well as her own, while her employer doesn’t need to think about her experience. Researchers writing about LGBTQ people, communities, and cultures have built on these explorations, addressing related yet unique concerns about heterosexist and transphobic biases within society; the unique perspectives of LGBTQ people navigating heterosexist and transphobic institutions; and the role that research can play, and has played, in dominant attitudes toward LGBTQ people. In particular, researchers have had to confront stigma about sexual and gender transgressions within society and research institutions, and to address the role that academic research has played in justifying discrimination against LGBTQ people. Such concerns exist across disciplines, although the legacy of particular sites of knowledge production may be particularly fraught. Two examples of such tensions are psychology’s role in

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institutionalizing LGBTQ people, and criminology’s role in criminalizing LGBTQ people. These legacies may make finding support for LGBTQaffirming research among colleagues difficult as well as increase distrust of these researchers among LGBTQ community members. Nonetheless, policy makers remain more likely to take seriously quantitative data from these disciplines rather than explorations of queer life and resistance documented using qualitative data or theoretical analysis.

Approaches to Research: Foci and Audience How researchers approach the process of documenting LGBTQ lives differs dramatically. Descriptions of research foci reflect not only disciplinary norms, but also relationships between researchers and subjects. For example, research with or about LGBTQ people or populations is quite different from research about LGBTQ communities or culture. While a shared investment in expanding knowledge about sexual communities informs all these foci, who the experts are and how and where knowledge is produced are quite different. These concerns affect what kind of knowledge is produced, who is likely to encounter it, and the kinds of influence research is likely to have. Another, related difference among disciplinary approaches is audience. Some research focuses on changing dominant attitudes toward LGBTQ people. The goal for these researchers is for the general public and policy makers to have accurate information about LGBTQ people. Ideally, this will provide documentation of discrimination and its effects that can be used to create policies that do not reflect heterosexist and cisgendered bias, as well as policies that can address existing biases. While such documentation is very important, the focus on dominant attitudes can, generally unwittingly, affirm dominant value systems and institutions rather than challenge them. Since dominant values rarely affirm and frequently denigrate gender and sexual-minority perspectives, addressing research findings to populations that hold

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these values requires framing research in ways that will be well received, which, intentionally or not, affirms rather than questions these discriminatory values. Similarly, research invested in reaching people within conservative institutions cannot challenge the legitimacy of those institutions. If, for example, research seeks to document law-abiding LGBTQ people, it is unlikely to address why some LGBTQ people earn their livelihood through illegal activities such as sex work because of homophobic and transphobic biases in familial, educational, and workplace settings. Moreover, research that demonstrates that current institutions cannot meet LGBTQ people’s needs is unlikely to be supported by those institutions. Similarly, queer humor that parodies dominant values is unlikely to be deemed valuable within such research despite its role as a community-building and coping mechanism. In contrast, other researchers document LGBTQ lives across time and space in order to demonstrate the existence of, and unique contributions of, LGBTQ people in ways that may change dominant attitudes but, more importantly, provide examples for LGBTQ people and their allies. Such research has explored organized resistance to legal repression, alliances between LGBTQ communities and other marginalized groups, the creation of cultural institutions, and a variety of forms of cultural production. These kinds of studies are less likely to provide data for policy makers but are also less likely to uphold dominant value systems.

Research Methods Social science researchers working with LGBTQ populations use a variety of methods. Psychologists, political scientists, and sociologists have, unsurprisingly, been particularly likely to document the existence and behavior of LGBTQ people using statistical analysis drawn from survey data. Such data has provided documentation of voting behavior, violence against LGBTQ people, longterm psychological stress due to homophobia and transphobia, discrimination in hiring, how welladjusted many LGBTQ people are despite

discrimination, and other macro-level social and psychological processes. Such documentation has proved helpful for policy makers and legal analysts, even while it has been less able to address the effects of stigma and the creation of communities of resistance. In addition, some social scientists, particularly sociologists, anthropologists, and historians, as well as researchers working in interdisciplinary fields such as women’s and gender studies, ethnic studies, disability studies, and LGBTQ studies, utilize qualitative methods in order to demonstrate the effects of the patterns identified by quantitative methods. Qualitative interviews, participant observation, focus groups, and archival research, sometimes in combination with quantitative data, have provided important documentation of LGBTQ organizing strategies, the creation of communities and alternative value systems, and coping strategies. Interpretive research—that is, research that focuses primarily on analysis of difficult-todocument social and cultural dynamics—has helped analyze the effects of social stigma, explored the limitations of existing organizing models, and provided road maps for change. Some of this work is explicitly theoretical in nature, analyzing cultural values and advocating particular methods for change. Political theorists, for example, may use legal cases and celebrity controversies as examples that demonstrate widespread understandings of LGBTQ people and build on existing political theories to advocate for change. Cultural theorists employ similar methods with different examples, focusing instead on popular cultural or subcultural art and performance. Critical historians use archival data and close readings of published documents, including novels, to demonstrate dominant, often discriminatory social values and resistance to these values. Methods such as critical-interpretive ethnographies, autoethnographies, and performance ethnographies remain grounded in participants’ understandings of their lived experiences, while simultaneously exploring the cultural and sociopolitical contexts they occur within. This blending of

Disciplinary Tensions in Studying LGBTQ Populations

empirical and interpretive approaches enables researchers to address how people navigate different social realities and make meaning within them. In such research, evidence is drawn from a variety of sources such as interviews; participant observations; and analysis of cultural objects including legal documents, fiction, news reports, mass media, performances, and ephemera. Arts-based researchers explore the ways that artistic practices including writing, performance, and visual art provide embodied methods to express emotional responses and build communities of support. Some such research works with therapeutic models designed to explicitly address trauma resulting from oppression and violence. Other approaches emphasize the communitybuilding experience, focusing less on specific outcomes and more on providing opportunities for engagement and expression. Increasingly, researchers using quantitative, qualitative, interpretive, and arts-based methods are approaching their research intersectionally. Sexuality and gender identity interact in dynamic ways with race, class, disability, immigration status, and other forms of social hierarchy. The best research, regardless of discipline, explores how LGBTQ lives are informed by a variety of forms of privilege and oppression as well as by creative and resilient responses to ongoing homophobia and transphobia. Given this diversity of approaches both within and among traditional disciplines and interdisciplinary fields, disciplinary tensions are not surprising, but neither are they insurmountable. Audience influences the type of research done and the methods of presenting findings. In a broad sense, a scholar’s location within the humanities or social sciences dictates both audience and methodology; however, scholars working on the edges of their respective disciplines frequently draw from methods and theoretical models not traditionally considered part of those disciplines. It is at these edges and within new institutional locations that disciplinary tensions are the least salient. Nonetheless, assumptions about what counts as data, who produces knowledge and under what conditions,

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and what an audience expects affect how and why people do their research and the degree to which they are willing to question disciplinary norms. Elizabeth Currans See also Ethical Research With Sexual and Gender Minorities; Heterosexist Bias in Research; Intersections Between Sex, Gender, and Sexual Identity; Qualitative Research; Quantitative Research

Further Readings Bailey, M. M. (2013). Butch queens up in pumps: Gender, performance, and ballroom culture in Detroit. Ann Arbor: University of Michigan Press. Browne, K., & Nash, C. J. (2010). Queer methods and methodologies: Intersecting queer theories and social science research. Burlington, VT: Ashgate. Doan, P. (2010). The tyranny of gendered spaces— reflections from beyond the gender dichotomy. Gender, Place & Culture, 17, 635–654. Ferguson, R. A. (2004). Aberrations in black: Toward a queer of color critique. Minneapolis: University of Minnesota Press. Halberstam, J. (2005). In a queer time and place: Transgender bodies, subcultural lives. New York, NY: NYU Press. Meezan, W., & Martin, J. (Eds.). (2009). Handbook of research with lesbian, gay, bisexual, and transgender populations. New York, NY: Routledge. Muñoz, J. E. (1996). Ephemera as evidence. Women & Performance, 16, 5–18. Parent, M. C., DeBlaere, C., & Moradi, B. (2013). Approaches to research on intersectionality: Perspectives on gender, LGBT, and racial/ethnic identities. Sex Roles, 68, 639–645. Pelton-Sweet, L. M., & Sherry, A. (2008). Coming out through art: A review of art therapy with LGBT clients. Art Therapy, 25, 170–176. Phelan, S. (2001). Sexual strangers: Gays, lesbians, and dilemmas of citizenship. Philadelphia, PA: Temple University Press. Shuttleworth, R. (2012). Bridging theory and experience: A critical-interpretive ethnography of sexuality and disability. In R. McRuer & A. Mollow (Eds.), Sex and disability (pp. 54–68). Durham, NC: Duke University Press.

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Discrimination Against LGBTQ Elders

DISCRIMINATION AGAINST LGBTQ ELDERS Discrimination is generally understood to be the practice of treating a person or group of people unfairly or differently than other people are treated, in this instance on the basis of their sexual orientation. The entry will provide an overview of the discrimination that LGBTQ elders can face generally as a group and then will discuss the specific discriminations and potential oppression that each subgroup within the larger LGBTQ community can encounter as a result of their specific identity. Although only estimates are available, it has been suggested that there are anywhere between 1 million and 4 million Americans over the age of 60 who identify as LGBTQ. As well, it has been documented that the number of older Americans will increase and that by 2030, one in five Americans will be 65 or older. This means an increasing number of LGBTQ individuals will be among the older population as they are estimated to comprise 2% to 3% of that population.

Ageism, Homophobia, and Heterosexism Despite the fact that American society has seen continual increases in the older population, we are considered an ageist society that prefers and promotes youth over older ages. Ageism has been defined as negative attitudes toward older people, including stereotyping and discrimination against people simply because they are old. Ageism has been noted as prevalent in the media, health care, advertising, and employment practices (e.g., hiring, training, and promotion). Ageism is also demonstrated in personal interactions and everyday language. For example, although intended as a compliment, to say, “Wow, you don’t look 75!” demonstrates that there is a belief that 75-yearolds are not attractive. It also implies that looking younger means looking better, while looking older equates with looking worse. Parallel to the youth culture found in general society, several researchers have reported that older lesbian, gay, bisexual, and transgender (LGBT) individuals experience ageism

not only in the general culture but also specifically within the LGBTQ community. There is a lack of recognition of LGBTQ elders’ needs, which is linked to institutionalized homophobia and heterosexism through institutions that do not recognize LGBTQ persons. In some cases, these institutions may even actively work to deny services and benefits to older LGBTQ persons. Despite a large and growing number of LGBTQ elders, the National Resource Center on LGBT Aging states that there are no known current federal programs that explicitly recognize or provide supports for LGBTQ elders. Yet, in 2001, the U.S. Office of Aging stated that LGBTQ elders are underserved. Research has also reported that older LGBTQ individuals experience discrimination in a host of areas such as housing, health and wellness, economic disparities, supportive services, employment, and social stigma. Supports and programs are needed for older LGBTQ individuals to address these problems. The lack of recognition of LGBTQ elders’ needs can be seen as a result of institutionalized homophobia and heterosexism that is seen in our culture through various institutions that do not recognize LGBTQ persons or that even actively work to deny services and benefits to them. For example, many states do not have laws that protect LGBTQ individuals in their employment. As a result, individuals can be fired from their jobs simply on the basis of their sexual orientation. This has resulted in many LGBTQ elders having spent a lifetime fearful for the loss of their income, in unstable and even hostile work settings, and unable to live authentically within their workplace environments. As well, there is documented bias of mainstream health care providers against LGBTQ individuals, where providers are, at best, unaware of the sexual identity of their patients. These policies and practices are issues that can be relevant for all members of the LGBTQ community, but are often especially pertinent for LGBTQ elders, as they are most likely to need and seek all of the above services as a part of the aging experience. They are often more economically vulnerable, and these financial discriminations and health care barriers can increase and aggravate health issues.

Discrimination Against LGBTQ Elders

As a result of this difficulty, some LGBTQ elders go back in the closet or attempt to pass as heterosexual as a survival strategy when seeking longterm care, entering nursing homes, and using the services of health care providers. This also results in LGBTQ elders not accessing the very programs that they need or could benefit from. However, research has also demonstrated that LGBTQ elders have high levels of resiliency. As a result of a lifetime of facing oppression and discrimination, and overcoming these barriers and obstacles, LGBTQ elders are more likely to adjust and adapt emotionally to aging than their heterosexual counterparts.

Differences Among Sexual Identities While there is much discrimination that LGBT elders have in common, there are also differences in experience based on their unique sexual identities. The following discusses the differences found, specific to each subgroup. Lesbian Elder Discrimination

In addition to facing ageism, homophobia, and heterosexism, lesbian elders also can face the discrimination that comes from being female in a male-dominated society. It is well documented that women continue to earn lower income than men, are less likely to be in positions of power and responsibility, and are often stereotyped in their gender role expectations as weaker and less capable than men both physically and emotionally. Women are often viewed as sexual objects and prized for their attractiveness, and as a result of ageism, the focus on attractiveness decreases for women as they age. Although they can emotionally benefit from no longer being sexually objectified, women often find as they age that they are then invisible and not noticed at all. This sense of loss is documented as especially true for elder lesbians, as they have been defined by American society for their sexuality and sexual behaviors and now are seen as asexual due to their age. This invisibility impacts the ability to access resources, recognition of their needs, and their social supports.

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Gay Elder Discrimination

In addition to facing ageism, homophobia, and heterosexism in general society, older gay males report greater experiences of ageism within the gay male community, when compared with the other subgroups within the LGBTQ community. Their unique experience with ageism is a result of an even greater emphasis on youth culture in the gay male community. Both the LGBTQ community and members of the broader society often stereotype gay elders as “old drag queens,” and thus the experiences outside of that stereotype are discounted. Elder gay men have reported less family and social support than elder lesbians and thus often face aging alone or only within their partnerships. It is also important to note that the HIV/AIDS epidemic of the 1980s and its connection to the gay community, in terms of rates and contracting the disease, has had lasting discriminatory outcomes for aging gay men. Health care providers and researchers continue to put a great deal of focus on the HIV/AIDS experience, mental health, and sexually transmitted disease rates of gay males, often to the neglect of other potential health concerns. However, it should be noted that older gay men are less likely to go back into the closet than are members of other LGBTQ subgroups, thus demonstrating potentially less fear about aging and a desire for a more authentic life. Bisexual Elder Discrimination

Bisexual elders are discussed in the literature as the “invisible of the invisible,” as bisexual people are often invisible both in the general society and within the LGBTQ community. As a result of this, there is almost no research literature on the aging experience of bisexual persons. Even though it is routine for bisexual individuals to be included in discussions of sexual minorities in general (i.e., “LGBTQ”), their specific experience is assumed to be one and the same with other subgroups. However, much more research is needed to increase awareness of the bisexual aging experience and how it differs from the other LGBTQ subgroups. In terms of discrimination experiences of bisexual

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elders, much of it depends on their visibility and how “out” they are. In the few existing studies of bisexual aging, some of the participants felt an intense pressure to choose one sexual orientation or the other (heterosexual or homosexual) as they aged, and the majority chose heterosexuality for the ease and security found in that sexual identity. As well, participants shared that they felt more intensely sure of their bisexuality as they aged but did not live according to it, again for ease and security in a homophobic culture. Elder bisexual individuals have reported discrimination within the LGBTQ community as a result of their sexual identity not being accepted or recognized, in addition to now facing ageism and discrimination in general.

find that the support they formerly counted on within the LGBTQ community is no longer necessarily present, given the priority of youth culture and its promotion in the LGBTQ community. As well, it is important to note that there are differences among each subgroup within the older LGBTQ community; what an older lesbian faces in terms of discrimination can differ greatly from that of an older gay male, and so on. There is need for acknowledgment, practices, policies, and services that are holistic yet also tailored to specific needs of each subgroup within the older LGBTQ community in order to provide greater financial, emotional, and physical security for LGBTQ individuals as they age. Paige Averett

Transgender Elder Discrimination

Transgender elders face additional stigma and discrimination based on their identity when compared with all the other subgroups. In addition to the issues discussed earlier, older transgender individuals also face increased violence; greater employment and housing discrimination; more privacy and documentation issues in health care; and specific health issues that are not acknowledged, such as the impact of long-term use of hormones. In the rare studies that address elder transgender individuals, the most frequently reported concern is negative attitudes among their health care providers. Transgender elders report the least amount of social support of all groups, thus making them most vulnerable to discrimination and oppression.

Conclusion Members of the older LGBTQ community face general homophobic-based discriminations, such as federal, state, and agency laws and policies that do not provide the same benefits for LGBTQ individuals as for heterosexual individuals. Many older LGBTQ individuals return to the closet in order to avoid discrimination, which creates additional stressors. Older LGBTQ community members also face the same ageism as all older adults within U.S. society. Older LGBTQ individuals may

See also Ageisms in LGBTQ Cultures; Aging and Gay Men; Aging and Lesbian Women; Aging and Transgender People; Discrimination Against LGBTQ People in the Public Sector; Heterosexism; Homophobia

Further Readings Averett, P., Yoon, I., & Jenkins, C. (2013). Older lesbian experiences of homophobia and ageism. Journal of Social Service Research, 39, 3–15. Cahill, S., South, K., & Spade, J. (2000). Outing age: Public policy issues facing gay, lesbian, bisexual, and transgender elders. Washington, DC: National Gay and Lesbian Task Force Policy Institute. Dworkin, S. (2006). The aging bisexual: The invisible of the invisible minority. In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging: Research and clinical perspective (pp. 36–52). New York, NY: Columbia University Press. Funders for Lesbian and Gay Issues. (2004). Aging in equity: LGBT elders in America. New York, NY: Author. Knauer, N. (2009). LGBT elder law: Toward equity in aging. Harvard Journal of Law and Gender, 32, 302–358. National Resource Center on LGBT Aging. http:// lgbtagingcenter.org Services & Advocacy for GLBT Elders (SAGE). http:// www.sageusa.org/index.cfm

Discrimination Against LGBTQ People, Cost of

DISCRIMINATION AGAINST LGBTQ PEOPLE, COST OF Discrimination can be understood as the denial of social participation based on prejudices. This includes negative treatment of and attitudes toward an individual or group based on their actual or perceived membership in a certain group or social category. Throughout history, discrimination has found a home wherever there is opportunity to highlight our differences such as sex, age, race, ethnicity, place of origin, social class, religious affiliation, employment, and level of education, among others. Sexual diversity is one such aspect of human diversity that has historically been fraught with prejudice and discrimination mainly grounded in religious and cultural values and beliefs. In this entry, using a social-determinantsof-health framework, the impact of discrimination based on sexual orientation and sexual identity is discussed from two perspectives: first, the cost of discrimination against LGBTQ people and second, the cost to the broader communities to which LGBTQ people belong. Social determinants of health are the conditions in which people are born, grow, live, work, and age. Money, power, and resources at the global, national, and local levels in great part shape these circumstances. This framework facilitates understanding how key factors—such as income, education, and community support—may have an impact on the health and well-being of different populations. The impact of discrimination, as a socially defined exercise of power, can be understood using this framework and assessed at the population level. Around the globe, the costs associated with discrimination for LGBTQ people have been severe. Discrimination is pervasive and has been exercised within a wide cross-section of social structures— from archaic laws prohibiting entry to countries based on sexual identity to more subtle discriminatory practices that restrict opportunities for LGBTQ people in the workplace. Discriminatory actions are not always illegal. In fact, laws from

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multiple countries around the globe support discrimination against LGBTQ individuals. Some laws, for example, even punish with the ultimate penalty—death—for those found “guilty” of engaging in homosexual acts. Other laws and policies officially exclude LGBTQ people from access to basic social services such as education, employment/working conditions, food and sanitation, and health care services, among others. The mere existence and implementation of these policies perpetuate burdensome socioeconomic costs to the lives, health, and well-being of many LGBTQ people who, de facto, are second-class citizens in their respective countries. Researchers have documented that LGBTQ people, due to the discrimination they face, are more likely to experience violence, higher rates of school dropout, substance misuse, homelessness, and poorer health status, and they have lower income (even when they have the same level of education) than their counterparts. The negative economic footprint of discrimination is undeniable. These negative outcomes associated with discrimination are often layered, complicated, and far-reaching. For example, coming out as LGBTQ to their parents or legal guardians may cause young people to face the difficult decision of living under oppressive and sometimes violent circumstances, or leaving their households. Being a young LGBTQ person living on the streets increases the risk of violence, disconnection from structured education, malnutrition, and physical and mental diseases. At the same time, some research suggests that discrimination has ultimately resulted in some positive consequences for LGBTQ groups. Some social scientists agree that it was in fact the accumulation of experiences of discrimination and its negative consequences that led to community organization, mobilization, and advocacy in countries in which LGBTQ visibility and rights have improved in recent decades. Also, among some members of the LGBTQ groups, such as gay men, experiences of discrimination related to their sexual orientation, sexual identity, and sexual practices have been found to help them cope and develop resilience to

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deal with health issues, such as HIV infection and the HIV epidemic in general. Furthermore, these experiences may speak in general to human resilience and ability to overcome obstacles. Discrimination against LGBTQ people impacts their interpersonal relationships, their family and social networks, and the communities in which they live. This can be defined as the social cost associated with discrimination against LGBQ people. It has been documented that discrimination toward LGBTQ individuals affects the interactions that they develop with friends, peers, and romantic partners. Their experiences of discrimination may be integrated into their beliefs and practices in ways that lead LGBTQ individuals to experience social isolation. Self-identified queer men, for example, may struggle with developing meaningful relationships with lesbian, gay, bisexual, and transgender (LGBT) people based on their understanding of the fluidity and social nonconformity of sexual orientation and gender identity. Further, there is social exclusion within LGBTQ communities. Within groups of LGBTQ people, sometimes, members can feel excluded when their experiences or needs are not addressed in social efforts for equality made by their own group/community. This could be the case of transgender people, whose experiences of discrimination may vary. In fact, their experience might be worse than those of lesbian, gay, bisexual, and queer (LGBQ) individuals, since their transgression of the social norms clearly challenges fundamental structures of power and hegemony associated with gender-based differences. It can be argued that discrimination against LGBTQ people not only has a detrimental effect on them but is further reaching, significantly impacting their communities as well. This is plausible if we understand our communities as environments in which all members should have the same opportunity to contribute to social wellbeing. In microeconomic theory, opportunity cost may be defined as the value of the best alternative forgone. Imagine the added value to a community of their LGBTQ members contributing at optimal capacity—one where the burden of discrimination

has been lifted and they have been afforded access to the same opportunities as their straight counterparts. From that perspective, discrimination against LGBTQ people has a cost, a clear negative impact to the communities and social groups in which discrimination is enacted. Exclusion of LGBTQ people via discrimination affects general social capital and consequently the opportunity for a productive and healthy society. In places where any other expression but heterosexuality is criminalized, LGBTQ individuals are socially forced to conceal their personal lives just to survive, and their potential productivity and contributions to their communities are made all the more challenging. Correspondingly, even in places where LGBT rights—such as same-sex marriage—have been won, the exclusion of protection from discrimination at work based on real or perceived sexual orientation or identity may continue to perpetuate negative consequences. These disjointed legal environments challenge not only LGBTQ people and their families but also business and government, by increasing health care costs and diminishing economic returns and productivity. The cost of discrimination against LGBTQ people is high and may result in dangerously irreparable negative outcomes to most. In general, discrimination against LGBTQ people produces social exclusion and subsequently an economic burden. The evidence of the negative impact of discrimination toward these groups suggests the need to reduce the disenfranchisement resulting from social exclusion in order to improve their ability to have and enjoy better, healthier, and more fulfilling lives. Carlos Rodríguez-Díaz See also Business; Criminal Legal System and LGBTQ People; Discrimination Against LGBTQ People by Law Enforcement; Don’t Ask, Don’t Tell and Public Opinion

Further Readings Clark, F. (2014). Discrimination against LGBT people triggers health concerns. Lancet, 383(9916), 500–502.

Discrimination Against LGBTQ People by Law Enforcement Logie, C. (2012). The case for the World Health Organization’s Commission on the Social Determinants of Health to address sexual orientation. American Journal of Public Health, 102(7), 1243–1246. Ozeren, E. (2014). Sexual orientation discrimination in the workplace: A systematic review of the literature. Social and Behavioral Sciences, 109, 1203–1215. Williams Institute. (2015). The business impact of opening marriage to same-sex couples. Los Angeles, CA: Author. Retrieved December 2, 2015, from http:// williamsinstitute.law.ucla.edu/interactive-economicimpact/

DISCRIMINATION AGAINST LGBTQ PEOPLE BY LAW ENFORCEMENT Historically, police forces targeted the LGBTQ community through the use of sodomy laws, bar raids, entrapment, selective arrests, and excessive physical violence and harassment, especially toward particularly vulnerable groups within the LGBTQ community. These historical problems continue to manifest in some form in the present day despite changes in laws and policies to become more protective of LGBTQ people. The evidence of ongoing mistreatment of the LGBTQ community by police indicates the need for additional interventions to further protect LGBTQ people in the law enforcement context.

Sodomy Laws Prior to 1961, every U.S. state had criminalized certain types of sexual behavior through sodomy laws. Sodomy laws resulted in numerous arrests and convictions of LGBTQ people, as well as other secondary consequences including job loss, denial of state licenses for certain professions, and loss of children in custody cases. In many states, the laws were broadly written and could apply equally to same-sex and different-sex partners, but they were selectively enforced against same-sex partners. In 1961, states began to repeal these laws. In 2003,

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the U.S. Supreme Court found them unconstitutional in the case of Lawrence v. Texas. Although sodomy laws have been unenforceable since Lawrence, they are still used by law enforcement to arrest and harass LGBTQ people in some states where they remain on the books. For example, in 2013, a gay man was arrested in East Baton Rouge Parish, Louisiana, for accepting an invitation to go to an undercover officer’s home for “some drinks and some fun.” The incident was one among several in Louisiana in recent years. Other recent examples of enforcement have been documented in Michigan, North Carolina, and Virginia.

Bar Raids In the 1950s and 1960s, police began raiding gay bars under the guise of enforcing various state and local laws that targeted LGBTQ people. Such laws included those that prohibited LGBTQ people from gathering publicly, business licensing restrictions that applied only to gay bars, and sodomy laws. Often the raids became violent and resulted in arrests. Bars throughout the country were raided during this period, but the most famous examples occurred at the Stonewall Inn in New York City and the Black Cat Tavern in Los Angeles. Today, there are no longer explicitly antigay laws to encourage or justify police raids of gay bars or other establishments. However, even in the last decade, routine inspections by local vice or liquor licensing agencies have turned into violent raids at gay bars, particularly in the South. For example, in 2009, police raided gay bars in Atlanta, Georgia; Dallas–Fort Worth, Texas; and Memphis, Tennessee.

Entrapment A 1965 study found that police departments in Los Angeles County regularly used techniques designed to lure gay men into attempting “homosexual acts.” Similar practices were implemented in other jurisdictions around the country, including in large cities such as New York, Chicago, Detroit, San

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Francisco, and others. These incidents led to arrests under laws that were either expressly directed at LGBTQ people, such as sodomy laws, or laws that were broadly written but selectively enforced against LGBTQ people, such as solicitation laws. Several recently documented examples show that some police departments are continuing to entrap LGBTQ people in order to arrest them under laws against solicitation, public indecency, and similar statutes. For example, in 2010, a total of 33 gay men were arrested in Kent County, Michigan, under the state’s solicitation statute after undercover officers approached them in public parks. Recent large-scale stings have also been documented in Washington, D.C.; Houston, Texas; New York City; Milwaukee, Wisconsin; Palm Beach, Florida; and other cities.

Selective Arrests For decades, LGBTQ people have been selectively targeted under general, broadly written laws that could apply to anyone, regardless of LGBTQ status. Examples discussed above include sodomy laws that could apply to both same-sex and differentsex sexual conduct, solicitation laws, and lewd conduct laws. Recent reports show that the trend of selective enforcement against lesbian, gay, and bisexual (LGB) people and particularly against transgender people continues today. For example, recent studies by governments and nongovernmental organizations (NGOs) have documented discriminatory enforcement against LGBTQ people in New Orleans and New York. Other studies have found that particularly vulnerable groups within the LGBTQ community, including transgender people, people of color, and youth, have experienced even higher rates of selective enforcement than the LGBTQ population overall.

Excessive Physical Violence and Harassment The use of excessive physical violence and harassment by law enforcement against the LGBTQ

population has been extensively documented. Historical examples include cases of severe physical beatings during bar raids and incidents of rape and sexual assault by law enforcement, particularly against transgender women, among many others. Recent research indicates that law enforcement’s use of excessive physical violence and harassment is still common today. Surveys have found high rates of physical violence and harassment against LGBTQ people by law enforcement. Five surveys conducted since 2011 found that of LGBTQ people who had interacted with police, 14% to 66% reported being verbally harassed or assaulted, 2% to 21% reported being physically harassed or assaulted, 3% to 24% reported being sexually harassed or assaulted, and 6% reported being entrapped by the police. The percentages were highest among particularly vulnerable groups within the LGBTQ community, including transgender people and people of color. In addition, numerous anecdotal reports of excessive physical violence and harassment against lesbian, gay, bisexual, and transgender (LGBT) people by law enforcement have been documented in court cases, in complaints to legal organizations and NGOs, and by media outlets. Christy Mallory and Amira Hasenbush See also Bias in the Criminal Justice System; Criminal Legal System and LGBTQ People; Juvenile Justice System; Laws Banning Homosexuality and Sodomy; Police Officers/Law Enforcement Officials; Stonewall

Further Readings Amnesty International. (2011). Stonewalled: Police abuse and misconduct against lesbian, gay, bisexual and transgender people in the U.S. Retrieved October 30, 2014, from http://www.streetwiseandsafe .org/wp-content/uploads/2011/01/StonewalledAI .pdf D’Emilio, J. (1983). Sexual politics, sexual communities: The making of a homosexual minority in the United States. Chicago, IL: University of Chicago Press.

Discrimination Against LGBTQ People in the Public Sector Project Report. (1966). The consensual adult homosexual and the law: An empirical study of enforcement and administration in Los Angeles County. UCLA Law Review, 13, 643–797.

DISCRIMINATION AGAINST LGBTQ PEOPLE IN THE PUBLIC SECTOR LGBTQ people have faced a long history of discrimination in public sector employment, which continues to the present day. The legacy of discrimination can be traced back to purges of thousands of LGBTQ employees from U.S. public sector employment that began in the 1940s. Despite changes in laws and policies to be more protective of LGBTQ employees over the past 70 years, recent evidence of discrimination has been documented in a variety of sources. This evidence indicates that public sector employment discrimination against LGBTQ people continues to be widespread and pervasive.

History of Discrimination Purges of LGBTQ government employees began with the federal government in 1947 and were soon copied by state and municipal employers. From 1947 to 1960, LGBTQ people were labeled a security threat, due to the impression that they could be blackmailed by those who knew of their LGBTQ identity, and thus were driven out of federal government employment. During this period, which came to be known as the “Lavender Scare,” more than 5,000 allegedly LGBTQ federal civil servants lost their jobs for no reason other than their sexual orientation, and thousands of applicants were rejected for the same reason. By the mid-1950s, state and local governments had implemented similar purges of LGBTQ employees. Statewide purges were conducted in at least eight states, including California, Florida, Iowa, Massachusetts, Texas, Oklahoma, Idaho, and North Carolina, and impacted thousands of employees.

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A distinct but related basis for denying public sector jobs to LGBTQ people historically was the existence of state antisodomy laws. Such laws were used to deny LGBTQ people jobs in education and law enforcement, in particular, on the belief that someone who engaged in criminal behavior could not be around children or enforce the law. Antisodomy laws were held to be unconstitutional by the U.S. Supreme Court in 2003.

Recent Evidence of Discrimination Recent evidence of discrimination against LGBTQ public sector employees has been documented in surveys; wage studies; reports by federal, state, and local governments; findings by courts; court opinions; complaints filed with administrative agencies; and the media. This evidence indicates that discrimination against LGBTQ people in public sector employment continues to be widespread and pervasive. Surveys of LGBTQ Employees

More than 80 surveys of LGBTQ people, in which either all or some of the respondents worked in the public sector, have found that significant percentages of LGBTQ public sector employees report experiencing employment discrimination. For example, the 2008 General Social Survey found that 1 in 5 lesbian, gay, or bisexual (LGB) employees reported experiencing at least one form of employment discrimination based on their sexual orientation at some point in their career. More specifically, 17% reported being fired, 13% reported being denied a promotion or receiving a negative job evaluation, and 20% reported being harassed verbally or in writing on the job. Surveys of transgender workers have shown higher rates of discrimination. For example, a 2009 survey conducted by the Transgender Law Center found that 70% of transgender respondents reported experiencing employment discrimination based on their gender identity. More than 11% of the survey respondents were public sector employees. The findings from these two surveys

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are consistent with the findings of other surveys of LGBTQ public sector workers, as well as those in the private sector. Wage Studies

Studies have shown wage gaps between LGB government employees and their heterosexual counterparts, controlling for factors expected to influence wages. Together, two recent studies have shown that LGB government employees earn 8% to 29% less than heterosexual government employees. Reports by Federal, State, and Local Governments

A number of state and local elected officials, legislative bodies, and special commissions have issued findings of widespread discrimination against lesbian, gay, bisexual, and transgender (LGBT) people in their jurisdictions, including in public sector employment. A 2009 study identified 29 such examples from 17 different states.

that complaints of sexual orientation and gender identity discrimination are filed by state and local government workers at a rate of 3 complaints per 10,000 LGBTQ employees. Among private sector employees, the rate of discrimination was 4 complaints per 10,000 LGBTQ employees. Examples of Discrimination From Court Opinions, Administrative Complaints, and the Media

A 2009 study gathered a record of 380 anecdotal examples of employment discrimination against LGBTQ government employees that had occurred from 1990 through 2009. The examples were collected from court opinions, administrative complaints, academic journals, books, newspapers, and community-based organizations. The findings and examples of discrimination summarized here provide insight into the existence and nature of discrimination against LGBTQ public sector employees, but are by no means a complete record of such discrimination. Christy Mallory and Brad Sears

Findings by Courts

Several courts and legal scholars have acknowledged a history and pattern of discrimination against LGBTQ people by governments in the United States. Every court that has substantively considered whether sexual orientation classifications should be presumed suspect for purposes of equal protection analysis has recognized that LGBTQ people have faced a long history of discrimination. In making this determination, many courts expressly considered examples of discrimination, including employment discrimination, by federal, state, and local governments. Administrative Complaints

A 2011 study found that LGBTQ state and local government employees file complaints of discrimination with administrative enforcement agencies at slightly lower, but similar, rates compared with LGBTQ workers in the private sector. Using data gathered from 13 states, the study determined

See also Employment Non-Discrimination Act (ENDA); Gender Identity Discrimination as Sex Discrimination; Nondiscrimination Protections, State and Local; Sexual Orientation Discrimination as Sex Discrimination; Workplace Discrimination

Further Readings Johnson, D. K. (2000). The Lavender Scare: The Cold War persecution of gays and lesbians in the federal government. Chicago, IL: University of Chicago Press. Sears, B., Hunter, N. D., & Mallory, C. (2009, September). Documenting discrimination on the basis of sexual orientation and gender identity in state employment. Los Angeles, CA: Williams Institute. Retrieved December 2, 2015, from http:// williamsinstitute.law.ucla.edu/research/workplace/ documenting-discrimination-on-the-basis-of-sexualorientation-and-gender-identity-in-state-employment/ Sears, B., & Mallory, C. (2011, July). Evidence of employment discrimination on the basis of sexual orientation in state and local government: Complaints

Discrimination on the Basis of HIV/AIDS in Health Care filed with state enforcement agencies 2003–2007. Los Angeles, CA: Williams Institute. Retrieved December 2, 2015, from http://williamsinstitute.law.ucla.edu/ wp-content/uploads/Sears-MalloryDiscriminationComplaintsReport-July-2011.pdf

DISCRIMINATION ON THE BASIS HIV/AIDS IN HEALTH CARE

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An initial lack of understanding about HIV/AIDS contributed to the birth of HIV-related stigma, and laws, policies, and practices based on irrational fears and misconceptions about the disease. This has given rise to targeted discrimination against people living with HIV (PLWH), such as discrimination on the basis of HIV/AIDS in health care. This entry reviews such discrimination, particularly discrimination in dental care, and summarizes legal and ethical rules prohibiting discrimination. Studies have found that health care providers have denied service to HIV-positive patients due to fear, homophobia and prejudice, and a mistaken belief or understanding of scientific facts or the law. Discrimination against PLWH is often masked by providers’ justifications such as lack of proper training and expertise, or lack of proper equipment. This leads to policies and practices that result in differential treatment and care of HIVpositive patients, including categorical refusals to treat HIV-positive patients and blanket referrals of all HIV-positive patients to “specialists.” Not only have these justifications been found to be scientifically unwarranted, but courts have also found such practices and policies to constitute unlawful discrimination against PLWH.

Discrimination in Dental Care Dental care is vital to PLWH because oral manifestations may be the first sign of infection and may also indicate progression of HIV. The impact of discrimination in dental care is especially harsh, as PLWH are also uniquely at risk for painful and compromising oral health conditions. For these reasons, researchers have sought to document and

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understand this form of discrimination through surveying dentists, dental school faculty, and dental students. Between 1986 and 1995, studies found that 33% to 80% of dentists surveyed did not want to serve patients that are HIV-positive or at risk of becoming HIV-positive. Other studies during this period found that 25% to 50% of dental students did not want to provide care to PLWH. Reasons cited for not wanting to serve HIV-positive patients were fear of infection, homophobia, and the belief that PLWH are responsible for their illness. A more recent study in 2012 found that only 34.1% of dental and 19.7% of dental hygiene students were able to accurately identify the risk of HIV transmission from occupational exposure, and over 8% of dental students surveyed admitted an unwillingness to serve HIV-positive patients. In 2007–2008, testing studies focused on dental providers in Los Angeles County found that 5% of dental offices contacted had an unlawful blanket policy of refusing to provide dental services to any PLWH. Another 5% indicated they would treat PLWH differently from HIV-negative patients. These rates were almost double for providers affiliated with a public dental benefit program for low-income Californians, Denti-Cal.

Legal and Ethical Rules Prohibiting Discrimination All health care providers have legal and ethical duties to serve PLWH. Because state laws vary greatly, they will not be discussed here. Federal laws prohibit discrimination based on HIV/AIDS status. In the 1998 case Bragdon v. Abbot, the U.S. Supreme Court ruled that all PLWH are protected from discrimination under the Americans with Disabilities Act of 1990 (ADA). Health care providers cannot refuse services to PLWH, with few exceptions. In order to make an exception, they must make an individualized inquiry about the specific circumstances of the patient’s condition and the services requested and carry the legal burden to prove that threats to the health of the provider or patient cannot be substantially eliminated by making a reasonable change to practices or

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procedures. Most important, considerations must be based on reasonable judgments informed by current medical knowledge and not on stereotypes or irrational fears. In addition to the ADA, some health care providers fall under the jurisdiction of Section 504 of the Rehabilitation Act of 1973. Recipients of federal funding, including hospitals affiliated with academic institutions receiving federal funding or service providers accepting payment from Medicaid or Medicare, must also comply with disability nondiscrimination provisions. This law applies to HIV status. Federal agencies such as the U.S. Department of Justice and the U.S. Department of Health and Human Services have authority to investigate administrative complaints based on these laws. Both agencies have pursued action against health care providers as a result of unlawful discrimination against PLWH. Finally, ethical codes of conduct apply to most, if not all, health care providers. An American Medical Association Opinion states that a physician may not ethically refuse to treat an HIV-positive patient solely because of the person’s HIV status. Three major dental associations have incorporated specific duties for dentists to provide care to PLWH, and failing to follow these standards can result in censure, suspension, or expulsion from these associations. Ethical codes for other health care providers such as nurses and pharmacists similarly demand providers treat patients respectfully, regardless of their health problem.

Conclusion Although one might assume that health care workers are informed and educated about HIV, research indicates that continuing education is needed. Protective laws that demand nondiscrimination against PLWH in health care and ethical duties to encourage such are necessary. Enforcing nondiscrimination laws will allow society to monitor this trend in discrimination on the basis of HIV/AIDS in health care and to motivate health care providers to deliver health care in an equitable manner. Ayako Miyashita and Brad Sears

See also Disabilities Among LGBTQ Elders; Health Care System; HIV and Treatment

Further Readings Myers, J. E., Myers, R., Wheat, M. E., & Yin, M. T. (2012). Dental students and bloodborne pathogens: Occupational exposures, knowledge, and attitudes. Journal of Dental Education, 76(4), 479–486. Sears, B., Cooper, C., Younai, F., & Donohoe, T. (2012). HIV discrimination in dental care: Results of a testing study in Los Angeles County. Loyola of Los Angeles Law Review, 45, 909–956. U.S. Department of Health and Human Services. (2014). Civil rights enforcement success stories involving HIV/ AIDS. Retrieved December 2, 2015, from http://www .hhs.gov/ocr/civilrights/activities/examples/AIDS/hiv/ aidscivilrightscases.html U.S. Department of Justice, Civil Rights Division. (2014). DOJ HIV/AIDS enforcement. Retrieved December 2, 2015, from http://www.ada.gov/aids/ada_aids_ enforcement.htm

DIVISION OF LABOR IN LGBTQ-PARENT FAMILIES Examination of the ways in which same-sex couples organize their households provides insight into the lives of LGBTQ-parented families. But, more broadly, it also reveals new information about the operation of gender in society. Household labor has traditionally been organized along gendered lines with women being primarily responsible for domestic labor, such as cooking, cleaning, and caring for children, while men have been responsible for earning income—that is, they have occupied the role of the breadwinner. Understanding processes by which same-sex couples organize their work and family life demonstrates possibilities for reshaping household practices along nontraditional lines. But also, perhaps conversely, the experiences of LGBTQ-parented families can show the ways in which an individual’s gender shapes his or her experience of parenting, domestic life, and the workplace, irrespective of the person’s sexuality or the gender of the partner.

Division of Labor in LGBTQ-Parent Families

Division of Labor Among LGBTQ Parents The division of household labor refers to the ways in which couples organize domestic tasks such as cooking, cleaning, and general home maintenance. For couples that are parents, household labor also includes caring for children. Along with household and child care tasks, research on the division of household labor includes consideration of the ways in which couples manage the need to earn an income with the demands of raising children. Decisions about whether one or both members of a couple will take on paid work, and the amount of time they spend at work versus time spent at home, are central to the organization of households. Studies have suggested that same-sex couples are likely to divide housework and child care tasks more equally than heterosexual couples. There are a number of reasons why this might be the case. First, many LGBTQ parents have a strong ideological commitment to achieving equality in their relationships, particularly when it comes to parenting. Research has suggested that this ideological commitment is one of the strongest predictors of whether a couple will achieve equality in their division of household labor. This also applies in heterosexual couples; when both members of a couple overtly express their commitment to equality, they are less likely to divide tasks according to gender norms and more likely to achieve an equal division of labor. Furthermore, being of the same gender means same-sex partners do not have the option of falling back on traditional gendered expectations regarding household tasks. In a household with two mothers, for instance, the task of taking out the garbage cannot be allocated based on the assumption of it being a “man’s job.” Similarly, tasks traditionally considered “women’s work,” such as cooking or ironing, could be assumed to be the responsibility of either member of the couple. Allocation of tasks therefore has to be actively negotiated within same-sex couples. The division of household labor may be organized according to each member of the couple’s strengths, preferences, or available time rather than gendered assumptions or norms. In some female same-sex couples, the division of household labor may be organized to accommodate

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a mother carrying and breastfeeding a child or children. One mother may take on the role of primary caregiver for a period while she cares for and breastfeeds a baby. Over time, she may move back into the workforce to enable her partner to take on the primary care role. Often this will occur when the other partner becomes pregnant and takes time off work to care for the baby. Sharing the roles of primary caregiver and breadwinner, by moving in and out of each role, enables the couple to negotiate an equal division of labor over time. There is, however, a growing body of research that challenges the finding that most LGBTQ parents achieve, or desire, equality in housework or child care. Some researchers argue that most studies of LGBTQ parents have predominantly focused on affluent, well-educated, White lesbian couples. Affluence and high levels of education are associated with an ideological commitment to genderbased equality among both LGBTQ and heterosexual adults. Research with a greater diversity of participants has included lesbian couples who follow more traditional patterns of household organization—with one partner working full-time while the other takes primary responsibility for domestic tasks. This may be due to the couple’s choice and values or because one partner has greater earning power or more prestigious employment than the other. In some studies, female samesex couples report being aware of, and at times uncomfortable with, the fact that their division of labor mimics traditional heterosexual patterns. However, they often find it difficult to overcome this—either due to the values or attitudes of one or both members of the couple, or due to the couple’s reluctance to relinquish financial rewards that come with the arrangement.

The Influence of Gender Some researchers argue that the effect of gender is “neutralized” in families parented by same-sex couples. That is, given the couple are of the same gender, they will make decisions about paid work and the allocation of household tasks on a neutral basis—one that is not influenced by gender-based assumptions and norms.

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However, the view that gender does not influence the households of same-sex couples in any way has been widely critiqued. Indeed, some researchers have pointed out that female same-sex couples may be successful at achieving an egalitarian division of labor because they are both women. Despite the wide influence of feminism on contemporary attitudes toward gender, women still tend to be socialized to take on the majority share of household and child care tasks. Indeed, recent research has shown that in heterosexual couples, many women still take on the bulk of housework and child care even if they and their male partner spend an equivalent number of hours in paid work. Female same-sex couples in effect are two parents who have been raised to assume primary household and child care responsibilities. Negotiating these tasks on an equal basis therefore may come more easily for two women than for heterosexual couples. In this context, women in a same-sex relationship enact gendered social scripts regarding motherhood in the same way that heterosexual women do. In fact, the importance of undertaking tasks traditionally assigned to mothers may be particularly salient for nonbiological mothers. Given that nonbiological mothers cannot make a claim to motherhood on a genetic/biological basis, these mothers are often acutely aware of the need to construct their motherhood identity through actions associated with “mothering” their children. Maintaining an equal division of household labor may also be more achievable for a female same-sex couple due to structural reasons, such as the position of women in the workforce. There is some research that suggests female same-sex couples are more likely than heterosexual couples to manage work commitments and child care by limiting the number of hours spent in the paid workforce—either by both working part-time or by taking turns moving in and out of the workforce. Heterosexual couples, by contrast, are more likely to manage work and home by having one member of the couple (usually, but not always, the man) working full-time while the other partner is home

full-time or in part-time paid work. Shifting out of the traditional “breadwinner/homemaker” model may be easier for a female same-sex couple than a heterosexual couple in part because it is considered acceptable in many industries for women to negotiate part-time work, flexible work practices, or time out of the workforce to care for children. By contrast, men who are seeking part-time work or time off for family reasons are often viewed as professionally uncommitted or unreliable. This potentially affords less flexibility for men in heterosexual or male same-sex couples to take on primary child care responsibilities. Unfortunately, there is limited research on the ways in which fathers in same-sex couples negotiate the demands of paid work and child care. Some studies have suggested that the higher earning capacity of men potentially affords male same-sex couples more options than female same-sex or heterosexual couples to purchase child care and household services, paying for nannies, babysitters, and house cleaners. This would enable fathers in same-sex relationships to adopt fatherhood roles without compromising their investment in a masculine identity associated with paid work. To date, however, there are no studies that have tested this theory, so it is not clear whether male same-sex couples are more likely to purchase domestic labor than heterosexual or female same-sex couples.

Bisexual and Transgender Parents Most research on LGBTQ-parented families focuses on same-sex couples. This may include some people who identify as bisexual or transgender and who are in a same-sex relationship, but in general the majority of research participants in these studies identify as gay or lesbian (or they are simply labeled that way by the researcher because of their membership in a male same-sex or female same-sex relationship, respectively). This means that bisexual and transgender identities and issues are often hidden or not acknowledged. Many people who identify as bisexual have a different-sex partner with whom they live and parent. Yet there is very little research on the

Divorce, Legal Issues in

parenting or relationship experiences of people who identify as bisexual. As such, it is not possible to know if people who identify as bisexual differ from heterosexual, lesbian, or gay parents in their attitudes or practices relating to division of household labor. Transgender people may be in different-sex or same-sex relationships. In some cases, transgender people may have undergone a gender transition while in an intimate relationship. Thus, they may have entered into a different-sex relationship that became a same-sex relationship, or vice versa. However, many transgender people do not identify their gender in dichotomous male/female terms and so may not identify their relationship as either different- or same-sex. There is some research on the division of household labor in different-sex couples where one member of the couple is a transgender man. This research suggests that these couples often have a nonegalitarian division of household labor, with the woman taking on the majority of caring tasks. Notably, many of these couples explain their division of labor as resulting from the free choices of each member of the couple, rejecting the notion that they are following traditional, heteronormative patterns. Researchers have pointed to the significance of this work in terms of explaining gender roles and inequality in division of household labor as a social, rather than biological, phenomenon. Jennifer Power See also Gender Binaries; Nonbiological, Nongestational Mother; Work–Family Interface, LGBQ Parents

Further Readings Coltrane, S., Miller, E. C., DeHaan, T., & Stewart, L. (2013). Fathers and the flexibility stigma. Journal of Social Issues, 69(2), 279–302. Goldberg, A. E. (2013). “Doing” and “undoing” gender: The meaning and division of housework in same-sex couples. Journal of Family Theory & Review, 5(2), 85–104. Goldberg, A. E., Smith, J. Z., & Perry-Jenkins, M. (2012). The division of labor in lesbian, gay, and heterosexual

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new adoptive parents. Journal of Marriage and Family, 74(4), 812–828. Kurdek, L. A. (2007). The allocation of household labor by partners in gay and lesbian couples. Journal of Family Issues, 28, 132–148. Lachance-Grzela, M., & Bouchard, G. (2010). Why do women do the lion’s share of housework? A decade of research. Sex Roles, 63, 767–780. Patterson, C., Sutfin, E., & Fulcher, M. (2004). Division of labor among lesbian and heterosexual parenting couples: Correlates of specialized versus shared patterns. Journal of Adult Development, 11(3), 179–189. Perlesz, A., Power, J., Brown, R., McNair, R., Schofield, M., Pitts, M., et al. (2010). Organising work and home in same-sex parented families: Findings from the Work, Love, Play Study. Australian and New Zealand Journal of Family Therapy, 31(4), 374–391. Pfeffer, C. (2010). “Women’s work”? Women partners of transgender men doing housework and emotion work. Journal of Marriage and Family, 72(1), 165–183.

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IN

The second decade of the 21st century has witnessed extensive changes on the marriage equality front. As of July 2015, same-sex marriage is available nationwide. By contrast, just over 2 years earlier, in January 2013, only 10 states and the District of Columbia permitted same-sex couples to marry. A handful of states also allow same-sex couples (and sometimes some or all different-sex couples) to enter into other legally recognized relationships, such as domestic partnerships and civil unions. This entry addresses the legal issues that arise for same-sex couples in connection with divorce or dissolution, including jurisdictional issues that previously restricted access to divorce for some samesex couples and issues related to dissolution of civil unions and domestic partnerships that may continue to exist. Studies find that the relationships of LGBTQ people are similar to those of heterosexual people. Thus, like many heterosexual people, many

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LGBTQ adults are in long-standing, committed relationships, and many same-sex couples are choosing to formalize their commitments to each other by marrying. Indeed, in 2011, the Williams Institute reported that 47% of same-sex couples who lived in states that permitted same-sex marriage or alternative legal statuses entered into one or more such relationships. As is true with different-sex married couples, some of these married same-sex couples will break up and will want to end their legal relationships by getting divorced. According to the Williams Institute, same-sex couples currently have annual divorce rates that are a bit lower on average (1.1%) than that of different-sex couples (2%). These findings confirm that a significant number of same-sex couples seek to formally dissolve their legal relationships each year. Although it is less celebrated than access to the right to marry, the right to the formal, orderly divorce process is also an important development for same-sex couples. In the past, same-sex couples ending their relationships often had few legal protections. Because same-sex couples were unable to enter into formally recognized legal relationships, they were treated as unmarried cohabitants. Even today, in the overwhelming majority of states, an unmarried cohabitant has no automatic right to share property acquired during the relationship. Moreover, even in states that do extend some property rights to unmarried cohabitants, the protections are usually very limited. With the newly available right to divorce comes a more established set of rules and procedures, as well as a host of automatic protections. In many respects, divorce proceedings for samesex couples are similar to those involving differentsex couples. But some divorcing same-sex couples could encounter hurdles not faced by divorcing different-sex couples. First, before marriage was available nationwide, some same-sex couples had a hard time finding a court that had the authority, or jurisdiction, to grant them a divorce. Being unable to get a divorce can be difficult both emotionally and legally. Obtaining a divorce is often an important step

toward achieving some sense of closure. In addition, spouses who want to end their legal relationship, but who are unable to do so, may face a host of legal and practical challenges. Such couples might continue to accrue rights and responsibilities with respect to each other, even if they no longer want to be in a relationship. Adding another layer of complications, many same-sex couples are in multiple legal relationships. For example, many same-sex married couples in California are also registered as domestic partners. If such a couple end their relationship, it is important for them to terminate both their marriage and their domestic partnership. Today, most if not all same-sex married couples will have access to a court that can terminate their marriage as well as decide all of the ancillary issues related to a divorce proceeding, such as property division, spousal support, and child support. When that is the case, the rules applicable to different-sex married couples generally will apply equally to same-sex couples. Because the right to marry has only been available to same-sex couples for a relatively short time, however, there may be some important protections that former same-sex spouses are unable to access.

Jurisdictional Issues In the past, some same-sex married couples were unable to get divorced. No state requires a person to be a resident of the state to marry there. By contrast, it is generally understood that a divorce action must be brought in the home state, or “state of domicile,” of at least one of the spouses. Indeed, most states have statutes requiring a person to be a resident of the state for a certain length of time before he or she can either file or obtain a divorce judgment. In the past, this “domicile” requirement created problems for same-sex spouses who validly married in one state, but who, at the time of the divorce proceeding, lived in a state that did not recognize marriages between same-sex couples. This was the case for a gay male couple in Texas. J. B. and H. B. legally married in Massachusetts in 2006. Shortly after moving to Texas in

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2008, the couple’s relationship ended, and J.  B. filed a divorce action in a Texas court. Even though both spouses wanted a divorce, a Texas appellate court held it lacked jurisdiction or the power to grant the divorce. To grant a divorce, the court held, would require the court to recognize the parties’ same-sex marriage, something Texas law prohibited. Moreover, due to the domicile requirement, in order to get divorced in Massachusetts—the state in which they married—one of them would have to move back to Massachusetts. To use the phrase coined by Mary Patricia Byrn and Morgan Holcomb, J.  B. and H.  B. were left “wedlocked.” Unfortunately, many other same-sex spouses found themselves in a similar position. These wedlocked same-sex couples faced a host of legal complications. Even if their home state did not recognize their marriage at that time, their marriage was valid and recognized in many other states. The fact that the parties remained in a valid marriage despite their desire to end it could matter a great deal. Hundreds of rights and obligations are automatically extended to spouses because they are married. Depending on the state, many of these rights and obligations continue to accrue so long as a couple remains married (even if they no longer want to be married). For example, property acquired by either spouse during the marriage is generally presumed to be the marital or community property of the couple. Thus, if the parties remained married, one spouse may have a claim to property acquired by the other, even if the property was acquired after their relationship was over. On the other side, one spouse may be responsible for debt acquired by the other during their marriage, even if the debt was acquired after the breakdown of the relationship. If one spouse had a child while the couple was still validly married, the other spouse may be presumed to be the legal parent of that child, even if the couple had long since broken up. In addition, if one spouse attempted to marry someone else—either of the same sex or of a different sex—that conduct may constitute bigamy and could result in criminal penalties. These are just some of the reasons why

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it can be important to obtain a divorce when the relationship is over. Fortunately, now that marriage is available nationwide for same-sex couples, few if any married couples will face this hurdle; divorce is also available nationwide for same-sex couples. As discussed below, however, couples in other legal statuses, like civil unions or registered domestic partnerships, may continue to face these jurisdictional difficulties going forward.

Rules Applicable to a Same-Sex Divorce If the court has jurisdiction over all of the relevant issues, including child custody, child support, property division, and spousal support, most of the rules applicable to divorcing different-sex couples will apply equally to same-sex couples. So, for example, unless the spouses entered into a valid pre- or postmarital agreement, all states distribute the available property either equally or equitably upon divorce. In most states, the property available for distribution is only property acquired during the marital relationship. (Typically, a few types of property acquired during the marriage are excluded, including property inherited by one of the spouses.) A minority of states allow courts to distribute any property owned by either spouse, “however and whenever acquired.” Whatever the relevant rules are, they will apply equally regardless of the respective sexes of the spouses. Further, as is true for different-sex spouses, the court can order one spouse to support the other, either indefinitely, or (more commonly) for some set period of time. When considering a spousal support request, courts typically take a variety of factors into account, including the education, skills, and earning potential of both spouses, as well as the health of both spouses. The rules regarding children of the marriage apply equally as well. All states presume that a child born during a marriage is the child of both spouses. Many states also have specific rules governing the parentage of children born through assisted reproduction. Typically, if a spouse— male or female—consents to his or her wife’s

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insemination, the law will treat the spouse as the child’s legal parent. If both spouses are legal parents, the court will apply the usual rules regarding child custody and child support in a divorce proceeding. All states apply the “best interests of the child” standard to determine child custody and visitation between two legal parents. Under this standard, courts typically consider a number of factors, including the child’s relationships with both parents, the age of the child, the child’s current living situation, any history of domestic violence, and/or (depending on the child’s age) the child’s wishes. The court will determine the amount of child support using the state’s child support guidelines. Until recently, the federal tax consequences of a divorce for a same-sex couple were very different from those for a different-sex couple. That was the result of Section 3 of the Defense of Marriage Act (DOMA). Section 3 prevented the federal government from recognizing or giving effect to any marriages between same-sex couples. Under Section 3, the more favorable tax rules that apply to divorcing different-sex couples did not apply to divorcing same-sex couples. In 2013, however, the Supreme Court held Section 3 unconstitutional in United States v. Windsor. As a result, the federal tax rules that apply to divorcing different-sex couples now apply equally to divorcing same-sex couples. While many aspects of a divorce proceeding for a same-sex couple will be similar to those for a different-sex couple, there may be some important differences. As noted, in the absence of a valid preor postmarital agreement, all states distribute available property equally or equitably at divorce, and, in most states, the property available for distribution only includes property acquired during marriage. This may create inequities or unfairness for some same-sex couples. Marriage has only recently become available for same-sex couples. Thus, there are many married same-sex couples who were together for years, if not decades, prior to their date of marriage. In such circumstances, distributing only the property acquired during the marriage, but not any of the property acquired prior to their marriage, may produce unfair results. This may be particularly true if one party was the primary

wage earner, while the other party was the primary caregiver to the couple’s child(ren). In some states, there may be other rules that enable the court to distribute property acquired during the relationship but prior to the marriage. This may be true, for example, in Washington State under what is known as the committed intimate relationship doctrine, which says that a court can equitably distribute property acquired during a committed but nonmarital relationship. In other states, however, the court may be powerless to distribute property acquired during the relationship but prior to the marriage. There are other problems or inequities that may arise for same-sex married couples who were together for a long time and who would have married long ago if they could have. Former spouses who were married for at least 10 years and who are otherwise qualified can get Social Security benefits based on their former spouse’s entitlement. At the present time, however, there are very few former same-sex spouses who were married for 10 or more years. For those long-term same-sex couples who would have married years ago if they could have, denying one of them the Social Security benefits available to long-term former spouses may be harsh and unfair. There are other benefits that are available to former spouses only if the couple was married for a relatively long period of time. To retain full military benefits and privileges as a former spouse, for example, the person must have been married to the service member for 20 years. Currently, no samesex former spouse can fulfill that requirement.

Issues for Couples Dissolving Other Forms of Legal Relationships There are some same-sex couples who are in domestic partnerships or civil unions rather than marriages. To end a registered domestic partnership or a civil union, couples typically have to follow the same rules and procedures that apply to divorce actions. If the action is filed with a court that has full authority over it, the general rules, including the rules regarding division of property, spousal support, child custody, and child support, should apply the same as to divorces.

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That said, couples seeking to terminate a domestic partnership or civil union may face some unique challenges. First, if the parties live in a state that does not permit same-sex couples to enter into a registered domestic partnership or a civil union, the parties may have difficulty obtaining a divorce/ dissolution. In the past, some courts in such states held they lacked jurisdiction to dissolve these alternative statuses. Now that all states recognize samesex marriage, however, courts may be less likely to conclude they lack jurisdiction to dissolve these statuses between same-sex couples. Also, in many states, the usual divorce jurisdiction requirements apply, including the domicile requirement. Thus, unless one or both parties moves to the state in which they entered the relationship, the courts of that state may lack the power to consider a dissolution petition. In recognition of this possibility, however, some states have enacted special divorce jurisdiction statutes to address this challenge faced by samesex couples. California is one such state. When parties register as domestic partners in California, they must consent to allow a California court to dissolve their domestic partnership later should one or both parties request a dissolution. California courts have the authority to dissolve a California domestic partnership, even if neither party is or ever was a California resident. A number of other states have passed similar provisions allowing courts in that state to terminate alternative legal statuses entered into in that jurisdiction. Even if the court can terminate the nonresident spouses’ civil union or domestic partnership (i.e., issue them a divorce decree) under one of these types of provisions, the court may not have the power (i.e., jurisdiction) to decide other issues related to the divorce proceeding. For example, the court may not have authority to address child custody or visitation issues, and the court may also lack the power to divide the parties’ property or to make a spousal or child support award. In addition, at the moment, the federal government is not extending federal marital rights and obligations to couples who are in a domestic partnership or a civil union and not a marriage. Thus, the federal tax rules applicable to divorcing spouses

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may not apply equally to couples who are seeking to terminate a domestic partnership or a civil union. As a result, the federal government may tax a property division award from one domestic partner to the other. In addition, a federal law known as the Employee Retirement Income Security Act (ERISA) limits a court’s ability to transfer most types of retirement accounts to people other than spouses. Because a domestic partner or civil union spouse is not considered a spouse for purposes of this federal law, the court may be unable to divide the couple’s retirement accounts. This can be particularly problematic when the couple’s only or primary asset is a retirement account.

Looking Ahead Now that same-sex marriage (and divorce) is permitted nationwide, the jurisdictional challenges discussed above have been eliminated for married couples. But other challenges, including the lack, or lesser amount, of protection for the premarriage portion of the couple’s relationship, will persist into at least the near future. Courtney G. Joslin See also Child Support After LGBQ Divorce/Separation; Divorce and Relationship Dissolution, Psychological Experience of; Divorce and Separation, Historical Perspective on

Further Readings Badgett, M. V. L., & Herman, J. L. (2011). Patterns of relationship recognition by same-sex couples in the United States. Los Angeles, CA: Williams Institute. Retrieved December 7, 2015, from http:// williamsinstitute.law.ucla.edu/wp-content/uploads/ Badgett-Herman-Marriage-Dissolution-Nov-2011.pdf Byrn, M. P., & Holcomb, M. (2012). Wedlocked. University of Miami Law Review, 67, 1–40. Cal. Fam. Code §2320. Estin, A. L. (2001). Ordinary cohabitation. Notre Dame Law Review, 76, 1381–1408. Joslin, C. G. (2011). Modernizing divorce jurisdiction: Same-sex couples and minimum contacts. Boston University Law Review, 91, 1669–1721.

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Joslin, C. G., Minter, S. P., & Sakimura, C. (2014). Lesbian, gay, bisexual, and transgender family law. Eagan, MN: Thomson West. National Center for Lesbian Rights. (2013). Divorce for same-sex couples who live in non-recognition states: A guide for attorneys. San Francisco, CA: Author. Retrieved December 3, 2015, from http://www .nclrights.org/wp-content/uploads/2013/07/Divorce_ in_DOMA_States_Attorney_Guide.pdf Vt. Stat. Ann. tit. 15, §592.

DIVORCE AND RELATIONSHIP DISSOLUTION, PSYCHOLOGICAL EXPERIENCE OF The ending of any relationship is complex and difficult at best, and much research on different-sex couples suggests that the experience of separating and divorcing often comes with many psychological consequences. Such consequences can include increased depression, anxiety, loneliness, and drinking and substance use, as well as stress surrounding child custody (when children are involved) and the division of property, to name a few. Much less is known about the experiences of same-sex couples that seek to end their relationships (i.e., dissolution) or marriages (i.e., divorce), or about how their children fare in the wake of same-sex parental relationship dissolution or divorce. This entry focuses on these experiences, and, for ease, uses the term dissolution to refer to the ending of any long-term, committed relationship regardless of legal status except in cases where divorce was examined specifically. In doing so, the entry discusses (a) some of the biases of dissolution research, (b) the psychological experiences leading to dissolution, (c) the psychological experiences of the transition to dissolution and after, and (d) the experiences of children.

Biases of Dissolution Research The lack of attention to the separation and dissolution experiences of gays and lesbians has limited

our understanding of the needs of these groups. Marriage traditionally has been considered the only form of a real relationship in the United States, thereby reducing any other type of committed, long-term partnership to a trial for marriage or other form of a “less than” relationship (e.g., dating). Initial research on LGBTQ individuals and couples often labeled gays and lesbians as mentally ill or incapable of forming long-term committed relationships. Until more recently, public opinion has not supported the recognition of same-sex couples. Further, producing research about dissolution among same-sex couples might have been seen as counterproductive to the marriage equality movement. As such, the lack of research on samesex dissolution is understandable when considered with the social context in mind.

Psychological Experiences Leading to Dissolution Same-sex couples who perceive their relationships (or marriages) as more rewarding and with fewer costs experience greater relationship satisfaction and, in turn, a greater desire to maintain their relationships. Generally, relationship satisfaction appears to gradually decrease over time, with some evidence suggesting it begins to increase slightly much later in a relationship, but never reaches the same levels compared with the early years. As relationship satisfaction decreases, the likelihood of dissolution increases. Accordingly, higher levels of conflict and negative affect may enter the relationship, resulting in more costs and lowered rewards. Some of the sharpest declines in satisfaction among different-sex couples coincide with bringing children into a relationship. However, the opposite has been found among some same-sex couples, likely due to the intentional efforts and planning (e.g., adoption, surrogacy) needed to add a child to the family. Alternatively, the couples who choose to adopt may be characterized as having higher initial relationship stability, resilience, and emotional resources, offsetting the difficulty of bringing children into the family. Couples should expect, and can navigate, some levels of relational conflict.

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Couples tend to weather relational conflict as long as perceived investments are higher (couples have been together longer or have children), barriers to leaving the relationship exist (such as lack of financial independence), fairness is perceived, and there are fewer perceived alternatives (such as a better potential partner). Stated another way, when a partner experiences high levels of conflict and negative affect, has few investments, has few barriers to leaving, does not perceive fairness, and sees attractive alternatives, she or he is likely to dissolve the relationship. Some research examines ways in which negativity begins to take over the emotional climate of a relationship, especially as conflict becomes increasingly common between partners. Research by John Gottman has been especially important in highlighting the psychological and physiological experiences of conflict that lead to divorce or dissolution. His work with different-sex and same-sex couples suggests that as partners begin to criticize each other more and more, partners become defensive (in response to feelings of being attacked), and this can lead to contempt. When this pattern becomes a regular occurrence in the relationship, it predicts divorce/dissolution with extremely high accuracy. Contempt refers to the devaluing of a partner, disrespect, mocking, eye-rolling, and so forth, and leads to stonewalling, or the psychological withdrawal and absence of the partner from the relationship. As these processes persist, the overall climate of the relationship becomes toxic and leads to depressed mood, anxiety, and stress, and can have a detrimental effect on the health of all family members that are part of this climate.

Psychological Experiences Among Those Who Separate and Dissolve Relationships It is common among those who experience the processes just described to consider dissolution, and those who experience contempt and stonewalling most likely will. In fact, research finds that couples who dissolve their relationships do so because of partner nonresponsiveness (a potential indicator of stonewalling), no or negative

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communication, mental cruelty (a potential indicator of contempt), and incompatibility. These interpersonal patterns can combine with external factors (e.g., social network influences, financial difficulties, perceived alternatives) to increase the perceived stress of staying in the relationship—or can result in reduced stress. For example, some separated individuals report relief after leaving high-conflict relationships. Others report an opportunity to start over and grow personally, whereas still others report loneliness and difficulty in establishing new routines and identities. Expecting dissolution to occur is related to a higher chance of positive adjustment and other beneficial short-term outcomes such as personal growth. Among same-sex couples, many encounter added stress as they contemplate what separation will mean for their lives and go on to actually dissolve their relationship. This is especially true when it is a partner in a different-sex marriage who comes out to her/himself as gay and goes through a divorce at the same time. Also unique to some in this group are worries about legal issues surrounding their divorce, especially those related to custody when children are involved. The one somewhat consistent factor for married different-sex couples is that courts overseeing divorce proceedings are family courts and base decisions on previous case precedent. Although it is not necessarily the case that court involvement will alleviate the psychological experiences of divorce for any couple, it can be argued that it provides some stability in that decisions are made more fairly and equitably when based on case precedent. This is not always true for same-sex couples. These couples do not always have their relationships recognized legally or socially, leading to the reduced availability of social and family support, chronic social stress, worry about anticipated rejection, and internalized homophobia. These factors can result in both reduced well-being for the individual and greater stress on their relationship. The lack of legal recognition and associated benefits further increases difficulty, although, with recent legal decisions regarding same-sex marriage, this landscape is likely to change drastically in the future.

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Until recently, most same-sex couples lacked legal recognition and had to decide the terms of their dissolution independently, with a therapist or other family practitioner, or through a civil court. Importantly, there is no case precedent for dissolution or divorce in civil court, and a judge can make any decision without consulting family laws governing divorce. For example, the precedent of equitable division of assets only applies to divorces heard in family courts and not to dissolutions heard in civil courts. So, it is possible a civil court judge overseeing a dissolution could render a decision that awards all resources to one partner, even if both partners jointly accumulated most of their assets. In this way, the experiences of many same-sex couples are unique, thereby potentially adding and intensifying some of the psychological consequences. Alternatively, some research does exist that demonstrates same-sex couples’ abilities to navigate independent dissolution fairly successfully. This likely represents what other research has found: strong levels of flexibility and adaptability. In addition to encountering added stress over dividing resources given the lack of legal intervention during the course of dissolution, many samesex couples also may negotiate parental custody rights. Indeed, recent estimates suggest that about 31% of cohabiting same-sex couples have children. For these same-sex parents, the nature of their relationship (i.e., cohabiting, married) can influence the outcome of custody decisions. For couples who are not legally married or in which both partners do not share custody, there are no legal rights or obligations (i.e., visitation, child support) enforced for both parents. Typically, the law may view only one as the real parent. In these cases, coparents can lose all access to children, especially if the separation is less than amicable. This can result in increased financial and psychological strain on both parents and children. Even with carefully constructed agreements, coparents can often end up feeling marginalized, invisible, and vulnerable, and some have referred to this experience as one of ambiguous loss. Again, this demonstrates potential psychological consequences

in the absence of legal protections afforded by marriage equality, as an example. Social networks can also exert an influence on the way same-sex couples experience separation and dissolution. The powerful influence of social norms and commonly held beliefs can alter the way individuals conduct their relationships and the expectations for their relationships. For example, tightly woven LGBTQ communities may exert pressure for amicable separations so as to keep the cohesion of the community intact. This is likely related to the tendency for same-sex ex-partners to remain in each other’s friendship or family networks after a separation. This network cohesion may be a function of the bonding that occurs in groups that experience discrimination and prejudice (i.e., collective identity), as a method of protection from sources external to the group that may be harmful to its members, and an influence of smaller social networks and communities. Importantly, social networks are sources of social support, and this is necessary to aid in the psychological adjustment to dissolving a relationship.

Children’s Experiences With Parental Relationship Dissolution Children with same-sex parents experience loss and grief related to the ending of their parents’ relationship. As is the case with adults, children generally adjust well over time. The ability to establish new routines, parents being cordial toward one another, and having other supportive adults in their lives help with adjustment. Implicit is that children do need to process their experiences in order to better adjust, and this can be more challenging for children with same-sex parents. For example, research indicates that these children may find it more difficult to discuss their parents’ separation or relationship dissolution, given that most people may assume that the child has different-sex parents. This is another negative influence of LGBTQ-related stigma and discrimination. Children also experience more worry about their parents being stigmatized and

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often increase their protectiveness toward parents. When parents had entered a coparent adoption before the dissolution, children experienced more closeness and less loss postdissolution. It is well known that (a) maintaining contact with all parents and (b) the ability of ex-partners to be cordial following dissolution are critical to children’s adjustment. It appears same-sex couples may be particularly adept at providing such a context for their children, and this seems to somewhat mitigate the negative psychological experiences of dissolution. At the same time, the experience is challenging and difficult for all of these children.

Conclusion The period prior to divorce or dissolution often is characterized by conflict and the buildup of psychological stress. Outcomes for all family members appear to be somewhat negative in the short term, with positive adjustment over the long term. However, some have experienced dissolution more positively and have even reported personal growth. It is clear that societal discrimination and lack of access to legal means of divorcing can exacerbate adjustment difficulties, although these circumstances appear to be improving. More research is needed to fully understand these experiences and impacts on same-sex couples who end their relationships, as well as on the children who experience the separation, dissolution, and/or divorce of their parents. Brad van Eeden-Moorefield See also Child Support After LGBQ Divorce/Separation; Coming Out, Disclosure, and Passing; Custody and Litigation, LGBQ Parents; Custody Issues in Transgender Parenting; Discrimination Against LGBTQ People, Cost of; Divorce, Legal Issues in; Divorce and Separation, Historical Perspective on

Further Readings Gartrell, N., Bos, H., Peyser, H., Deck, A., & Rodas, C. (2011). Family characteristics, custody arrangements,

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and adolescent psychological well-being after lesbian mothers break up. Family Relations, 60( 60(5), 572–585. Goldberg, A. E., & Allen, K. R. (2013). Same-sex relationship dissolution and LGB stepfamily formation: Perspectives of adults with LGB parents. Family Relations, 62, 529–544. Gottman, J. M., Levenson, R. W., Gross, J., Frederickson, B. L., McCoy, K., Rosenthal, L., et al. (2003). Correlates of gay and lesbian couples’ relationship satisfaction and relationship dissolution. Journal of Homosexuality, 45, 23–43. Kurdek, L. A. (1991). The dissolution of gay and lesbian couples. Personal Relationships, 8, 265–278. Oswald, R. (2006). Same-sex relationships and their dissolution. In M. Fine & J. Harvel (Eds.), Handbook of divorce and relationship dissolution (pp. 499–513). New York, NY: Taylor & Francis.

DIVORCE AND SEPARATION, HISTORICAL PERSPECTIVE ON The processes of separation and divorce have affected the lives of LGBTQ people since the first wave of LGBTQ liberation in the 1960s and 1970s. Initial research and commentaries on divorce and separation considered LGBTQ people leaving heterosexual marriages and relationships. Subsequently, though, attention has turned to same-sex relationship separation. As legislation surrounding same-sex marriage becomes more favorable in many different countries and legislatures, consideration is now turning to same-sex divorce. The children of LGBTQ parents and how they fare after parental divorce has been one of the central research areas influencing public debate. This entry reviews the legal, social, and psychological aspects of divorce and separation involving LGBTQ adults and their children since the first wave of LGBTQ liberation. Historical developments and landmark legal judgments related to divorce and separation are contextualized in relation to contemporary issues faced by LGBTQ people and their families.

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Leaving Different-Sex Marriages and Relationships With the first wave of LGBTQ liberation, many lesbians, bisexuals, and gay men began to be more open about their sexual identity. For many, this process of coming out also meant the end of a different-sex marriage that was no longer compatible or satisfying. Men leaving heterosexual marriages often had experienced same-sex attractions during adolescence and young adulthood but tended to have dismissed or repressed any thoughts of a nonheterosexual future. In contrast, lesbians leaving heterosexual marriages sometimes reported that they had no earlier awareness of same-sex attractions whatsoever. Many lesbians, bisexuals, and gay men reported having felt genuine feelings of love for their spouse and had seen their marriage as the only socially acceptable route to a “family lifestyle” that included children. Many newly identified LGBTQ people delighted in liberation but also struggled with leaving behind a heterosexual past. The redefinition of self and establishment of new relationships and social networks after coming out may take a year or longer to achieve. For example, a man who previously had prioritized the traditional goals of heterosexual marriage and children might contend with his own internalized homophobia or biphobia as he gradually begins the process of assembling a new sexual identity. Released from marriage, he could experience the excitement of satisfying sexual encounters with another man without the previous feelings of anxiety and guilt associated with living a dual life. Nevertheless, he might miss the companionship and emotional intimacy he had previously enjoyed with his wife and grieve the loss of this attachment and the pulling apart of family and home. Further, the man’s previous heterosexual identity might well mean that he is older, on average, when coming out as a gay man. Thus, developing a gay identity, or finding a partner, could be a challenge within gay social spaces that prized youthful body images and freedom from responsibilities to others. Depending on one’s relationship with an expartner and one’s particular social circumstances,

separation and divorce could be not only emotionally distressing with the ending of an intimate attachment, but also financially difficult, disruptive of domestic routines, and socially embarrassing. Compounding the usual realignment of relationships with extended family and friends as a marriage ends are the reactions of others to the disclosure of a stigmatized identity (i.e., as LGBTQ) and the accompanying experience of social isolation. Under legislative systems that sought to apportion joint assets by establishing culpability, LGBTQ individuals were particularly vulnerable to prejudice when seeking to legally end a marriage that was no longer viable. In many jurisdictions, the introduction of no-fault divorce laws has helped to end incompatible marriages without the additional aggravation of a contested divorce. Many of the high-profile divorce cases that involved lesbian mothers also involved making custody and access arrangements for their children who had been conceived or adopted during the marriage. Until the turn of the 21st century, contested divorces often meant that a lesbian mother would lose custody and possibly face severe restrictions on the circumstances under which she could visit her child. For example, in Bottoms v. Bottoms (1993), Sharon Bottoms’s mother was granted custody of her grandson because Bottoms was deemed unfit to parent due to her lesbian relationship. Sharon Bottoms was allowed to visit her son, but he was not allowed to visit her home or to see her same-sex partner. Some of the most difficult legal cases have involved transgender parents. For instance, in Kantaras v. Kantaras (2004), Michael Kantaras fought a drawn-out custody battle with his ex-wife with whom he parented two children (his ex-wife’s child from an earlier relationship whom Kantaras had adopted, and the child the couple had together through donor insemination). Initially, the Florida county judge had ruled that Kantaras was the children’s legal father and had awarded him custody. This was then overturned by the Florida Supreme Court ruling that Kantaras was born and remained female, rendering the marriage null and void because same-sex marriages were not legal in that state, thus undermining his claims to custody.

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Nonetheless, with increasing pressure from equal rights groups, LGBTQ parents gradually began to win custody and access battles for their children. Often the nexus test is applied in cases where custody or visitation is disputed. In the nexus test, parental behavior (including aspects connected with parental sexual identity) cannot be used as legal evidence unless a direct connection is recognized between the behavior and a negative effect on children’s well-being. By the early 1990s, equal rights advocacy groups were able to point to research on the wellbeing of children brought up in lesbian-mother families, which played a critical role in helping to change public and professional perceptions in custody and visitation cases. Research on children brought up by their lesbian mother after she and the child’s father had divorced has shown that children with lesbian mothers generally do not differ from children with heterosexual mothers in their relationships with their parents or their peers, their psychological well-being, or their psychosexual development. Far less research has looked at children of divorced gay fathers, or at bisexual, queer, and transgender parents. One reason for the lack of research on children of divorced gay fathers and divorced transgender parents may be that many are nonresidential parents to their children. Nevertheless, reports from gay fathers have indicated that their relationships with their children are generally warm and positive. Gay fathers also may be better than nonresidential heterosexual fathers at providing a structured routine to their child’s visit and setting appropriate limits on their child’s behavior. For those gay fathers who did have resident children, a key factor in satisfaction with family has been the extent to which the father’s new partner was integrated into family life. Likewise, research with small samples of children of divorced transgender parents indicate that children are more likely to be troubled by parental conflict but otherwise show no general difficulties in psychological development. Currently, many LGBTQ parents have children from previous different-sex relationships, and this

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may be more likely for LGBTQ parents from Black and ethnic-minority groups. Data from the U.S. Census has indicated that same-sex couples who reported a prior heterosexual marriage were nearly twice as likely to have children compared with same-sex couples who recorded no prior history of heterosexual marriage. Parenting by lesbian couples when one mother has children living with her from a previous heterosexual relationship may be organized differently than parenting in planned two-mother families. One study of African American lesbian stepfamilies found that the biological mother took on major responsibility, compared with her new partner, not only for her children but also for household chores and decision making.

Same-Sex Couples Separating and Divorcing When same-sex couples who lack legal recognition of their same-sex partnerships end these relationships, they are often vulnerable to disputation in a number of ways, since no legal redress can be sought and the couple themselves must arrange the redistribution of joint assets. Further, if the relationship ends, then ex-partners might not have extended family and friends to rally around them. Within some feminist lesbian communities, there may be particular pressures for an amicable and equitable separation—yet this may drive underground feelings of resentment, leaving tensions between ex-partners unresolved. Reviews of research on committed same-sex relationships generally have concluded that same-sex couples experience similar levels of relationship happiness and satisfaction as compared with different-sex couples. Couples also seem to have similar conflict resolution patterns, although lesbian couples tend to indicate more positive feelings about conflict resolution than do women in heterosexual relationships. Longitudinal research on White, American, middleclass, same-sex cohabiting couples in the 1980s and 1990s indicated that same-sex couples were less likely to break up if they had been together for more than 10 years and were more vulnerable

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to separating if the cohabitation was more recent. Emotional nonresponsiveness, experiencing individual problems (e.g., drugs), arguing about money or work, and feeling sexually dissatisfied were all cited as reasons for relationship breakdown by both same-sex and different-sex couples. Nevertheless, it seems that when compared with different-sex couples, same-sex couples might perceive fewer barriers to leaving a relationship that no longer brings them happiness. Some research has also attended to the potential impact that same-sex parents’ relationship dissolution may have on children brought up within that union. When the child is biologically related to, or adopted by, only one parent, then the nonbiological/ nonlegal LGBTQ coparent is in a weak legal position if the couple separates. Subsequently, the coparent may be tempted to withdraw financial support for the child if the ex-partners are not able to find a solution to custody disputes. Children of separated LGBTQ parents may experience a complex set of emotions in the wake of parental relationship dissolutions, such as feeling isolated because their grief at the end of their parents’ relationship is not appreciated or recognized by others. Data from the U.S. National Longitudinal Lesbian Family Study (NLLFS) has indicated that 17-year-old adolescents in the sample had experienced higher rates of parental separation than recorded in comparable national U.S. surveys. Nevertheless, over time, adolescents and their mothers also reported higher rates of cooperation between ex-partners over parenting than are recorded in heterosexual samples; these adolescents generally reported high levels of well-being and life satisfaction. Around two thirds of expartners in the NLLFS shared custody of their children, although whether or not mothers shared custody was not associated with adolescent psychological adjustment. Shared custody arrangements were typically negotiated between the separating mothers themselves, but were more likely to be in place if a comother had legally adopted the child previously. The field now awaits the results of further studies on the impact of separation and divorce on the well-being of LGBTQ parents and their children in

light of the U.S. Supreme Court ruling in June 2015 legalizing same-sex marriage across state legislatures. Fiona Tasker See also Child Support After LGBQ Divorce/Separation; Custody and Litigation, LGBQ Parents; Custody Issues in Transgender Parenting; Divorce, Legal Issues in; Divorce and Relationship Dissolution, Psychological Experience of; Legal Rights of Nonbiological Parents; Living Arrangements of Children After LGBQ Divorce/Separation; Relationships With Former Spouses

Further Readings Bigner, J. J. (1996). Working with gay fathers: Developmental, postdivorce parenting and therapeutic issues. In J. Laird & R.-J. Green (Eds.), Lesbians and gays in couples and families (pp. 370–403). San Francisco, CA: Jossey-Bass. Gartrell, N., Bos, H., Peyser, H., Deck, A., & Rodas, C. (2011). Family characteristics, custody arrangements, and adolescent psychological well-being after lesbian mothers break up. Family Relations, 60, 572–585. doi:10.1111/j.1741-3729.2011.00667.x Gates, G. (2008). Diversity among same-sex couples and their children. In S. Coontz (Ed.), American families: A multicultural reader (pp. 394–399). New York, NY: Routledge. Green, R. (1978). Sexual identity of 37 children raised by homosexual or transsexual parents. American Journal of Psychiatry, 135, 692–697. Lau, C. Q. (2012). The stability of same-sex cohabitation, different-sex cohabitation, and marriage. Journal of Marriage and Family, 74, 973–988. doi:10.1111/j.1741-3737.2012.01000.x Logue, P. M. (2002). The rights of lesbian and gay parents and their children. Journal of the American Academy of Matrimonial Lawyers, 18, 95–129. Morton, S. B. (1998). Lesbian divorce. American Journal of Orthopsychiatry, 68, 410–419. Oswald, R. F., & Clausell, E. (2006). Same-sex relationships and their dissolution. In M. A. Fine & J. H. Harvey (Eds.), Handbook of divorce and relationship dissolution (pp. 499–514). Mahwah, NJ: Erlbaum. Tasker, F. (2005). Lesbian mothers, gay fathers and their children: A review. Journal of Developmental &

Domestic Partnership Behavioral Pediatrics, 26, 224–240. doi:10.1097/00004703-200506000-00012 Tasker, F. (2013). Lesbian and gay parenting postheterosexual divorce and separation. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Possibilities for new research and implications for practice (pp. 3–20). New York, NY: Springer. doi:10.1007/978-1-4614-4556-2

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commitment, with provisions for hospital visitation rights and the right to represent an incapacitated partner. The second form of partnership is sanctioned through municipal, county, or state “registries,” in which two partners proclaim to a government agency that they share a common commitment. The third form originated from employers requiring demonstration of domestic partnership to establish a partner’s entitlement to employment benefits. Such demonstration can take the form of proclaiming exclusive commitment to each other, demonstrating joint dependence, and/ or proving a shared residence exists.

See Defense of Marriage Act Emergence of Domestic Partner Benefits

DOMESTIC PARTNERSHIP A domestic partnership is a relationship between individuals who share the same household, may combine tangible assets, and are financially interdependent. The criteria for a legal or quasi-legal recognition of a domestic partnership vary widely. Domestic partnership is a concept advanced as an alternative to marriage. Beginning in the late 1970s, LGBTQ activists sought legal recognition for individuals in same-sex relationships because of frustrations with restrictive U.S. marriage laws. Other activists sought and continue to seek an alternative to the institution of marriage due to its history of patriarchal power relations and exclusion. Some activists advocate for recognition and openness to relationships that include opposite-sex couples who rejected marriage, same-sex couples, and those in relationships that include more than two individuals. Others are simply not interested in marriage due to a history of divorce, fear of divorce, or lack of interest in marriage. The 2010 U.S. Census recorded 7.5 million opposite-sex couples cohabiting, with 514,735 same-sex couples cohabiting.

Domestic Partnership Forms Domestic partnership takes several forms. The first form is a legally binding contract between two or more individuals who express a mutual

In the early 1980s, LGBTQ activists, frustrated by the lack of equitable employment benefits, began working to attain spousal benefits for their partners. In many cases, health insurance became the rallying point for employees due to the lucrative health benefits offered by some employers and the cost and challenges of attaining coverage on the private market in the United States. Prior to the implementation of the Patient Protection and Affordable Care Act in the mid-2010s, individuals with preexisting health conditions had difficulty attaining coverage. Beginning in the late 1980s, health care expenses in the United States began escalating rapidly, making health care coverage a valuable employee benefit. These economic concerns became a central argument for securing domestic partner benefits (DPBs). Requests for DPBs began with gay and lesbian employees requesting that their employers begin extending spousal benefits to same-sex partners. In 1982, the New York newspaper The Village Voice became the first employer to offer DPBs, and in 1991, Lotus Development Corporation became the first major company to offer them. Following Lotus, other major companies began offering DPBs. Emergence of this phenomenon is due to three forces: competitive forces in companies’ quest to attract and retain employees, pressure to be seen as embracing diversity, and formal and informal employee groups lobbying their

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employers. The offering of DPBs has become widely prominent among large corporations but is less common in the public sector. In some organizations, benefits have been extended for both opposite-sex and same-sex partnerships. This broader approach to DPBs was more typical when trade unions or women’s employee groups were also advocating for the offering of DPBs. Government-sanctioned domestic partnerships rarely require that employers provide DPBs. Historically, in states where marriage was unavailable to same-sex couples, employer-based DPBs were typically the primary means of attaining benefits for same-sex partners.

Challenges With Domestic Partner Benefits Employers and employees have faced various challenges in offering DPBs. First, U.S. tax law allows health insurance contributions by employers and employees to not be subject to federal income taxes. However, this exemption from taxes applies only to benefits for the employee, the employee’s spouse, and legal dependents. Most domestic partners do not meet this definition, typically resulting in hundreds of dollars in additional taxes incurred by employees with DPBs each year. Both the employee contribution and the employer subsidy of benefits are included in calculating an employee’s income taxes. Additional challenges arose due to constitutional amendments enacted in some states to ban same-sex marriage and any “marriage-like benefits” offered by any state institutions. This resulted in some entities (e.g., state universities) revoking DPBs, while others attempted to work around the law by offering benefits that were separate from state benefits plans or enacting broader and more inclusive benefits policies. For example, in some cases, employers changed policies to allow “qualifying adults” to be added to employee benefits. Such individuals were not defined as having a romantic relationship with the employee, opening up the benefits to a larger population beyond those previously included.

A third set of challenges has arisen due to employer policies. Some employers require periodic (e.g., annual) updating that asks employees to affirm that their domestic partnership continues to exist. Such periodic updating has been controversial because legally married couples are rarely required to regularly affirm continuation of a marriage. In addition, some organizations do not allow an employee’s stepchildren to be covered under DPBs, while allowing such coverage for legally married couples.

Evolution of Domestic Partnership In the face of rapid social transformation in the acceptance and availability of same-sex marriage, some have questioned the continuing need for the concept of domestic partnership. Some employers are eliminating or phasing out domestic partner benefits, and some state and local governments are phasing out domestic partner registries. Other individuals and activists have responded negatively to such changes, noting that some individuals have no desire to pursue marriage, including some opposite-sex couples who have utilized domestic partnership. Rod Patrick Githens and Tonette S. Rocco See also Long-Term Same-Sex Couples; Work Environments; Workplace Policies

Further Readings Badgett, M. V. L. (2001). Money, myths, and change: The economic lives of lesbians and gay men. Chicago, IL: University of Chicago Press. Badgett, M. V. L. (2007). Unequal taxes on equal benefits: The taxation of domestic partner benefits. Washington, DC: Center for American Progress and Williams Institute. Githens, R. P. (2009). Capitalism, identity politics, and queerness converge: LGBT employee resource groups. New Horizons in Adult Education and Human Resource Development, 23(3), 18–31. Githens, R. P. (2012). Organization change and social organizing strategies: Employee-initiated organization

Don’t Ask, Don’t Tell and Public Opinion development. Human Resource Development Quarterly, 23(4), 487–518. Hornsby, E. E. (2006). Using policy to drive organizational change. New Directions for Adult and Continuing Education, 112, 73–83. Raeburn, N. C. (2004). Changing corporate America from inside out: Lesbian and gay workplace rights. Minneapolis: University of Minnesota Press.

DOMESTIC VIOLENCE, FEMALE See Intimate Partner Violence, Female

DOMESTIC VIOLENCE, MALE See Intimate Partner Violence, Male

DON’T ASK, DON’T TELL AND PUBLIC OPINION The policy of Don’t Ask, Don’t Tell (DADT) was instituted by the U.S. military in 1993 and removed in 2011. To understand the policy, it is necessary to understand the history of bans on homosexuality in the military and the specific policy known as DADT. Further, an examination of DADT must also address the impact of public opinion as it shifted over the years, what affected this public opinion, and how public opinion affected public policies.

History Homosexuals were implicitly banned from serving in the U.S. military since its inception during the Revolutionary War (1775–1783). However, not until a policy went into effect in 1921 was sodomy explicitly added as a crime in the Articles of War. Twenty years later, homosexuality itself was added as a disqualifying characteristic to joining the

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military. Before 1950, “blue discharges,” which were neither honorable nor dishonorable, were given to homosexual personnel. It was President Harry S. Truman who signed the Uniform Code of Military Justice into law in 1950, formalizing the procedures for discharging homosexual servicemen and servicewomen and making homosexuality a crime resulting in dishonorable discharge and loss of benefits. In 1982, President Ronald Reagan signed Defense Directive 1332.14, which specifically stated that homosexuals were not allowed to serve in the military and were to be discharged. However, enforcement of these rules varied depending on whether there was a shortage of soldiers, whether it was wartime, or whether individuals could be identified as homosexual. Although the military publicly claimed that policies banning and discharging homosexuals from serving in the military were in the interest of national security or unit cohesion, there was evidence to the contrary. The Crittenden Report (1957) found no evidence that homosexuals posed a security risk but still supported a ban on homosexuality based on perceived public norms of morality. Various studies conducted by the military continued to indicate that homosexuals did not perform any differently from nonhomosexuals, did not have different personalities than nonhomosexuals, did not constitute a security risk, and did not negatively affect missions. However, many of these studies were not released to the public until many years after they had been completed. Instead of being based on security concerns, the military’s ban on homosexuals was mostly based on public opinion. It was founded on fear of how allowing homosexuals to serve in the military would affect recruitment and retention of military personnel. In addition, based on public opinion, the military feared that allowing homosexuals to serve openly would damage the military’s reputation. Some military leaders went on record suggesting that having homosexuals in the military would result in physical risk to other soldiers due to AIDS and psychological damage to heterosexual soldiers’ well-being from having to be in close quarters with homosexuals. Thus, the homophobic

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fears of the general public and morality norms of the 1950s through the 1980s were reflected and influenced the views and policies of the military regarding homosexuality.

DADT and Changing Public Opinion William Jefferson Clinton campaigned for president in 1992 on a platform that included a promise to eradicate the ban on homosexuality in the military. However, after his election, lingering disapproval from the general public resulted in a compromise on policy. Clinton issued Defense Directive 1304.26 in 1993, which stated that the military could not ask its personnel about their sexual orientation, but if they were found to be homosexual, they could still be discharged. This policy was informally referred to as “Don’t Ask, Don’t Tell” (DADT), but the full name was “Don’t Ask, Don’t Tell, Don’t Pursue,” and later, “Don’t Harass” was added. DADT was a compromise between divided public opinions of acceptance and rejection of homosexuality in the military. The stance of the military was that DADT, by allowing homosexuals to serve, would result in lower unit cohesion, lost productivity, lower morale, and poorer order and discipline. In 1993, when this policy was instituted, the majority of U.S. citizens did not fully support equal rights for homosexuals, but subsequently negative attitudes have decreased, and acceptance of equal rights for sexual minorities has become the majority opinion in the United States. Part of this is due to campaigning by gay activists who encouraged gays and lesbians to come out of the closet. Coming out helped make the discrimination that was occurring toward gays and lesbians more visible and concrete in the eyes of Americans, since they now knew exactly whom these policies were affecting. An indication of the success of such campaigns was increases in acceptance for homosexual civil rights. Today, a majority of people support public policies that protect sexual minorities against hate crimes and discrimination in employment, and guarantee health benefits for same-sex partners. However, not as many people

support public policies that allow sexual minorities to get married or adopt children, although these policies are also rapidly gaining support.

Demographic Differences in Public Opinion Members of different demographic groups support policies favoring sexual minorities in varying numbers. For example, heterosexual men and people who consistently attend church are more likely to have negative attitudes toward LGBTQ people than heterosexual women and nonreligious individuals, respectively. In addition, people who are older, and people who are less educated, are more likely to have negative attitudes than younger and more highly educated individuals, respectively. One of the reasons for the trend toward increasing support is generational differences. Millennials (people born after 1980) support equal rights for sexual minorities more than any other generation, and Gen X (people born between 1965 and 1980) support sexual minorities’ rights more than the baby boomer generation (people born between 1946 and 1964). So, as the number of millennials increases and the number of baby boomers decreases, public support of homosexuality has also increased. Public support for sexual minorities can also vary depending on how the question is asked (wording effects), such as using the term homosexuals versus gays and lesbians. When surveying the public, using the terms gays and lesbians may elicit more support/positive attitudes than the term homosexuals. Order and format effects, social desirability, title of the survey, the researchers’ affiliation, and answer choices (yes/no vs. a continuous “disagree” to “agree” scale) can also affect survey results, so it is important to keep these in mind when examining public opinion polls.

The Repeal of DADT Because the policies in the U.S. military are set by an elected government, as the views of the public changed regarding homosexuality, military

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policies also changed. Like Clinton before him, Barack Obama campaigned for president in 2008 on a platform that included a promise to end the ban on homosexuality and DADT in the military. Once elected, President Obama chose not to use an executive order to unilaterally repeal DADT but charged Congress to repeal it. After many obstacles, such as court injunctions and filibustering, Congress finally passed the Military Readiness Enhancement Act (MREA) in 2010, which went into effect in 2011, thus effectively repealing DADT and the ban on homosexuality, and allowed gays and lesbians to serve openly in the military. Joel T. Nadler and Tiffany G. Maglasang See also Antigay Ballot Initiatives (and LGBTQ Activism); Freedom to Marry (and Other Marriage Equality Organizations); Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Homophobia

Further Readings Belkin, A., & Bateman, G. (Eds.). (2003). Don’t Ask, Don’t Tell: Debating the gay ban in the military. Boulder, CO: Lynne Rienner. Frank, N. (2009). Unfriendly fire: How the gay ban undermines the military and weakens America. New York, NY: Macmillan. Nadler, J. T., Will, K., Lowery, M. R., & Smith, K. (2012). Don’t Ask, Don’t Tell and other LGB civil rights issues: Effects of terminology on public opinion. Journal of Gay & Lesbian Social Services, 24, 331–345.

DOWN LOW Down low, or DL, is a term originally used within African American vernacular tradition to connote actions performed with discretion, or outside the realm of surveillance. The DL, according to Geneva Smitherman (2000), describes things in the Black community that were “kept very quiet

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and secretive; also something done on the sly” (p. 109). These acts of discretion took place on several fronts: political, social, criminal, sexual, and so on. In 1995, rhythm and blues artist R. Kelly took the term into the public with his hit song titled “Down Low (Nobody Has to Know).” This song was all about secrecy, but Kelly specifically linked the DL to discreet heterosexual acts of infidelity. The term shifted from its social and often nonsexual usage to having a meaning within the social and sexual realm. This was the first incarnation of the DL as a term exclusively for sexual stigma. Following Kelly’s musical moves, artists such as TLC and Brian McKnight also incorporated the DL into their lyrics. Until 2001, men who had sex with men who considered themselves “on the down low” went unrecognized by media and largely Black heterosexual communities. The term kept its conventional uses for socially discreet doings and was sparingly used to discuss those acts of male–female sex outside of committed relationships. After the first article on the DL as a “bisexual phenomenon” in the Los Angeles Times (February 2001), several other articles followed. In the course of just 2 years, the DL moved from being the common, colloquial phrase to signifying an ironic, contradictory, and paradoxical hip-hop “homo-thug” (who was presumably responsible for the fact that, as of 2001, Black women were identified as comprising 64% of all new HIV/AIDS cases among U.S. women). As the media spun one story after the other, and Black magazines and newspapers disseminated information, the idea that individuals who engaged in DL behaviors were “dangerous bisexuals” gained traction within the Black community between 2001 and 2003. Yet the U.S. Centers for Disease Control and Prevention—the major distributor of information on disease and its impact—had made no statement affirming such assertions about these sexual connections. In 2003, when French journalist Benoit DenizetLewis published his New York Times article, “Double Lives on the Down Low,” the term gained greater currency among the larger American

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public. This article took an ethnographic approach to “understanding” DL men and their lives within and outside traditionally gay communities. This perceived threat to Black women—and particularly the Black heterosexual, often middle-class family—issued an alarm that would spark articles in major news sources throughout the United States (including USA Today, The Washington Post, the St. Louis Post-Dispatch), and Black magazines (Essence, Ebony, Jet), as well as mainstream television (ER, Law and Order, Girlfriends), and The Oprah Winfrey Show (2004). Indeed, these stories were reproduced in more local newspapers and received attention within local and national news stories for television. As discursive interests spread throughout the country, so did the amount of investment in the DL as the blame for the increase in HIV/AIDS in America. The term has evolved into a global descriptor of Black men who have sex with other men, while having wives/girlfriends. Yet the DL still operates within Black communities as social/political/sexual acts done secretly, with some trepidation. The DL is often used by men of color who only have sex with men, as an alternative to such terms as gay, same-gender loving, queer, and so on. The DL, as a term, has provided men of color a way to describe their experiences of sexuality, as well as a desired gender performance. Most recently, scholarship has offered new ways of interpreting its manifestation in discourse and everyday life. C. Riley Snorton (2004) offers the “glass closet” as “an analytic to work through multiple axes of oppression . . . [which] demonstrate(s) how blackness transforms the closet from a space of concealment— however partial or contingent—to a site of confinement and display” (p. 23). In contrast, Jeffrey McCune, Jr. (2014) disavows the closet as a space of Black containment, arguing that it reproduces “carceral logic” in Black life, in a time when society is stricken with the material and social realities of Black men’s actual incarceration. Instead, he offers “sexual discretion” as a way to better characterize how the DL acts as a “complex presence that has historical and

cultural significance in the survival of people of color, in the face of surveillance” (p. 173). Today, the term serves both commercial and colloquial usages. On one hand, it has marketability in commercial advertisements such as for the clothing store Old Navy, where their “sales are on the down low.” On the other hand, its use as sexual nomenclature still remains and is often referred to as the specter behind the high rates of Black HIV/ AIDS infection in the United States. At the same time, it continues to be deployed as a label for anything done outside the reach of surveillance. Jeffrey Q. McCune, Jr. See also Bisexuality, Female; Bisexuality, Male; HIV/AIDS and Gay Masculinity; HIV/AIDS and Racial/Ethnic Disparities; Men Who Have Sex With Men (MSM); Racialized Masculinity; Sexual Risk-Taking

Further Readings Boykin, K. (2005). Beyond the down low: Sex, lies, and denial in Black America. New York, NY: Caroll & Graf. McCune, J. Q., Jr. (2014). Sexual discretion: Black masculinity and the politics of passing. Chicago, IL: University of Chicago Press. Smitherman, G. (2000). Black talk: Words and phrases from the hood to the Amen Corner. New York, NY: Houghton Mifflin. Snorton, C. R. (2014). Nobody is supposed to know: Black sexuality on the down low. Minneapolis: University of Minnesota Press.

DRAG Drag, most simply defined, is the act of performing a gender identity other than one’s own. At its core, doing drag involves the manipulation of bodies and identities through performance. Drag has been a fixture in gay and lesbian subcultures since the mid20th century. Drag has provided a safe space for gender creativity; has offered an outlet for protest against homophobia and heteronormativity; and

Drag

has been used to raise money and attention for LGBTQ causes and communities, specifically during the AIDS pandemic. This entry discusses the existing research on drag performance, details the major theoretical debates about drag, considers how drag is racialized, and concludes with a description of drag in a global world. Historically, although as recently as World War II drag was performed by presumably straight men as substitutes for female actors, by the mid-20th century, lesbians and gay men began to adopt drag performance as a method to safely enter public homophobic spaces. Historians have records of effeminate gay men and butch lesbians crossdressing in public as an attempt to avoid violence when with their partners. Whereas in the 1960s drag provided a safe public space for sexual minorities, today many drag performers are queer public figures. The two most common types of drag are drag queens and drag kings. Drag queens are gay men who dress and perform as women but do not want to become women or have a woman’s body. Drag queens publicly perform femininity for an audience that knows they are male bodied, regardless of how convincingly female they might otherwise appear. Drag kings, somewhat newer in terms of popularity than queens, are women or sometimes trans men who perform masculinities. Drag kings are often more focused on the deconstruction of gender and sexuality than on the impersonation or illusion of presenting as a man. There are some critical gender distinctions in drag performance. Drag queens typically rely on camp, vulgarity, and shock value, while drag kings tend to keep a strong focus on artful protest. Although drag kings and queens are the most popular, drag is exceedingly diverse in that multiple genres of drag have recently gained popularity, such as women performing hyperfemininity, transwoman queens, or bearded drag queens. Some scholars of gender and sexuality argue that contemporary drag can be seen as a political and social protest that coincides with many of the other goals of gay and lesbian social movements. Drag can potentially disrupt gender and sexual

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dichotomies because drag performances illuminate the fluidity of gender and sexuality. Femininity, masculinity, and queerness often circulate freely in drag performance settings, and through a parody of gender, drag performance can expose the artificiality of both femininity and masculinity. Thus, when viewed through this lens, drag can be both transgressive and subversive. Others, however, assert that drag reproduces gender norms by reinscribing traditional hierarchies of gender and sexuality and reifying the dichotomous gender system rather than dismantling or critiquing it. Much of this criticism has been directed at drag queens more than drag kings. As drag queens embody femininity, they further encourage the pursuit of a hyperfemininity rather than multiple femininities. Others critique drag queens for their ability to rely on their male privilege. Drag queens are in a unique position in that, even as they perform as women, they can still claim a male body and identity, and use their male and cisgender privilege to disassociate from transwomen. Some argue that drag kinging, more so than queening, contests the idea of a heteronormative gender system through subversive protest. Whereas drag queens are almost always gay men (with the exception of a small, emerging transwomen queen circuit), drag kings are straight women, queer women, cis women, trans men, and masculinegendered women. Some argue that because of the wider range of gender diversity, drag kings utilize drag performance as a way to critique gender more than drag queens do. In addition, drag kings lack the male privilege of the queens, creating a power dynamic of female bodies disrupting gender rather than male bodies appropriating femininity. Some scholars have identified patterns within drag and race, suggesting that White drag focuses on camp, Latina drag focuses on the impersonation of artists, and Black drag focuses on dance. Drag performances are also racialized to the extent that White performers frequently adopt and perform Blackness. Some scholars suggest this desire to identify with and rely upon the imagery of blackness is to position oneself as defiant to

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mainstream culture. However, the practices of racial drag are far less disruptive than the performances of gender and sexuality because White performers most often do these performances. It is far less common for performers of color to be rewarded for pursuing Whiteness. White drag performers may embody Blackness for a desired number, but they can always reclaim their White privilege once off the stage. Local queer communities across the globe use drag performance for protest and entertainment. Western-style drag has a complex relationship with types of local and traditional drag in that it enforces Western queer identities, fashion, and dance styles while also allowing the local queer communities to affirm their identities within the larger, international gay rights movement. Although Western-influenced drag enables communities to disrupt gender, it has been criticized for identifying with colonial ideas of racial and ethnic oppression. Dana Berkowitz and Ray Siebenkittel See also Gender Spectrum; Genderqueer; Transgender Identities

Further Readings Moreman, S., & McIntosh, D. (2010). Brown scriptings and rescriptings: A critical performance ethnography of Latina drag queens. Communication and Critical/ Cultural Studies, 7(2), 115–135. Rupp, L. J., & Taylor, V. (2003). Drag queens at the 801 Cabaret. Chicago, IL: University of Chicago Press. Shapiro, E. (2007). Drag kinging and the transformation of gender identities. Gender and Society, 21(2), 250–271.

DYING, DEATH,

AND

BEREAVEMENT

Dying, death, and bereavement are experiences that will touch everyone’s lives. Comprehensive care that addresses the social, psychological, emotional, physical, and spiritual needs of the

individual, often referred to as “holistic care,” is a central tenet of care for the dying, and in particular, palliative care. Current thinking about bereavement is also shaped by acknowledging individual difference and variety in ways of grieving, characterized by fluidity rather than stages people move through. Available evidence shows that socially excluded groups have poorer access to end-of-life care, and it is increasingly acknowledged that more attention is required to address issues of cultural sensitivity. However, with some exceptions, acknowledging and researching diversity among dying and bereaved people is a neglected area in the literature. This diversity of experience should include the differing aspects of people’s identities based on sexual orientation and gender identity as well as variations within and between LGBTQ populations and the ways in which sexual orientation and gender identity may intersect with ability, age, class, gender, and so on. While there will be commonalities between LGBTQ individuals’ experiences of dying, death, and bereavement and those of their heterosexual counterparts, there are also a range of significant factors that are different. This entry considers these distinctions in more detail, including influences that can affect life expectancy for LGBTQ people as well as issues that affect LGBTQ experiences of dying, death, and bereavement. There is an increasing body of research addressing broader health and social care needs and concerns for LGBTQ individuals, but, to date, less research has been undertaken with a specific focus on dying, death, and bereavement.

Influences That Can Affect Life Expectancy for LGBTQ People The prevalence of ongoing discrimination and marginalization on the basis of sexual orientation and gender identity directly affects the health and well-being of many LGBTQ people. Evidence suggests that the mental and physical health of LGBTQ people is poorer than that of their heterosexual counterparts with associated consequences for the lifespan. LGBTQ individuals are likely to

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have a higher incidence of life-limiting and lifethreatening disease, attributed to risk behaviors such as smoking or alcohol abuse, which in turn are linked to minority stress. Minority stress is a term used to define chronically high levels of stress faced by members of stigmatized minority groups. This stress may include experiences of stigma, marginalization, or discrimination, acknowledged as social determinants of health, which may have a significant impact on the health and well-being of LGBTQ people. Chronic levels of stress can contribute to higher rates of risk behaviors and poorer health outcomes, including increased risks for some cancers, high blood pressure, stroke, heart attack, and depression. Minority stress may also contribute to reduced social participation and engagement within society, and delaying or not seeking care because of past experiences of or anticipation of discrimination. As LGBTQ people grow older, there is evidence that they are more at risk of life-threatening conditions for which incidence increases with age. Over their lifetime, LGBTQ people might avoid preventive health care because of concerns related to both discrimination and insensitivity by health care providers. Lesbian and bisexual women have a higher lifetime risk than heterosexual women of breast and endometrial cancer. In addition to being linked to the increased prevalence of risk behaviors as outlined, these cancers can be associated with nulliparity (i.e., not having been pregnant and given birth). Gay and bisexual men have a greater risk than heterosexual men of anal cancer, especially those who are HIV-positive. Little is known about the long-term impact on transgender men and women of using hormone therapies, but it is known that there are risks of congestive heart failure linked to testosterone use (used by female-tomale trans individuals) and that estrogen therapy (used by male-to-female trans individuals) increases the risk of deep vein thrombosis (DVT) and other thrombosis. Given evidence of an increased prevalence of risk behaviors (such as smoking) in LGBTQ populations, it should also be noted that there are higher health risks associated with a combination of hormone replacement therapies and

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smoking. Transgender people have complex bodies, depending on the extent of gender reassignment surgery they may have undergone and when (reassignment surgeries have progressed over time). More research is needed into the specific health risks facing transgender men and women. There is a legacy of AIDS-related deaths that had a particularly heavy impact on gay communities. While HIV/AIDS is now acknowledged to date further back, the outbreak in the 1980s was strongly associated with gay men (starting in America), such that it was initially termed GRID (gay-related immune deficiency). For many years, HIV and AIDS provided a dominant focus of research relating to LGBTQ communities; this research addressed the subject of dying, death, and bereavement, although with primary attention being on younger gay men’s experiences. HIV and AIDS carried a particular social stigma (which still exists to some extent) and involved experiences for the bereaved of multiple losses and survivor guilt. Survivor guilt is a term often used to include feelings of survivors about not doing enough to try to help others who died or feelings of being unworthy compared with those who died. In relation to HIV and AIDS, survivors may feel guilty about being HIV-negative in light of the suffering of their peers, or if HIV-positive, they may worry about their own health status factors, which may confound bereavement. Much of this literature originates from a period when an HIV/AIDS diagnosis was accompanied by a short prognosis. More recently, as a result of improvements in life-extending treatments, HIV has come to be considered a long-term condition, albeit potentially life-limiting and not without complications. Further, HIV-positive gay men may suffer from disrupted careers, with associated impacts on income, reliance on benefits, and possibly reduced support networks.

Issues That Affect LGBTQ Experiences of Dying, Death, and Bereavement There is a small but growing corpus of research identifying the issues that may affect LGBTQ experiences of dying, death, and bereavement.

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As noted, while some of the issues facing LGBTQ individuals are similar to those facing the wider population, there are also a number of separate issues that need to be addressed related to the wider social influences that shape LGBTQ experience. These include experiences of stigma, discrimination, and legal inequality, which are discussed in more detail in the following sections. End-of-Life Care Needs and Concerns

Consultation undertaken for the UK End of Life Care Strategy Equality Impact Assessment, published in 2008, suggests that there is a scarcity of available evidence addressing LGBTQ individuals’ concerns and needs at end of life. The report also concluded that in relation to quality of end-oflife care provision, LGBTQ people were most likely to be at risk of discrimination. A systematic review of peer-reviewed research published between 1990 and 2010 regarding palliative and end-of-life care in LGBTQ populations seems to confirm the scant evidence base. This review identified only 12 relevant papers (the criteria excluded papers not published in English). The majority of papers resulted from studies in the United States, and the primary focus of the research was identified to be end-of-life care relating to cancer in populations of lesbians and gay men. Very little evidence alluded to bisexual experience. No papers were found that reported on transgender people’s experiences. However, this is a burgeoning field of research, and since this systematic review of papers published up to 2010, there have been a number of other papers published, primarily from the United States, the United Kingdom, and Australia, specifically addressing LGBTQ experiences and concerns relating to dying, death, and bereavement. While there are commonalities between LGBTQ and heterosexual individuals in relation to experiences of dying, death, and bereavement, there are additional issues that need to be addressed for LGBTQ people. Research that addresses broader health and social care issues suggests that older LGBTQ people may receive care that is not of the highest standard or quality, due to assumed

heterosexuality and negative attitudes and behavior toward people who are identified or perceived as being lesbian, gay, bisexual, or transgender. Because of a general lack of awareness and gaps in knowledge, the experience of end-of-life care may be similarly inadequate. Older LGBTQ individuals may be particularly reluctant to challenge poor service provision or hesitant to approach services. There is growing evidence that a legacy of past stigma, hostility, discrimination, and marginalization has an ongoing impact on the present lives and future plans of older LGBTQ people. Even in parts of the world where social attitudes and acceptance of LGBTQ people have improved significantly, and laws have been implemented that secure more legal rights and recognition for LGBTQ people, these changes do not eradicate experiences of the past. The sociolegal position for LGBTQ people varies internationally. Many LGBTQ people in different parts of the world are still criminalized rather than protected by laws such as those that now exist in the United States, Canada, Australia, the United Kingdom, and other parts of Europe. In such contexts, LGBTQ individuals facing lifelimiting or life-threatening disease may need to hide their sexual orientation, same-sex relationships, and other aspects of their lifestyle and culture. Where same-sex relationships are not legally recognized, this may mean that one’s partner is not involved in one’s care or that dying wishes may not be recognized by families of origin, who may override decisions. To be living with a life-limiting condition, dying, or bereaved can be a socially excluding experience. Further, there are additional layers of exclusion that LGBTQ people may face at these times. This may include feeling unable to disclose their sexual orientation, gender identity, or other aspects of their lifestyle and culture because of previous experiences or concerns about discrimination from the wider society; bisexual and transgender people may also face discrimination from within lesbian and gay communities. Other issues include a potential lack of support networks, and one’s loss and grief not being fully acknowledged.

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It is often assumed that many existing concerns about access and provision of care when dying as well as support for the bereaved shared by the oldest generations of LGBTQ people would not apply to younger LGBTQ generations. It is argued that because in many parts of the world there have been improvements in social attitudes and tolerance toward LGBTQ people, and there is an increasing range of protective legislative rights, younger LGBTQ generations will feel more confident in requesting needed services. However, little is known about points of transition in older age or ill health and the consequences of these. For example, levels of confidence and assertiveness may be affected in transitions from active and independent lives through to frailty or conditions that require care and support. Evidence from the United States and the United Kingdom suggests that older LGBTQ people are more likely to live alone and to age without partners and children; they are more likely to rely on friends for support of all forms. Given the issues outlined above, they may be in more need of support but feel less able to access it. Often service providers do not consider that some service recipients may be LGBTQ. Further issues for transgender people include concerns about being placed in inappropriate hospital wards or having inadequate access to services. Feelings of exclusion may be exacerbated for LGBTQ people in a range of settings such as nursing homes or communal areas of supported living. This may be due to negative attitudes expressed by other residents who grew up in times when there were significant prejudicial attitudes toward LGBTQ people. There may be more subtle forms of exclusion such as feeling they do not have common experiences to talk about with their peer group. Together, these factors complicate preparations for and discussions about the end of life. Many LGBTQ people do, however, have strong supportive networks—although these may appear different from those of heterosexual individuals. Some who have lost touch with families of origin may build and rely on alternative networks of support and people who are important to them—often

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termed “chosen families” in the literature. However, these networks may lack full recognition and legal protection. For example, the term “next of kin” is used widely in health and social care, but there is a misunderstanding that it refers to and needs to be a person related by blood or marriage. LGBTQ people may be concerned that someone close to them will be denied visiting rights and information because he or she is not seen as the next of kin. Members of a chosen family are often of the same generation, aging and dying through the same period of years without an intergenerational support system. This experience could lead to further social isolation for older LGBTQ people. Advance Care Planning

It can be particularly important for LGBTQ people to consider advance care planning for a number of reasons including the need to counter discrimination and die with dignity. Advance care planning may include identifying who they wish to nominate to be involved in their care and in decisions about their care. This may require same-sex relationships and other important relationships to be communicated to and validated by families of origin and health care professionals. LGBTQ people have concerns that if they become ill, or if it becomes necessary for others to make decisions about their care in the event that they lose capacity, the most important people in their lives might be excluded from being informed or from making decisions about their care. A number of barriers to advance care planning have been identified within existing research. Some of these issues in common with the general population are not wanting to think about the end of life, giving the issue low priority, or lack of knowledge about options. However, there are also some specific issues relating to LGBTQ people about not knowing whom to appoint to significant decision-making roles, as in the case of those whose networks tend to consist of people within the same generation or who are estranged from families of origin. It has also been noted that ageism within gay communities in

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particular means for some that there is a denial of the realities of aging and death. Many people express a preference to die at home, which can necessitate the need to have a range of health and social care professionals coming into one’s home. This can be daunting for LGBTQ people who have spent a lifetime carefully managing their social networks in order to minimize any exposure to discriminatory behavior or attitudes. Having care workers coming into their homes may lead LGBTQ people to alter their home, for example by putting away items or photographs that might be associated with their sexual orientation or gender identity. Some may live in households with more than one partner or have a number of people close to them with whom health and care professionals will need to interact. LGBTQ people may feel too vulnerable or dependent on care services to be able to challenge any discrimination encountered. Transgender people can face further dilemmas. Service providers often have even less knowledge about the issues relating to transgender people than those that affect lesbian, gay, bisexual, and queer (LGBQ) individuals. Transgender people can face particular challenges if they have to negotiate intimate care with care workers who may not be aware of their particular needs. It is important to be aware of the diversity among transgender people; some will have spent most of their lives with a gender identity and body other than the one assigned at birth, while for others this may be a relatively recent transition. Others might not have undergone any form of gender reassignment surgery. Some who fall under the definition of transgender may not necessarily see themselves as transgender. They may instead refer to “transgender” as an aspect of their status or history, but not their current identity.

Bereavement and Loss The experience of bereavement may be different in some ways for LGBTQ people, compared with the heterosexual population. Surviving LGBTQ people may have particular support needs following loss of a partner. They may experience “disenfranchised

grief,” a phrase used to describe a situation where the full extent of a person’s grief and loss may not be acknowledged by those around them. When a heterosexual spouse dies, the surviving partner has a recognized social role of widow/widower that carries a certain social status and a permissible range of emotional expression. These kinds of privileges may be denied a same-sex partner. Transgender people may have particular concerns that the gender they have lived in be respected after death.

Conclusion In the last years of life, individuals and those important to them may need access to a number of services across different settings. It is important that LGBTQ people and those close to them feel safe in approaching services for assistance; if they are not confident about services or staff, they may not seek support. The care of the dying is said to be a good indicator of the care for all sick and vulnerable people. It is a crucial time to deliver good-quality care to enable individuals to die in comfort and with dignity because, to paraphrase Dame Cicely Saunders (recognized as the founder of the modern hospice movement), how someone dies remains a lasting memory for the individual’s friends, family, and staff involved. All individuals should be afforded the same care, compassion, and dignity through life and at the end of life, but inequalities in terms of access to services, lack of confidence to access services, and discriminatory attitudes still exist. Addressing the distinctly complex and multiple needs of LGBTQ people holds the potential to develop nondiscriminatory services that will benefit all. Kathryn Almack See also Caregiving; Chronic Illness; Health Care Plans; Health Care System; Health Disparities; Health Disparities, Transgender People

Further Readings Almack, K., Moss, B., & Smith, T. (2014). Research and policy about end of life care for LGBT people: Identifying implications for social work services.

Dying, Death, and Bereavement In J. Fish & K. Karban (Eds.), Social work and lesbian, gay, bisexual and trans health inequalities: International perspectives (pp. 173–186). Bristol, England: Policy Press. Almack, K., Seymour, J., & Bellamy, G. (2010). Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders. Sociology, 44, 908–924. doi:10.1177/ 0038038510375739 Cartwright, C., Hughes, M., & Lienert T. (2012). End-of-life care for gay, lesbian, bisexual and transgender people. Culture, Health and Sexuality, 14, 537–548. doi:10.1080/13691058.2012 .673639 Cox, K. (2011). Sexual orientation. In D. Oliviere, B. Monroe, & S. Payne (Eds.), Death, dying and social difference (2nd ed., pp. 191–199). Oxford, England: Oxford University Press. Fenge, L. A., & Fannin, A. (2009). Sexuality and bereavement: Implications for practice with older lesbians and gay men. Practice: Social Work in Action, 21, 35–46. doi:10.1080/ 09503150902745997

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Harding, R., Epiphaniou, E., & Chidgey-Clark, J. (2012). Needs, experiences, and preferences of sexual minorities for end-of-life care and palliative care: A systematic review. Journal of Palliative Medicine, 15, 602–611. doi:10.1089/jpm.2011.0279 Higgins, A., & Glacken, M. (2009). Sculpting the distress: Easing or exacerbating the grief experience of same-sex couples. International Journal of Palliative Nursing, 15, 170–176. doi:http://dx.doi.org/10.12968/ ijpn.2009.15.4.41963 National Council of Palliative Care. (2011). Open to all? Meeting the needs of lesbian, gay, bisexual and trans people nearing the end of life. London, England: National Council for Palliative Care. National End of Life Care Programme. (2012). The route to success in end of life care: Achieving quality for lesbian, gay, bisexual and transgender people. London, England: Author. Stein, G., & Almack, K. (2012). Care near the end of life: The concerns, needs and experiences of LGBT elders. In R. Ward, I. Rivers, & M. Sutherland (Eds.), Lesbian, gay, bisexual and transgender ageing: Biographical approaches for inclusive care and support (pp. 114–134). London, England: Jessica Kingsley.

E geographic and social spaces [including the interplay between on- and off-line spaces] organize sexualities); family, intimacy, and normativity (how queer people navigate the powerful norms associated with marriage and family); critical approaches to globalization (how globalizing forces impact queer sexualities in the region, beyond a simplistic focus on Westernization or Americanization); and the turn toward inter-Asia organizing and scholarship. The entry focuses on sexualities in the 21st century. Readers who desire a more comprehensive survey of the field are advised to consult the list of Further Readings. Transgender studies in East Asia is another burgeoning field, which overlaps with but also diverges meaningfully from this entry on sexualities, with its own key texts and questions. Works related to East Asian transgender subjectivities and embodiment are also provided under Further Readings for readers who wish to delve into this related area of inquiry.

EAST ASIAN SEXUALITIES This entry provides an introduction to a vibrant, multidisciplinary body of scholarship on sexualities in East Asia. Scholars have long recognized the importance of producing knowledge about gender and sexuality beyond dominant EuroAmerican models and theories. Yet the tendency to approach East Asian sexualities through the lens of difference, as area studies or as a point of comparison within an East–West binary opposition, has left theoretical Eurocentrism largely intact. (Here, Eurocentrism refers to the use of theories created in the West to analyze data collected elsewhere; constantly referring back to Euro-American experiences and ideas as the norm or standard of measurement for a field of study; and describing Euro-American sexuality studies as, simply, “sexuality studies” without denoting its regional specificity, while the specificity of other regions is consistently highlighted.) East Asian sexuality studies is not only an empirically rich field—contributing new knowledge about non-normative genders and sexualities in the region—but also a source of new theory and innovative approaches for the broader study of sexualities. This entry briefly delineates theoretical developments in the field across five thematic areas: transnational sexualities (how sexual practices, meanings, and subjects circulate and take shape across national borders); sexual spaces (how

Defining and Studying “East Asia” Defining East Asia is itself a political task. The binary constructs “East” and “West” are products of what literary critic Edward Said has called “imaginative geography,” arising from European colonialism and imperialism, and often used in ways that perpetuate cultural essentialism (the assumption that cultures are “natural” and unchanging, and that all people within a cultural group experience and enact that culture in the 349

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same ways). While this entry provisionally defines East Asia to include mainland China, Mongolia, Hong Kong, Japan, North and South Korea, and Taiwan, this is not a static regional boundary; for example, labor and marriage migration and other forms of transnational movement increasingly complicate the distinction between East Asia and Southeast Asia. In addition, it is crucial to recognize the political and cultural diversity not only between the societies named above, but also within each of these societies, including linguistic- and ethnic-minority populations, and occupied and nonurban areas that have traditionally received less attention in the field of sexuality studies. While this entry identifies analytic threads stretching across borders throughout the region, these connective ideas are not intended to flatten the variation that also exists. Inasmuch as ideas about sexuality have been central to Orientalism, the field of sexuality studies has a particularly important role to play in critiquing these ideas and dismantling controlling images of East Asia as culturally monolithic. Toward this end, commitments to situated knowledge (recognition that knowledge is not objective or universal, but is shaped by historical and social influences) and deep engagement with local languages and contexts have been fundamental to the growth of the field.

Transnational Sexualities The “transnational turn” within sexuality studies has roots and branches throughout East Asian sexualities scholarship. Researchers have especially noted the regional influences of China and Japan, through mechanisms ranging from military occupation to diffusion of cultural norms and practices. For example, several scholars have explored the popularization of Japanese enjo kosai, or teenage sex work, outside of Japan, and what this process of transmission reveals about teen girls’ sexual agency under diverse political and moral regimes. More recently, scholars have begun to document how K-pop (a popular musical genre) and Korean constructions of femininity are hybridized and incorporated into gay subcultures throughout Asia. National and ethnic boundary-making have

also figured prominently in the literature on East Asian sexualities. For example, anthropologist Franck Billé shows how nationalistic ideologies in Mongolia motivate the disciplining of two kinds of sexual subjects: gay men, and Mongolian women who have sex with Chinese men (and may bear Chinese children, since ethnicity in Mongolia is determined patrilineally). As these examples demonstrate, transnational influences on East Asian sexualities are not always or predominantly “Western” or connected to “Americanization.” Inter-Asia transnational flows are centrally important and represent some of the most flourishing sites of research.

Sexual Spaces The creation of virtual and cultural sexual spaces (also often spanning national borders) has been important for East Asian queer organizing both politically and socially. Media, and the Internet in particular, serves as a crucial site of queer cultural formation and representation, as well as a first meeting place for many individuals who are exploring their own sexual desires, and forming affinities around these aspects of their lives. In their 2003 edited volume Mobile Cultures: New Media in Queer Asia, Chris Berry, Fran Martin, and Audrey Yue examine how the exponential growth of new media has transformed lives and lifestyles in diverse Asian contexts. The authors intentionally blur the boundaries between the “virtual” and the “real” by showing how digital technologies are embedded in queer people’s everyday lives, from use of the Internet to arrange sexual encounters and share sexual content, to the display of phone charms to signal sexual orientation in Japan, to online collection of signatures for petitions to the government about sexuality-related issues in Taiwan and Korea. Other researchers have emphasized how online communities and physical spaces intersect to shape possibilities for queer lives and relationships. For example, sociologist Denise Tang notes that state-imposed policies to maintain land scarcity and keep rental prices high, combined with women’s economic disadvantages, have prevented

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Hong Kong lesbian and bisexual bar and business owners from accessing prime real estate, and as a result, many establishments for lesbian and bisexual women are located on the upper floors of highrises. In this context, online networking has been especially critical in enabling queer women to find one another, and to learn about local events and resources. In another example of how physical space matters, a majority of Tang’s lesbian and bisexual subjects shared close living quarters with their family members (a common characteristic of daily life for queer people in many East Asian societies). This living arrangement created practical obstacles to intimacy, which in turn shaped the women’s relationship strategies and goals, from finding ways to sneak a girlfriend into the room where multiple family members were sleeping, to achieving financial stability and independence with a goal of moving out. These processes of balancing family and intimacy represent another important theme within East Asian sexualities scholarship, discussed next.

Family, Intimacy, and Normativity Gender- and sexually nonconforming people in East Asia are navigating normative institutions of marriage, family, and patrilineal kinship in multiple and creative ways. Some integrate same-sex intimacy with heterosexual marriages, maintaining private same-sex relationships while also carrying out other family roles and obligations. Marriages of lesbians to gay men—sometimes referred to as “contract marriages” or “cooperative marriages” in English-language literature—are increasing in Korea, Taiwan, and mainland China (and possibly in other places as well). Arrangements within these marriages vary, but usually involve a public display of coupledom for the families, while husband and wife are released from expectations for heterosexual consummation and, ostensibly, enjoy freedom to cultivate their primary same-sex relationships under the protective cover of marriage. In many other respects, however, lesbians who marry gay men face similar pressures to lesbians who marry straight men, particularly surrounding family work and pressure from in-laws. For example,

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cooperatively married lesbians often live with or near to their husband’s parents, and shoulder the bulk of the elder care as well as child care and other housework. The challenges of such marriages, particularly for women, underscore the extent to which family pressures for lesbians are not only or even primarily moral and ideological, but also material (embodied through reproductive labor) and economic (as family resources continue to be disproportionately allocated to sons). A particularly thoughtful analysis of gender within contract marriages is provided by anthropologist John (Song Pae) Cho, who writes about the decision-making processes and living arrangements of such couples in South Korea. In addition to the arrangements described above, East Asian scholars have identified many historical and contemporary forms of resistance to heterosexual marriage, and increasing numbers of young people in East Asia report that they do not plan to marry despite strong normative pressures to do so. Across these varying family arrangements and strategies, gender- and sexually nonconforming people have complex relationships to normativity, as explicated in Yau Ching’s 2010 edited collection, As Normal as Possible: Negotiating Gender and Sexuality in Mainland China and Hong Kong. Contributors to the volume foreground the context-specificity of what is considered normative in a given place and time, and of queer “love-and-hate relationships with normativity” as a site of both desire and impossibility. This strand of research within East Asian studies promises to advance broader understandings of how normativity is constructed, negotiated, and challenged by diverse sexual subjects.

Queer(ing) Globalization Among the most central themes within sexuality studies in East Asia has been a thorough and critical response to the assumption that there is a “global gay” culture exported from the West, which serves as a primary referent for East Asian queers. It is here that challenges to the East–West binary opposition, mentioned earlier in this entry, have been vigorously deconstructed.

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An illustrative debate on this topic was carried out between sociologists Wah-Shan Chou and Day Wong, concerning the relevance of “coming out” to family in a Chinese context. Chou proposed the term huí jiā, ā “coming home,” as an alternative to a ā, Western, individualist sexual self-concept that is separate and distinct from cultural-familial roles and relationships. For Chou, the “coming home” lexicon is deeply embedded in the culturally unique category of the jiā (home, family, household), which denotes both a physical location and a mental/spiritual one in Chinese cosmology. Chou uses this notion of coming home to describe the behaviors of his Hong Kong study subjects, many of whom integrated their same-sex partners into the family through everyday rituals like sharing meals and playing mahjong, and through the use of quasi-kin categories like half-sister/brother, without discussing the sexual nature of these relationships with their parents. In contrast, Day Wong (re)interprets silent tolerance of homosexuality as a localized form of homophobia, and critiques Chou for reinscribing a binary opposition between the (individualist) West and (collectivist) non-West. Wong challenges readers to abandon the East– West binary altogether, and to consider instead how coming home is inseparable from and indispensable to coming out in the narratives of many Chinese bisexuals, lesbians, and gays. Another site of critical engagement with globalization theories can be found in work on global governance and civil society. Several scholars have shown how transnationally circulating discourses of anti-trafficking and child protection have led to increased surveillance and disciplining of sexual subjects throughout East Asia. In an article pointedly titled “Is Global Governance Bad for East Asian Queers?”, Josephine Ho, cultural critic and director of the Center for the Study of Sexualities at National Central University in Taiwan, highlights the role of conservative nongovernmental organizations, or NGOs (whose scope of influence has rapidly expanded under global governance), in blocking anti-discrimination legislation and gender diversity in education, and advancing other antisex and antiqueer agendas in Taiwan, Hong Kong, Singapore, and South Korea. Thus, while some

LGBTQ groups have optimistically looked to expanding civil society for leverage in social activism, they have also encountered new challenges through what Ho calls “the new state-NGO power bloc.” As Ho acknowledges and as other researchers also show, East Asian queers have risen to this challenge through determined and creative organizing, and through the creation of alliances with other marginalized groups within and across their respective societies.

Inter-Asia Focus One of the major projects of the field in the early 21st century has been the cultivation and institutionalization of inter-Asia scholarship and organizing around gender and sexualities. This inter-Asia turn is illustrated by, for example, the AsiaPacifiQueer Network and other regional scholarly networks and conferences, the Queer Asia book series launched by Hong Kong University Press in 2008, and a new international master’s program in Inter-Asia Cultural Studies (with a gender/sexuality concentration option) offered by a consortium of top research universities in Taiwan. These efforts highlight Asia not merely as an anthropological field site, but as an epicenter of knowledge production about non-normative genders and sexualities. As noted earlier in the entry, an important next step in this project is a heightened attention to understudied areas within the region, including (but not limited to) Mongolia, Tibet, and North Korea, as well as attention to rural, poor, and working-class queer populations that are often underrepresented in queer organizing locally and globally. Amy Brainer See also Intersections Between Sex, Gender, and Sexual Identity; LGBT Health in Non-Western Contexts; LGBTQ People of Color; Queer Ethnographies/ Autoethnographies; Transgender Geographies

Further Readings Berry, C., Martin, F., & Yue, A. (2003). Mobile cultures: New media in queer Asia. Durham, NC: Duke University Press.

Education Chalmers, S. (2002). Emerging lesbian voices from Japan. New York, NY: Routledge. Chiang, H. (Ed.). (2012). Transgender China. New York, NY: Palgrave Macmillan. Ching, Y. (Ed.). (2010). As normal as possible: Negotiating sexuality and gender in mainland China and Hong Kong. Hong Kong: Hong Kong University Press. Cho, J. S. P. (2009). The wedding banquet revisited: “Contract marriages” between Korean gays and lesbians. Anthropological Quarterly, 82, 401–422. Ho, J. (2008). Is global governance bad for East Asian queers? GLQ: A Journal of Lesbian and Gay Studies, 14, 457–479. Huang, H. T.-M. (2011). Queer politics and sexual modernity in Taiwan. Hong Kong: Hong Kong University Press. Khor, D., & Kamano, S. (Eds.). (2011). “Lesbians” in East Asia: Diversity, identities, resistance. New York, NY: Routledge. (First published as a 2006 special issue of the Journal of Lesbian Studies) McLelland, M., & Dasgupta, R. (Eds.). (2005). Genders, transgenders, and sexualities in Japan. New York, NY: Routledge. McLelland, M., & Mackie, V. (Eds.). (2014). Routledge handbook of sexuality studies in East Asia. New York, NY: Routledge. Na, T. Y., & Choo, H. Y. (2011). Becoming a female-to-male transgender in South Korea. In C. Bobel & S. Kwan (Eds.), Embodied resistance: Challenging norms, breaking the rules (pp. 48–57). Nashville, TN: Vanderbilt University Press. Sang, T.-L. D. (2003). The emerging lesbian: Female same-sex desire in modern China. Chicago, IL: University of Chicago Press. Tang, D. T.-S. (2011). Conditional spaces: Hong Kong lesbian desires and everyday life. Hong Kong: Hong Kong University Press. Wong, D. (2007). Rethinking the coming home alternative: Hybridization and coming out politics in Hong Kong’s anti-homophobia parades. Inter-Asia Cultural Studies, 8, 600–616.

EDUCATION This entry traces the history of the LGBTQ civil rights movement in terms of education and, as such, employs the terms used to refer to the

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LGBTQ community during the time period in discussion. It begins by situating homosexuality within the context of the societal aims of education and then describes the impact of various movements on LGBTQ teachers and students. It ends by describing the current climate in today’s schools. Because schooling has been seen as a way of preserving and passing on tradition, education has long been a site of cultural contestation. In addition, children are often viewed as being “innocent” and in need of protection. Public education in particular comes under scrutiny because it is supported by taxpayer money. Combined with a conflation of homosexuality and pedophilia, these various factors created heightened attention to schools as potential “breeding grounds” of homosexuality, which manifested itself in various ways throughout recent history. Unfounded fears led to “witch hunts,” where attempts were made to identify and eradicate homosexuals and homosexuality because they were seen as potential “threats” to family and heterosexuality. This effort to purge schools of homosexuality largely took place in terms of policing teacher behavior, including behaviors outside of school, and policing curriculum, that is, what teachers taught in school. The younger the students, the more scrutiny was involved.

The “Homosexual Menace” of the 1950s In the 1950s, there was increased awareness and fear of the “homosexual menace,” a phrase that arose following World War II, during a period of heightened tension between the United States and the Soviet Union. U.S. Senator Joseph McCarthy and his followers attempted to purge government and other institutions not only of supposed communists, but also of “sexual perverts,” leading to what became known as the “Lavender Scare.” During this period, people associated homosexuality with pedophilia, and local police stations would sometimes team up with their local school districts to create public service announcements warning youth to beware of homosexuals, who were depicted as preying on innocent children and teenagers. Although McCarthyism died out toward

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the end of the 1950s, concerns about homosexuality, particularly homosexuality in public schools, did not. While the 1950s brought increasing awareness of homosexuality to heterosexuals, it also made homosexuals more aware of each other. Gay groups started forming across the country. For example, the Mattachine Society, one of the earliest gay rights groups in the United States, started in 1950, and the Daughters of Bilitis, the first lesbian civil rights group in the United States, started in 1955. The burgeoning gay rights movement during the sixties culminated with the Stonewall Riots in 1969, when drag queens and other gender and sexual minorities took to the streets of New York to protest police brutality in the gay bar called the Stonewall Inn. Due to fears of being charged with pedophilia, these early gay rights groups did little to reach out to youth or schools.

The “Save Our Children” Campaign of the 1970s This newfound awareness of discrimination against homosexuals led to Dade County, Florida, passing nondiscrimination legislation that included sexual orientation in the 1970s. In response, Anita Bryant, an American singer and spokesperson for the Florida Citrus Commission, successfully lobbied to have sexual orientation removed from the legislation with her “Save Our Children” campaign in 1977. Bryant claimed that because homosexuals could not have children on their own, they became teachers in order to “recruit” new members. The gay community’s boycott of orange juice in reaction to her campaign resulted in Anita Bryant’s contract as spokesperson for the Florida Citrus Commission not being renewed in 1979. Anita Bryant’s self-termed “crusade” spread to California where the far-reaching Briggs Initiative, which would ban any school employee from even talking about homosexuality, was proposed. It was defeated as celebrities, including Ronald Reagan, voiced their opposition. However, similar initiatives in other parts of the country, including Oklahoma, did pass, laying the groundwork for “no promo homo” laws—laws that prohibit teachers

from portraying homosexuality in a positive light. It was under one of these laws that straight teacher Penny Culliton of New Ipswich, New Hampshire, was fired for teaching Maurice, a novel by E. M. Forster with a gay main character, in 1995. (She fought back and was reinstated in 1996.) Meanwhile, “morality clauses”—clauses in teachers’ contracts stating that they could be fired over any immoral conduct, regardless of whether or not it took place on school grounds—lived on and served as a wide net to catch teachers whose behaviors did not comport with local views about how people should act. Despite Morrison v. State Board of Education (1969) narrowing the scope of morality clauses to just those actions shown to affect a teacher’s ability to teach, an unknown number of LGBTQ teachers were fired because they were found to be in violation of the morality clause in their contract. Some of these instances resulted in court cases, including cases about LGBTQ teachers who were fired after being “found out” (Gaylord v. Tacoma School District [1977]; Acanfora v. Board of Education of Montgomery County [1974]). In 1985, a court upheld the firing of a bisexual teacher for disclosing her sexual orientation to a staff member in Rowland v. Mad River. These cases represent the tip of the iceberg, as many LGBTQ teachers who were fired either directly for being gay or indirectly by being targeted for being gay did not choose to fight back through the court system, or often did not fight back at all. Morality clauses were, and possibly still are, used as a legal means to “save our children” by those who deem LGBTQ teachers to be morally corrupt.

The Birth of Gay–Straight Alliances in the late 1980s In 1988, Kevin Jennings, a high school history teacher in a private school in Concord, Massachusetts, started the nation’s first Gay–Straight Alliance (GSA), a group of teachers and students dedicated to making school a safe space for gay students. Currently, there are GSAs in every state in the United States. However, that accomplishment did not come about without a fight. Because the Equal Access Act requires that if a school allows

Education

one extracurricular club, it must allow all extracurricular clubs, in 1996 a Salt Lake City school board voted to ban all extracurricular clubs to prevent a GSA from forming. This was later found to be in violation of the Equal Access Act in Utah, in East High Gay/Straight Alliance v. Board of Education of Salt Lake City School District (1999). In 1990, Jennings started a group that would later become the Gay, Lesbian & Straight Education Network (GLSEN), an organization that seeks to end homophobia in schools. Jennings also authored the first state-commissioned survey on gay and lesbian youth. Titled “Making Schools Safe for Gay and Lesbian Youth,” findings about the amount of harassment gay and lesbian students faced in school, including harassment by teachers and other school staff, led Massachusetts to become the first state in the nation to outlaw discrimination against students on the basis of sexual orientation. Currently, GLSEN’s National Climate Survey is used by scholars and politicians alike to gauge experiences of LGBTQ youth in our schools. In Weaver v. Nebo School District (1998), the court found that a school district violated a lesbian teacher’s freedom of speech when they prohibited her from disclosing her sexual orientation. While this may have legally ended any school districts’ “Don’t Ask, Don’t Tell” (DADT) policies—a term borrowed from President Bill Clinton’s 1994 policy allowing gay service members in the military as long as they did not disclose their sexual identity— teachers remained closeted for fear of losing their jobs. This fear was furthered when, during arguments against the Employee Non-Discrimination Act (ENDA) in the 1990s, U.S. senators objected to this federal legislation that would protect workers from being fired for being gay because it would include teachers. Despite, or perhaps because of, GSAs increasing the awareness of the presence of LGBTQ students and faculty in schools, many teachers followed the code of DADT.

No Promo Homo: Students, Teachers, and Curriculum in the 1990s and 2000s In 1996, a student named Jamie Nabozny won a near-million-dollar settlement in a suit against his

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school district for failing to protect him from his antigay tormentors. The publicity surrounding Nabozny v. Podlesny et al. (1996) led to several school districts adding sexual orientation to their nondiscrimination policies. However, a number of incidents since then demonstrate the need for proactive tactics as well as enforcement of these policies. One of the more widely publicized of these incidents occurred in 2008, when a middle school student by the name of Larry King was shot in the back and killed by a schoolmate on school grounds. The shooting occurred after Larry King had publicly asked the shooter to be his valentine. Even when education is not directly involved in the fight for LGBTQ rights, concerns over teachers’ influence on students are often used to inflame prejudice. For example, in the fight over samesex marriage in California, advertisements for Proposition 8—a ballot proposition for a state constitutional amendment to prohibit same-sex marriage—largely centered around false claims that same-sex marriage leads to schools teaching about homosexuality and gay marriage. California did become the first state in the nation to pass “pro homo” legislation—legislation requiring that curricula include prominent LGBTQ people, milestones in the fight for LGBTQ rights, and contributions by LGBTQ people to all fields, but this occurred before same-sex marriage was made legal in California. In contrast to California’s forward thinking, there are eight states that have “no promo homo” laws and one state that has a pro-heterosexuality law, as of 2014. Various other forms of censorship have also been used to try to erase homosexuality from our schools. This has ranged from banning books to using Internet filters to try to prevent students from accessing gay-positive websites. The Web filter for at least one filtering site allowed students to see antigay sites, including giving them access to the Bowers v. Hardwick (1986) decision allowing states to keep antisodomy laws on the books, while preventing access to gay-positive sites, including the Lawrence v. Texas (2003) decision that overruled Bowers. In Parents, Families, and Friends of Lesbians and Gays (PFLAG) v. Camdenton R-III School District (2012), the

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judge ordered that the school district replace its Internet filtering system with one that does not discriminate. Several studies have documented LGBTQ teachers’ experiences in schools. The first few studies in the late eighties presumed teachers were in the closet, describing their “double lives” and “coping mechanisms” such as avoiding gay events like pride celebrations and conforming to gender norms. However, author and activist Eric Rofes in 1999 interviewed his former students 20 years after their having studied with him as an openly gay teacher and found that students attributed their open-mindedness to his openness. Janna Jackson published a study in 2007 that detailed the processes that nine LGBTQ teachers had experienced in their various stages of coming out to their students. More recent studies have explored various subcategories of LGBTQ teachers such as by the subject they taught or by the teacher’s race/ ethnicity to discuss how those particular aspects impacted their experiences.

Current Climate While sentiment in the United States has recently swung toward being more supportive of LGBTQ people and their rights, and the right of same-sex couples to marry in all 50 states has been declared by the U.S. Supreme Court, the experiences of LGBTQ students in our schools still remains spotty. Harassment of LGBTQ youth outside of school, including in their own homes by their own parents, also impacts their school experiences, leading to lower grades and dropping out. Even in Massachusetts, the first state to outlaw discrimination against gay students, in 2009 an 11-year-old student named Carl Walker committed suicide after suffering from antigay bullying. While there is some controversy over the exact numbers of LGBTQ youth who commit suicide, there is general agreement that suicide rates are higher compared to the general population. A number of organizations including The Trevor Project have formed to try to combat LGBTQ suicide. The It Gets Better Project, founded by columnist Dan Savage and his partner Terry Miller, sparked

a number of YouTube videos aimed at helping LGBTQ youth who are being bullied. The GSA Network’s Make It Better Project provides materials and supports for LGBTQ youth to advocate for themselves. While attention to bullying has increased, proposed anti-bullying and nondiscrimination policies in schools that explicitly name sexual orientation and gender identity have come under pressure. Even though an LGBTQ teacher, administrator, staff, or student’s experience in school can vary in the United States, by and large, conditions are improving. However, around the globe, LGBTQ youth, teachers, administrators, and staff can still experience extreme homophobia. In 2013, GLSEN met with the United Nations Educational, Scientific and Cultural Organization (UNESCO) during the World Comparative Education Conference in Buenos Aires, Argentina, to discuss conditions for LGBTQ people in schools around the world. While awareness is increasing across the globe, steps need to be taken locally and globally to ensure that all LGBTQ students, teachers, administrators, and staff feel welcome in school. Janna Kellinger See also Bullying, Legal Protections Against; Bullying, Rates and Effects of; Bullying, School-Based Interventions for; Campus Climate; Gay, Lesbian & Straight Education Network (GLSEN); Gay–Straight Alliances (GSAs); Gender Nonconformity, Youth; It Gets Better; No Promo Homo Policies; School Climate; Schools as Heteronormative Spaces; Sexualities at School; Trevor Project, The; Violence and Victimization of Youth

Further Readings Blount, J. (2005). Fit to teach: Same-sex desire, gender, and school work in the twentieth century. Albany: State University of New York Press. Graves, K. (2009). And they were wonderful teachers: Florida’s purge of gay and lesbian teachers. Champaign: University of Illinois Press. Harbeck, K. (1992). Coming out of the classroom closet: Gay and lesbian students, teachers, and curricula. New York, NY: Harrington Park Press.

Effeminacy Jackson, J. (2007). Unmasking identities: An exploration of the lives of gay and lesbian teachers. Lanham, MD: Lexington Books. Jennings, K. (1994). One teacher in ten: Gay and lesbian teachers tell their stories. Los Angeles, CA: Alyson Publications. Kissen, R. (1996). The last closet: The real lives of lesbian and gay teachers. Portsmouth, NH: Heinemann. Kumashiro, K. (2002). Troubling education: Queer activism and anti-oppressive pedagogy. New York, NY: RoutledgeFalmer. Meyer, E. (2009). Gender, bullying, and harassment: Strategies to end sexism and homophobia in schools. New York, NY: Teachers College Press. Pinar, W. (1998). Queer theory in education. Mahwah, NJ: Erlbaum. Talburt, S., & Steinberg, S. (2000). Thinking queer: Sexuality, culture, and education. New York, NY: Peter Lang. Woog, D. (1995). School’s out. Boston, MA: Alyson Publications.

EFFEMINACY Effeminacy describes a man’s performance of traits or mannerisms that are usually associated with femininity. This may encompass a broad range of activities extending from a man merely displaying emotionality through to displays that are more distinctly marked as feminine—such as wearing obvious makeup. When a male body performs femininity with the purpose of identifying as the opposite gender, then this body would not be identified as effeminate but as transgender. One of the reasons why effeminacy has been central to LGBTQ politics is that, in contemporary Western culture, effeminacy is read as the dominant signifier of homosexuality. This wasn’t always the case, however. Throughout history, there have been examples of cultures that have accepted (and even celebrated) performances that would, by contemporary standards, be deemed effeminate. However, after the public disgrace of the writer Oscar Wilde in 1895, effeminacy became interpreted in anglophone culture as the signifier of homosexuality. Prior to Wilde’s public

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downfall, effeminacy was merely considered the signifier of upper–middle-class laxity and not of homosexuality. The reason for the conflation of effeminacy and homosexuality was that Wilde—arguably one of the first celebrities in anglophone culture— was also one of the first publicly identified homosexuals. Although Wilde may have entered the courtroom charged with committing acts of sodomy, he left the court identified as a sodomite. Therefore, after Wilde’s disgrace, the sexual acts were perceived as an identity, and the signifier of this identification was the Wildean trait of “dandyism” or, as contemporary culture would label it, effeminacy. More than a century after Wilde’s public disgrace, effeminacy is still regarded as the main identification of homosexuality. This conflation of homosexuality and effeminacy has been supported by the media (especially Hollywood cinema) which, until recently, identified queer characters on the screen through gender transitivity so that lesbians were represented as butch and gay men as effeminate. However, although effeminacy has caused anxiety because it is viewed as the signifier of homosexuality, it can also be a source of unease in itself. Indeed, critics have coined the term effeminophobia to describe the fear of effeminacy. Effeminophobia is not simply a fear of effeminacy as suggestive of homosexuality, but is also an anxiety about the way effeminacy disturbs the hierarchical gender binary. School playgrounds are often rife with effeminophobic abuse, given that when a 10-year-old boy calls another 10-year-old boy a “fag,” he is not suggesting that his peer is sexually active, but rather that he is not conforming to traditional performances of masculinity. Arguably, effeminacy is troubling to many people on a number of levels. First, the effeminate man is an upsetting sight for many effeminophobes because he is openly renouncing masculine privilege by adopting traits usually associated with femininity. Therefore effeminophobic terms of abuse—pussy-boy, nelly, and sissy (the abbreviaabuse— tion of sister-boy)—are grounded in misogyny because they are suggesting that the man in

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question is like a woman, and this is only an insult in a society of gender inequality. Second, the effeminate man is drawing attention to the constructed and performative nature of gender. He is showing that a male body can do femininity and is therefore challenging essentialist beliefs that ascribe masculinity to male bodies and femininity to female bodies. To use contemporary slang, the effeminate man “gender fucks.” Third, the effeminate man is not simply challenging gender politics but can be seen to trouble the matrix of sexuality. The gender binary is commonly regarded as the scaffold of sexuality. Heterosexuality translates as the sexualization of difference (hetero = difference), while homosexuality is the sexualization of sameness (homo = same), and the sameness or difference that is supposedly eroticized is gender. For example, when Aretha Franklin sings “You make me feel like a natural woman,” she is telling her masculine, male lover that his masculinity stands in opposition to her femininity and that the binary not only feels “natural” but is also erotic. If her male lover were effeminate, then her sense of femininity would be shaken and the erotic binary challenged. In this respect, the effeminate man is thought to trouble the scheme of eroticism (both heterosexual and homosexual) by falling between the genders and failing to appeal to anyone. For this reason, mainstream media allowed the representation of the effeminate man or sissy to thrive on the screen. Not only was the sissy unthreatening, because he had abandoned masculine privilege to descend the gender hierarchy, but he also did not seem to have a sexuality because he fell between the genders and failed to be either masculine or feminine. For this reason, much of gay liberation politics of the 1970s and 1980s was concerned with challenging the effeminate stereotype and asserting that gays were exactly like their heterosexual counterparts in everything apart from sexual object choice. Arguably, this prejudice against effeminacy still continues both in heterosexual and gay culture. Indeed, a cursory glance at any gay dating site will show a large number of personal ads expressing distaste for meeting anyone effeminate. “No effeminates, please” is a standard request. It could

be argued that for many of us, despite the advancements in LGBTQ politics, the situation is not very different from the school playground, as nonconformity to masculinity is still being policed with cruel taunts. It may well be that, in future years, LGBTQ politics may not be fighting against homophobia but against effeminophobia. Niall Richardson See also Gender Binaries; Gender Nonconformity, Youth; Genderqueer; Masculinity Stereotypes; Nonbinary Genders; Policing Masculinities and Femininities; Sissyboy Experience

Further Readings Baker, P. (2003). No effeminates please: A corpus-based analysis of masculinity via personal adverts in Gay News/Times 1973–2000. Sociological Review, 51, 243–260. Richardson, N. (2009). Effeminophobia, misogyny and queer friendship: The cultural themes of Channel 4’s Playing It Straight. Sexualities, 12(4), 525–544. Richardson, N. (2012). Fashionable “fags” and stylish “sissies”: The representation of Stanford in Sex and the City and Nigel in The Devil Wears Prada. Film, Fashion & Consumption, 2(9), 137–157. Sinfield, A. (1994). The Wilde century: Oscar Wilde, effeminacy, and the queer moment. London, England: Cassell.

ELDER ABUSE In the United States, elder abuse is defined by state law. All states have laws that address physical abuse, such as hitting or slapping; most also cover much more. Other types of elder abuse can include emotional or psychological abuse (the infliction of anguish, pain, or distress through verbal or nonverbal acts) and sexual abuse (nonconsensual sexual contact of any kind or sexual contact with a person considered incapable of giving consent). Due to poor physical or mental health or frailty, some elders require help with basic needs such as food and personal safety. If someone has agreed to provide such care and fails to do so, it is considered

Elder Abuse

neglect. It is called self-neglect when the elder is unable or refuses to obtain services necessary for health or safety. Financial or material exploitation (the illegal or improper use of an elder’s funds, property, or assets) is also usually considered elder abuse. With the exception of self-neglect, all of these forms of elder abuse may also occur in congregate living settings, where they are typically labeled institutional abuse. Because only a small percentage of elders ever live in such facilities, this entry focuses on abuse of elders who do not live in institutions. Although any elder, regardless of sexual orientation or gender identity, can be the victim of abuse, this entry focuses on the additional tactics abusers can use against elders who are LGBTQ and the additional barriers LGBTQ victims face in recognizing abuse and getting help. Although some types of elder abuse are considered crimes and are addressed by law enforcement, more often cases are reported to government agencies called Adult Protective Services (APS). Reports are first assessed to ensure the alleged victim falls under the APS law. Some states cover everyone over a particular age (typically 60 or 65), while others cover only elders who are also considered “vulnerable” or unable to protect themselves due to physical or cognitive limitations. Once APS accepts a report, a caseworker visits and interviews the victim and other witnesses and tries to determine whether the alleged abuse occurred. If APS determines abuse occurred, the agency usually tries to make the victim safe by providing additional services or making agreements with caregivers. Sometimes APS provides services to the victim or moves the victim into a nursing home or assisted living while prosecution of the abuser proceeds. Most elder abusers are spouses, adult children or grandchildren, or other people (such as neighbors, religious leaders, or in-home aides) whom the elder cares about and relies upon. Because of the emotional ties victims may have to abusers, elder abuse is considered a “betrayal” crime with particularly devastating emotional aftermaths. Victims are often unwilling to report abuse out of fear it may lead to their loved one being jailed. Moreover, victims may put up with abuse if the abuser also provides assistance such as grocery shopping or

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some rent money, fearing that they will be unable to stay in their home if the abuser no longer helps them. Abusers often manipulate their victims by first isolating them from contact with other people and then convincing the victim that only the abuser cares about him or her. This makes the victim even more dependent on the abuser. Because of the history in the United States of prejudice against and stigma around LGBTQ people, elder abusers have additional techniques they can use to isolate and intimidate LGBTQ victims. If there is someone in the LGBTQ elder’s life who does not know the elder is LGBTQ, the abuser may control the elder by threatening to “out” the person. An abuser may take advantage of social stigma by telling an LGBTQ victim that if he or she tries to report the abuse, officials would never believe the person or would mistreat him or her because of being LGBTQ. Some same-sex couples, to lower chances of being “outed,” put finances and/or assets in only one person’s name; if the owning partner later liquidates the account, and the couple never married, the other partner will have little recourse. Throughout their lifetime, LGBTQ individuals typically hear that people like them will probably “grow old alone”; fear of this can lead an LGBTQ elder to prefer an abusive partner to no partner at all. Isolating an LGBTQ elder may be easier than isolating a non-LGBTQ elder because family members may already be estranged, and the LGBTQ elder may already be  reluctant to access health care providers and mainstream aging services out of fear of encountering prejudice there. Because there has traditionally been little accurate mainstream discussion of LGBTQ life, LGBTQ people who come out later in life or who are relatively isolated from other LGBTQ people may be convinced by their abusers that whatever they are experiencing is normal in LGBTQ relationships. In a similar vein, they may have become convinced by popular stereotypes that being LGBTQ is inherently bad or harder than being non-LGBTQ, and so they settle for abusive relationships simply because they do not think healthy LGBTQ relationships are possible. Even when an LGBTQ elder abuse victim recognizes the abuse and wants it to end, the person

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may be reluctant to seek help. LGBTQ elders have experienced decades of discrimination and stigma. Typically, survival meant keeping silent, staying hidden, and protecting their own and their loved ones’ privacy. It has been especially important for many LGBTQ elders to stay away from government officials, since they know such officials have confined LGBTQ people in mental hospitals, arrested them, or worse. Because of this history, many LGBTQ elders take pride in being self-sufficient and are very reluctant to ask authorities for help. Although there are a growing number of LGBTQ organizations that are developing expertise and programming around aging issues, few are talking about elder abuse and encouraging LGBTQ elders to come forward and seek assistance if they are being mistreated or exploited. Loree Cook-Daniels See also Ageisms in LGBTQ Cultures; Aging, Social Relationships, and Support; Disabilities Among LGBTQ Elders; Discrimination Against LGBTQ Elders; Intimate Partner Violence, Female; Intimate Partner Violence, Male; Senior Living Programs and Policies

Further Readings National Center on Elder Abuse. (n.d.). Mistreatment of lesbian, gay, bisexual, and transgender (LGBT) elders: Research brief. Retrieved December 4, 2015, from http://www.centeronelderabuse.org/docs/ ResearchBrief_LGBT_Elders_508web.pdf National Resource Center on LGBT Aging and FORGE Transgender Aging Network. (2013). Identifying and assisting LGBT elder abuse clients: A guide for abuse professionals. Retrieved December 4, 2015, from http://www.lgbtagingcenter.org/resources/pdfs/ Assisting_LGBT_Elder_Abuse_clients.pdf National Resource Center on LGBT Aging and FORGE Transgender Aging Network. (2013). A self-help guide for LGBT older adults and their caregivers and loved ones: Preventing, recognizing, and addressing elder abuse. Retrieved December 4, 2015, from http:// www.lgbtagingcenter.org/resources/pdfs/SELF-HELP_ elderAbuse_Guide.pdf

EMBODIMENT Embodiment is a term used to describe the experience of living in and as one’s body, and negotiating its psychological, physical, and social identity and the power, pleasures, and limitations that shape bodily experience. Those who study LGBTQ embodiment understand the body as equally and simultaneously the home of individual personhood and a site of shared political, cultural, and social meaning. Understanding embodiment as both private and public is necessary for understanding and analyzing embodied LGBTQ life, since LGBTQ identities are experienced as both personally real and socially consequential. There is no singular LGBTQ mode of embodiment. LGBTQ embodiment, like LGBTQ identity and all identity, is thoroughly intersectional. This means that the particular embodied experiences an LGBTQ person has over a lifetime will be inflected by other socially relevant markers of identity; such as race; ethnicity; class; national identity; age; health and/or disability; and the cultural, historical, and political contexts in which embodied life is lived. Therefore, LGBTQ embodiment will always reflect the specificity of time and place, and its dominant ideologies and social and political structures. This entry summarizes theories of embodiment with particular relevance to LGBTQ experience and highlights some of the most salient topics related to contemporary LGBTQ embodiment in Western culture.

The Body and the Self Contemporary theorists of embodiment from LGBTQ perspectives typically reject descriptions of embodiment that assume a firm and hierarchical division between mind and body, in which the mind is associated with the self and the body is seen as separate from the self and therefore a nonessential aspect of identity. LGBTQ theorists, often informed by feminist, queer, and disability theory, claim that the body plays an enormous role in determining a person’s identity, ability, and social status. As a nexus of nature and culture,

Embodiment

a person’s body signals membership in social categories, such as gender, sexuality, and race, and those social categories assign varying degrees of power and vulnerability to individuals. Members of socially denigrated and historically disenfranchised groups (LGBTQ individuals, women, people of color, the disabled) experience restrictions and oppressions linked directly to their bodily status. LGBTQ bodies may become stigmatized, misrecognized; pathologized; and targeted for moral, legal, medical, and social regulation and intervention. Perhaps because of these challenges, LGBTQ embodiment may also involve creative and innovative efforts at embodied selfdetermination, as well as approaches to embodied pleasure that defy socially sanctioned views of embodied pleasure typical of societies that favor cisgendered heterosexuality. (Cisgender refers to individuals whose gender identity conforms to the gender they were assigned at birth; cisgendered heterosexuality refers to the culture of heterosexual identity, norms, and practices of cisgendered people.) Thus, LGBTQ embodiment may include varied and multiple experiences of danger and violence as well as empowerment and pleasure.

Gender Identity Gender identity is a social and psychological understanding of oneself as belonging to one of the available gender options in any given culture— usually “male” and “female.” Gender identity is assigned at birth but is also maintained and managed over a lifetime through numerous social institutions (such as religion, school, modern medicine) that teach and regulate gender identity. Bodies are assigned gender identities based on genital traits: Babies born with female sex traits are assigned a female gender, and babies born with male sex traits are assigned a male gender. In this way, sex and gender are correlated at the site of the body, and often assumed to be causally linked, such that male body traits are thought to cause male gender identity, and female body traits are thought to cause female gender identity. Central to gender identity is an assumption of opposite-sex desire, in that those

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designated “male” are thought to exclusively desire those designated “female,” and vice versa. LGBTQ individuals are understood as deviating from normative gender identity if they claim a gender identity that does not conform to the body traits typically correlated to that gender, or if they do not exhibit exclusive opposite-sex attraction assumed to be part of gender identity, itself thought to be built into the body. Under these norms of embodiment, LGBTQ embodiment may be perceived and experienced as gender nonconforming, or as failing to express correct gender identity properly.

Sexual Regulation and Pleasure Bodies, and what we can do with them, are heavily regulated in different ways across cultures. This is especially true of sexual activity. How, when, where, and with whom one may engage in embodied sexual behavior is a matter of considerable legal, moral, medical, and psychological concern, with some sexual acts (for instance, heterosexual intercourse between married, cisgender adults) encouraged and rewarded, and others (such as sex among lesbian, gay, bisexual, transgender, and queer folks) discouraged and punished. Sexual regulation may take official, legal form such as “decency” laws prohibiting sexual activity in public (which have historically tended to target gay men). Indeed, until a 2003 Supreme Court decision ruled a Texas sodomy law and all similar laws unconstitutional, more than a dozen U.S. states had official laws criminalizing same-sex sexual activity. Sexual regulation may also take unofficial form, such as cultural taboos that prohibit sex outside of marriage. Gender, too, is regulated in cultures that rely heavily on traditional gender ideologies. LGBTQ individuals whose embodied life violates rules of sexual conduct, or whose embodiment does not conform to normative gender roles, may face bullying, gender- and sex-based harassment, gender- and sex-based hate crimes, and other embodied dangers such as sexual assault and violation. Such trauma can register in the body for a lifetime, significantly diminishing an individual’s sense of freedom in, and sovereignty over, his or her own body.

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Embodiment is often idealized as a state of feeling “at home” in one’s body. Such a feeling of wholeness and security may elude LGBTQ individuals who live in eras and places of sexual and gender regulation that heavily favor cisgendered heterosexuality. In those settings, LGBTQ people are likely to experience their sexual desires and actions as sinful, unsafe, or pathological, and as a result, they may feel their bodies to be under constant surveillance and in perpetual danger. Even for those who have not directly suffered such sex- or gender-based violence, the fear of potential violence functions to keep all LGBTQ individuals vigilant and unsure of their bodily safety, based on the knowledge that their sexual or gender identity puts them at risk of bodily punishment and violence. Consequently, embodiment for LGBTQ people may be experienced as conflicted, insecure, and alienated. LGBTQ individuals may respond to a culture of sexual regulation by internalizing those external regulatory forces, so as to discipline their own bodies to conform to dominant norms of sexual behavior. Embodied life includes embodied pleasure, especially sexual pleasure. Under regulatory conditions such as those described above, LGBTQ people still pursue sexual pleasure even if their freedom to do so is not universally protected. Because LGBTQ embodiment varies from cisgendered heterosexual embodiment, sexual pleasure for LGBTQ individuals will vary as well. Without a desire, or mandate, to reproduce, LGBTQ sexual behavior may allow for embodied pleasures that do not exclusively center on penetrative intercourse. Such alternative sexual practices can endow bodies, body parts, and embodied sexual scenarios with erotic meaning not typically acknowledged in cultures of cisgendered heterosexuality.

Bodily Intervention In cultures that favor cisgender heterosexuality, embodiment for LGBTQ individuals may also be marked by intervention, or efforts at intervention, by outside forces. In the United States and elsewhere, sexual minorities may undergo (voluntarily or involuntarily) “conversion therapy” designed to

transform their sexual orientation from nonheterosexual to heterosexual. Conversion therapy includes a range of practices, many of them involving treatments to the body, including behavior modification therapy and, at times, painful genital manipulation. Physical and psychological trauma may result from being subjected to physical pain in order to “cure” one’s sexuality, and such abuse can, like other forms of violence, make for anguished embodiment wherein one’s bodily, sexual self may be experienced as a liability. In the early 21st century, conversion therapies are being increasingly discredited as both unethical and ineffective, suggesting that sexual orientation is not so malleable a trait. While some interventions to manage LGBTQ embodiment have been abusive and surely unwelcome, medical (and political) intervention to manage the devastating impact of HIV/AIDS on LGBTQ embodiment would have been most welcome. The notoriously slow political and cultural responses to the HIV/AIDS crisis in its early years, when gay men were the most visible victims, had profound effects on the cultural designation of certain bodies as both unhealthy and unsafe. Embodiment for LGBTQ individuals who are HIV-positive has thus been marked by a fear of bodily failure as well as social rejection. Activist organizations that sprang up in response to the HIV/AIDS crisis, such as ACT UP and the Gay Men’s Health Crisis, put LGBTQ health concerns on the national agenda, and made clear that LGBTQ embodiment is a political issue. Medical intervention into LGBTQ embodiment may be understood in other, positive terms. Hormonal and/or surgical intervention to “cure” or “correct” someone considered gender nonconforming or sexually deviant is clearly abusive in its violation of individual bodily sovereignty. However, when LGBTQ individuals, especially transgender individuals, pursue hormonal and/or surgical therapies on their own behalf to achieve the anatomical features of their chosen gender, this is more commonly understood as medical intervention motivated by embodied self-determination. The same may be said for the use of assisted reproductive technologies (ARTs) for LGBTQ

Employment Non-Discrimination Act (ENDA)

individuals pursuing biological parenthood. Thus, the role of modern medicine in LGBTQ embodiment is complex, and its ethical value depends entirely on why, how, and by whom it is used.

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See also Body Image Disturbance and Eating Disorders in LGBTQ People; Body Modification; Body Size and Weight; Cisgenderism; Intersexuality

Further Readings

Styles of Embodiment How individuals style their bodies, and how those styles are socially understood, has particular relevance to LGBTQ embodiment. Many people may not turn to fashion to express a particular gender or sexual identity, and sometimes fashion is a resource for not calling attention to one’s sexual and gender identity. However, for others, personal and collective style can be a crucial dimension of personal and social identity related to LGBTQ embodiment. More than merely a matter of clothing, style includes body modification, body habits, patterns of speech and movement, and other deliberate uses of the body to signify one’s membership in categories and cultures of gender and sexuality. Embodied, stylistic choices for LGBTQ individuals may include breast-binding; hiding one’s penis; wearing dildos; concealing or revealing erotically charged body parts; and referencing, through both clothing and body comportment, histories of LGBTQ aesthetics of embodiment, including butch/femme, androgyny, camp, and boi aesthetics, among countless others. Androgyny is a style of embodiment that refuses a single gender association and instead references both masculinity and femininity. Camp is a deliberately “over-the-top” style that has a strong self-consciousness to it, emphasizing performance, irony, and parody, which can be powerful modes of signaling awareness of the cultural and historical, rather than natural, basis of gender identity. Boi is an aesthetic of LGBTQ masculinity often favored by queer women and trans men that features preppy, youthful, and/or dandy style. As this brief catalogue of LGBTQ styles of embodiment shows, creative self-fashioning can be a powerful mode for using the body to enact sexual and gender identities that gesture to difference from normative heterosexuality. Marjorie Jolles

Bloodsworth-Lugo, M. (2007). In-between bodies: Sexual difference, race, and sexuality. Albany: State University of New York Press. Bornstein, K. (1995). Gender outlaw: On men, women, and the rest of us. New York, NY: Vintage. Butler, J. (1993). Bodies that matter: On the discursive limits of “sex.” New York, NY: Routledge. Foucault, M. (1985). The history of sexuality, Vol. 2: The uses of pleasure (R. Hurley, Trans.). New York, NY: Random House. Grosz, E. (1994). Volatile bodies: Toward a corporeal feminism. Bloomington: Indiana University Press. Heyes, C. (2007). Self-transformations: Foucault, ethics, and normalized bodies. New York, NY: Oxford University Press. Pitts, V. (2000). Visibly queer: Body technologies and sexual politics. Sociological Quarterly, 41(3), 443–463. Serano, J. (2007). Whipping girl: A transsexual woman on sexism and the scapegoating of femininity. Emeryville, CA: Seal Press.

EMPLOYMENT NON-DISCRIMINATION ACT (ENDA) The Employment Non-Discrimination Act (ENDA) refers to proposed federal legislation in the United States that would prohibit discrimination based upon sexual orientation and gender identity/ expression by employers with at least 15 employees. Proponents of ENDA recognize that LGBTQ people have been historically marginalized in the workplace, and passage of ENDA would prohibit employers from firing, denying job opportunities to, or otherwise discriminating against LGBTQ workers. ENDA becoming law in the United States would mean that LGBTQ workers would become a protected group alongside other protected categories, such as race, color, religion, sex, national origin, disability, and age.

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Employment Non-Discrimination Act (ENDA)

ENDA is modeled after other important civil rights legislation of the past century. For example, Title VII of the Civil Rights Act of 1964 prohibits discrimination at work based on race, color, religion, sex, or national origin, and provides a strong foundation for a comprehensive civil rights bill protecting LGBTQ workers. Even though LGBTQ workers are not explicitly protected under Title VII, certain harassment impacting LGBTQ workers has been recognized under Title VII. For example, the Supreme Court ruled in Oncale v. Sundowner that workplace discrimination based on sex also applied to harassment between individuals of the same sex. However, absent explicit protections, proponents say, LGBTQ workers are at risk for adverse workplace actions. ENDA, in its various forms, has been proposed, defeated, and stalled at the federal level for the past 40 years. The Equality Act of 1974 was a much broader predecessor of ENDA that was introduced by Representatives Bella Abzug and Edward Koch. The Equality Act of 1974 would have outlawed discrimination based upon sexual orientation, relationship status, and gender in public accommodation, housing, and employment. Representative Abzug and others introduced various forms of employment protections during the years following, but those measures failed to become law. ENDA has been proposed in nearly every Congress since the mid-1990s yet has failed to gain the momentum needed to become law. Employment nondiscrimination policies and legislation have been more successful in the United States at the state, local, and organizational level. Eighteen states and many local jurisdictions offer protections based upon sexual orientation and gender identity. Three states provide protections only based upon sexual orientation. Over 450 Fortune 500 companies have policies that expressly prohibit discrimination based upon sexual orientation, and over 300 prohibit discrimination based upon gender identity. Some employers actively recruit LGBTQ workers as part of their policies to promote workplace diversity. Many cities and states offer comprehensive anti-discrimination

protection that extends beyond employment and includes areas such as housing and public accommodations. In addition, the federal government offers certain protections to its own workers and contractors. Federal civil service employees have enjoyed nondiscrimination policies prohibiting discrimination based on sexual orientation since 1995. The military’s Don’t Ask, Don’t Tell policy was repealed in 2010, and the armed forces do not currently ban sexual minorities from entering military service, but gender identity/expression is still not protected in the military. In terms of federal employees, there have been other important decisions impacting LGBTQ workers, including the Supreme Court’s 2015 ruling that the U.S. Constitution guarantees the right to marry for samesex couples. Coupled with significant changes in public opinion about LGBTQ people, these important federal decisions set the stage for passage of a comprehensive federal ENDA. However, passage of the bill has not occurred as of this writing. In 2013, ENDA was reintroduced in both the House and Senate. Although the bill passed in the Senate, major LGBTQ rights and other social justice advocacy organizations have withdrawn their support for ENDA because of its broad exemption for religious organizations. In contrast, Title VII offers a very narrow religious exemption that allows religious organizations to have some degree of latitude in hiring so that they can employ individuals with similar religious convictions. These opponents note, however, that ENDA’s current religious exemption could offer any religious person, regardless of whether the person is in the business of ministry, the ability to discriminate against LGBTQ workers. Other opponents of ENDA, some within the LGBTQ equality movement, argue that ENDA itself is fundamentally flawed. Rather than amending Title VII to include sexual orientation and gender identity/expression, passage of ENDA would create a separate law, further perpetuating the idea that sexual orientation and gender identity/expression discrimination are different from other forms of discrimination. States that have

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been most successful at implementing protections based upon sexual orientation and gender identity/ expression have done so by expanding existing civil rights laws rather than creating new laws. These opponents say the solution is to amend Title VII to include sexual orientation and gender identity or perhaps to amend the entire Civil Rights Act of 1964. In 2014, President Barack Obama, who has long supported the passage of ENDA, signed an executive order prohibiting discrimination based upon sexual orientation and gender identity/ expression for federal contractors. This executive order also formally extended protections based upon gender identity/expression to federal civil service employees. Though President Obama’s executive order was narrow in scope, it further expanded protections in the United States for LGBTQ workers. There are an estimated 24,000 companies that are designated federal contractors with over 28 million workers. President Obama’s executive order was issued after years of urging policy makers to pass a comprehensive federal nondiscrimination act that would protect all LGBTQ workers. Trevor G. Gates See also Defense of Marriage Act (DOMA); Don’t Ask, Don’t Tell and Public Opinion; Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Workplace Discrimination

Further Readings Badgett, M. V. L., Lau, H., Sears, B., & Ho, D. (2007). Bias in the workplace: Consistent evidence of sexual orientation and gender identity discrimination. Los Angeles, CA: Williams Institute. Gates, T. G., & Rodgers, C. G. (2014). Repeal of Don’t Ask, Don’t Tell as “policy window”: A case for passage of the Employment Non-Discrimination Act. Journal of Discrimination and the Law, 14(1), 5–18. Library of Congress. (2013). Employment NonDiscrimination Act of 2013. Retrieved December 4, 2015, from https://www.congress.gov/bill/113thcongress/house-bill/1755

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ESSENTIALIST–CONSTRUCTIONIST DEBATE ON THE ORIGINS OF SEXUAL ORIENTATION Sexual identities, behaviors, and lifestyles have always been a subject of much discussion and controversy. One of the enduring questions posed by academics and the general public alike is how and why some individuals become gay, lesbian, or bisexual. Put more simply—but not unproblematically—sometimes individuals ask what “causes” someone to be bisexual, homosexual, or queer. Questions about the origin or causation of sexual orientation are often answered using one of two frameworks: biological essentialism (nature) or social constructionism (nurture). This entry begins by providing definitions and applications of biological essentialism and social constructionism, both in general and then more specifically in the context of LGBTQ identities and behaviors. Next, a brief historical context of the emergence of the essentialist–constructionist debate in sexology is offered. This is followed by a description of major concepts and implications of the biological-essentialist and social-constructionist approaches. Then, the either/or dichotomy/binary that this debate continues to engender is explored. Finally, this entry addresses the reasons this debate has been fought so fiercely in LGBTQ studies and in the broader field of sexuality studies.

Definitions and Applications of Biological Essentialism and Social Constructionism The origins of certain human behaviors and characteristics are often explained through the lenses of biological essentialism and social constructionism. Biological essentialism suggests that biological factors (e.g., genetics, hormones, and/or neuroanatomical structures) are responsible for various human traits, qualities, and characteristics. Social constructionism maintains that sociocultural forces create, shape, and maintain human behaviors, traits, and qualities. For example, human intellect has been explained using biological-essentialist

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and social-constructionist theories. If someone is perceived as smart, biological essentialists would attribute this “brainpower” to genetic giftedness: The person is seen as genetically hardwired for brainpower, born with a biological endowment for heightened intellectual capacity. Social constructionists would claim that intellectual prowess pertains to how someone has been nurtured and encouraged to read, think critically, keep the company of those who value ideas, and be intellectually engaged: They maintain that intellect is not a product of biological factors, but rather is created from social circumstances that foster intellectual development and capacity. The origins of criminality, alcoholism, athletic ability, and a variety of other human traits have also been argued along biological-essentialist and social-constructionist lines. Perhaps the most fervent discussion about the roles of biological factors and social influences, however, centers on the origin of nonheterosexual sexual identities and behaviors. Much attention, and countless scholarly and popular-press writings, has been devoted to the age-old question about why individuals become LGBTQ-identified and/or engage in nonheterosexual sexual activities. Why do some people develop nonheterosexual, “non-normative” sexualities? Is there a biological root of their sexual behaviors and attractions? Are there multiple biological factors at work? Or, completely out of the biological arena, are there social or environmental factors that form one’s sexuality? These questions are at the basis of an ongoing debate known as the essentialist–constructionist debate regarding sexual orientation, sometimes simply referred to as the biological essentialism (or determinism) versus social constructionism debate (or “nature versus nurture”). Arguments and strongly held positions about the origin of heterosexuality and nonheterosexuality have been prominently featured in the field for several decades. Many scholars and researchers have devoted the bulk of their academic careers— and in some cases, their entire careers—espousing either the biological-essentialist or the socialconstructionist view. It is important to understand the tenets of both positions.

Biological essentialists assert that biology alone determines to whom a person is sexually attracted in terms of same sex or opposite sex. Research in the areas of behavioral genetics, endocrinology, and neuroanatomy has attempted to pin down the origin of same-sex attractions and behaviors. Genetics research suggests that being gay or lesbian is more likely when family members are gay or lesbian: A gay male is apt to have other males in his family who are also gay; a lesbian is likely to have other females in her family who are lesbians. Studies of monozygotic (identical) and dizygotic (fraternal) twins suggest inheritability of sexual orientation. Chromosomal research and studies have been done on hand-use preference, fingerprints, and length of fingers and their connection with being gay or lesbian. Several studies have been performed on the effects of testosterone and estrogen on sexual orientation. It has been hypothesized that gay men have a deficient amount of testosterone and that lesbians are short on estrogen. Researchers have concluded that biology plays a major role in the formation of sexual attractions and behaviors. Social constructionists, however, assert that sexuality is a product of social influences and that meanings about sexuality are socially constructed through language and discourse. Social constructionists maintain that sexuality cannot be reduced to a physical core or essences that emerge through biological mechanisms. Rather, meanings, interpretations, and values about sexuality are malleable—not biologically fixed—and are created, for example, through educational, legal, literary, medical, political, and religious discourses, just to name a few. Language and discourse are used by various institutions, such as religion, law, medicine, education, and social welfare, to control sexual and gender expression. These institutions have enforced meanings that normalize sexual and gender stereotypes and have marginalized nonprocreative forms of sexuality, such as bisexuality, homosexuality, masturbation, and other forms of nonheterosexual sexual expression. Nonheterosexual and heterosexual sexualities are not immutably fixed, according to social

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constructionists. As social conditions change, so do realities, perceptions, and attitudes about various sexualities. These shifts happen on a societal level and potentially on an individual level as well. Homosexuality in the United States is a good example. Before the 1970s, homosexuality was viewed as a de facto mental illness. Until recently, there were state laws (sodomy laws targeting nonheterosexuals) that criminalized many nonprocreative sexual acts and federal laws (e.g., Uniform Code of Military Justice) that outlawed gays and lesbians serving openly in the U.S. military. The medical (psychiatric) and legal discourses perpetuated and reinforced the dim societal views and attitudes about homosexuality. However, there was resistance to counter such antigay and antilesbian sentiments in various cities across the nation in the 1950s and 1960s, including, but not limited to, the Compton’s Cafeteria Riot in San Francisco in 1966 and the Stonewall Inn Riot in New York City in 1969. Empirical psychological research on gay men conducted by Dr. Evelyn Hooker at UCLA in the late 1950s debunked the long-held claim that gays and lesbians were categorically mentally ill. Several significant changes followed that disrupted the discourse of pathology regarding homosexuality. For example, the American Psychiatric Association removed homosexuality as a mental disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. In 2003, the landmark U.S. Supreme Court decision in Lawrence v. Texas struck down sodomy laws targeting gays and lesbians nationwide. In 2013, the U.S. military’s Don’t Ask, Don’t Tell policy was repealed, allowing gays and lesbians to serve openly in the U.S. military. Finally, in June 2015, the U.S. Supreme Court ruled that same-sex marriage was legal in all 50 states. These are only some examples of the events that have brought about change in the discourses. The sociopolitical realities have changed, creating more permissive and accepting attitudes generally about nonheterosexuality in U.S. society. Social constructionism not only influences societal views about gays and lesbians and nonheterosexuals in general, but affects individuals as well.

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Social constructionists maintain that people “choose” their sexualities insofar as sexual behaviors, identities, and lifestyles are not biologically programmed or predetermined. More specifically, according to social-constructionist theory, sociocultural situations and environments create individuals’ sexual realities: Sexualities are products of social surroundings, learnings, and experiences.

Brief Historical Overview of the Essentialist–Constructionist Debate in Sexology From the early 19th until the late 20th century, sexology (the study of sexuality) in Europe and the United States was dominated by biomedical researchers, including psychiatrists. The popular notion was that sexuality was “natural,” innate, and biologically driven. Perhaps one of the most prominent European sexologists in the late 19th century was Dr. Richard von Krafft-Ebing, who authored the widely known and celebrated sexological book Psychopathia Sexualis. Among other ideas he advanced—lodging sexuality in the realm of biology—was that the sex instinct is an irrepressible impulse meant to perpetuate the human race. Procreative sexuality was seen as both natural and expected. In his writings, Krafft-Ebing espoused a downright negative view of nonheterosexuality. He postulated, for example, that homosexuality was due to biodevelopmental problems in utero that led to an inversion of the brain. Another prominent thinker of the time, Sigmund Freud, in his seminal 1905 work, Three Essays on the Theory of Sexuality, suggested that a biological basis for homosexuality likely would be discovered, specifically regarding hormonal effects on the body and mind. Scores of sex researchers from the 19th century to the present not only have not questioned the assumption of the primacy of biological factors in determining sexuality, but have perpetuated this notion. Behavioral geneticists such as J. Michael Bailey, Dean Hamer, Brian Mustanski, Richard Pillard, and others have indicated that homosexuality has a genetic basis. Dick Swaab and Simon LeVay assert that certain anatomical

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locations in the brain are indicators of homosexuality. Endocrinological research by Melissa Hines, Dick Swaab, and others has suggested a hormonal basis for sexual orientation. Biological theories of sexuality dominated—and went largely unchallenged in—the sexological landscape until the early 1970s. The 1970s witnessed challenges to the notion that sexuality was biologically determined. Many scholars advanced the idea that historical and sociocultural factors shape sexuality. In the early 1970s, U.S. sociologists John Gagnon and William Simon proposed that sexual scripts were generated from social and psychological contexts. Later, acclaimed French philosopher Michel Foucault theorized that discourses shape sexualities. British historical sociologist Jeffrey Weeks suggested that sexuality is ultimately malleable and deeply influenced by history. The prominent academic Carole Vance wrote that the development of sexualities is not rooted in biological functions, but rather sexualities are created as products of human actions and historical factors. Another influential scholar, Leonore Tiefer, critiqued the notion that sexuality is “natural” and inextricably linked to biology; she has also been a leading critic of the biomedicalization of sexuality. Numerous other academics have joined the social-constructionist camp. In many ways, the development of gay and lesbian studies at U.S. universities in the 1970s provided an academic home and genre in which to question biologically deterministic views of homosexuality. Scholars in queer studies have continued this effort since the field’s inception in the academy in the 1990s.

Implications of the Biological-Essentialist and Social-Constructionist Approaches The essentialist–constructionist debate has largely involved deep and contentious academic discussions about the etiology of nonheterosexualities. That is, lesbian, gay, bisexual, and queer (LGBQ) people have been under the academic microscope about the origin of their sexualities, but the cause of heterosexuality has gone almost entirely

unexamined. In many ways, heterosexuality has been seen as unquestionably “normal” and so socially expected and accepted that it has remained invisible and off the proverbial table regarding a discussion about the origin and impact of heterosexuality on society. The belief in a biological basis of homosexuality has historically had very negative impacts on some LGBQ people. For example, due in part to KrafftEbing’s reputation as a sexologist and his stance on the biological basis of sexual perversions, many people—homosexuals and “other perverts”—were forcibly sterilized between the late 19th and mid20th centuries. As late as the early 1950s, lobotomies and gonadectomies were performed on gays and lesbians because homosexuality was considered a mental illness. The idea of scientists finding a definitive biological basis for nonheterosexualities and developing “corrective measures” to “cure” or otherwise obliterate them has been feared by some and infuriating to others. Reparative psychotherapy, used to “correct” homosexual attractions and behaviors, has also come under fire. In 1993, a stage play entitled The Twilight of the Golds featured a hypothetical situation in which genetic testing could determine the sexual orientation of fetuses. One of the main characters, Suzanne, is pregnant and decides to have her unborn baby genetically tested. The baby is a boy, and genetic analysis reveals that he is going to be gay. Suzanne agonizes about whether to abort the fetus. She ends up getting an abortion, and her decision devastates her gay brother. This stage performance highlights the potential dangers and ethical dimensions of such a laboratory test, as well as the decisions that come from having it available and the social upheaval and devastation that can result because of such actions. The motivations for researching the possible biological roots of nonheterosexualities have been varied and sometimes viewed as suspect. Some who espouse the biological foundations of nonheterosexualities claim that scientific support for the biological origin of nonheterosexual sexualities would be liberating. That is, there would be some comfort in knowing that sexual orientation is

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deeply and immutably lodged in one’s biology and there is no choice in the matter, because there is unquestionable legitimacy in one’s biology. Social constructionists find it empowering to theorize that sexuality is the product of social, political, and environmental forces. Another implication of the essentialist– constructionist debate concerns the notion of “opposite sex.” Individuals often refer to the opposite sex as if females and males are opposite of one another. This is a prime example of a socially constructed concept masquerading as a biologically based truism. However, much research has challenged and even debunked the veracity of opposite sex as a binary. In fact, according to a body of literature, females and males have more in common than they have differences. The concept of opposite sex is a social construction, not rooted in biological realities. The ideas surrounding opposite sex also have the potential of reinforcing sexism, which is based on the myth that females and males are fundamentally different from one another. If the perception of opposite sex is not challenged, it is likely that commonly held assumptions about gender stereotypes will continue along with sexist beliefs about both females and males. However, if individuals have an understanding that opposite sex is a social construction and that females and males are not completely different, there is the potential for flexibility regarding how females and males can be in the world. Another benefit is that individuals might be open to exploring sexual relationships with same-sex and other-sex partners. If heterosexuality rests on the assumption that females and males are opposite, then an understanding that “opposite” is grossly overstated destabilizes part of the foundation upon which heterosexuality has been built. The implications of biological essentialism and social constructionism can be profound.

The Dichotomous/Binary Aspects of the Debate The essentialist–constructionist debate has been dichotomous. Often issues and questions are

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presented in an “either/or” fashion. Using the example of nonheterosexuality, the question is usually why certain individuals become LGBQ. Is it nature or nurture? Does it have to do with biological influences or social factors? This dichotomization happens in both popular culture and academic circles, reducing a complicated and nuanced question about the origin of sexual orientation to simplistic terms. The majority of individuals hold firmly to the notion that it is either biology or social influences. The majority of individuals in the general population believe sexual orientation is biologically determined. Perhaps this is because biological studies receive a disproportionate amount of attention in the popular press compared to social conditions as the determining factor of sexual orientation. Newspapers, magazines, and other popular-press publications, as well as news programs on television and radio, have historically featured the results of biological studies and the causal relationship of biology to sexual orientation. Scholarship focusing on the social construction side of the debate rarely gets the popular-press coverage that biological studies receive. In fact, most social-constructionist scholarship resides in academic journals and scholarly books that are geared toward academicians, not the general reader. The essentialist–constructionist debate has been underway for approximately the past 40 years, and the majority of the scholarship reveals that the question about the origin of nonheterosexualities is polarized. Many researchers maintain that sexual orientation is either biologically determined or socially constructed. This has been a bitterly fought debate. A plethora of books and articles expose just how the issues surrounding this debate have been divisive and have even caused irreparable rifts in professional relationships of some sexologists. It often comes down to biological essentialists versus social constructionists. While many individuals maintain that the origin of sexual orientation is a matter of either biology or social influences, other individuals argue that a combination of biological and sociocultural influences is responsible. One such approach is

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interactionist theory, which suggests that biological and social aspects interact with one another to form an individual’s sexual orientation. This has also been called the multifactorial model or the interactive biopsychosocial approach. These theories propose that several forces interact to create various sexualities. Another explanation for how sexual orientation develops is the dialectical approach. This is a far more nuanced and complicated theory than those mentioned above. In this approach, both biological and sociocultural realities are acknowledged as “ingredients” that create sexualities. The dialectical approach suggests that biological materials (e.g., genes, hormones, etc.) are potentialities that get realized through sociocultural and environmental aspects of life and vice versa. It is not that the internal (biology) interacts with the external (sociocultural), but rather that they are mutually constitutive and penetrative, and sexual orientation develops as a result of a unique and complicated relationship between biological and sociocultural factors. One does not take precedence over the other. Neither biological nor sociocultural aspects are primary in determining sexual orientation—both are equally important and necessary. The biological components cannot be separated or teased apart from the sociocultural aspects, and together they create sexualities.

Reasons This Debate Has Endured for Decades in LGBTQ and Sexuality Studies The essentialist–constructionist debate has continued for numerous reasons; only a few will be explored here. First and foremost, this debate has been highly political. The question about whether being LGBQ is an inborn reality (nature) or a creation of sociocultural phenomena (nurture) has raised the issue about whether sexual orientation is a “choice.” Many individuals have argued that finding sexual orientation to be a product of biology would be “protective” against admonitions about the sinfulness of choosing to be LGBQ. Some people feel if the notion of choice is removed, then LGBQ individuals will be less targeted and discriminated against. Others, however, argue that the

social-constructionist view is more empowering for LGBQ individuals. In addition, social constructionists have attempted to liberate LGBQ individuals from the medicalization and pathologization of nonheterosexuals. Giving agency to LGBQ people to be active participants in their sociosexual lives has also been part of the social-constructionist project. Heterosexual orientation, however, has been conspicuously absent from the essentialist– constructionist debate. The focus has been on nonnormative sexualities. Heterosexuality has gone almost entirely unexamined and uncontested; however, one of the main impulses of queer studies for the past two decades has been to challenge heteronormativity. In any event, the essentialist–constructionist debate has hardly been settled and is likely to continue for the foreseeable future. John P. Elia See also Heteronormativity; Heterosexism; Laws Banning Homosexuality and Sodomy; Sexology

Further Readings DeCecco, J. P., & Elia, J. P. (1993). A critique and synthesis of biological essentialism and social constructionist views of sexuality and gender. Journal of Homosexuality, 24(3–4), 1–26. DeLamater, J. D., & Hyde, J. S. (1998). Essentialism vs. social constructionism in the study of human sexuality. Journal of Sex Research, 35(1), 10–18. Foucault, M. (1978). The history of sexuality, Volume 1: An introduction. New York, NY: Vintage Books. Tiefer, L. (1995). Sex is not a natural act and other essays. Boulder, CO: Westview Press. Weeks, J. (1991). Against nature: Essays on history, sexuality and identity. London, England: Rivers Oram.

ETHICAL DEBATES ABOUT SURROGACY Commercial surrogacy is one of the most hightech, expensive, and controversial paths to parenthood. In addition, surrogacy is often fraught with ethical dilemmas and complicated by race, class,

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and gender distinctions. The relatively high cost of surrogacy means that people who create their families through this route are typically White, affluent couples and individuals who desire a biological tie to their child. In this arrangement, a surrogate mother, often a non-White female of lower socioeconomic status, agrees to bear a child for a person or couple who is unable or, less frequently, unwilling to do so without her assistance. As the number and visibility of gay fathers constructing families through surrogacy increases, it is important to understand how sexuality is implicated in these situations. This entry provides a brief background on surrogacy practices and continues with a discussion of the most prominent ethical debates about surrogacy. These debates will include how surrogacy is specifically related to sexual-minority families, as well as ethics in international surrogacy.

Surrogacy: A Background Surrogacy is an assisted reproductive technology (ART) in which the prospective parents forge a contract with a woman to carry and birth their child. Surrogate motherhood has been traced back to prehistoric origins; however, perhaps the earliest and most widely cited case in Western culture is that of Hagar in the Old Testament. Hagar was the handmaiden to Sarah, a wife of Abraham in the Book of Genesis. When Sarah became aware of her inability to conceive a child, she offered Hagar to Abraham as a surrogate mother to birth their children. Women, both single and those in heterosexual partnerships, who cannot carry or birth a child are the majority of commercial surrogacy consumers. One reason for the rise in surrogacy among single women and heterosexual couples is the postponing of childbearing to later years, which has impacted female fertility by reducing the likelihood that a female will have the physical ability or desire to use her own body for reproduction. In addition to reduced female fertility in today’s cultural environment, individuals or couples seek surrogacy not only in the case of female infertility, but also in circumstances of further physical barriers to

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procreation—among single men or gay male couples, for example, who do not have a female partner with whom to procreate. There are two different types of surrogacy arrangements: traditional genetic surrogacy and gestational surrogacy. Traditional genetic surrogacy features the fertilization of the surrogate mother’s egg, which she then carries to term and gives birth to a child to whom she is genetically related. Gestational surrogacy, also called in vitro fertilization (IVF) surrogacy, occurs when a woman’s ovum is fertilized with sperm using IVF, and the resulting embryo is transplanted into another woman’s womb. In gestational surrogacy, the surrogate who carries the fetus to term and births the child is not genetically related to the child. Surrogacy arrangements can be made independently or with the assistance of an agency. Arranging surrogacy independently, however, without the assistance of an agency, is risky and can create a host of potential legal problems regarding custody of the child. Since gay men and their families lack so many of the legal protections of heterosexual families, these problems can potentially be augmented. Prior to the recent rise of agencies like Growing Generations, which are willing to work with single gay men and gay couples, gay men were forced to find surrogate mothers through placing ads in newspapers or through other informal channels like inviting friends or family members to serve as surrogates. Today, however, in order to minimize the possible legal complications, many gay men, like heterosexuals, choose to work with an agency. Working with an agency increases the cost of surrogacy exponentially. Commercial surrogacy, as mediated through an agency, can range anywhere from $115,000 to $150,000 in the West. Because of its high cost, surrogacy as a practice is uncommon, in spite of its visibility and cultural relevance. In the United States, slightly fewer than 1,000 babies are born each year through the assistance of a surrogate mother.

Debates About Privileging Biology The most frequently cited reason that people choose to construct their families through surrogacy (rather

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than through adoption) is the desire for a genetic link to their child. Some gay men may pursue surrogacy as opposed to adoption because they believe that their family members are more likely to accept a child who is biologically related to them than one who is related to them through adoption. Another reason gay men may opt to have a child through surrogacy results from the lack of ceremonial and legal recognition of their families. For gay families, the presence of a genetic link can be a meaningful symbol that validates their relationship to their child. Nonetheless, surrogacy requires a female body to carry the fetus to term and birth the child and only allows for one parent to be genetically related to the child, thus introducing a biological imbalance in genetic linkage of parents to child.

The Ethical Dilemma of the Female Body Research with heterosexual and gay and lesbian couples has documented that parents who use ARTs, like surrogacy, are often motivated by the high level of control they have in choosing what their child will look like by carefully evaluating the characteristics of the surrogate mother and/or egg donor. Some gay prospective fathers have reported that as they evaluate their surrogates-to-be, they think about the importance of racial and ethnic matching, speculating how adding another dimension like racial differences to their family might confuse their child or attract unwanted criticism. Making separate choices about an egg donor and a gestational surrogate allows intended parents to choose among a wider pool of egg donors, and the ability to select a donor who’s physical, cultural, and biographical characteristics are more similar to themselves or their partners. Individuals or couples who construct families through surrogacy have a unique opportunity to consciously create what their families will look like. Prospective parents can select desired physical traits in gestational surrogates or egg donors with whom to reproduce their own DNA. Because of this, commercial surrogacy has been criticized for allowing White, affluent people to purchase the means to reproduce White infants in their own

idealized image. Those with the financial wherewithal literally have the purchasing power to procure a womb and produce a genetically engineered child. However, for gay men, who have for so long had little control over their reproductive options, this can provide them the ability to regain control of their reproductive choices. Onlookers tend to acknowledge a family as such if they look like a family. Utilizing biological connection or the semblance of it through surrogacy is one method by which gay men can ensure the most legitimacy possible for their families. Choosing a surrogate mother who looks like one of the gay fathers may be a preemptive measure, as they are well aware that they have to prepare for questions about their legitimacy as parent and child because they occupy different racial or ethnic categories. Yet this option is only available to a privileged minority of affluent gay men.

Motivations of the Surrogate While the motivations of an individual or couple seeking to utilize a surrogate, as described above, may seem rather straightforward, the motivation for a surrogate’s participation in a process that is both physically and emotionally taxing requires further inspection. Research reveals how prospective parents evaluate the surrogate mother’s age, race, physical attractiveness, medical history, intelligence, athleticism, and artistic ability. Alongside this, prospective parents also evaluate her motives. Although surrogates in the United States are reimbursed approximately $20,000, the majority report that they are not motivated solely by money, but rather by altruism, selflessness, and a desire to help a family have a child. Some researchers and social commentators assert that money is a substantial factor in motivating surrogate mothers, even if an altruistic motive is also present. People desiring children through surrogacy often grapple with whether the birth mother is motivated purely by financial considerations or by an inclination to help people who strongly desire to have children. Gay men, having few other options for birthing children, may be especially worried about this motivation.

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However, research has found that surrogates actually preferred to work with gay men because there was no mother in the picture who might potentially be dealing with emotions surrounding infertility (e.g., envy or feelings of exclusion). Moreover, unlike heterosexual couples, for which ART is usually a last resort, gay fathers may turn to surrogacy joyfully as a pathway to parenthood. Because such assisted technologies are universally necessary for gay men who wish to create their own biological offspring, they carry none of the stigma or sense of failure of many infertile heterosexual couples. Some argue that while the basis of commercial surrogacy is a financial arrangement, the realities are such that this is often a relationship pervaded by appreciation, mutual respect, and gratitude. Specifically, the limited research on gay fathers who have children via surrogacy reports that they forge deep bonds with their surrogates. Even well after the pregnancy and birth, many gay fathers choose to have ongoing relationships with their surrogates, and in some cases, with their egg donor.

International Surrogacy Although surrogate mothers are often motivated by financial or emotional compensation and enter willingly into their role as a surrogate, many critics of international surrogacy claim that the arrangement is exploitive of the surrogates themselves. International surrogacy is an arrangement in which the surrogate mother is located in a different country from the individual or couple who employ her reproductive services. Some international human rights advocates condemn commercial surrogacy, claiming that surrogate mothers are involuntarily forced into the commodification of their bodies and exploited by the affluent class due to their social position as female, ethnically brown, and located in a country where poverty is endemic. However, citing their pay of $5,000 to $8,000 as 10 times what a working-class woman may make after 1 year of labor in India, proponents of international surrogacy claim that surrogacy can financially empower women who would otherwise have no other opportunities for such financial gain.

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Surrogate mothers have claimed to use their compensation to pay for health care for their husbands, purchase a small home or a car, and send their children to finer schools. In response, however, opponents of surrogacy assert that not only is surrogacy dehumanizing, reducing a woman’s value to only that of her reproductive organs, but the amount of compensation does not adequately cover the experience of pregnancy and all it entails for 24 hours a day, 7 days a week, for 9 months straight; nor, they argue, do the fees adequately compensate the surrogate for the physical and emotional toll of hormone treatments, or in some cases multiple attempts at implementation, and her postpartum recovery. It has been speculated that the harsh criticism among anti-surrogacy advocates originates in the misappropriation of female gatekeeping of virtuous sex and reproduction. Others may shame the surrogate and reject the act as deviant and immoral on the grounds that she has allowed her body to be used for reproduction outside of the confines of social procreation norms. Surrogate mothers have reported hiding their pregnancy by moving to a hostel facility to prevent the discovery of their service as a surrogate, because they are aware that their friends and family would shun them for participating in what may be considered an act of disrespect or infidelity. Other concerns among critics of international surrogacy relate to the lack of regulation of surrogacy in many countries and pertain to the health and overall care of surrogate mothers. Critics discuss the necessity for all surrogate mothers of acceptable living conditions, healthful food, proper medical care, and trauma counseling after the pregnancy has ended. Moreover, additional concerns for the well-being of both the surrogate and the child have arisen in rare cases where the intended parents abandon the child due to a birth defect, illness, or capriciousness, thus leaving the surrogate to care for the child but without the means to do so. These issues in particular, along with allegations of medical malpractice and general reproductive exploitation, have gained the attention of critics advocating for the global regulation of surrogacy practices.

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However, the decreased regulation of international surrogacy may contribute to its appeal to same-sex families. Many individuals and couples who utilize surrogacy hail from countries that do not legally recognize same-sex couples as eligible for parenthood by adoption or child-rearing. Therefore, even if surrogacy is legal in their country of origin, a gay couple may not be eligible to participate in such reproductive outsourcing. International surrogacy provides an option for those individuals who seek a genetic link to their child, but are not offered the rights to pursue this in their home country. As most international surrogacy locations are not regulated by such legal restraints, gay couples can seek a surrogate elsewhere. In this way, an increase in regulation of surrogacy internationally may bring with it barriers similar to those that gay couples may find in their home countries. Dana Berkowitz and Crystal Paul See also Assisted Reproductive Technologies (ARTs); International Surrogacy/Reproductive Outsourcing; Surrogacy; Surrogacy, Legal Considerations of

Further Readings Berkowitz, D. (2013). Gay men and surrogacy. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 71–85). New York, NY: Springer. Dillaway, H. E. (2008). Mothers for others: A race, class, and gender analysis of surrogacy. International Journal of Sociology of the Family, 34, 301–326. McEwen, A. G. (1999). So you’re having another woman’s baby: Economics and exploitation in gestational surrogacy. Vanderbilt Journal of Transnational Law, 32, 271–304. Mitchell, V., & Green, R. J. (2007). Different storks for different folks: Gay and lesbian parents’ experiences with alternative insemination and surrogacy. Journal of GLBT Family Studies, 3, 81–104. Tobin, J. (2014). To prohibit or permit: What is the (human) rights response to the practice of international commercial surrogacy? International Comparative Law Quarterly, 63, 317–352.

ETHICAL RESEARCH WITH SEXUAL AND GENDER MINORITIES The second half of the 20th century saw a dramatic increase in the focus on ethical concerns related to research with human subjects. This was in large part due to the world’s becoming aware of severe ethical transgressions in human research that had taken place in the previous half-century, including the Nazi regime’s torturous experiments on humans. By 1974, all institutions in the United States receiving federal funding for behavioral or biomedical research were required to have an institutional review board (IRB) to evaluate the ethical foundations of all research conducted with human subjects. This entry discusses the history of research ethics as they apply to LGBTQ research; the debate concerning whether or not LGBTQ individuals should be considered a “vulnerable population”; methods of best practice for conducting ethically sound, inclusive LGBTQ research; and the ethics of selecting research topics concerning LGBTQ populations and experiences.

History of Ethics in LGBTQ Research It is not necessary to travel very far back into history to find professionals who have advocated for the erasure of individuals with same-sex attractions or transgender identities. In 1963, psychiatrist Karl Menninger emphatically stated that same-sex sexuality constituted abnormal behavior in need of treatment, and, as recently as 1985, a prominent Canadian psychologist noted that it was unlikely that the goal of preventing individuals from becoming transgender would ever gather systematic opposition. In fact, the larger part of the 20th century was replete with studies that pathologized all forms of same-sex sexuality and gender diversity. Prior to 1970, two-thirds of all research concerning gay men and lesbians focused on topics related to sickness, diagnosis, and causation. Researchers subjected lesbian and gay participants to practices now deemed unethical, such as

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involuntary castration, hormone injections, shock treatment, institutionalization, and behavioral therapies. Even when individuals participated in these studies of their own free will, consideration was not given to the role that societal devaluation, discrimination, or family pressures might have played in coercing their decisions to participate. The ethical transgressions of past research led to an intense focus on the protection of LGBTQ populations in research once the topic began to grow in popularity during the 1990s and early 2000s. Early research focused predominantly on lesbians and gay men, and emphasized the need to treat them as a “vulnerable population” for the purposes of ensuring their safety throughout the research process. Early LGBTQ-affirming researchers were very concerned about not causing harm to a population that they considered to already be quite vulnerable. It was also believed that LGBTQ individuals constituted a vulnerable population due to the power imbalances created by the lack of LGBTQ civil rights and the social marginalization that lesbians and gay men regularly experienced. LGBTQ research participants were often closeted and consequently, the protection of their privacy and confidentiality was of the utmost concern. In one of the earliest “affirming” studies on same-sex sexuality, Evelyn Hooker went to great lengths to ensure that her participants’ identities would be protected, even going so far as to conduct interviews in her own home instead of bringing the participants into her university office.

Current Status of Vulnerable Population Designation Although it made sense to view lesbians and gay men as members of a vulnerable population during the early years of affirmative LGBTQ research, when participants were often closeted and societal views were largely negative, researchers have since questioned the current designation of LGBTQ individuals as a vulnerable population. Because IRBs often review research protocols with vulnerable populations more closely and may even be less likely to approve such protocols, current LGBTQ

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researchers are concerned that continuing to treat LGBTQ populations as vulnerable is actually preventing the progress of LGBTQ research. Although the precise definition of a vulnerable population may vary between individual IRBs, for the most part, the term is used to refer to groups of individuals who have a diminished capacity to make decisions in their own interest, such as individuals who are cognitively disabled or children, as well as groups that may experience a power differential that could make them susceptible to coercion (e.g., prisoners, students). Based on this definition, it is only the latter portion that might apply to LGBTQ participants, as there is no evidence to suggest that LGBTQ individuals have a diminished capacity to make informed decisions about participating in research. The concern related to potential power differentials is relevant chiefly when considering the historical treatment of LGBTQ individuals, especially within the fields of psychology and medicine. The past pathologizing of sexual and gender minorities makes it important to take additional steps to ensure that research does not further perpetuate negative research experiences for LGBTQ individuals. The danger, however, lies in applying the vulnerable population status so broadly that it ultimately further marginalizes LGBTQ people by preventing research that might improve their quality of life or contributes to additional experiences of exclusion. It may be that some IRB members have difficulty distinguishing between a population that is vulnerable to negative outcomes (such as health disparities) and a population that is vulnerable to coercion by researchers. It may also be that IRBs tend to be overprotective of LGBTQ populations because of past ethical transgressions. This historical sense of a failure to protect past LGBTQ research participants may now, ironically, be contributing to the continued stigmatization of LGBTQ populations by creating unnecessary obstacles to LGBTQ-inclusive research. Ultimately, it is important that a balance be struck between protecting the safety, dignity, and confidentiality of LGBTQ participants while still ensuring that they have equal access to

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participation in research and that their lives and experiences are not excluded from bodies of research under the guise of paternalistic protection. There are still situations in which it may be appropriate to apply the procedures applicable to vulnerable populations to research with sexual and gender minorities; however, these procedures must be applied in a way that focuses solely on protecting the individual research participants, rather than excluding them from participation in research. In other words, the question should not be whether or not a researcher could conduct the same study without accessing a “vulnerable population,” but rather, whether the researcher has taken the steps necessary to ensure the safety of the participants within this vulnerable population. The extent to which any given sample of LGBTQ participants might be considered vulnerable will fluctuate depending on time and place. The same study conducted in two different locales may alter the interpretation of a population’s vulnerability. A study on same-sex relationships in Uganda (where homosexuality is illegal and punishable with a jail term) might produce very different power imbalances between participants and researchers, along with significant risks to participants should their confidentiality be breached in any way, compared with the same study conducted in, say, Toronto or San Francisco. In addition, trans* (trans* is a term that refers to all identities within the gender identity spectrum) individuals may frequently find themselves in precarious situations where researchers are affiliated with the institutions that govern access to transitioning health care services, such as gender-affirming surgeries or hormone treatments. In these cases, the extreme power imbalance (either actual or perceived) and the position of trans* individuals seeking approval for their health care needs would constitute their being treated as a vulnerable population for research ethics purposes. However, it should still be emphasized that this status should only serve to ensure that research protocols respect the dignity and autonomy of participants and should not be used as a means of delaying or preventing research using gender-minority populations.

A final area where researchers have debated whether or not LGBTQ populations should be considered vulnerable is in the study of LGBTQ youth. In general, youth are considered vulnerable populations by most IRBs and therefore require both the consent of the youth to participate in research as well as parental permission. For LGBTQ youth, however, the requirement of parental permission could place youth at additional risk, given that they may not be out to their parents or that their parents may not be supportive of their sexual or gender identity. Research has found that youth as young as 14 years of age have proven as capable as adults of making informed decisions about participating in research and that they should not be viewed as having a diminished capacity. In addition, research has found that requiring parental permission to participate in research on LGBTQ youth can significantly alter the results of a study by underrepresenting the experiences of participants who are less likely to participate in research that requires parental permission. Specifically, parental permission in LGBTQ research leads to the underrepresentation of racial and ethnic minorities, bisexual youth, and youth who experience lower levels of family support. Regardless of whether a population is deemed vulnerable or not, it is imperative that research with LGBTQ populations place a strong emphasis on issues related to confidentiality, privacy, and the prevention of harm. Data should be stripped of any identifying information as early as possible in the collection process, and participants should be clearly informed of how their identifying information will be handled so that they can make informed decisions about participating in research. It is also crucial that steps be taken to ensure the psychological and physical well-being of LGBTQ participants. Resources must be made available to participants should they experience any form of distress associated with their participation in research, and it is important that the resources provided be LGBTQaffirming. This can be difficult in areas where there are fewer LGBTQ resources available, and consequently, the onus is on the researcher to

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ensure that enough resources are collected and made available prior to launching the study.

Methods for Best Practice in Ethical and Inclusive LGBTQ Research One of the most effective means of reducing the likelihood of negative psychological experiences for participants in LGBTQ research is the reduction (and ideally, removal) of heterosexist bias. Heterosexist bias is displayed in the implementation of the conscious or unconscious assumption that there are only two biologically determined sexes, each having its own unique set of behaviors and each naturally inclined to desire the other. The consideration of heterosexist bias in research is relevant not only for those conducting LGBTQ research, but also for researchers with no specific interest in LGBTQ issues, given that LGBTQ individuals are still likely to encounter their research. For example, research that fails to ask about sexual or gender identities, or research that automatically excludes sexual and gender minorities, further perpetuates experiences of marginalization and stigmatization. In and of itself, the exclusion of LGBTQ individuals from research represents systemic heterosexism. Heterosexist bias needs to be considered at nearly every stage of the research process, from the theory that generates the research questions to the presentation and publication of results. If the theory used to design a study is based in heteronormative belief systems, then the entire study is likely to demonstrate heterosexist bias (e.g., basing research questions on the assumption that the cause for homosexuality needs to be identified, but that no cause or explanation is required for heterosexuality). The phrasing of recruitment materials should also be considered for evidence of bias, such as when a study indicates that it is open to all women, only trans women are rejected from the study. Similarly, it is important to select measures that are free from heterosexist bias and to use language that is inclusive. For example, failing to provide more than two gender options (male/female) informs participants that the study is not inclusive of diverse gender identities; not allowing

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individuals to identify a sexual identity other than straight, gay, or lesbian indicates that the study is not interested in the experiences of bisexual, queer, questioning, two-spirited, or asexual individuals. The failure to include queer identities in recruitment materials or response options has been shown to have implications for who ultimately participates in the research, as well as the research results. If participants are to be asked about their parents, using terms like “mom” and “dad” further reinforces the researcher’s assumption that parents come in heterosexual pairings only; instead, the researcher can ask about parent 1 and parent 2 (and possibly parent 3 and 4 as well) and ask participants to indicate each parent’s relation to them, or parenting role. Heterosexist bias can also be found in the specific wording of questions within the survey that do not directly relate to a participant’s identity. For example, asking about sexual intercourse may indicate that the researchers predominantly view “sex” as involving penile–vaginal penetration, which excludes many of the sexual activities engaged in by same-sex couples. In presenting research results, it is equally important to consider how terms are phrased and whether or not any bias is being displayed. For example, stating that a study examined the experiences of newlyweds or new parents and then failing to present information on the sexual identity of participants may indicate an underlying assumption that all newlyweds and new parents are heterosexual. Finally, even studies that have gone out of their way to avoid bias may still encounter efforts to incorporate bias into their study during the peerreview process. It is important for individuals reviewing research not to automatically assume that a study inclusive of LGBTQ experiences should be relegated to an LGBTQ-specific journal, and it is rarely if ever appropriate to ask authors to remove the LGBTQ participants from their sample in order to make the manuscript more appealing to a “mainstream” journal’s audience. Just as it is important to include multiple identities within an inclusive study, it is also important to recognize the heterogeneity of LGBTQ identities. While the LGBTQ acronym may

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provide a literary short form in writing, it should not be taken to imply that all identities included within this acronym share the same experiences. Even within the LGBTQ community, different identities experience various forms of marginalization, exclusion, and discrimination (e.g., the treatment of LGBTQ femme identities by other LGBTQ people as inauthentic). This spills over into research, such that the body of research on lesbians and gay men is much greater than the body of research on bisexuals, trans* identities, and queer individuals. For example, the exclusion of queer women from HIV research has systemic implications for the health of queer women living with HIV, demonstrating how, even within the LGBTQ community, certain identities are seen as privileged (and in competition with one another) within HIV research discourse. The erasure of specific identities can also take place during the data analysis phase, when specific identities may be dropped altogether from the analysis or collapsed into other categories (e.g., bisexuals not being analyzed separately from lesbians and gay men). Other areas where language can reinforce heterosexist bias and exclusionary research practices include the conflation of sex and gender or the use of pathologizing language, such as gender identity disorder, which places gender-independent kids outside the realm of healthy lives and identities. The mere perception of heterosexism or cis-sexism in the research process will contribute to feelings of discomfort and exclusion for LGBTQ participants, which thereby fails to properly protect participants from the experience of harm. One method for avoiding heterosexist and cis-sexist bias in research is the use of community research practices, in which members of the LGBTQ community are asked to participate in, and provide feedback on, each stage of the research process, from research question development to the publication and dissemination of results.

The Ethics of Research Topic Choices in LGBTQ Research In addition to considering the language used in LGBTQ research and publications stemming from

such research, it is also important to consider the broader implications of research questions. Researchers need to consider how their research questions will impact the quality of life experienced by LGBTQ individuals and whether or not the research is of enough importance to justify any potential harm that might befall the participants or the community they represent. Given that views about same-sex sexuality and gender diversity vary greatly around the world, researchers must also adopt a global perspective in evaluating how the results of any given study might be misinterpreted and used to cause harm. Given the past ethical transgressions in research against LGBTQ individuals, it is important to be vigilant about the potential uses of LGBTQ research and to give careful thought and consideration to how best to present results in ways that are accurate and least susceptible to distortion. One area of LGBTQ research that prompts ethical debates is the question of whether researchers should study the causes of same-sex sexuality or gender diversity. Those opposed to causal lines of research argue that any research that seeks the cause of same-sex sexuality inherently reveals evidence of homophobia and heterosexism. Those in favor argue that there is nothing inherently unscientific or unethical about seeking information on the origins of sexual identities and erotic desires. Perhaps the caveat to keep in mind is that, while it may not be unethical to study the origins of sexuality in general (i.e., what causes homosexuality and what causes heterosexuality), to only study one side of this equation (the causes of homosexuality) implies a value judgment that defines samesex sexuality as a developmental abnormality in need of research and the other side (causes of heterosexuality) as the normal course of human development. Consequently, it is important to thoroughly examine the motivations for specific research questions as well as the potential implications of all possible research outcomes. Concerns have been raised in the past that genetic research on the origins of same-sex sexuality will lead to the development of prenatal tests to determine the sexual orientation of a fetus or treatments aimed at

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eradicating same-sex sexuality from the human condition. Although current understandings related to the development of same-sex sexuality make such tests unlikely, it is still necessary to consider how future developments in this area of research may lead to ethically questionable practices that could be implemented in jurisdictions that do not protect the rights and freedoms of LGBTQ citizens. Those in favor of causal lines of research have often contended that if the biological origins of same-sex sexuality can be proven, same-sex sexuality will consequently be viewed as a “natural” variation in human development, thereby contributing to the advancement of LGBTQ rights. In fact, many of the recent advancements in LGBTQ rights in the United States have been predicated on the immutability of sexual orientation, thus bringing into play the Equal Protection Clause of the U.S. Constitution. However, such arguments can be dangerous in that they suggest that diverse sexual and gender identities are only “worthy” of civil rights protections to the extent that they were not consciously chosen and were biologically predetermined outcomes. In other words, were sexual or gender identity proven to be a choice, then sexual and gender minorities could be deemed blameworthy and no longer eligible for legal protections. Consequently, discourses on human rights strongly oppose genetic research on the causes of same-sex sexuality, as human rights should be granted regardless of the biological underpinnings associated with any given human identity. Finally, it is important for researchers to consider their own personal beliefs, biases, and motivations for pursuing specific lines of research. As is true for many areas of research, those conducting LGBTQ research are often personally motivated and invested, either because they care about the social justice issues associated with LGBTQ lives and experiences or because they themselves are members of an LGBTQ community. Although science often purports to be objective and valueneutral, it is often impossible to separate one’s own personal biases and values from one’s work when conducting social justice research. For this reason, it is important that LGBTQ researchers be

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prepared to acknowledge their own assumptions and values that influence the questions they ask and the lenses through which they interpret their findings. Ethical LGBTQ researchers must be open to any possible results, even those that might reflect poorly on the LGBTQ community. Failure to be able to do so may place a researcher at risk of engaging in unethical practices, such as data fabrication or the selective reporting of results. At the same time, it is also important that researchers seek to study a broad array of LGBTQ experiences. LGBTQ research has been criticized in the past for placing too great of an emphasis on the negative outcomes for LGBTQ individuals, rather than also highlighting the resilience that is common within LGBTQ populations. As the field of LGBTQ studies grows, ethical considerations will continue to fluctuate and change with the time and place. At times, LGBTQ researchers will find themselves educating and challenging their IRBs, which may produce decisions indicative of stereotypes and latent sexual prejudices in their well-meaning attempts to protect LGBTQ research participants. It is recommended that researchers always carefully consider the feedback from IRBs and that they attempt to challenge or educate their IRBs prior to revising a protocol if they feel that any of the IRB’s concerns may be rooted in heterosexist or cis-sexist biases. Karen L. Blair See also Heteronormativity; Heterosexism; Heterosexist Bias in Research; Scientific Integrity, Debates About; Sexual Orientation Conversion Therapy

Further Readings Meezan, W., & Martin, J. (Eds.). (2009). Handbook of research with lesbian, gay, bisexual, and transgender populations. New York, NY: Routledge. Murphy, T. F. (1997). Gay science: The ethics of sexual orientation research. New York, NY: Columbia University Press. Mustanski, B. (2011). Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: A call to action for a scientifically informed approach. Archives of Sexual Behavior, 40, 673–686.

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Schüklenk, U., Stein, E., Kerin, J., & Byne, W. (1997). The ethics of genetic research on sexual orientation. Hastings Center Report, 27(4), 6–13. Tufford, L., Newman, P. A., Brennan, D. J., Craig, S. L., & Woodford, M. R. (2012). Conducting research with lesbian, gay, and bisexual populations: Navigating research ethics board reviews. Journal of Gay & Lesbian Social Services, 24(3), 221–240.

EVOLUTIONARY THEORY The study of evolutionary theory as it relates to human psychology and behavior is called evolutionary psychology. Evolutionary psychology asks if a specific human behavior may have had adaptive value for early human ancestors, that is, whether it contributed directly to survival or reproduction. Evolutionary psychology does not hold that behavior is genetically driven; rather, it holds that under certain conditions, humans have a tendency to engage in some forms of behavior rather than alternatives because those behaviors were adaptive during evolution. Same-sex attraction and sexual behavior have been studied in evolutionary psychology, but there is much disagreement about them from an evolutionary perspective. This disagreement arises in part from the fact that in the study of “homosexuality,” different researchers have studied seemingly related but actually different phenomena: samesex attraction, same-sex sexual behavior, sexual identity, and exclusive and nonexclusive forms of same-sex attraction and sexual behavior. There is increasing evidence for a genetic component to exclusive forms of same-sex attraction and sexual behavior, but there is also increasing evidence of nongenetic contributions. The likelihood that some genes for same-sex attraction and sexual behavior exist in humans and are passed on makes evolutionary explanations compelling, while the broad diversity in expression and degree of samesex attraction and sexual behavior suggest a significant influence of environmental factors. This entry presents the basic principles of the evolutionary perspective and some of the major ways

that same-sex attraction and sexual behavior have been explained from this perspective.

The Four Products of Evolution Scientists have argued that the process of evolution can result in one of four products. The first product, called an adaptation, is the best known, and it is the easiest to understand. It is a physical or behavioral characteristic that is passed along to the next generation because it helped the individual to reproduce more successfully, or to survive more effectively, than would have been the case otherwise. The assumption here is that a characteristic that contributes directly to survival contributes indirectly to reproduction because the individual who survives has increased chances of ultimately finding a mate and reproducing. A good example of an adaptation is the umbilical cord. All humans have one during prenatal development, and it is adaptive because it increased the survival of humans before birth. The second product of evolution is called noise. Noise is a characteristic due to random events or environmental factors, and it serves no role in survival or reproduction. For example, the shape of the belly button of any one person is due to noise: random and environmental factors such as how the umbilical cord was cut, the age of the person, and the weight of the person. The third product of evolution is called a by-product. It is a characteristic that is not adaptive itself, but it is passed along with a characteristic that is adaptive. The best example of this is the navel, or belly button. All humans have one, but it does not contribute to survival or reproduction. It was passed along with the umbilical cord. The fourth product of evolution is more controversial and more difficult to understand. It is called an exaptation. This is a characteristic that originally started out as either a by-product of an adaptation, which itself contributed to reproduction or survival and became adaptive, or as an adaptation that was selected to serve another function. For example, recently it has been observed that some birds in urban areas line their nests with cigarette butts. The cigarette butts have a significant pesticide quality, killing parasites in the nest, and the

Evolutionary Theory

result is that more baby birds survive. It appears that picking up butts for the nest is a by-product of picking up aromatic plants for the nest that can kill parasites. In theory, if there is a genetic aspect of this behavior linked to some birds, and these birds reproduce more successfully because of the behavior, future generations of descendants of these birds may exhibit a strong tendency to line their nests with cigarette butts. In this example, lining the nest with cigarette butts is a by-product, but the by-product could prove to be adaptive.

Same-Sex Attraction and Sexual Behavior and the Four Products of Evolution Adaptation

Scientists generally agree that exclusive samesex attraction and sexual behavior in humans are not adaptations because they do not lead to reproduction. Some theorists have argued that any same-sex sexual behavior is maladaptive because it decreases the likelihood of reproduction. However, research has shown that some same-sex sexual behavior does not decrease reproduction in those who exhibit it. Other theorists have argued that nonreproductive sexual behavior between both opposite-sex and same-sex individuals played an important role in social interactions, communication, and bonding for early human ancestors, thus contributing to survival, just as it does for closely related primate species of monkeys and apes. In this light, some nonexclusive same-sex attraction and sexual behavior could be conceptualized as having had adaptive value during the course of human evolution.

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sexual opportunity available. Similarly, cultural traditions generated by specific ecological conditions may have encouraged some forms of samesex attraction and sexual behavior. Noise is likely to be a factor in some cases, but certain universal patterns of same-sex attraction and sexual behavior across cultures and history also suggest a predictable expression consistent with an adaptation. Two theories that reflect the noise concept of random environment factors influencing same-sex attraction rely on research that shows that sex hormones act on the brain during a fetus’s development before it is born. They hold that same-sex attraction is a by-product of this process, and it can be influenced by many factors. Simply put, depending on how the brain develops under the influence of the hormones, a person will develop an attraction to the opposite sex, the same sex, or both sexes. One theory holds that many people who consider themselves lesbian, gay, or bisexual have brains, shaped by hormones, that give them a package of same-sex and opposite-sex characteristics including sexual attraction to the same sex. A second theory goes a little further and speculates a developmental mechanism for same-sex attraction. At puberty, girls and boys act differently from each other, and they see the opposite sex as very different or exotic, and that difference is ultimately experienced as erotic or attractive. In essence, the exotic becomes erotic. The theory goes on to state that some boys and girls who are gender nonconforming in their behavior, due partly to unique aspects of their brain development under the influence of hormones, will find same-sex individuals to be different or exotic and thus find them erotic or sexually attractive.

Noise

Some theorists have argued that same-sex attraction and sexual behavior can be conceptualized as noise. That is, some random environmental event occurs, and same-sex attraction and sexual behavior are best explained by that random event. For example, people who are usually attracted to the opposite sex are temporarily segregated from opposite-sex partners for some reason and engage in same-sex sexual behavior because it is the only

By-Product

The most common explanation for same-sex attraction and sexual behavior is that they are byproducts of some other characteristic or process. There are many by-product theories, all of which have been criticized for a variety of reasons, and none emerges as a convincing argument that comprehensively explains same-sex attraction and sexual behavior.

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Human Plasticity. One theory that is most applicable to nonexclusive same-sex attraction and sexual behavior holds that they are the by-product of general plasticity or flexibility in human behavior resulting from a highly evolved brain. Thus, learning, thinking, and abstracting play a more important role in generating behavior than do biologically programed behavioral dispositions. Consequently, people have the potential to learn that same-sex sexual behavior is pleasurable, and they can learn to overcome cultural taboos and restrictions about it. More Attractive Mates. A second theory holds that exclusive same-sex attraction in males is a byproduct of selection for more “feminized” male ancestors. Specifically, it is theorized that male homosexuality results from selection for a number of characteristics that contribute to fitness. Male– male sexual attraction results from a shift in male brain organization to a more feminized direction, allowing males to exhibit characteristics like kindness, tenderness, and empathy that would have made ancestral males better fathers and more attractive mates. Due to random genetic distribution, a small number of males would have more extreme feminization of their characteristics than others, resulting in sexual attraction to other males. Birth Order. A third theory holds that exclusive male same-sex attraction is influenced by birth order. Some studies have shown that men who identify as gay have a higher number of older brothers than their heterosexual counterparts. It is speculated that this is the by-product of maternal immune reactions to the H-Y antigen produced by the male fetus. The gestation of several male fetuses leads to changes in the intrauterine environment that cause the feminization of the brains of laterborn males resulting in predominantly same-sex sexual attraction. Improved Female Fecundity. A fourth theory holds that predominant same-sex attraction in males is the by-product of a genetically based characteristic linked to increased fertility in their female

relatives. Specifically, it is argued that genes on the X-chromosome contribute to increased fecundity in female carriers and to the development of same-sex attraction in their male relatives. Thus, the genes for male homosexuality remain in the population, although these males show a significantly lower rate of reproduction relative to heterosexual males. Some studies have shown that men who identify as gay do have larger families through the maternal line (and not the paternal line) than their heterosexual counterparts. Female Sexual Plasticity. A fifth theory addressing nonexclusive same-sex attraction in women is related to the argument that female sexuality exhibits more plasticity than male sexuality. Plasticity in this case means greater responsivity to situational and interpersonal factors. The theory notes that in species where the females have a very specific period of estrus, motivation to initiate sexual behavior and receptivity to sexual advances are closely linked, and they occur when females are most likely to conceive. In higher primates, there is a trend for an uncoupling of motivation and receptivity, which allows a broader range of sexual strategies for females. This trend culminates in human females for whom there is a highly evolved independence between proceptivity, or motivation to initiate sexual activity, and arousability, or the capacity to become aroused by sexual stimuli. This uncoupling of proceptivity and arousability, and the greater presence of arousability in women’s day-to-day desires, allows environmental and situational factors to have greater influence on female desire. The independent arousability allows the development of desire to a range of situationdependent stimuli including, in some cases, samesex individuals. Exaptation

The alliance theory focuses on same-sex attraction and sexual behavior in males but has been applied to females as well. It holds that the evolution of same-sex sexual attraction and behavior is the result of an exaptation. That is, same-sex sexual attraction and behavior were originally

Evolutionary Theory

by-products of the sociosexual behavior exhibited by all primates and used for a variety of social and communication purposes. The sexual behavior between same-sex individuals may have reinforced alliances between them that contributed directly to their survival and indirectly to their reproductive success. Individuals in alliance with a partner would have been better able to fight off predators and enemies and hold onto food resources, all contributing to better survival and ultimately to reproduction. The alliances may have been particularly important to younger ancestral males who, it is argued, were highly vulnerable to aggression from older males and had to work their way up the male hierarchy before gaining access to female mates for reproduction. The theory holds that all humans could experience same-sex attraction and engage in same-sex sexual behavior under conditions similar to those in which the behavior was adaptive in the evolutionary past. This theory draws on cross-species and cross-cultural evidence and can be applied to some human group settings. However, the theory has been criticized for the lack of empirical evidence to support it.

Conclusion Same-sex sexual attraction and behavior are not unitary phenomena and may have multiple origins that include evolutionary, genetic, and environmental factors, and interactions between these. The evolutionary model has generated a large number of theories about the origins of same-sex sexual attraction and behavior. All of the theories have been criticized for a variety of reasons, and they are all lacking strong evidence to support them. Despite this, the evolutionary model can be seen as a useful one because it generates so many ideas and theories. More recent work on the evolution of human sexuality has begun to look at the role of nonreproductive sexual behavior in all humans, whether between members of the opposite sex or the same sex. This work suggests that nonreproductive sexual behavior played a very important role as a social adhesive in early human groups that may not have been able to survive without it. The advent of agriculture and the

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cultural changes that this brought about resulted in nonreproductive sexual behavior being discouraged and prohibited. Thus, evolutionary processes may very well be at the root of some same-sex attraction and sexual behavior and provide us with useful insights into their natural history. Frank Muscarella See also Bisexuality, Female; Bisexuality, Male; Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation; Pansexuality; Theories of Sexual Orientation

Further Readings Bem, D. J. (1996). Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review, 103, 320–335. Blanchard, R., & Klassen, P. (1997). H-Y antigen and homosexuality in men. Journal of Theoretical Biology, 185, 373–378. Buss, D. M., Haselton, M. G., Shackelford, T. K., Bleske, A. L., & Wakefield, J. C. (1998). Adaptations, exaptations, and spandrels. American Psychologist, 53(5), 533–548. Diamond, L. M. (2006). The evolution of plasticity in female–female desire. Journal of Psychology and Human Sexuality, 18, 245–274. Gallup, G. G., & Suarez, S. D. (1983). Homosexuality as a by-product of selection for optimal heterosexual strategies. Perspectives in Biology and Medicine, 26, 315–321. Iemmola, F., & Camperio Ciani, A. (2009). New evidence of genetic factors influencing sexual orientation in men: Female fecundity increase in the maternal line. Archives of Sexual Behavior, 38, 393–399. Kirkpatrick, R. C. (2000). The evolution of human homosexual behavior. Current Anthropology, 41, 385–414. LeVay, S. (2011). Gay, straight, and the reason why. Oxford, England: Oxford University Press. Miller, E. M. (2000). Homosexuality, birth order, and evolution: Toward an equilibrium reproductive economics of homosexuality. Archives of Sexual Behavior, 29, 1–34. Muscarella, F. (2000). The evolution of homoerotic behavior in humans. Journal of Homosexuality, 40, 51–77.

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Muscarella, F. (2006). The evolution of male–male sexual behavior in humans: The alliance theory. Journal of Psychology and Human Sexuality, 18, 275–311. Ryan, C., & Jethá, C. (2010). Sex at dawn. New York, NY: Harper.

EX-GAY MOVEMENT The ex-gay movement has been an important cultural influence and political force in reaction to efforts to achieve LGBTQ social and political equality. This entry describes the ex-gay movement, a social movement founded on the belief that gays, lesbians, and bisexuals can become heterosexual or otherwise “leave homosexuality behind” through counseling, prayer, and other therapies. The entry explains the origins of the movement, the events that led to its appearance in the national spotlight, and the consequences of that visibility including current issues and controversies related to the movement.

Origins of the Ex-Gay Movement Historically, the ex-gay movement has its primary origins in the United States, and is ideologically founded in conservative Christian Protestantism. The first ex-gay ministry, Love in Action, was formed in 1973 in San Rafael, California (a suburb of San Francisco), by Frank Worthen and John Evans, two men struggling with reconciling their same-sex attractions and their religious beliefs, along with heterosexual minister Kent Philpott. In 1975, cofounder Philpott published a book called The Third Sex? that included interviews with six people who sought to become heterosexual through counseling and prayer. As a result, other ministries started around the country. In 1976, an ex-gay conference was held in Anaheim, California, and resulted in formation of Exodus International—a coalition organization for ex-gay ministries. In the years that followed, affiliates of this newly created organization were founded throughout the country, and eventually overseas in Europe, East Asia and the Pacific, and Latin America. Somewhat counterintuitively, in the United States, new affiliates

were not likely to form in areas with a large presence of conservative Protestants, but instead formed in states with predominantly sexually libertarian attitudes and states where Metropolitan Community Churches were formed (the Metropolitan Community Church is a pro-gay Protestant Christian denomination formed specifically for ministry to the LGBTQ community). This suggests that the perception of sociocultural threat represented by changing norms and values around sexuality, especially in a religious context, were one of the driving forces in the emergence and growth of these ex-gay ministries.

Growth and Visibility of the Ex-Gay Movement Although ex-gay mobilization has spanned several decades, the movement spent much of its early existence in relative obscurity, slowly gaining strength and support through low-visibility, local, faith-based support groups. Exodus affiliates and other ex-gay ministries primarily operated as selfhelp and support groups, providing guidance for individuals who wanted to “recover from homosexuality” as well as support for their family (parents, spouses, children, and relatives) and friends. The movement first gained widespread national attention in 1998 with the “Truth in Love” ad campaign, which promoted “hope and healing for homosexuals” through participation in ex-gay ministries. This campaign was largely funded by conservative faith-based organizations that oppose LGBTQ rights laws (e.g., the Alliance for Traditional Marriage, American Family Association, Christian Coalition, Christian Family Network, Citizens for Community Values, Concerned Women for America, Family First, Family Research Council, Focus on the Family, and National Legal Foundation). Full-page ads about the ex-gay movement ran in newspapers across the country, including the New York Times, the Washington Post, USA Today, the Los Angeles Times, the Chicago Tribune, the Miami Herald, and the San Francisco Examiner. The ads caused the media’s interest in the subject to rise dramatically, peaking with a Newsweek cover story featuring an ex-gay man

Ex-Gay Movement

and ex-lesbian, John and Anne Paulk, who were leaders within the movement and had become a married couple. With this newfound visibility, Exodus International, as an umbrella organization for ex-gay ministries, became more vocal and politicized. It began to hold regular protests of the American Psychiatric Association, which held the position that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm. Exodus International also increasingly organized lobbying on public policy issues. A set of policy statements argued for marriage as a sacred, legal, and social union between one man and one woman, against same-sex parenting and adoption as not in the best interest of children, and for the repeal of “thought crimes laws” (otherwise known as hate crime laws). As a result, during the 2000s, Exodus’s directory grew to list over 230 affiliated ministries, counselors, and churches in the United States, as well as many ministries outside the country, becoming by far the largest organization in the ex-gay movement. By way of comparison, during the same time period, the second-largest network, Homosexuals Anonymous, had fewer than 40 chapters, some of which were also affiliated with Exodus. A few other local-level and independent national membership groups also grew in visibility during this period. These included the National Association for Research & Therapy of Homosexuality (NARTH), a professional organization that makes secular arguments in support of conversion therapies and other treatments to change sexual orientation; and Parents and Friends of Ex-Gays and Gays (PFOX), an analogue to the pro-gay PFLAG organization.

Current Issues and Controversies Related to the Ex-Gay Movement The surge in visibility and growth resulted in some more recent negative outcomes for the ex-gay movement. Greater visibility invited public criticism and pushback from groups supporting LGBTQ rights. One damaging outcome for the movement was research that questioned the efficacy of ex-gay therapies. Several psychologists and

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other mental health professionals researched whether or not ex-gay therapies were effective in changing same-sex sexual attractions or behaviors, and they found few studies that supported the effectiveness of sexual orientation change therapies. Further, they found methodological issues in those studies that did support their effectiveness, and evidence that such therapies might cause mental health harms. For example, perhaps the bestknown research study seen as supporting the effectiveness of conversion therapies was published in 2003 by prominent psychiatrist Robert Spitzer. However, at the time, Spitzer noted that it had been difficult to find 100 participants, and they did not represent a random sample but rather the strongest cases for conversion. In 2012, he retracted the study because he felt the results were misleading and the credibility of participants’ reports of sexual orientation change was questionable. As a result of these findings regarding conversion therapy efficacy, most mainstream medical and healthrelated professional organizations made official statements that the practice of trying to change sexual orientation is ineffective and harmful. These organizations included the American Psychiatric Association (as noted above, protested by Exodus), American Medical Association, American Psychological Association, American Academy of Pediatrics, American Counseling Association, and the National Association of Social Workers. Beyond these general concerns, ex-gay ministries have drawn particular criticism for targeting youth, especially those who may be under pressure from their families to undergo conversion therapy. To date, California, Oregon, Illinois, and New Jersey, as well as Washington, D.C., have passed laws preventing the use of therapies intended to change the sexual orientation of LGB youth, and other states are currently considering such legislation. Furthermore, the actions of Exodus and other ex-gay organizations, along with related controversies, have caused fragmentation within the ex-gay movement itself. One point of contention among those affiliated with the movement is a disagreement about the degree to which the movement should be politicized. There is no consensus within or outside of the movement about whether

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the ex-gay movement is a separate movement that sometimes allies itself with the antigay movement or whether it is a subgroup of that movement. Prominent national LGBTQ rights organizations, such as the Human Rights Campaign and National Gay and Lesbian Task Force, call ex-gay groups an integral part of the Christian right and label Exodus International a notorious antigay group. Supporting these claims, some ex-gay leaders have worked for organizations known for their antigay lobbying (in particular, there has been a close association with the conservative Focus on the Family organization). However, Tina Fetner’s social movement analysis characterizes ex-gay conversion groups and antigay social movement organizations as separate entities working together. Suggesting an even stronger distinction, Tanya Erzen, based on her in-depth ethnographic work, identifies the ex-gay movement as a political, cultural, and social movement that she regards as a challenge to not just LGBTQ movements but also traditional antigay politics. She found that many of the ex-gay men and women she talked to did not oppose LGBTQ rights. Supporting this view, some ex-gay ministries did distance themselves from Exodus after it became a more politicized organization. Another set of divergent views relates to what is seen as the ultimate goal of the ministries in terms of personal transformation. As phrases such as “conversion therapy” suggest, some participants in the movement believe the goal or expectation should be a change in sexual orientation—a shift in attractions toward heterosexuality, or at least attraction to a spouse of a different gender. However, other participants focus on managing samesex attractions and providing a supportive atmosphere for single celibacy. Indeed, some groups eschew the term “ex-gay” and instead prefer alternatives such as “struggler” as more accurate terminology. The most prominent messaging during the period of the ex-gay movement’s high visibility has been representative of the former view, which has been a source of embarrassment for the movement. For example, John Paulk, the ex-gay man featured in the Newsweek cover story, as well as a former chair of the board of Exodus

International, was identified in a gay bar in 2000, which resulted in a public scandal, and in 2013 he announced that he was still gay, had ended his relationship with his former wife, and renounced conversion therapies as ineffective in changing sexual orientation and as potentially harmful. Other prominent figures within the movement have likewise publicly announced they were leaving due to lack of success in changing orientation. These controversies likely contributed to the eventual closure of the Exodus International organization in 2013. At the time of its closure and in the months leading up to the decision, Exodus’s president, Alan Chambers, expressed a desire for a more spiritual and less political focus, as well as regret for focusing on the idea that only a change in attractions constituted success. Chambers and some other former Exodus leaders formed a new organization, Speak Love, which is focused on reconciliation between people with differing beliefs about the morality of same-sex sexual behavior. However, most of the Exodus affiliates reformed into a new umbrella organization, Restored Hope Network, which continues to advocate for conversion therapy and orientation change. To date, research on the ex-gay movement has explored the claims of the movement, the social dynamics within the movement, and the relationship of the ex-gay movement with other groups. However, considering the movement’s influence on national politics in regard to LGBTQ issues, relatively little research has been conducted that focuses on ex-gay men and women. As the broader culture changes in regard to gender and sexuality and the ex-gay movement evolves in response to these changes, this may open up future opportunities for research. Jason Lee Crockett See also Essentialist–Constructionist Debate on the Origins of Sexual Orientation; Heteronormativity; Heterosexism; Internalized Homophobia; MixedOrientation Marriages; Religious Identity and Sexuality, Reconciliation of; Sexual Attraction, Behavior, and Identity; Sexual Orientation Conversion Therapy

Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation

Further Readings American Psychological Association. (2009). Report of the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation. Retrieved September 1, 2014, from http://www.apa.org/pi/lgbt/resources/therapeuticresponse.pdf Arthur, E., McGill, D., & Essary, E. H. (2014). Playing it straight: Framing strategies among reparative therapists. Sociological Inquiry, 84, 16–41. Crockett, J. L., & Kane, M. D. (2012). Mobilizing in response to threat: The case of the ex-gay movement. Research in Social Movements, Conflicts, and Change, 33, 227–256. Erzen, T. (2006). Straight to Jesus: Sexual and Christian conversions in the ex-gay movement. Berkeley and Los Angeles: University of California Press. Fetner, T. (2008). How the religious right shaped lesbian and gay activism. Minneapolis: University of Minnesota Press. Ponticelli, C. M. (1999). Crafting stories of sexual identity reconstruction. Social Psychology Quarterly, 62, 157–172. Serovich, J. M., Craft, S. M., Toviessi, P., Gangamma, R., McDowell, T., & Grafsky, E. L. (2008). A systematic review of the research base on sexual reorientation therapies. Journal of Marital and Family Therapy, 34, 227–238. Wolkomir, M. (2006). Be not deceived: The sacred and sexual struggles of gay and ex-gay Christian men. New Brunswick, NJ: Rutgers University Press.

EXOTIC BECOMES EROTIC: A DEVELOPMENTAL THEORY OF SEXUAL ORIENTATION There is evidence that biological factors, including genes, are correlated with an individual’s sexual orientation. But as we are often reminded, correlation is not necessarily causation. This entry describes a developmental theory of sexual orientation that proposes that biological factors do not, in fact, directly influence an individual’s sexual orientation but act indirectly by influencing the

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child’s preferences for sex-typical or sex-atypical activities. Children who prefer sex-typical activities and who play primarily with same-sex playmates are called gender conforming; children who prefer sex-atypical activities and who play primarily with opposite-sex playmates are called gender nonconforming. These preferences lead children to feel different from either opposite- or same-sex peers—to perceive them as dissimilar or exotic. Gender-conforming children will experience opposite-sex children as different from themselves, and gender-nonconforming children will experience same-sex children as different from themselves. The theory further proposes that this feeling of difference produces heightened emotional arousal to members of the dissimilar sex that subsequently becomes transformed into erotic attraction to them. Accordingly, the theory is called the exotic-becomes-erotic (EBE) theory of sexual orientation.

Genes Are Correlated With Sexual Orientation To determine whether a physical or personality trait is correlated with genetic factors, researchers look to see whether individuals are more similar to close relatives on that trait than they are to more distant relatives. For example, individuals’ heights are more closely related to the heights of their parents than to the heights of their aunts and uncles. This implies that the physical trait of height has a significant genetic component, or is heritable. The best studies are those that compare identical twin pairs (called monozygotic twins) with a matched sample of same-sex fraternal twin pairs (dizygotic twins). Monozygotic twin pairs share all of their heritable genes with one another, whereas dizygotic twin pairs share only about half of their heritable genes with one another. So, if monozygotic twin pairs are more alike on a trait than are samesex dizygotic twin pairs, we can infer that the trait is partially heritable. Studies have now established the heritability of sexual orientation for both men and women. In a study of gay men who had twin brothers,

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52% of monozygotic twin brothers were also gay, compared with only 22% of dizygotic twin brothers. Some men also had adopted brothers in their families, men who did not share any heritable genes with their gay brothers: Only 11% of those adopted brothers were also gay. A parallel study of lesbians showed the same pattern: In that study, 48% of monozygotic twin sisters were also lesbian, compared with only 16% of dizygotic twin sisters and 6% of the lesbians’ adopted sisters. A subsequent study of nearly 5,000 twins who had been drawn from a twin registry confirmed the heritability of sexual orientation.

Gender Conformity/Nonconformity Is Correlated With Sexual Orientation To date, there have been more than 45 studies confirming a correlation between childhood gender conformity/nonconformity and an adult sexual orientation. The largest of these compared nearly 1,000 gay men and lesbians with 500 heterosexual men and women on many aspects of their childhoods, including family relationships and early sexual experiences with both sexes. None of these aspects correlated with their later sexual orientations. In fact, there was only one childhood variable that correlated with adult sexual orientation for both men and women: gender conformity/ nonconformity. For example, many more gay men than heterosexual men reported that as children, they had not enjoyed typical boy activities (such as sports), had enjoyed typical girl activities, and had had more childhood friends who were girls. Similarly, more lesbians than heterosexual women reported they had not enjoyed typical girl activities, had enjoyed typical boy activities (especially sports), and had had more childhood friends who were boys.

Gender Conformity/Nonconformity and Feeling Different EBE theory proposes that gender-conforming children will feel different from their opposite-sex

peers, and gender-nonconforming children will feel different from their same-sex peers. The large study, cited above, found that 71% of the gay men and 70% of the lesbians in the sample had felt different from their same-sex peers during childhood. When asked in what ways they had felt different, they overwhelmingly cited genderrelated reasons. Gay men were most likely to reply that they had not liked sports; lesbians were most likely to reply that they had liked sports more and had been more masculine than other girls. In contrast, less than 8% of heterosexual men and women said that they had felt different from same-sex childhood peers. Those who did tended to cite non–gender-related reasons such as having been poorer, more intelligent, or more introverted than other children. EBE theory’s proposal that individuals can become erotically attracted to a class of individuals from whom they felt different during childhood also applies to erotic preferences based on characteristics other than biological sex. For example, a light-skinned person could come to eroticize darkskinned persons through this same exotic-becomeserotic process. However, to produce a differential homoerotic or heteroerotic attraction requires that the individual must feel different for sex-based or gender-related reasons. Simply being poorer, more intelligent, or more introverted than one’s childhood peers does not produce differential homoerotic or heteroerotic attraction.

How Does Exotic Become Erotic? In his 1st-century Roman handbook, The Art of Love, Ovid advised any man who was interested in sexual seduction to take the woman in whom he was interested to a gladiatorial tournament because she would there be more easily aroused to passion. A contemporary version of Ovid’s claim can be understood to be a special case of what psychologists call the two-factor theory of emotion. It states that the physiological arousal of our nervous system provides the cues that we feel emotional, but the more subtle judgment of which emotion we are feeling often depends on our

Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation

interpretation of the surrounding circumstances. The experience of erotic arousal thus arises from the conjunction of physiological arousal and circumstances that permit it to be interpreted as erotic arousal. There is now experimental evidence that an individual who has been emotionally aroused— whether that arousal is neutral, pleasant, or unpleasant—will show heightened sexual responsiveness to an appropriate target person. In one study, male participants were physiologically aroused by running in place, by hearing an audiotape of a comedy routine, or by hearing an audiotape of a grisly killing. No matter how they had been aroused, these men reported greater erotic interest in a physically attractive woman than did a control group of men who had not been aroused. This effect has also been observed physiologically. Men and women were shown an erotic video while their physiological sexual arousal was monitored (penile erection in men and vaginal blood flow in women). But before seeing the erotic video, half the participants first saw a disturbing video of a grisly automobile accident; the remaining participants saw a video of peaceful landscapes. Participants who had seen the disturbing video subsequently showed more sexual arousal in response to the erotic video than did those who had seen the peaceful video. EBE theory thus proposes that an individual’s experience of feeling different from same- or opposite-sex peers in childhood produces a physiological arousal that gets eroticized when the maturational, cognitive, and situational factors coalesce to provide the defining moment when it can be interpreted as sexual arousal. The timing of this moment, however, is influenced by several factors, including actual sexual experience with opposite- and same-sex peers and the norms of the surrounding culture. The recent heightened visibility of gay men and lesbians in our society appears to be leading individuals who experience same-sex arousal to recognize it, label it, and act on it at earlier ages than in previous years.

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An Empirical Test of the Direct Genetic Link Versus EBE Theory The discovery that genes are correlated with sexual orientation has led some people to believe that there must be a “gay” gene or set of genes that directly influence or “code for” sexual orientation. In contrast, EBE theory proposes that the link between genes and sexual orientation is only indirect: The genes influence early personality traits that lead a child to become gender conforming or gender nonconforming, and it is gender conformity or nonconformity that provides the important intervening link between the genes and sexual orientation. Because the large study of twins, discussed above, assessed both sexual orientation and gender conformity or nonconformity, those data provide for a comparative test of the direct and the indirect EBE paths from genes to sexual orientation. First, the data confirm the first link proposed by EBE theory: Monozygotic twins are significantly more alike on gender conformity or nonconformity than are same-sex dizygotic twins. This is equally true for both men and women. Second, the data confirm the second link proposed by EBE theory: Childhood gender conformity or nonconformity is significantly correlated with sexual orientation. When the direct and EBE paths were statistically compared, it was found that the EBE path significantly accounts for the correlation between genes and sexual orientation, but the direct path does not. This one test does not, of course, establish the validity of EBE theory as a whole, which proposes several other links and processes (e.g., the link between feeling different in childhood and later erotic attractions), but it does demonstrate that the correlation between the genes and sexual orientation should not be interpreted as a direct causal link. This general point is nicely illustrated by the finding that there is a correlation between genes and getting divorced: If a monozygotic twin is divorced, his or her twin is also more likely to be divorced than if they are dizygotic twins. Yet nobody has proposed that there must be a “divorce”

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gene because it is obvious that there must be some intervening heritable personality traits (e.g., irritability or clinical depression) that account for the link between genes and divorce. EBE theory is an example of that same reasoning applied to sexual orientation. Daryl J. Bem See also Bisexualities; Developmental Aspects of Sexuality; Essentialist–Constructionist Debate on the Origins of Sexual Orientation; Homosexuality, Female; Homosexuality, Male; Sexual Fluidity; Sissyboy Experience; Theories of Sexual Orientation; Tomboy Experience

Further Readings Bailey, J. M., Dunne, M. P., & Martin, N. G. (2000). Genetic and environmental influences on sexual orientation and its correlates in an Australian twin sample. Journal of Personality and Social Psychology, 78, 524–536. Bell, A. P., Weinberg, M. S., & Hammersmith, S. K. (1981). Sexual preference: Its development in men and women. Bloomington: Indiana University Press.

Bem, D. J. (1996). Exotic becomes erotic: A developmental theory of sexual orientation. Psychological Review, 103, 320–335. Bem, D. J. (2000). Exotic becomes erotic: Interpreting the biological correlates of sexual orientation. Archives of Sexual Behavior, 29, 531–548. Diamond, L. M. (2003). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 173–192. Diamond, L. M. (2009). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press. Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press. Hamer, D., & Copeland, P. (1994). The science of desire: The search for the gay gene and the biology of behavior. New York, NY: Simon & Schuster. Walster, E. (1971). Passionate love. In B. I. Murstein (Ed.), Theories of attraction and love (pp. 85–99). New York, NY: Springer. White, G. L., Fishbein, S., & Rutstein, J. (1981). Passionate love and the misattribution of arousal. Journal of Personality and Social Psychology, 41, 56–62.

F FAMILIES

OF

natural desire, and heterosexual family relations with normal adult relational life. In fact, “the family” has long posed a threat to those who do not identify as heterosexual. In the past, LGBTQ kin often experienced violence at the hands of family members, and even today such violence continues to be reported. More commonly, they experienced family exclusion and rejection because of their refusal to go along with heteronormative order. Coming out as LGBTQ implies disregarding the heterosexual self that most people are attributed from birth. This can be linked to a sense of personal crisis, or ontological disruption, which is exacerbated by the risk or fact of losing access to family, friendship, community, and other personal supports that are available to heterosexuals. Because of this, some have argued that until very recently coming out as LGBTQ necessarily involved a process of social relocation: from the families, communities, friendships, and locales that sustain heterosexual selves, to new LGBTQ ones where the person becomes, in a very real sense, a “different person.” Thus it has been said that coming out of heterosexuality entails entering into and/or actively forming new friendships, networks, and community supports that, in turn, provide the context for creating new families.

CHOICE

The concept of families of choice has its roots in the idea that LGBTQ-identified people create their own families, because of the hostility they may encounter from their families of origin. Whereas LGBTQ families have sometimes been discussed as “friendship families,” the concept of families of choice refers to the ways in which all manner of relationships (including couples, ex-partners, friends, accepting family of origin, coparents, LGBTQ community members, and so on) can be included as family. Some argue that unlike heterosexual families, which impose heteronormative norms, values, and inequalities, LGBTQ families of choice are underpinned by a friendship ethic that promotes autonomy, mutuality, and democratic patterns of relating. Some suggest that because heterosexuals are increasingly rejecting “traditional” family scripts, mainstream families are becoming more like LGBTQ chosen ones. Several criticisms have been made of these propositions, not least on the basis of the limits of choice in everyday life.

Family and the Heterosexual Assumption Despite the increasing social acceptance of LGBTQ identities in some contexts, it is still the case that most families operate according to, and actively promote, a heterosexual assumption. Most people are taught to associate heterosexuality with

Friendship Families One of the key ways in which LGBTQ families have been discussed is as friendship families, where 391

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friends provide the “goods” (mutual care and economic, social, cultural, and emotional supports) more commonly associated with families of origin. On the one hand, some have conceptualized LGBTQ friendship families as substitutes or replacements for estranged families of origin. On the other hand, some argue that friendship families provide the love, mutual recognition, respect, and unconditional support commonly associated with biological or legal kin, but that the latter often fail to provide in practice. In this context, the terminology of “elective” and “chosen” family alludes to the fact that LGBTQ people who participate in friendship families are not mimicking “real” families, but are selfconsciously choosing to create alternative family forms that are more conducive to translating democratic relational ideals of mutuality, equality, and negotiation into practice. It is argued that because LGBTQ families are made up of adults (be they friends, partners, ex-partners, coparents, or LGBTQ community members) who opt to participate in family practices with each other, they are not simply following mainstream cultural guidelines and scripts that support unequal (gendered) roles, obligations, and responsibilities. Rather, they are more likely to operate according to a “friendship ethic” that promotes creativity, equality, mutuality, and autonomy. A number of studies have focused on the material, social, cultural, and emotional resources that friendship families and families of choice provide for their members. As well as the comforts associated with “idealized” families, they can also provide an anchor for self-made identities, a sense of belonging, and a focus for personal/political agency. Friendship families and families of choice can, but do not necessarily, include couples; sexual partners; ex-partners; single and couple friends who are straight or queer; and asexual, monogamous, or polyamorous emotional and/or sexual bonds as well as the care of children. They are fluid in terms of their membership over time, and they are especially associated with urban LGBTQ ways of living, although their existence in nonurban areas has also been documented. Some argue that at the heart of the friendship ethic underpinning

friendship families and families of choice is the idea that they are relationships between adults that are not skewed by unequal power relations and that their boundaries and limits are open to negotiation. Ultimately, the limits to unequal power relations are set by the fact that one, some, or all of the participating parties can dissolve the family relationships when they no longer provide the “goods.”

Chosen Families Kath Weston’s 1991 book, Families We Choose, which was based on a study of LGBTQ relations in San Francisco, made a pivotal contribution to the literature on families of choice. First, it highlighted the ways in which LGBTQ families were not “pretend” or “substitute” family forms, but were a matter of LGBTQ agency. Second, through an ethnographic study it demonstrated the operation of chosen families on the ground, and showed that they were not only a matter of how people defined their families, but also the family practices they engaged in. Third, Weston’s work extended understandings of chosen families by showing that they could include members of family of origin who were accepting and supportive of their LGBTQ kin’s identity and way of living. A decade later, in 2001, Jeffrey Weeks, Brian Heaphy, and Catherine Donovan published Same Sex Intimacies, based on the findings of their study on British families of choice. This extended Weston’s insights by linking familial developments in nonheterosexual cultures to developments that were underfoot in mainstream intimate life. Drawing on Weston’s ideas, feminist and LGBTQ deconstructive approaches to “the family,” and European work on transforming patterns of intimacy, Weeks and colleagues interpreted LGBTQ families of choice as an exemplar of broader developments in Western democracies, where the structure and meaning of all family and intimate relationships were increasingly becoming subject to self-definition, self-creation, and negotiation in everyday practice. Both Weston and Weeks and colleagues acknowledged that LGBTQ theory and politics

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have historically had good reason to adopt an antagonistic approach to the family as a social institution, and to the use of family terminology to describe LGBTQ relationships. Not least among these reasons was the central part “the family” plays not only in the reproduction of capitalist, patriarchal, and disciplinary social orders, but also in terms of violence, abuse, and the imposition of gendered and sexual inequalities. Despite this, the use of the family terminology by LGBTQ people to describe and make sense of their relationships has continued to be recorded in studies of LGBTQ relational lives.

Criticisms There are now several criticisms made of the concept of families of choice, not least on the basis of questioning the extent to which LGBTQ friendships, intimate and sexual relationships, couples, parenting, and community relationships are the subject of “real” and “free” choices. The terminology of choice fits well with the pervasive discourse of neoliberal consumer ideology, where increased choice is associated with enhanced agency and citizenship. It rests on the idea of individualized and reflexive agents who are more or less wholly disembedded from their biographical roots and can more or less wholly reinvent themselves and their relating orientations in contexts of their own choosing. This seriously overstates the extent to which family as heterosexual institution, based on biological and legally defined kinship, has been deconstructed in Western cultures and in everyday practice. It also undermines the biographical, social, cultural, and economic factors that limit choice in relationships. Personal relating orientations are embedded in relational biographies, which in turn are influenced by class, race, gender, ethnicity, religion, generation, and other factors, all of which shape perceptions of the possibility of breaking away from “given” kin and reinventing new forms of family relationships. While family connectedness and obligations may no longer be simply given by biological and legal relatedness, people can still carry with them a sense of responsibility to

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biological and legal kin. In the case of LGBTQ people, this can still be experienced as a pressure to remain closeted, or to continue to be involved with, and even care for, hostile kin. The notion of being able to choose family is also predicated on the availability of like-minded people who are willing to participate in family practices relationships. It is also predicated on the assumption that people have access to social skills, resources, and confidence to seek coparticipants. Economic, social, and cultural resources matter in facilitating LGBTQ choices, and the availability of such resources is linked to economic and sociocultural positioning in terms of class, race, gender, ethnicity, religion, generation, geographical location, and so on. Thus, while the creation of families of choice is a real possibility for some LGBTQ people, for others such possibilities are limited by the pull of given families, communities, and cultures as well as the lack of resources required to participate in the personal reinvention of family.

Transforming Relationships? Two further criticisms of LGBTQ families of choice are worth consideration. The first of these concerns the notion that friendship and other kinds of elective families are more democratic than traditional heterosexual ones and that they are “power-neutral.” Some studies have demonstrated that these notions rest on an idealized version of friendship, and a partial understanding of LGBTQ familial life. The theoretical argument that families of choice are underpinned by a friendship ethic is often centered on friendship as the ideal type of relationship. A problem arises when this is transported into claims made about friendship and friendship families as empirical realities. Research has shown that in practice friendship families and families of choice are not necessarily as democratic and power-neutral as some theorists have imagined them to be. Rather, they can involve unequal domestic and emotional labor, unequal decisionmaking power and, in the most extreme cases, emotional and physical abuse. The second criticism concerns the extent to which theoretical arguments about LGBTQ

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families of choice are politically partial in the sense of the ideological work they do, especially where LGBTQ families are argued to be indices of broader developments in the individualization and democratizing of all (including heterosexual) family and intimate relationships. Several critics have noted how arguments about the democratic transformation of heterosexual relationships and families are empirically unsupported. Some LGBTQ critics have also argued that the discourse that suggests greater equality within heterosexual families and between them and LGBTQ families is an illusionary one that works to make invisible continuing gender inequalities in heterosexual relationships, and masks the construction of new hierarchies and new inequalities in LGBTQ life. Same-sex marriage is an important issue in this respect. On the one hand, it can be argued to recognize and support LGBTQ relationships as equal to heterosexual ones that, in turn, is indicative of the ways in which heterosexual marriage nowadays involves a relationship between social and economic equals. On the other hand, it can be argued that because same-sex marriage privileges the couple and legally recognized kin, it imposes a heteronormative structure on same-sex relationships that neutralizes the more radical implications of families of choice as they were perceived to be based on a friendship ethic and informal bonds with nonbiologically or legally related kin as well and anchored in diverse kinds of emotional, sexual, and caring commitments. Brian Heaphy See also Families of Origin, Relationships With; Friendships; Heteronormativity; Homonormativity; Marriage, Reasons for and Against

Further Readings Butler, J. (2002). Is kinship always already heterosexual? Differences: A Journal of Feminist Cultural Studies, 13(1), 14–44. Carrington, C. (2002). No place like home: Relationships and family life among lesbians and gay men. Chicago, IL: University of Chicago Press.

Giddens, A. (1992). The transformation of intimacy. Cambridge, England: Polity Press. Heaphy, B., Smart, C., & Einarsdottir, A. (2013). Same-sex marriages: New generations, new experiences. Basingstoke, England: Palgrave Macmillan. Weeks, J., Heaphy, B., & Donovan, C. (2001). Same sex intimacies: Families of choice and other life experiments. London, England: Routledge. Weston, K. (1991). Families we choose: Lesbians, gays, and kinship. New York, NY: Columbia University Press.

FAMILIES OF ORIGIN, RELATIONSHIPS WITH Family relationships among lesbian and gay adults and their families of origin are critical to consider in understanding a variety of related health outcomes for lesbian and gay individuals. Thus, this entry discusses the relationship dynamics of sexual-minority individuals and their families of origin, as well as their influence on physical and psychological health. In particular, research in this area has focused on the disclosure of one’s sexual-minority identity, or the “coming out” process, to parents.

Coming Out to Families of Origin Sexual-minority individuals have been conceptualized as “family outlaws” even with ongoing trends toward greater acceptance of nonheterosexuality in the United States as well as in many places around the world. Coming out to families of origin is a rite of passage and formative event in the lives of sexual-minority individuals and one that often sets changes in motion within the family system. Despite growing acceptance of sexualminority lives in the United States, coming out to one’s family is still one of the most difficult challenges that lesbian and gay individuals must face. Various cultural, sociodemographic, and other contextual factors influence how families react to, manage, and then embrace or reject their child’s

Families of Origin, Relationships With

sexual-minority identity. For example, recent international research on gay men in Slovenia has suggested use of the terms “transparent closet” and “family closet” to differentiate between situations in which family members fully accept and embrace their child’s coming out from situations in which family members know about the child’s sexual-minority identity but refuse to accept the child’s coming out. On the other hand, members of families of origin who fully embrace and accept their nonheterosexual relative often must go through a sort of coming out process of their own in which they decide whether they will disclose or discuss their family member’s sexual-minority identity (or not) within their own social networks and experiences.

The Role of Religion in Influencing Family Relationships Religious values have constituted one pivotal set of influences on family reactions to a child’s comingout process. Among gay men in Chile, family values of religiosity, including views of homosexuality as unnatural that have been shaped by Catholic and evangelical churches, play dominant roles in feelings of self-rejection, self-discrimination, and a lack of self-acceptance. Similarly, among parents of gay men and lesbian women in Italy, Catholic religious beliefs must often be reconciled with attitudes about sexual orientation in order to accept their sexual-minority children. Interestingly, these parents frequently draw on different and even contradictory cultural norms in order to negotiate seemingly irreconcilable positions in public discourse (acceptance of sexual-minority lives and Catholic identity). For example, the idea that the “homosexual is destined to suffer” allows for the capacity of parents to accept their child (and an alternative to rejection) while maintaining a grasp of heteronormative cultural values. As a result of conservative religious or family beliefs, sexual-minority adults often endure pervasive internal struggles to achieve their own personal acceptance and perceived normalization of being a sexual-minority person.

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Disclosure to Siblings Some research has focused on the reactions of siblings from families of origin, in addition to parents, to the coming-out experiences of sexualminority individuals. Interviews with heterosexual biological siblings of lesbian and gay individuals reveal themes of varied reactions to the sexualidentity disclosure, including feelings that being gay was “different,” as well as feelings that were much more comfortable with having a lesbian or gay sibling. Commonly, siblings appear to suspect that their brother/sister is gay/lesbian before the disclosure occurs. Siblings often feel protective toward their lesbian/gay sisters/brothers and express anger if their parents react negatively to the disclosure. Heterosexual brothers and sisters also note changes in their sibling relationship (both positive and negative), reference the challenge of dealing with heterosexism, and perceive positive changes in themselves as a result of their siblings’ coming out.

Disclosure to Family and Social Support Some research about the implications of disclosure and coming out to families of origin had its roots in studies of HIV-positive gay men and their families. Early research showed a notable lack of social support from the families of origin of gay men with AIDS, which was tied to the family’s lack of acceptance of nonheterosexuality and/or a relationship with a male partner, as well as stigma surrounding AIDS, the inability of family members to communicate openly or competently about nonheterosexuality and/or AIDS, and overprotectiveness or infantilizing behavior by parents. Findings from these studies consistently demonstrated that, on a more positive note, when gay men do disclose about their sexuality (and potential HIV status), higher levels of social support are experienced from all family members (mothers, fathers, and siblings) as well as lower levels of barriers to support from parents. Gay men appear most likely to disclose to and receive support from mothers and siblings (particularly

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sisters), as compared with fathers. When families do provide support, it is often in the form of emotional rather than instrumental (or informational) support. Beyond coming-out and disclosure experiences, some more recent research has investigated the reactions of members of lesbian and gay individuals’ families of origin to their announcement of same-sex marriage, particularly as this topic has received increasing public, legislative, and scholarly attention in the United States. From interviews with gay male couples who legally married in the state of Iowa, it is clear that many sexualminority persons may hold high expectations about the “power of marriage” to facilitate increased recognition and support from their families of origin. Often, however, family reactions are more varied and complex even with same-sex marriage frequently leading to overall positive family outcomes. Some negative outcomes are possible too, including renewed or potentially new experiences of rejection by families of origin. Thus, the act of legal marriage appears to hold both the capacity to cultivate or limit greater support from, and status among, sexual-minority individuals’ families of origin. Attendance at family-of-origin rituals and feelings of belongingness have also been examined among sexual-minority adults. Whether lesbian women and gay men choose to attend rituals with their families of origin and how much they feel a sense of belongingness (vs. feeling like an outsider) appear to revolve around the quality and perceived closeness of relationships with their family members, as well as the type of ritual (e.g., family reunions, holiday gatherings, family dinners, weddings). Often, sexual-minority individuals feel pressure to “desexualize” their current samesex relationship in an effort to feel a sense of belonging based on family connection (or racial identity) during extended family rituals. Different family rituals appear to be linked with different strategies among sexual-minority individuals in negotiating and redefining roles (e.g., their own same-sex wedding versus a family memorial service).

Contact Between Children and Their Parents’ Families of Origin The degree to which the children of lesbian and gay parents are involved with parents’ families of origin has also been assessed. When sexual-minority adults have children, their own parents (and other members of the family of origin) are often called upon to renegotiate or negotiate new kin relationships. Indeed, some families of origin are reported to have become more accepting when their sexual-minority relatives have children. Support from families of origin may be particularly critical at this time in the life cycle, since sexual-minority parents often perceive significantly less social support from friends overall (especially gay and lesbian friends) after having children. In terms of actual contact among the children of sexual-minority parents with families of origin, research with lesbian mothers who created their families via donor insemination debunks myths that children are isolated from their parents’ families of origin. Children appear to have regular contact with grandparents, other relatives, and other adult nonrelatives outside their own households, with no differences found between children of heterosexual and lesbian parents. However, when looking within lesbian mother families formed through donor insemination, children tend to have more frequent contact with their biological mother’s relatives, particularly grandparents, than with their nonbiological mother’s relatives.

Benefits of Family Acceptance In terms of outcomes linked with family acceptance of sexual-minority family members who are adolescents, those enjoying greater acceptance from their families of origin have higher selfesteem, greater social support, and better overall health status. Family acceptance appears to be protective against symptoms of depression, suicidal ideation and behaviors, and substance abuse. In contrast, rejection from families of origin or even perceptions of rejection (and lack of disclosure) are linked with a whole cascade of detrimental health effects for sexual-minority persons.

Film

Thus, acceptance of sexual-minority relatives’ identity is key to positive mental and physical health.

Future Research and Implications for Practice The aforementioned studies have many implications for therapy and education, particularly with sexual-minority individuals struggling to gain acceptance from their families of origin and/or those living in predominantly conservative Christian cultures’ sociopolitical contexts. Interventions that promote parental and caregiver acceptance of sexual-minority adolescents may be particularly crucial in reducing health disparities among heterosexual and sexual-minority persons early in the life course, as support from families of origin is associated with a host of positive adjustment outcomes. Future research could address best practices for working with family members (and not only parents, but also siblings and other relatives) of sexual-minority individuals in terms of cultivating acceptance, especially with consideration of religious or cultural factors that might conflict with the ability to embrace nonheterosexual lives. Additional studies could be framed from a more strengths-based perspective to highlight the positive characteristics of families to whom children feel comfortable disclosing their sexual orientation, to understand the positive changes that family systems often undergo in response to a child’s coming out, and to determine the factors that can contribute to these adaptive transformations within families. Despite prejudice and discrimination faced by sexual minorities, lesbian women and gay men have clearly demonstrated the ability to successfully create and maintain family relationships for themselves and their children.

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Further Readings Bertone, C., & Franchi, M. (2014). Suffering as the path to acceptance: Parents of gay and lesbian young people negotiating Catholicism in Italy. Journal of GLBT Family Studies, 10(1–2), 58–78. Figueroa, V., & Tasker, F. (2014). “I always have the idea of sin in my mind. . . .”: Family of origin, religion, and Chilean young gay men. Journal of GLBT Family Studies, 10(3), 269–297. Fulcher, M., Chan, R. W., Raboy, B., & Patterson, C. J. (2002). Contact with grandparents among children conceived via donor insemination by lesbian and heterosexual mothers. Parenting, 2(1), 61–76. Glass, V. Q. (2014). “We are with family”: Black lesbian couples negotiate rituals with extended families. Journal of GLBT Family Studies, 10(1–2), 79–100. Hilton, A. N., & Szymanski, D. M. (2011). Family dynamics and changes in sibling of origin relationship after lesbian and gay sexual orientation disclosure. Contemporary Family Therapy: An International Journal, 33(3), 291–309. Ocobock, A. (2013). The power and limits of marriage: Married gay men’s family relationships. Journal of Marriage and Family, 75(1), 191–205. Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 205–213. Švab, A., & Kuhar, R. (2014). The transparent and family closets: Gay men and lesbians and their families of origin. Journal of GLBT Family Studies, 10(1–2), 15–35.

FERTILITY TOURISM See International Surrogacy/Reproductive Outsourcing

Rachel H. Farr See also Catholic LGBTQ People; Christian LGBTQ People; Closet, The; Coming Out, Disclosure, and Passing; Community Climate; Discrimination Against LGBTQ People, Cost of; Support Groups and Resources

FILM This entry focuses on the cinematic representations of LGBTQ subjects. It explains the critical methods used to identify such representations, which

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span over a century of filmmaking, from experimental shorts to commercial features to independently produced documentaries and beyond. It describes the history of global LGBTQ film from 1895 to the present, with attention to numerous key works. The entry concludes with an examination of how the critical study of LGBTQ film has evolved, and what it can contribute to the study of human sexuality more generally.

Categories of LGBTQ Film Cinematic representations of LGBTQ subjects have long been crucial to popular and scholarly efforts to understand sexual minorities. Such representations are typically defined in three overlapping ways: as direct depictions of self-identified LGBTQ individuals, as the products of LGBTQ authors (usually screenwriters and directors), and as particularly relevant to LGBTQ audiences. The first, subject-specific paradigm encompasses works as diverse as Jennie Livingston’s documentary Paris Is Burning (1990), about New York’s drag-ball scene, and Robert Wise’s The Haunting (1961), a horror film that features a lesbian character (a chic psychic played by Claire Bloom). The second, authorship-specific paradigm includes films by lesbian director Dorothy Arzner, such as Christopher Strong (1933), about an aviator (Katherine Hepburn) in love with a politician (Colin Clive), and The Bride Wore Red (1937), about a cabaret singer (Joan Crawford) who masquerades as a woman of great wealth. Finally, the third, spectator-specific paradigm describes films that neither were made by self-identified LGBTQ authors nor feature LGBTQ subjects, but that, like the comedies of Mae West and many of the melodramas of Bette Davis, have been demonstrably popular among LGBTQ moviegoers. Ranging from the deeply politically committed to the seemingly trifling, LGBTQ films have made tremendous contributions to the complexity of global popular images of human sexuality, in some cases even prompting new social movements, cultural theories, and legislative measures.

LGBTQ Representation in Early Cinema Filmic images of LGBTQ subjects are traceable to cinema’s invention in the 19th century, as are critical efforts to make sense of such images. Produced at the Thomas Edison estate in 1895, a short film popularly known as The Gay Brothers consists of two young men who together perform a particularly romantic waltz, and while speculation abounds surrounding the precise goals of the film’s makers, who may or may not have intended to depict same-sex erotic attraction, their work nevertheless offers an iconographic record of a pronounced male intimacy. Arriving at commercial cinema’s very inauguration, The Gay Brothers seemed to promise an explosion of similar representations despite the constraints both of social convention and of sexological classification. Similarly romanticized images of same-sex intimacy are relatively rare in early cinema, however. They include the famous same-sex kiss—shared by the actors Buddy Rogers and Richard Arlen—that arrives toward the end of William Wellman’s war film Wings (1927), as well as the loving bond between a violinist (played by Conrad Veidt) and his adoring protégé (played by Fritz Schulz) in Richard Oswald’s German film Different From the Others (1919). The former film privileges the respective heterosexual encounters of its male protagonists, while the latter is plainly a work of advocacy predicated on the basic human rights of homosexual citizen subjects—those deemed “different from the others,” yet who are no less deserving of fair treatment or of simple recognition. Cowritten by Magnus Hirschfeld, whose Institute for Sexual Science was committed to promoting tolerance for sexual minorities, Different From the Others vividly demonstrates that early cinema in fact accommodated the sort of representational strategies that would later be associated with the gay rights movement. Beyond depictions of same-sex erotic attraction— as in G. W. Pabst’s Pandora’s Box (1929), whose characters include a lesbian-identified countess, and Mauritz Stiller’s The Wings (1916), a Swedish film about a young man’s doomed love for his bisexual male companion—early cinema furnished

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a remarkable representation of the fluidity of gender and sexuality, including Sidney Drew’s A Florida Enchantment (1914), in which magical seeds precipitate a range of transformations. The extent to which these and other silent works were, at the time of their release, understood to be LGBTQ films may be gauged from contemporaneous print reviews, the vast majority of which sought to pathologize LGBTQ subjects according to the popular biases of their era. While designations have changed considerably in the years since The Gay Brothers was released—with the term “gay” becoming a popular substitute for “homosexual” in the 1960s and 1970s, and with “transgender” and “queer” emerging even later—a variety of idiomatic, now-archaic expressions (such as “invert” and “sodomite”), appearing both in films and in the critical and publicity texts surrounding them, functioned to establish a corpus of LGBTQ cinema long before the acronym was coined.

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homosexuality. These included William Wyler’s The Children’s Hour (1961), adapted from Lillian Hellman’s lesbian-themed 1934 stage play (and the second of Wyler’s efforts to shape this source material cinematically, after 1936’s heterosexualized These Three); Edward Dmytryk’s Walk on the Wild Side (1962), about a Louisiana brothel headed by a lesbian madam (played by Barbara Stanwyck); and Otto Preminger’s Advise and Consent (1962), which features a young senator haunted—and eventually driven to suicide—by his affair with another man. Both The Children’s Hour and Advise and Consent illustrate that, for Hollywood in the early 1960s, suicide was the only viable option for the inevitably self-loathing homosexual, suggesting that the Production Code’s conception of “tasteful” representation demanded punitive measures for sexual minorities.

LGBTQ Film in Europe and Africa in the 1960s and 1970s Censorship and Hollywood’s “Golden Age” In the Hollywood context, one of the most prominent obstacles to the development of LGBTQ film was the Production Code Administration, which in 1930 drafted a series of regulatory measures for the content of commercial motion pictures. Enforced in 1934, these measures prominently included injunctions against so-called “sex perversions,” effectively barring LGBTQ subjects from direct cinematic depiction, relegating them to a regime of substitution and connotation. The prevailing mode of Hollywood censorship for over 30 years, the Production Code conspired to limit LGBTQ subjects to fleeting instances of same-sex intimacy (as in Nicholas Ray’s 1955 film Rebel Without a Cause, with James Dean and Sal Mineo playing particularly devoted friends), or stolen moments of gender-bending (as in Cary Grant’s cross-dressing performance in Howard Hawks’s 1938 film Bringing Up Baby and Mercedes McCambridge’s role as an “ethnic tough” in Orson Welles’s 1958 thriller Touch of Evil). In 1961, the Production Code was amended in order to accommodate certain “tasteful” representations of

Beyond Hollywood, a range of film industries contributed representations of LGBTQ subjects throughout the 1960s and well into the 1970s. In Britain, a cultural movement marked by social realism saw the production of such groundbreaking films as Tony Richardson’s A Taste of Honey (1961), about a gay student who attempts to care for a pregnant teenager, and Basil Dearden’s Victim (1961), about Britain’s infamous “blackmailer’s charter”—the longstanding law that criminalized homosexuality as a form of “gross indecency,” leading to the extortion of countless gay men. Elsewhere in Europe, representations of LGBTQ characters ranged from the melodramatically duplicitous lesbian of Roberto Rossellini’s Rome Open City (1945) to the panoply of effete gay men in Rosa von Praunheim’s It Is Not the Homosexual Who Is Perverse, But the Society in Which He Lives (1971). In Africa, filmmakers such as Ousmane Sembène and Med Hondo offered allusions to the figure of the goor-jigeen (Wolof for “man-woman”), while Djibril Diop Mambéty, in his 1973 film Touki Bouki, included a wealthy, unashamedly sexual gay character,

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rounding out his path-breaking portrayal of the Senegalese social spectrum.

LGBTQ Film in Hollywood After 1968 In Hollywood, the abolishment of the Production Code in 1968, coupled with the Stonewall riots in 1969, ushered in an era of relatively open expressions of LGBTQ subjects. Some examples of these are John Schlesinger’s Midnight Cowboy (1969), which covers New York City’s “sexual underground” in a melodramatic account of the friendship of two men; Sidney Lumet’s Dog Day Afternoon (1975), about a botched bank robbery motivated (in part) by the high cost of genderreassignment surgery; and the documentaries Word Is Out (1977) and Gay USA (1978). In the mid1980s, the perceived commodification of LGBTQ subjects—exemplified by a series of high-profile 1982 releases, including Robert Towne’s lesbianthemed Personal Best, Blake Edwards’s genderbending Victor/Victoria, and Arthur Hiller’s gay romance Making Love—gave way to tentative, exploratory representations of the HIV/AIDS crisis, such as Arthur Bressan’s Buddies (1985) and Bill Sherwood’s Parting Glances (1986).

The New Queer Cinema By the early 1990s, political neglect of the HIV/AIDS crisis had inspired what lesbian critic B. Ruby Rich labeled the New Queer Cinema, an explosion of genre-defying, stylistically adventurous films. Exemplars of the New Queer Cinema included Todd Haynes, who made the wideranging omnibus film and AIDS allegory Poison in 1991; Marlon Riggs, director of the documentaries Tongues Untied (1989) and Black Is . . . Black Ain’t (1994); John Greyson, whose Zero Patience (1993) addresses HIV/AIDS through a range of irreverent methods; and Rose Troche, who directed the lesbian romantic comedy Go Fish (1994).

Queer Cinema Beyond the United States Coterminous with the New Queer Cinema were a number of equally provocative filmic developments

in Asia, Latin America, and the Middle East. Tomás Gutiérrez Alea’s Cuban film Strawberries and Chocolate (1993) addresses the Cuban Revolution from a queer perspective, while Lucinda Broadbent’s documentary Sex and the Sandinistas (1991) considers the social conditions for sexual minorities before and during the Nicaraguan Revolution. By the early 1990s, the Tunisian filmmaker Nouri Bouzid had developed a global reputation for critiquing gender norms in his films, which include 1986’s Man of Ashes, about the effects of childhood sexual molestation on two adult men, and 1992’s Bezness, about a male prostitute (played by Abdellatif Kechiche) who pursues both female and male clients. In 1993, Egyptian director Yousry Nasrallah made Mercedes, which features gay and lesbian characters, and which remains one of the few Middle Eastern films to have been screened at multiple queer film festivals around the world. In China, Chen Kaige’s Farewell, My Concubine (1993) tackled the topics of male homosexuality and gender performance, becoming the first—and, to date, the only—Chinese film to win the coveted Palme d’Or at the Cannes Film Festival. In 1996, Indian director Deepa Mehta completed Fire, a lesbian romance that didn’t open in India for nearly three years; when it finally did, in 1999, it was to considerable controversy. By the late 1990s, the New Queer Cinema had given rise to an abundance of big-budget, critically acclaimed, and award-winning Hollywood films, from Sam Mendes’s American Beauty (1999) to Stephen Daldry’s The Hours (2002). At around the same time, a number of African filmmakers were addressing LGBTQ subjects from a range of perspectives: in 1997, Guinean director Mohamed Camara made the groundbreaking Dakan, a variation on Romeo and Juliet, in which two boys come to terms with their taboo love for one another, and in 2001, Senegalese director Joseph Gaï Ramaka made Karmen Geï, an adaptation of Prosper Mérimée’s novella and Georges Bizet’s opera Carmen, starring Djeïnaba Diop Gaï as the bisexual title character. In Israel, director Etyan Fox made Yossi & Jagger, which follows the love affair of two men in the Israeli army.

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The Study of LGBTQ Film The study of LGBTQ film represents a distinctly interdisciplinary pursuit, generally encompassing film and media studies, gender studies, feminist and queer theory, and sociology. Resting on a rich history of subcultural criticism that includes the pioneering work of Parker Tyler, Kenneth Anger, and Vito Russo, the study of LGBTQ film is predominantly concerned with the matters of authorship, representation, and reception. While Anger’s book Hollywood Babylon, first published in France in 1959, is largely specious in its author’s efforts to “out” such movie stars as Rudolph Valentino, Randolph Scott, and Cary Grant, it nevertheless suggests several salient methods for analyzing mainstream Hollywood films beyond conventional, straight-identified interpretive frameworks. First published in 1972, Tyler’s Screening the Sexes: Homosexuality in the Movies was one of the first major books to borrow Anger’s subversive approach to cinema, reviving Anger’s combination of political resistance and libidinous engagement. However, as its subtitle suggests, Screening the Sexes is more directly concerned than Hollywood Babylon with filmic representations of same-sex eroticism, and it features not only Tyler’s original critical taxonomies, but also, at times, his detailed, even ecstatic appreciations of individual filmmakers, from Sergei Eisenstein to François Truffaut. Tyler’s chapter-long analysis of Mae West, in which he makes a case both for West’s status as a camp icon and for her diverse contributions to various films, suggests that, for him, “gay culture” extends well beyond direct representations of gay men. In 1981, Russo published The Celluloid Closet, a compendium of analyses of Hollywood’s representations of LGBTQ characters; updated in 1987, the book continues to serve as a key reference for the study of LGBTQ film, although its author’s obvious affection for “positive” representations, and his unmistakable disdain for “negative” ones, has been met with considerable criticism in various academic publications. The study of LGBTQ film continues to occupy a central position in scholarly writings on human sexuality, reflecting the breadth and depth of representational practices that date

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back to the 19th century, and that only stand to proliferate in the years to come. Noah Tsika See also Bisexualities; Homophobia; Homosexuality, Female; Homosexuality, Male; Queer; Queer Politics; Queer Theory; Sexual-Identity Labels; Transgender Sexualities

Further Readings Anger, K. (1975). Hollywood Babylon. New York, NY: Dell. Benshoff, H. M., & Griffin, S. (2006). Queer images: A history of gay and lesbian film in America. Lanham, MD: Rowman & Littlefield. Leung, H. H. (2004). New queer cinema and third cinema. In M. Aaron (Ed.), New queer cinema: A critical reader (pp. 155–170). New Brunswick, NJ: Rutgers University Press. Rich, B. R. (2013). New queer cinema: The director’s cut. Durham, NC: Duke University Press. Russo, V. (1987). The celluloid closet: Homosexuality in the movies (Rev. ed.). New York, NY: Harper & Row. Tyler, P. (1972). Screening the sexes: Homosexuality in the movies. New York, NY: Holt, Rinehart & Winston.

FOCUS GROUPS This entry describes the use of focus groups as a way in which to conduct research with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. This entry begins with a brief overview of the different types of research methodology that have been used when investigating the lives and experiences of LGBTQ people. This includes a general discussion on the use of quantitative and qualitative research methodology with this population; however, the primary focus is on the importance of focus group research with LGBTQ individuals.

Research Methodology With LGBTQ Individuals Research that has specifically focused on LGBTQ people remains somewhat limited. Early research primarily focused on researching the “phenomenon”

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of sexual orientation. Initial research on sexual orientation was conducted in the late 1940s and early 1950s by Alfred Kinsey. Kinsey was among the first researchers to study male and female sexual behavior and in 1948, the findings were published. The collected published volumes continue to be referred to as the Kinsey Reports. The Kinsey Reports revealed that there was a continuum of sexual behavior from heterosexual to homosexual and individuals who were identified as being bisexual were somewhere in the middle. The Kinsey reports described individual and group variations in sexual behavior and reported that 37% of males and 13% of females engaged in at least one same-sex experience during adolescence, with 10% of men continuing to engage in homosexual behaviors after adolescence. The findings from these early studies were considered shocking by conservative heterosexuals, but welcomed by the lesbian and gay community. In the late 1950s, groundbreaking research reported that widely used psychological tests could not diagnose homosexuality. This finding was replicated by many mental health professionals who also found that homosexuality was not a psychopathological disorder. This eventually led the American Psychiatric Association and the American Psychological Association, respectively, to remove homosexuality from their lists of mental disorders in the mid-1970s. The removal of homosexuality from classification as a mental disorder led to empirical research focusing on discovering the diversity of the lesbian, gay, and bisexual (LGB) population and the ways in which discrimination and stigma have affected their well-being. Key clinical writings at this time focused on LGB identity development, disclosure, self-esteem, and relationship issues. However, the majority of this research was conducted with young adults—primarily White, middle-class gay males. Research that focused on transgender individuals was especially limited prior to the 1980s. With the 1981 reporting of numerous deaths among gay males living in San Francisco, California, clinical research on gay males shifted from psychological issues to physical/health issues.

Research also focused on preventing HIV/AIDS, coping with death, and maintaining physical health and social well-being. The research on HIV/AIDS continues and has been broadened to focus on health disparities between homosexual and heterosexual populations. The focus on physical health among LGB individuals led to including middleaged and older LGB individuals. It was during the late 1970s and early 1980s that scholars published their early studies on older gay men and older lesbians. The significant findings on older lesbians and gay men were that any negative outcomes discovered were primarily due to factors other than their sexual orientation. Problems for older gay men and lesbians were due chiefly to institutionalized heterosexism. Researchers reported that it was not sexual orientation per se that affected the psychological well-being of middle-aged and older LGB individuals, but rather the social stigma that LGB people faced because of their sexualminority status. Generally, older LGB individuals were found to have higher levels of life satisfaction, greater flexibility/fluidity in gender role definition, and adjusted to aging more successfully than their heterosexual counterparts. Despite these important early studies, empirical research with LGBTQ individuals remains sparse and the majority of research findings continue to be limited to White, socioeconomically secure, educated people. Additionally, most research that has focused on LGBTQ issues has not adequately focused on transgender, transsexual, intersexual, or queer populations. As the body of research with LGBTQ individuals evolves, it is essential for researchers to appreciate that the LGBTQ community is not a homogeneous group. As previously indicated, it is evident that the majority of published research on LGBTQ individuals primarily used lesbians or gay men as subjects. The inclusion of bisexual, transgender, or queer individuals as subjects continues to be rare. Additionally, the theoretical and empirical research on LGBTQ individuals has neglected LGBTQ people of color. The designers of future research studies need to recognize the diversity that exists among LGBTQ individuals and their

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multiple identities, and this requires both quantitative and qualitative research methods, with an emphasis on the use of focus groups.

Quantitative and Qualitative Research Methodology With LGBTQ Subjects Research can be broadly categorized as consisting of quantitative or qualitative analysis. Quantitative research analysis involves the quantification of data with the goal of understanding how prevalent a problem or issue is by constructing statistical models in an effort to explain what is observed and then generalizing the results from a large sample of respondents to an entire population of interest. Data in quantitative research is collected through questionnaires or surveys and the data is in the form of numbers and statistics. Qualitative research provides insights by eliciting detail from a typically small number of individuals. The data in qualitative research is most commonly in the form of words (e.g., what people say), but qualitative researchers also observe what people do. The aim of qualitative research is a complete and detailed description of a topic or issue of interest. Because qualitative research by definition is exploratory, the results are not generalizable to the general population. Rather, qualitative research enables a deeper and richer investigation of issues of interest. The common data collection methods used in qualitative research include in-depth interviews, participant observation, and focus groups.

Focus Group Methodology Focus groups are especially useful when existing knowledge of a subject or topic of interest is inadequate and new information is needed before a large-scale questionnaire can be constructed. Therefore, LGBTQ focus groups have been suggested as a useful starting point for the design of survey questionnaires for quantitative research. Focus groups provide a means for facilitating a group discussion around a particular issue, such as experiences with discrimination and stigma,

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and identifying questions that subsequently could be included in surveys. Participants in LGBTQ focus group discussions share key characteristics (sexual orientation, gender identity, race, age, etc.) pertinent to the study and are carefully recruited to avoid systematic biases in the selection process. The researcher is the focus group moderator and should be a good listener, be nonjudgmental, and ideally share some of the participants’ characteristics. The researcher/moderator develops a question guide/route (a series of prepared questions) that are used to guide the discussion and elicit participants’ perceptions, beliefs, opinions, and attitudes about the topic of interest. The questions posed must be open-ended, phrased clearly, and should draw upon concrete examples to illustrate a topic. Generally, the sequencing of questions engage the participants, allow for the exploration of the topic at hand, and include exit questions that enable the moderator to verify that nothing was missed that should have been included. Ideally, the moderator is flexible and receptive to relevant issues the participants raise that were not anticipated in the interview guide. The desirable number of participants in a focus group is between eight and ten and the suggested duration of the focus group discussion (session) is approximately 90 to 120 minutes. The focus group session takes place in a neutral setting that is acceptable and nonthreatening to those participating. Such a neutral setting facilitates an open, frank, and unhampered discussion. The goal of all focus group sessions is lively interaction between participants, with the researcher assuming the role of a facilitator/moderator and not a part of the discussion. A good facilitator/moderator is open and caring, but also possesses the ability to redirect the group to the purposes of the research and/or address potential conflicts that arise. The focus group sessions are audiotaped. Prior to the start of any discussion, all participants must provide their informed consent to participate in the focus group discussion and to have their remarks audiotaped. The analysis of focus group data is an ongoing process that begins prior to the focus group session

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and is based on the questions used and the purpose of the focus group. For example, if the purpose is to develop a questionnaire, the analysis may be different from that required if the purpose is to develop an in-depth understanding of a particular issue. All focus groups are audiotaped and transcribed verbatim. The information from the transcripts is examined, categorized, tabulated, and coded by the researcher. The expressed perceptions, beliefs, attitudes, and opinions are analyzed using qualitative data analysis techniques (e.g., constant comparison, discourse analysis, content analysis) and through this analysis common themes are identified. The focus group research method with LGBTQ populations can be a valuable and an instrumental way to increase knowledge and understanding of a key topic or area of interest. A key consideration when deciding whether or not to conduct focus group research is the research question. The choice between using a focus group (a qualitative research method) and a quantitative research method always depends upon the purpose and goals of the study, as well as the availability of resources. Combining both qualitative and quantitative research designs is becoming more common, and these mixed-methods studies can capitalize on the respective advantages of each approach. Often the results of a qualitative approach are used to inform a quantitative approach. This was evident in focus group research with LGB older adults that led to the development of an instrument, the LGB Elder Needs Assessment, that was subsequently used in quantitative research. The specific “focus” underlying the discussion within LGBTQ focus group research has included a variety of foci, such as individuals’ experiences when disclosing their sexual orientation or gender identity and LGBTQ individuals’ experiences with discrimination or stigma. Other topics of interest have included familial relationships, health concerns, minority stress, and federal policy development. Nancy A. Orel See also Heterosexist Bias in Research; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity; Qualitative Research; Quantitative Research

Further Readings Hooker, E. (1957). The adjustment of the male overt homosexual. Journal of Projective Techniques, 21(1), 18–31. doi:10.1080/08853126.1957.10380742 Kinsey, A., Pomeroy, W., & Martin, C. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders. Krueger, R. (2014). Focus groups: A practical guide for applied research (5th ed.). Thousand Oaks, CA: Sage. Liamputtong, P. (2011). Focus group methodology: Principle and practice. London, England: Sage. Miles, M., & Huberman, A. (1994). An expanded source book: Qualitative data analysis (2nd ed.). London, England: Sage. Orel, N. A. (2004). Gay, lesbian, and bisexual elders: Expressed needs and concerns across focus groups. Journal of Gerontological Social Work, 43(2–3), 57–77. doi:10.1300/J083v43n02_05

FOSTER CARE When children and youth experience the loss of parents or guardians and have no extended family to care for them, or when child welfare services remove them from families due to abuse or neglect, or when they have run away or been kicked out by their family but they are still minors, they may be placed in government care, or foster care. Foster care includes living with foster families assigned by child welfare services, placement in a group home, or occasionally, among older adolescents, supervised independent living with financial support from the government. Since extensive research has documented that LGBTQ youth report higher rates of abuse, as well as running away or being kicked out of their homes, some of them will inevitably end up in foster care. This entry summarizes what is known about the proportion of LGBTQ youth in foster care, the reasons they may be disproportionately in the child welfare or foster care system, and the limited evidence about their experiences in foster care. The entry also describes the policy changes and strategies child welfare systems are developing to improve foster care for LGBTQ children and youth in care.

Foster Care

Proportions of Youth in Foster Care Who Are LGBTQ There has been limited research estimating the proportion of LGBTQ youth in foster care in North America. This is primarily because most child welfare services do not systematically ask about sexual orientation or gender identity, or include these demographics in their tracking or reporting systems. Likewise, population-based surveys of youth in school that ask about sexual orientation seldom ask about foster care. However, one school-based survey in western Canada that asked about being in government care and one longitudinal study of older youth who were transitioning out of child welfare services in the midwestern United States found similar percentages of sexual-minority youth who had been in foster care: namely, about 12% of youth who had been in foster care identified as LGB, with a greater percentage of females than males identifying as LGB. Since most population studies of sexual orientation among adolescents estimate that somewhere between 2% and 6% of young people in the general population identify as LGB, this would suggest that LGBTQ youth are overrepresented in the foster care system. To date, there have been no published studies estimating the percentage of transgender youth in foster care.

Reasons for Higher Rates of Foster Care Among LGBTQ Youth A number of studies across North America have consistently found that LGBTQ youth are more likely to experience physical and sexual abuse than their heterosexual counterparts. Indeed, the growing number of studies has generated at least one metaanalysis, which found that on average, sexualminority youth were nearly 3 times more likely to report sexual abuse and 30% more likely to report parental physical abuse than heterosexual peers in the same studies. It is important to note this does not mean that physical or sexual abuse leads to LGB orientation, as older studies have sometimes suggested; the majority of LGB youth do not report abuse histories, and, given the much larger population of heterosexual adolescents, most abused youth

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identify as heterosexual. However, the disproportionate percentage of sexual-minority youth who have been physically or sexually abused means they are also disproportionately likely to need child welfare services and foster care placements.

Foster Care and Homelessness Among LGBTQ Youth LGBTQ youth may not end up with foster care, however, even when they cannot live with their family. Several studies have documented that LGBTQ youth are more likely to run away from home, or to be kicked out of home, than heterosexual adolescents, often due to conflict with family or even abuse by family members. This in part explains the disproportionate number of LGBTQ youth who become homeless or street involved. Yet leaving home may not ultimately end up being safer: Studies of homeless and street-involved youth have found that LGBTQ youth also experience homophobia on the street and in shelters. They are more likely to be targeted for physical violence and for sexual exploitation than heterosexual street-involved youth. Some homeless and street-involved LGBTQ youth have run away from homophobic discrimination and harassment in the foster care setting as well. Many youth, regardless of orientation, also struggle financially after transitioning out of foster care, which places them at risk for homelessness. One study of economic outcomes after foster care found that LGBTQ youth reported lower hourly wages, greater food insecurity, and one or more economic hardships, such as eviction, utility shutoff, or not having enough money to pay rent, compared to their heterosexual peers. They also found that 1 in 5 had been homeless once or more in the past year, although that was not significantly different from heterosexual peers who had also aged out of foster care. Such challenges can affect the long-term economic well-being of LGBTQ young adults after foster care.

Experiences of LGBTQ Youth in Foster Care A number of studies have documented the experiences of LGBTQ youth in foster care settings,

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whether in families or group homes, as well as their treatment within the child welfare system. These studies have identified pervasive experiences of stigma, discrimination, rejection, and outright violence, as well as failure to protect LGBTQ youth from violence by other youth. While most of these studies have been qualitative studies with relatively small numbers of young people, they have included youth across North America, from diverse ethnic backgrounds, gender identities, and ages, and in various child welfare jurisdictions, over many years. The similar experiences documented in studies from different regions and over time paint a consistent picture of how many LGBTQ youth in foster care struggle to be safe. Deciding whether or not to disclose their sexual orientation or gender identity is an important hurdle faced by LGBTQ youth in foster care settings. Some studies have found that when LGBTQ youth in foster care disclose their orientation or gender identity, many of them experience rejection from their child welfare workers as well as from foster parents. They may experience unwanted outing of their LGBTQ identity by social workers; for example, it may be documented in their child welfare case files, disclosed to their foster parents, shared with other youth in a group home setting, and even disclosed publicly during court hearings. Being outed has carried significant risks for some young people, including forced reparative therapy, religious indoctrination, violence from other youth in the foster care or group home setting, and even expulsion from the home. Youth in foster care often have trauma-related difficulty in trusting adults, because of their histories of abuse and neglect, and LGBTQ youth who have experienced prior rejection from families or child welfare workers may choose to remain closeted for fear of further rejection or violence. Young people in foster care also face challenges in developing healthy romantic relationships because of both prior abuse history and lack of positive role models for loving relationships. For LGBTQ youth in foster care, there are further complications; they may face stereotypes and myths about their sexual orientation or gender

identity, and unwarranted concerns about their sexuality or gender expression from social workers and foster parents. They may not be allowed to date, or may not be supported in developing healthy romantic relationships, even when other foster care youth in their setting have those supports. They may even be segregated from samegender peers out of a fear they will make unwanted sexual overtures. In most regions, there may be few or no LGBTQ foster parents available, either because of institutional discrimination, or because LGBTQ foster parents are directly forbidden by law. Thus, LGBTQ youth in foster care are seldom placed with LGBTQ foster parents, and may not have LGBTQ mentors. This means they may lack role models in caring adults who can support them as they begin dating, and ensure they have the relevant knowledge to make healthy choices around sexual intimacy. They may be more vulnerable to exploitative relationships, and at higher risk for unintended pregnancy, sexually transmitted infections, and sexual violence than heterosexual youth in foster care, or than other LGBTQ youth who are not in foster care.

Policies, Practices, and Guidelines to Support LGBTQ Youth in Foster Care In a growing number of jurisdictions, there has been increased attention to the rights of LGBTQ youth in the child welfare system. Several organizations have developed training programs for child welfare social workers, foster parents, group home staff, guardians ad litem, attorneys, and judges in family court, to help them understand the needs of LGBTQ youth and improve their policies and practices for supporting LGBTQ youth in care. Experts have developed practice standards and best practice models for supporting LGBTQ youth in government care, and professional organizations such as the Child Welfare League of America have disseminated practice guidelines and training materials to improve policies and practices in child welfare settings. These include guidelines around confidentiality of sexual orientation and gender identity information of youth in care, nondiscrimination

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policies aimed at creating inclusive organizations, practices to support family reconciliation and permanency options in placements for LGBTQ youth, training for child protection workers and foster parents, and policies to prevent the use of inappropriate segregation, punishment, or reparative therapy to try to change adolescents’ sexual orientation or gender identity. Although there has been extensive evidence of the stigma, discrimination, and rejection that LGBTQ youth have experienced within child welfare systems, there are also positive examples of programs to support their needs. For example, there have been some longstanding group homes, shelters, and transitional housing programs for LGBTQ youth in the foster care system. In the early 1980s, the first LGBTQ-focused group home, Gay and Lesbian Social Services (GLASS), was founded in Los Angeles, and in 1987, a similar program was established in New York City. Since then, a number of cities in the United States and Canada have licensed LGBTQ-focused group homes, and foster care matching programs to place LGBTQ youth with LGBTQ foster parents. Several jurisdictions have enacted systemwide policies to support LGBTQ youth in care in North America, as have regions of the United Kingdom and some countries in continental Europe. This progress in reducing stigma and discrimination and creating supportive environments is slow in some regions, however, and in other regions changing political climates have resulted in protective laws being rescinded and further barriers to supporting LGBTQ youth in child welfare systems care being enacted, including banning LGBTQ adults from becoming foster parents or mentors, as well as laws to prevent adults from talking with young people about sexual orientation in affirming ways. These reversals in protective policies and laws may further endanger LGBTQ youth who have the greatest need for protection and support. Elizabeth M. Saewyc See also Adoption via the Child Welfare System; Families of Origin, Relationships With; Foster Parenting; Homelessness; Violence and Victimization of Youth

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Further Readings Dworsky, A. (2013). The economic well-being of lesbian, gay, and bisexual youth transitioning out of foster care (OPRE Report No. 2012-41). Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families, Office of Planning, Research and Evaluation. Friedman, M. S., Marshal, M. P., Guadamuz, T. E., Wei, C., Wong, C. F., Saewyc, E., & Stall, R. (2011). A meta-analysis to examine disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and non-sexual minority individuals. American Journal of Public Health, 101(8), 1481–1494. doi:10.2105/ AJPH.2009.190009 Marksamer, J., Spade, D., & Arkles, G. (2011). A place of respect: A guide for group care facilities serving transgender and gender non-conforming youth. San Francisco, CA: National Center for Lesbian Rights; New York, NY: Sylvia Rivera Law Project. Wilber, S., Ryan, C., & Marksamer, J. (2006). CWLA best practice guidelines: Serving LGBT youth in out-ofhome care. Washington, DC: Child Welfare League of America. Retrieved from National Center for Lesbian Rights website: http://www.NCLRights.org

FOSTER PARENTING This entry describes the general phenomenon of foster parenting, and specifically, foster parenting by LGBTQ people. It explains the implications of foster parenting by LGBTQ people for child welfare practice. The entry also highlights the emerging changes in policies and practices that have impacted LGBTQ people’s experiences in becoming foster parents.

Foster Parenting: An Introduction Federal guidelines define foster care as 24-hour a day substitute care for all children placed away from their parents or guardians and for whom the state agency has placement and care responsibility. Foster care placement is intended to be a temporary rather than long-term solution to family problems,

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with the intent of reunifying children as expeditiously as possible with their families, when it is safe to do so. Foster care is developed in collaboration with the family and based on the needs and best interest of the child. Children come into foster care for a number of reasons. In many cases, they have experienced physical, emotional, or sexual abuse at home. A small percentage of children are in foster care because their parents are unable to control the children’s behavior, and the children’s past behavior may have led to delinquency or fear of harm to others. Some children have been physically, educationally, or medically neglected by their parents or legal guardians, or have parents or legal guardians who are unable to take care of them because of substance abuse, incarceration, or mental health problems. These children are placed into custodial care while the parents or guardians receive treatment or counseling. Children separated from their birth parents are placed in foster care in a variety of settings. They may be placed in the care of relatives other than the family members who have been involved in alleged neglect or abuse (kin placement), with nonrelatives, in therapeutic or treatment foster care, or in an institution or group home. Placement with a relative who expresses a willingness to provide a long-term commitment to the child and to become an approved resource parent is the preferred placement for most children. If placement with a relative is not possible or appropriate, the first alternative to consider should be a nonrelative foster family home. Foster parents must be licensed by the agency that handles a specific state or locality’s foster care system. The foster home must be assessed in a home study process, in which prospective foster parents are evaluated for appropriateness and their home is inspected for safety. All potential foster parents must attend training sessions covering a range of issues that focus on caring for a child. When a child is placed, the foster family takes responsibility for feeding and clothing the child, getting the child to school and to appointments, and doing any of the usual things a child’s parents

or legal guardians might be called to do. The foster parents might also need to meet with the foster child’s therapist, and will typically meet regularly with the child’s caseworker. The foster parent’s main goal is to help the foster child develop normally in a safe family environment. Foster placements may last for a single day or several weeks, and some continue for years; but the ideal is to keep the placement as short as possible. If the parents surrender their rights permanently, or if the court terminates their rights to their child, the foster family may adopt the foster child or the child may be placed for adoption— which is deemed to be a more permanent option. The goal of foster care is the care of the child within the child welfare system, but also is to place all appropriate and available services at the disposal of the parents so that they can create a safe home environment for their child when they are reunified.

Moving Toward a Policy of Inclusiveness Although policies increasingly have become more affirming toward LGBTQ people who desire to become foster parents, some jurisdictions maintain restrictions. At the time of this writing, however, only Utah enforces statewide restrictions on foster care by LGBTQ people. In June 2013, the U.S. Supreme Court ruled that the Defense of Marriage Act (DOMA)—which since 1996 had not recognized same-sex marriage as legal at a federal level—was unconstitutional. In support of this change in law, Justice Anthony Kennedy wrote that [DOMA] places same-sex couples in an unstable position of being in a second-tier marriage. The differentiation demeans the couple, whose moral and sexual choices the Constitution protects . . . and whose relationship the State has sought to dignify. And it humiliates tens of thousands of children now being raised by same-sex couples. The law in question makes it even more difficult for the children to understand the integrity and closeness of their own family and its concord with other families in their community and in their daily lives.

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This landmark ruling—and the subsequent 2015 U.S. Supreme Court decision rendering state marriage bans against same-sex marriage unconstitutional—will have significant positive implications for LGBTQ people hoping to become parents through foster care. Similarly, policies have made it possible for a broader range of adults to become foster parents, including families of color, single individuals (both male and female), older individuals, individuals with disabilities, and families across a broad economic range. At one time or another, many of these groups were excluded from the foster care system. Inclusion of some of these groups caused great controversy at the start. Moreover, as policies have moved toward greater inclusiveness, many professionals have voiced concern about lowering the standards of foster care and thereby damaging the field. The trend toward inclusiveness, and a broader understanding of who makes a suitable parent, has had a major effect on the almost 400,000 children in out-of-home care, some of whom have waited for extended periods for permanent homes. Such changes have allowed children and youth previously considered “unplaceable,” or not suitable for family foster care, to be provided with homes with caring adults, some of whom are LGBTQ. According to a study conducted in 2011 by the Williams Institute at the University of California, Los Angeles, School of Law, there are roughly 9 million gay, lesbian, and bisexual adults in the United States. Excluding such a significant population from becoming foster parents solely on the basis of gender identity expression and sexual orientation would seem unwise, considering how many children and youth are in need of loving families.

Trends in Foster Care: Dilemmas That Agencies Face in Accepting LGBTQ Prospective Parents Numerous child welfare agencies across the country have broken through their own organizational biases against LGBTQ people and are already placing children with same-sex parents. A 2011 report published by the Donaldson Adoption Institute,

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which focused on adoption but can be extrapolated to include foster parents as well, yielded a number of important findings relevant to LGBTQ parents and prospective parents. First, the survey found that more than 50% of lesbian and gay adoptive parents had adopted their children from the public child welfare system; further, 60% of all lesbian and gay adoptive parents had adopted transracially. Thus, these data demonstrate that nonheterosexual individuals and couples are important resources for children who linger in foster care. Further, the survey found that “gay-affirmative” images and information in a foster care agency’s “marketing” materials (website, brochures, newsletters, and recruitment documents) increased the comfort and confidence of nonheterosexual applicants in working with the agency and its staff. The survey also found that more than 80% of lesbian and gay study respondents reported that they voluntarily shared information about their sexual orientation with their caseworkers, and most caseworkers responded in a positive and accepting manner. Notably, 75% of those surveyed were generally satisfied with the professionalism and competence of their caseworkers, but less than half felt the same way about the caseworkers’ knowledge and sensitivity regarding LGBTQ issues and family life. Lesbian and gay parents reported feeling more satisfied with their experience when they were comfortable disclosing information about their sexual orientation to agency staff, received positive reactions, and obtained good preadoption preparation and support. Also of note is that two thirds of lesbian and gay survey respondents identified unmet training needs, including those related to general parenting, children’s developmental issues, helping children cope with adoption and parental sexual orientation, and race and culture issues.

How LGBTQ People Become Foster Parents Although many child welfare agencies are struggling to develop policies about LGBTQ parenting, there are still some that are not as open to the benefits of LGBTQ people becoming parents. Yet the reality is that LGBTQ people represent an

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untapped resource of potential foster parents for some of the almost 400,000 children who need substitute families through foster care. Importantly, although lesbian, gay, bisexual, and trans people may historically have been discouraged from becoming foster parents, changes in legislation and policy in many states over the past 10 years reflect a more open attitude toward LGBTQ people as potential parents. LGBTQ people become foster parents for some of the same reasons that heterosexual people foster children. Some pursue foster care as a single person; some seek to create a family as a same-gender couple. Regardless of whether they are single or coupled, LGBTQ people must do their “homework” about the foster care system in their locality. They must learn as much as they can about foster care and how to apply, be trained for, and become licensed as foster parents. The basic flow of the foster parenting process occurs as shown below. The steps are the same for all potential foster parents, LGBTQ or otherwise. Step 1: Get the Basic Information

Prospective foster parents should contact the foster parent agency in the local area where they live. Step 2: Attend an Orientation

Prospective foster parents should schedule an orientation. In many localities, it is possible to register online. At the orientation, child welfare professionals will provide an overview of foster care and will answer questions. Step 3: Complete the Foster Parenting Application

At the end of the orientation, the individual or couple will be given an application to fill out. Potential foster parents must fully complete the application and return it to the foster care agency. Once social workers have reviewed it and are satisfied that the basic elements are in place, they will contact the potential foster parents to begin a home study.

Step 4: Have a Home Study Prepared

The home study provides the child welfare agency and the courts with comprehensive information about potential foster parents. The individuals or couples and their social worker will meet several times during this process. Potential foster parents must submit various documents, including copies of birth certificates, marriage license (if applicable), income tax returns, personal references, and medical reports completed by physicians. All adults in the potential foster parent’s home must be fingerprinted and cleared through the State Central Registry for Abuse and Neglect. A foster care home study can take up to several months.  Step 5: Complete a Training Series

While the home study is under way, potential foster parents will attend an 8-to-10-week Model Approach to Partnerships in Parenting (MAPP) or Parent Resources for Information, Development, and Education (PRIDE) training course. Through these training sessions, potential foster parents will improve parenting skills and assess their own strengths as foster parents. Potential foster parents will learn how to work with birth parents and how to help children adjust to their temporary home. Potential foster parents will also learn about the subsidies that they will receive for the care of the child and will find out about their rights and responsibilities as a foster caregiver.  Step 6: Become a Certified Foster Parent

Upon the successful completion of the home study and training, potential foster parents become certified foster parents. This means that that they can now care for foster children in their home. Step 7: A Child Is Placed With the Family or Individual

Once a family is certified, foster parents will begin receiving calls from the agency to discuss placing children in their home. If the family is the

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right family for the young person, the child will come for a preplacement visit on either a short- or longer-term basis. Before a child is placed in a foster home, the caseworker will discuss visiting schedules with birth parents and siblings, and will give foster parents information that will help them provide the best care for the child. 

The Strengths of LGBTQ Parents There are numerous positive aspects to establishing policies and practices that welcome and support LGBTQ foster families. Data from the National Survey of Family Growth suggests that up to 2 million lesbian, gay, and bisexual (LGB) individuals expressed an interest in foster care/ adoption as a path to family-building. Other studies show that children raised by LGB parents are highly successful in all measures, from academic achievement to interpersonal relationships. Research provides evidence of myriad strengths and capacities that LGBTQ individuals and same-sex couples bring as prospective parents: LGBTQ parents are highly motivated to create families; for most, foster care/adoption is their first choice in family-building. They tend to be highly engaged and invested in the foster parenting process, have a deep understanding of how it feels to be “different,” and embrace a broader definition of family, often as a result of facing rejection by their family of origin and by establishing their “family of choice.” Many LGBTQ parents are able to advocate for fairness and equality for their family as they have experience overcoming oppression, discrimination, and other obstacles in their own lives. LGBTQ parents are able to support children who struggle with peer relationships and identity issues. Since there is vast regional, racial, and ethnic diversity within the LGBTQ community, LGBTQ people who choose to create families often have the advantage of already having redefined and reinvented their own meaning of family, precisely because they may exist outside of the traditionally defined family. They have the unique opportunity to break out of preconceived gender roles and be a new kind of parent to a child.

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Conclusion The social work—and more specifically, the child welfare—community’s response to lesbian, gay, bisexual, trans, and questioning foster parent applicants has been varied and sometimes unpredictable. Although not all social workers are heterocentric (i.e., subscribe to the concept that the only legitimate norm is heterosexuality) in their attitudes toward LGBTQ families, a major issue seems to be the lack of policies to guide their practice. Going out on a limb to approve or to work with an LGBTQ parent, or quietly implementing a home study, have been common themes in child welfare. Inconsistencies and lack of state and agency competency-based training for working with LGBTQ families have also been noted. It is important that agencies and social workers are prepared for issues that will arise, both professionally and individually, in working with prospective LGBTQ foster parents. Professionals need to be aware of assumptions and stereotypes that previously may have shaped policy and legislation and may have informed practice, which was less than competent. Social workers also need to examine their own personal attitudes toward LGBTQ people. They need to be careful not to assume automatic parenting skills in heterosexual applicants, just as they need to be careful not to assume unsuitability for parenting in LGBTQ applicants. The gender identity expression and sexual orientation of a potential parent does not, in itself, indicate anything about his or her ability to care for children who may have had difficult experiences. Social workers need to explore openly with each individual or couple their experience and skills in relation to caring for and parenting a child or adolescent. Gerald Mallon See also Adoption, Choices About; Adoption, International; Adoption, Openness in; Adoption and Foster Care Discrimination; Adoption via the Child Welfare System; Foster Care; Joint Adoption; SecondParent Adoption; Single-Parent Adoption

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Further Readings Brooks, D., & Goldberg, S. (2001). Gay and lesbian adoptive and foster care placements: Can they meet the needs of waiting children? Families in Society, 46, 147–157. Donaldson Adoption Institute. (2003). Adoption by lesbians and gays: A national survey of adoption agency policies, practices, and attitudes. New York, NY: Author. Downing, J., Richardson, H., Kinkler, L., & Goldberg, A. (2009). Making the decision: Factors influencing gay men’s choice of an adoption path. Adoption Quarterly, 12(3), 247–271. Downs, C., & James, S. E. (2006). Gay, lesbian, and bisexual foster parents: Strengths and challenges for the child welfare system. Child Welfare, 85(2), 281–298. Farr, R. H., Forssell, S. L., & Patterson, C. J. (2010). Parenting and child development in adoptive families: Does parental sexual orientation matter? Applied Developmental Science, 14(3), 164–178. Farr, R. H., & Patterson, C. J. (2009). Transracial adoption by lesbian, gay, and heterosexual couples: Who completes transracial adoptions and with what results? Adoption Quarterly, 12, 187–204. Gates, G. J. (2011). How many people are lesbian, gay, bisexual, or transgender? Retrieved from http:// williamsinstitute.law.ucla.edu/wp-content/uploads/ Gates-How-Many-People-LGBT-Apr-2011.pdf Gates, G. J., Badgett, L. M., Macomber, J. E., & Chambers, K. (2007). Adoption and foster care by lesbian and gay parents in the United States. Washington, DC: Urban Institute. Mallon, G. P. (2007). Assessing lesbian and gay prospective foster and adoptive families: A focus on the home study process. Child Welfare, 86(1), 67–86. Mallon, G. P. (2014). Issues in adoption practice. In G. P. Mallon & P. Hess (Eds.), Child welfare for the 21st century: A handbook of practices, policies, and programs (2nd ed., pp. 219–231). New York, NY: Columbia University Press. Mallon, G. P. (2014). Lesbian, gay, bisexual and trans foster and adoptive parents: Recruiting, assessing, and supporting an untapped resource for children and youth (2nd ed.). Washington, DC: Child Welfare League of America.

FOSTER PARENTING, LEGAL CONSIDERATIONS

IN

Foster parenting refers to a situation in which an individual or couple is raising a child who is in the care and custody of the state. Foster parents must be certified by the county in which they live and do not have legal decision-making power regarding the children in their care. The process of becoming a foster parent varies from state to state and county to county. LGBTQ individuals and couples experience an added layer of complexity when they initiate the foster care certification process, given that they face heterosexist policies and individuals that may deter the certification process. This entry describes the legal considerations for LGBTQ individuals and couples who are foster parents and who are pursuing foster parenthood. First, foster parenting in general is defined and described. Next, legal policies are discussed. Finally, interactions between LGBTQ foster parents and the legal system (e.g., attorneys, judges) are addressed.

Foster Parenting Motivations for becoming a foster parent vary, and may include altruism (i.e., wanting to do “good” or give a child a home), desire for an additional source of income, and desire to be parents (i.e., to be long-term foster parents or to eventually adopt the children in their care). A foster parent may be raising one or more children at a time and the children may or may not have a biological connection to one another (i.e., as siblings) or the foster parents (i.e., as aunt, uncle, grandparent). The amount of contact that the child in care has with biological parents varies from regular visits to no contact. The legal/placement goal for the children also varies. Some children in foster care remain in care for as little as a few days and others remain in care for years, possibly until they emancipate (i.e., “age out”) from the child welfare system. It is the foster parents’ responsibility to feed, clothe, and care for the child, which also includes

Foster Parenting, Legal Considerations in

bringing the child to school, medical appointments, therapy appointments, and so on. Foster parents are paid a stipend (which differs in each state and is dependent on the needs of the child) to care for the child.

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their awareness of this possibility can create significant intrapersonal stress and tension, potentially interfering with their ability to completely “ease in” to the placement, fully bond with the children in their care, and ultimately relax into the role of parent.

Foster Parent Legal Policies Foster care policies vary from state to state, as do the criteria for becoming a foster parent. Most states, over the past few decades, have acknowledged that in order to find more families for children in care, their criteria needed to become more inclusive. Common criteria for foster parents among most states include a minimum age of 18 years and a safe home with enough space and resources to accommodate children; furthermore, foster parents usually must attend a class to learn more about the needs of children in care. In addition, the parent must pass a background check. Despite the notion that parent sexual orientation has no impact on parenting ability, the sexual orientation of the individual applying to be a foster parent is taken into account in some states and by some agencies. Although most states do not take a position on whether LGBTQ individuals or couples can become foster parents, some do. The positions vary from explicit protection of the rights of LGBTQ foster parents to explicit prevention of LGBTQ individuals and couples from being certified foster parents. Moreover, most states leave the decision of who has the right to become a foster parent to local child welfare agencies. In addition, some states explicitly prohibit unmarried parents from adopting children; up until June 2015, this effectively made it impossible for LGBTQ individuals and couples to adopt when same-sex marriage was not legally possible in their state. Therefore, in some states, the only way LGBTQ couples could become parents was to become foster parents, an option that leaves parents with the responsibility to care for children, but without the legal protections that are afforded through adoption. That is, children can be removed from their care at any time, at the discretion of the child welfare agency. Research on LGBQ foster parents has found that

Navigating the Legal Challenges Because states and agencies are becoming more inclusive in their criteria for selecting certified foster parents, many LGBTQ individuals are taking the opportunity to do so. However, as mentioned, many states provide that local agencies and courts make the decision about whether LGBTQ individuals and couples can provide foster care. That is, the determination of parenting rights is made on a case-by-case basis and is often in the hands of an individual social worker or judge. Research has demonstrated that this causes feelings of frustration and disappointment for the parents pursuing foster care certification, especially given that the number of children waiting in care is high and that some of these parents wish to adopt the children in the long run. These parents often “agency shop,” that is, they look for an agency known to be friendly to the LGBTQ community, to improve their chances of being certified. The argument exists that fewer children would suffer the negative impact of waiting in care for a family (e.g., emotional disturbance, decline in school performance, behavioral difficulties) if states and local jurisdictions would move toward a position of equality for all individuals and couples desiring to provide foster care. In addition, scholars and policy makers have emphasized that states would likely benefit financially if LGBTQ individuals and couples had as much right to become foster parents as do heterosexual couples. In addition, it is important to note that little research has examined the foster parenting experiences of transgender and bisexual individuals. It is unknown whether these prospective foster parents encounter unique discriminatory policies by agencies or individual professionals related to their gender or identification as bisexual. It is possible, for example, that transgender

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individuals and couples may be perceived as “less fit” than cisgender individuals and couples if an agency or professional has little or no background working with transgender parents. In addition, bisexual individuals and couples may experience feeling “invisible” or “different” from heterosexual and same-sex couples given that their sexual orientation may not be as easily understood by agencies or professionals. Additional research is necessary to gain understanding of the foster parenting experiences of bisexual and transgender parents. April M. Moyer and Abbie E. Goldberg See also Adoption, Legal Considerations in; Foster Care; Foster Parenting

Further Readings Goldberg, A. E., Moyer, A. M., & Kinkler, L. A. (2013). Lesbian, gay, and heterosexual adoptive parents’ perceptions of parental bonding during early parenthood. Couple and Family Psychology: Research and Practice, 2, 146–162. Goldberg, A. E., Moyer, A. M., Kinkler, L. A., & Richardson, H. B. (2012). “When you’re sitting on the fence, hope’s the hardest part”: Experiences and challenges of lesbian, gay, and heterosexual couples adopting through the child welfare system. Adoption Quarterly, 15, 1–28. Shapiro, J. (2013). The law governing LGBT-parent families. In A. E. Goldberg & K. R. Allen (Eds.), LGBTparent families: Innovations in research and implications for practice (pp. 291–304). New York, NY: Springer.

FRATERNITIES

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SORORITIES

Fraternities and sororities are typically single-sex social organizations on college campuses. They are important in the LGBTQ context because they serve as formally organized sites where gender and sexuality are visible, serve as membership markers, and are reproduced. Traditional fraternities and sororities tend to both reinforce the gender binary and expect heterosexuality from their members. This entry discusses the critiques of traditional

fraternities and sororities, the development and practices of a gay fraternity and lesbian sororities, as well as the benefits and challenges of LGBTQ membership in traditional fraternities and sororities.

Critiques of Traditional Fraternities and Sororities College students who “rush” (a formal admission process) fraternities or sororities cite a myriad of benefits, such as access to a large group of friends, a quasi-familial environment (brothers, sisters, “big” and “little” brothers/sisters), a formalized relationship with other-sex organizations (fraternities and sororities have formal “mixers”), leadership opportunities, popularity and status associated with their organization, a “home” on the campus, access to parties, alumni contacts, continuing their family of origin’s legacy, and much more. Yet despite their benefits, fraternities and sororities have come under scrutiny. Scholars have described traditional fraternities as heterosexist institutions that reproduce gender, typically reinforcing hegemonic masculinity, the cultural ideal of masculinity that men are expected to achieve. Hegemonic masculinity is always framed as superior to femininity and other more feminine forms of masculinity. Fraternities also have a history of physically and psychologically abusing their pledges through hazing rituals, sometimes resulting in injury and—although rarely—even death. Scholars have also noted fraternities’ propensity to develop a culture that is conducive to sexual abuse, with disproportionately high rates of gang rape, for example. Sororities tend to encourage particular types of femininity and they frequently lack significant diversity. They have been criticized for reinforcing hegemonic femininity, defined as the cultural ideal of femininity. A defining feature of hegemonic femininity is that it always exists as a support or reinforcement of hegemonic masculinity and maintains the dominant position of men in the gender hierarchy. Additionally, a focus on femininity and appearance may be linked to distorted body image and possible eating disorders.

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Despite the costs of membership, openly lesbian, gay, and bisexual (LGB) college students have sought entry into these organizations. In both fraternities and sororities, the default assumption is that all members are heterosexual. While sororities are generally less homophobic than fraternities, homosexuality is a topic that is simply not discussed in many sororities. Although the rosters of these traditional fraternities and sororities had included nonstraight members in the past, the Gay Rights Movement encouraged LGB college students to disclose their identities following acceptance, rush traditional fraternities and sororities as openly LGB, and form their own organizations that were open to all sexual identities. Having openly LGB members of fraternities and sororities, and fraternities and sororities that do not make an assumption about the heterosexuality of their members, challenges the existing structure of fraternities and sororities in some ways but reproduces them in others.

Gay Fraternities Delta Lambda Phi (DLP) is a fraternity founded by gay men in 1986 in Washington, D.C., to provide more opportunities for gay men to make connections with each other, as well as with other openminded men. While founded by gay men, the organization is inclusive of all men, including heterosexual and bisexual men as well as transgender individuals. One of the chief goals of the organization is to overturn the assumption of heterosexuality in fraternities and emphasize that gay men are fit for membership in fraternities. Scholars note that the existence and practices of this fraternity challenge the heteronormativity and heterosexism of fraternities in some ways but reaffirm it in others. Similarly, the fraternity both challenges and reinforces the larger gay culture. Ethnographic research by Mindy Stombler and her colleagues found that DLP challenged the typical model of a fraternity in the following ways. The hazing of pledges, a practice typically viewed as a test of manhood in traditional fraternities, was strictly prohibited in DLP. Similarly, performing

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femininity was not considered a punishment or humiliation in DLP but was instead treated as an expression of identity. However, these performances of femininity were mostly limited to the private spaces of the fraternity (although there were a few exceptions to this rule, such as hosting a drag ball on campus). Performing masculinity served as a way to change the stereotype of gay men and for DLP to establish itself as a legitimate fraternity in the eyes of the other fraternities. The members of DLP also engaged in other contradictory strategies in order to legitimize their organization. Though one of the primary organizing categories of the fraternity is sexual orientation, the brothers also typically downplayed this aspect of the fraternity in public spaces. Additionally, the brothers went to considerable lengths to create an asexual image for the fraternity in order to change the perception, or presumption, that it was nothing more than a sex club. Dating among the brothers was formally discouraged, as was casual sex. The members emphasized that in the fraternity they were brothers rather than potential romantic partners. These practices, intended to give credibility to the fraternity, reinforced the existing heterosexism in fraternities. The founders of DLP decided to create a fraternity, as opposed to another type of social organization, as a way of distinguishing themselves from other LGBTQ organizations. They argued that both gay men and straight men would benefit from being in an all-male environment because men have a different social experience than women. This reinforces the idea that there are essential differences between men and women, contributing to the perpetuation of existing gender inequality. In addition to providing a model of a fraternity that was connected to but slightly different from traditional fraternities, DLP also provided a model of community that was connected to the larger gay community, yet differed from it. Researchers argued that one of the benefits of joining DLP was that it helped members construct their identities as gay men. The fraternity explicitly taught new members about gay culture in an effort to bring out the cultural aspect of gay identity. However,

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the fraternity was not completely accepting of gay culture as a whole. Members of DLP were critical of certain aspects of the larger gay community, reporting that they found it oversexualized, overly political, and that it encouraged destructive behavior. These members joined DLP because they were interested in a different kind of community and in creating different kinds of bonds with other gay men.

Gay Men in Traditional Fraternities DLP and other gay fraternities are not the only option for gay and bisexual men who desire to join a fraternity. Gay men also join traditional fraternities seeking friendships, expanded opportunities for social life, and for social support. Most fraternities do not have specific rules that bar gay men from membership. Traditional fraternities are unlikely to accept a known gay man into the organization, though members are generally accepting of brothers who come out after they are already members. Yet homophobic and heterosexist behaviors and attitudes are very common among members of traditional fraternities. Though there is little research exploring the distinction between the experiences of gay and bisexual men, the majority of gay and bisexual men who joined more traditional fraternities reported to researchers that they observed these behaviors and attitudes among other men in the fraternity. In many cases this homophobia and heterosexism discouraged them from disclosing their sexual orientation to their brothers in the fraternity. Although they still have to deal with homophobia in their organization, participating in a traditional fraternity provides benefits to gay men similar to those that straight men receive. While straight men tend to acquire greater personal gains as a result of membership, gay men and straight men report similar levels of leadership experience and satisfaction with their experience in their fraternities. Many gay men obtain leadership roles within fraternities even when they are out to other fraternity members. Gay men also report that in addition to leadership skills and experience, they

improved their social and interpersonal skills and cultivated long-term friendships as a result of joining a traditional fraternity.

Lesbian Sororities Though not as well studied as gay fraternities, there are some lesbian sororities; most are relatively young organizations with few chapters. Lambda Delta Lambda (LDL) was a sorority founded around the same time as DLP, but it did not expand in a similar manner and few chapters remain in operation today. One of the reasons for this may be the lack of an alumnae base that would help support the group financially. This may be one reason that lesbians might choose to join traditional sororities over lesbian ones, which tend to be newer and smaller. However, several new lesbian sororities have formed recently with some success. One of the largest, Gamma Rho Lambda (GRL), was founded in 2003 by 12 students at Arizona State University. They began expanding nationally in 2005. GRL is a growing organization with 15 chapters across the nation whose mission is to provide scholastic and emotional support, build community, and develop sisterhood among its members. Though it is known as a lesbian sorority, GRL tries to be inclusive of all members, including lesbian, bisexual, transgender, and straight members.

Lesbians in Traditional Sororities There has also been little research on the experiences of lesbians or bisexual women in traditional sororities, and the existing research tends to group these two populations together, providing scant information on how their experiences differ. However, research does show that sororities tend to enforce hegemonic femininity in the same way that fraternities enforce hegemonic masculinity. Lesbians present a challenge to hegemonic femininity, and many sorority members have concerns that lesbians in the sorority may lead to challenges to the femininity of the other members. Most lesbians who join sororities are closeted when they rush and many still identify as heterosexual when they

Fraternities and Sororities

graduate. Like fraternities, sororities are less likely to accept a known lesbian into their organization but tend to be accepting if a member comes out after they have already joined. Sororities also do not typically have explicit rules barring lesbians from membership and typically do not engage in explicitly homophobic behavior to the extent that men in fraternities do. However, if a woman’s lesbian identity is known, the existing members may come to the conclusion that she is not a “good fit” for the sorority and deny her group membership on that basis. Women in sororities tend to construct lesbianism as masculine and aggressive; they believe that lesbians will have different interests, styles, and social chemistry and will alter the sorority as a result of their presence. Sororities that do regularly accept openly lesbian pledges or otherwise have diverse membership tend to have less status in the hierarchy of other fraternities and sororities on campus. Failure to conform to the traditional model of a sorority typically damages a sorority’s reputation and the group is taken less seriously as a legitimate sorority. Kiersten Kummerow and Mindy Stombler See also Campus Climate; College Students; Coming Out, Disclosure, and Passing; Friendships; Heteronormativity; Transgender Inclusion on College Campuses

Further Readings Case, D. N., Hesp, G. A., & Eberly, C. G. (2005). An exploratory study of the experiences of gay, lesbian and bisexual fraternity and sorority members revisited. Oracle: The Research Journal of the Association of Fraternity Advisors, 1(1), 15–31. Connell, R. W. (1995). Masculinities. Berkeley: University of California Press. Delta Lambda Phi Social Fraternity. (2013). About. Retrieved August 6, 2014, from http://dlp.org/about/ Delta Lambda Phi Social Fraternity. (2013). FAQ: Joining a chapter. Retrieved August 13, 2014, from http://dlp .org/join/faq-joining-a-chapter/ Gamma Rho Lambda National Sorority. (2014). About. Retrieved August 12, 2014, from http://gammarholambda .org/?page_id=7

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Gamma Rho Lambda National Sorority. http://gamma rholambda.org/ Handler, L. (1995). In the fraternal sisterhood: Sororities as gender strategy. Gender and Society, 9(2), 236–255. Literte, P., & Hodge, C. (2012). Sisterhood and sexuality: Attitudes about homosexuality among members of historically Black sororities. Journal of African American Studies, 16(4), 674–699. Long, L. (2011). An exploration of the sexual orientation and educational outcomes of undergraduate fraternity members. Oracle: The Research Journal of the Association of Fraternity/Sorority Advisors, 6(1), 23–38. Moffatt, M. (1989). Coming of age in New Jersey: College and American culture. New Brunswick, NJ: Rutgers University Press. Schippers, M. (2007). Recovering the feminine other: Masculinity, femininity, and gender hegemony. Theory and Society, 36(1), 85–102. Schulken, E. D., Pinciaro, P. J., Sawyer, R. G., Jensen, J. G., & Hoban, M. T. (1997). Sorority women’s body size perceptions and their weightrelated attitudes and behaviors. Journal of American College Health, 46(2), 69–74. doi:10.1080/ 07448489709595590 Stombler, M. (1994). “Buddies” or “slutties”: The collective sexual reputation of fraternity little sisters. Gender & Society, 8(3), 297–323. Stone, A. L., & Gorga, A. (2014). Containing pariah femininities: Lesbians in the sorority rush process. Sexualities, 17(3), 348–364. doi:10.1177/ 1363460713516336 Trump, J., & Wallace, J. A. (2006). Gay males in fraternities. Oracle: The Research Journal of the Association of Fraternity/Sorority Advisors, 2(1), 8–28. Yeung, K.-T. (2009). Challenging the heterosexual model of brotherhood: The gay fraternity’s dilemma. In C. L. Torbenson & G. Parks (Eds.), Brothers and sisters: Diversity in college fraternities and sororities (pp. 184–209). Cranbury, NJ: Associated University Presses. Yeung, K.-T., & Stombler, M. (2000). Gay and Greek: The identity paradox of gay fraternities. Social Problems, 47(1), 134–152. Yeung, K.-T., Stombler, M., & Wharton, R. (2006). Making men in gay fraternities: Resisting and reproducing multiple dimensions of hegemonic masculinity. Gender & Society, 20(1), 5–31.

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Freedom to Marry (and Other Marriage Equality Organizations)

FREEDOM TO MARRY (AND OTHER MARRIAGE EQUALITY ORGANIZATIONS) Marriage is at once a deeply personal commitment to a person, a legal gateway to a crucial safety net of tangible and intangible protections and responsibilities, and a fundamental freedom guaranteed by the U.S. Constitution. In 2014, a majority of Americans (63%) believed that it was time to end marriage discrimination nationwide. And, in 2015, the U.S. Supreme Court ruled that it was unconstitutional to prevent same-sex couples from marrying, thus affirming the freedom to marry and equal protection under the law for all Americans. The current entry reviews the birth of the modern-day marriage movement and landmark victories for the freedom to marry in the United States, and the challenges that remain for the same freedom to be implemented in all states nationwide.

1970–1990s: The Birth of the Freedom-to-Marry Movement in America Same-sex couples have sought the freedom to marry in the United States since the dawn of the modern LGBTQ movement, in the immediate aftermath of the Stonewall riots in 1969. Same-sex couples filed early challenges in Minnesota, Washington, and Kentucky; but in 1972, the U.S. Supreme Court upheld a Minnesota Supreme Court ruling that the Constitution does not protect “a fundamental right” for same-sex couples to get married. Although those first marriage cases were rubber-stamped away, a second wave of marriage litigation in the 1990s launched the ongoing global freedom-to-marry movement. The Hawai’i Supreme Court in 1993 was the first high court in history to rule in favor of same-sex couples, finding that exclusion from marriage is discrimination and presumptively unconstitutional. But opponents succeeded in enacting an anti–gay marriage state constitutional amendment, undoing the court win. And even as Hawai’ian courts were seeing the

world’s first-ever trial on the freedom to marry, resulting in the first ruling in favor, the U.S. Congress passed the so-called Defense of Marriage Act (DOMA), which withheld federal respect for the marriages that gay couples seemed on the verge of winning.

Early 2000s: Marriage Legalization and Setbacks With Hawai’i stymied, and a second freedom-tomarry case in Vermont yielding civil union but not yet marriage, the Netherlands in 2001 became the first country in the world to allow same-sex couples to marry. Shortly after, in 2003, a court win made Massachusetts the first state in the United States where same-sex couples could marry. Following the win in Massachusetts, opponents succeeded in passing a wave of discriminatory state constitutional amendments to ban marriage for same-sex couples. One of the most notable marriage bans was Proposition 8, which stripped gay and lesbian couples in California of the freedom to marry. It was a painful blow, eased only slightly by freedom-to-marry victories in Connecticut, and, after Prop 8, in Iowa, Vermont, New Hampshire, and Washington, D.C.

Late 2000s: Majority Support for Marriage With the election of Barack Obama to the presidency and a new Congress, a new era began for marriage advocates. Continued campaigning yielded, in 2010, a majority of Americans embracing the freedom to marry for same-sex couples. Soon after, the Obama administration announced that it would no longer defend the Defense of Marriage Act, deeming it unconstitutional; and Congress introduced the Respect for Marriage Act to repeal it. Advocates also continued to build momentum at the state level in New York and elsewhere. Winning the right to marry in New York was transformative for same-sex couples and widely seen as a triumph for love and equality under the law. For the first time, a Republican-led chamber,

Freedom to Marry (and Other Marriage Equality Organizations)

the New York State Senate, joined a Democrat-led chamber in passing marriage legislation. The bipartisan bill was supported by some of America’s most prominent businesses, corporate leaders, Republican leaders, labor unions, and professional athletes. The unprecedented support demonstrated how ending the exclusion of same-sex couples from marriage had become truly mainstream.

2012: Election Year Brings Unprecedented Wins In May 2012, President Obama became the first sitting president to support the freedom of samesex couples to marry. His heartfelt message reflected a changed emphasis in the movement: that samesex couples want to marry for reasons of love, commitment, and family. President Obama’s announcement encouraged millions of Americans to think anew and move toward support. In September 2012, the Democratic Party became the first major political party in U.S. history to endorse the freedom to marry. On Election Day, following 30 consecutive losses in previous years, same-sex marriage advocates won four out of four ballot measures in Maine, Maryland, Minnesota, and Washington—vindicating the tenacious and hard work of learning how to persuade the public, build campaigns, and convince a majority to vote against discrimination. The victories were the result of millions of conversations and years of work by local campaigns and volunteers, supported by national and local groups across the country.

2013: Supreme Court Strikes Down Core of So-Called Defense of Marriage Act In June 2013, the U.S. Supreme Court struck down the core of DOMA as unconstitutional, thus ending the exclusion of legally married same-sex couples from more than 1,000 federal protections. The same day, the Supreme Court also let stand a lower court ruling restoring the freedom to marry in California, about four and a half years after the passage of Proposition 8.

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2013–2015: Continued Momentum for the Freedom of Same-Sex Couples to Marry Subsequent to the decision in U.S. v. Windsor, at least 65 federal and state judges concluded that excluding same-sex couples from marriage was unconstitutional. At the time of the June 26, 2015, decision by the Supreme Court that made bans against same-sex marriage unconstitutional, lawsuits were under way in each of the states that continued to discriminate against same-sex couples’ freedom to marry and equal respect for samesex couples’ marriages. Polls also showed support at an all-time high, with dwindling opposition isolated in a few holdout demographics. Thus, with a supermajority of supportive Americans and nearly three fourths of Americans living in a freedom-to-marry state, advocates of marriage equality were largely optimistic as they awaited the Supreme Court ruling on marriage, confident that they had built the critical mass of states and support they set out to secure. The Supreme Court decision was a great victory, as it served to end the systematic injustice and indignity faced by couples denied the freedom to marry. Evan Wolfson See also Defense of Marriage Act (DOMA); LGBT/Queer Studies Programs; Long-Term Same-Sex Couples; Marriage Equality, Landmark Court Decisions

Further Readings Ball, M. (2012, December). The marriage plot: Inside this year’s epic campaign for gay equality. The Atlantic. Retrieved August 26, 2014, from http://www .theatlantic.com/politics/archive/2012/12/the-marriageplot-inside-this-years-epic-campaign-for-gay-equality/ 265865/ Solomon, M. (2014). Winning marriage. Lebanon, NH: University Press of New England. Sullivan, A. (1989, August). Here comes the groom. The New Republic. Retrieved August 26, 2014, from http://www.newrepublic.com/article/79054/ here-comes-the-groom Wolfson, E. (2004). Why marriage matters. New York, NY: Simon & Schuster.

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Friendships

FRIENDSHIPS Friendships are close social relationships that are often distinguished in the general literature from family relationships or kinship ties. Because friendships are entered into voluntarily, they emphasize reciprocity, mutuality, and equality between friends. Friendship experience may differ across level of closeness (casual, close, or best friends) and size (dyadic, group, network, or communities). Research on the social and personal relationships of lesbian, gay, bisexual, transgender, and queer individuals (LGBTQ) has focused primarily on romantic and sexual relationships. By comparison, friendships have been de-emphasized. Friendships, however, do play an important role in the lives of LGBTQ individuals. In many ways, their friendship experiences are similar to the friendships of their heterosexual counterparts. LGBTQ and heterosexual individuals report having a similar numbers of friends and emphasize similar friendship needs, such as having someone to talk to, emotional support, being there when needed, and having fun. Despite similarities, sexual orientation and gender identity do contribute to unique friendship patterns and experiences for LGBTQ individuals. Because the importance of friendship is emphasized during periods of social and societal change, particularly for individuals who are experiencing times of transition or whose identities are at odds with social norms, friendships are considered to have increased importance for gender and sexual minorities. The importance of friendship is evidenced by the fact that LGBTQ identity disclosure, or coming out, often occurs first with a friend. Therefore, friendships can serve as an important practice ground for LGBTQ individuals learning to negotiate their identity in social and relational contexts. Coming out to friends can be met with negative reactions and outcomes leading to friendship loss or the creation of emotional distance within the relationship. Coming out may also lead to positive outcomes, such as strengthening feelings of trust and acceptance within the friendship. When this

occurs, LGBTQ individuals can experience friendship as a means of social support, which may take on increased significance when traditional support from family and community may not be reliably available. Consistently, LGBTQ individuals report more discrimination in their familial relationships than in their friendships. Friendships, then, may also take on additional importance by fulfilling a supportive role in relation to minority stress and status. The general literature emphasizes that friendships largely develop between individuals with similar characteristics, identities, or experiences. It is important to understand intersections of identity when considering the social and personal relationships of LGBTQ individuals. Not all LGBTQ individuals have the same experiences in friendship. Sexism, racism, heterosexism, biphobia, and transphobia all simultaneously impact friendship experience. In addition, LGBTQ friendship experience can differ greatly depending on whether it is experienced within or outside of the larger LGBTQ community.

Friendships Within the LGBTQ Community Friends as Family

LGBTQ friendship research has mostly focused on understanding friendships that form between individuals who identify within the LGBTQ community. In the same way that we see homophily (the idea that individuals connect with others who are similar to themselves) in heterosexual relationships, LGBTQ individuals also form relationships based on similarities. Many lesbians report having a majority of lesbian friends, and many gay men’s friends also identify as gay. LGBTQ friendship is often characterized as providing a unique familial type of support in which friendships function as chosen families and serve to buffer gender and sexual minorities from social isolation or rejection associated with homophobia, biphobia, and transphobia. That LGBTQ individuals consider others within the community in familial terms is evidenced by the colloquial use of the term “family” to refer to other individuals in the community.

Friendships

Friendships within the LGBTQ community are often characterized as social networks that not only make up larger LGBTQ communities, but are also an outlet for individuals in the community to positively experience their identity in a culture that often either dismisses or disapproves of them. These within-community friendships are seen as having unique benefits as they may provide a sense of shared experience and an avenue for processing minority status. Within-community friendships can provide a buffer against being socially devalued as a sexual minority and can provide an outlet for sharing daily aspects of life, especially for individuals who are not able to be open about their identity in larger society. LGBTQ friends can also serve as role models in a culture where LGBTQ experience is not widely visible. These withincommunity friendships may be particularly important because they represent a social relationship in which LGBTQ individuals can experience relative equality. While lesbians and gay men may find a unique type of support through same-orientation friendships, bisexual women and men are less likely to do so. Not only are they less likely to have sameorientation friendships with individuals who also identify as bisexual, but, in addition, bisexual individuals can experience discrimination and isolation from both within and outside the LGBTQ community. Bisexual women and men report often experiencing an invalidation of their bisexual identity within their friendships with lesbian, gay, and heterosexual individuals. LGBTQ individuals of color also experience marginalization within the larger LGBTQ community and are faced with simultaneously negotiating sexual orientation and race in their friendships. The pressure to choose one identity over the other is likely to impact their experience of friendship. Friendships, Romance, and Sexuality

In the general research literature, friendships are explicitly distinguished from romantic relationships and sexual attraction. The platonic nature of friendships is assumed to provide a unique type of

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freedom and support. Because close friendships between same-sex heterosexual friends are emphasized as the most typical and “model” friendship, friendships have been assumed to be nonsexual in nature. In fact, other-sex friendships have often been seen to be problematic because of the potential for sexual attraction or tension and a central research question has been whether (heterosexual) women and men can “really” be friends. The LGBTQ friendship literature has also stressed the importance of same-sex friendships. Because the potential for sexual attraction and tension exist among LGBTQ same-sex individuals, the friendship literature from the beginning has suggested that LGBTQ definitions of friendships may differ from traditional heterosexist definitions in important ways. For example, friendships of LGBTQ individuals may incorporate and acknowledge romantic feelings and/or sexual attraction. In fact, for LGBTQ individuals, romantic relationships most commonly develop out of friendships, and many sexual-minority individuals report being friends with their partner before becoming romantically involved. Likewise, sexual-minority individuals often report that lovers and ex-lovers are among their closest friends. Other-sex friendships for lesbian and gay individuals, in contrast, are more likely viewed as nonsexual, and a good deal of attention has focused on gay men’s friendships, for example, with heterosexual women as a friendship free from sexual tension and pressure. Bisexual individuals’ friendships have been uniquely considered for the ways both same- and other-sex friendships could be complicated by the potential for sexual attraction. Intense emotional interactions that involve elements of both friendship and romantic relationships have been referred to as “passionate friendships.” Passionate friendships most often develop out of close same-sex friendships that have had an intense emotional connection but lack a sexual component. Although more likely to be studied among young sexual-minority women, passionate friendships can develop for sexualminority and heterosexual women or men. The research on friendships of LGBTQ individuals

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emphasizes that friendships can include elements similar to romantic relationships, and may also include sexual elements. In addition, casual friendships may incorporate sexual behavior without a romantic component and may also serve as an important site for exploration of sexual identity and development.

Transgender Friendships: Friends as “Family” and as “Community Resource” In many ways within community, LGBTQ friendships generally serve as a proxy to family relationships. They can provide a sense of belongingness and shared culture that may not be fulfilled by families of origin. Friends can serve as “families of choice” by providing emotional support not provided by lost or strained familial relationships due to differences in sexual orientation. Transgender friendships in the LGBTQ community, likewise, fulfill a similar familial role. However, the stigma and marginalization experienced by transgender individuals can be even more pronounced than for sexual minorities (lesbian, gay men, bisexual, and queer individuals). Even though LGBQ and transgender individuals are generally conceptualized as a unified LGBTQ community, it is important to acknowledge the distinction. Transgender persons experience increased stigmatization and discrimination, increased pathologization within the medical community, and different (and often fewer) legal protections than are afforded to sexual minorities. Even within the LGBTQ community, transgender individuals and issues related to gender identity have a history of being overshadowed by the focus on sexual orientation and LGBQ experience. Thus, transgender individuals are more likely to be subject to social isolation and invisibility. Given the increased marginalization of transgender experience, it makes sense that within the LGBTQ community friendships take on an additional level of significance for transgender individuals. Having friends in the LGBTQ community is largely beneficial for transgender individuals, as it allows transgender people to feel comfortable being themselves and talking about issues related

to their gender identity. Friends within the LGBTQ community are also generally characterized as having an understanding of non-normative experience; are knowledgeable on issues of gender, sex, and privilege; and are relatively nonjudgmental and open-minded. In short, these friendships provide transgender individuals with a shared sense of belonging, family, and community. Benefits of within–LGBTQ community friendships for transgender individuals focus on common understandings, shared experiences, or knowledge in ways that made non-normative experience primary. Friendships between transgender individuals also take on an added significance. Sharing a transgender identity, these friendships not only offer support but also provide an exchange of shared knowledge and similar experiences. While providing support and having similar experiences are regarded as characteristics of friendship in general, friendships between transgender individuals often allow an exchange of knowledge surrounding transitioning and/or other issues that are unique to transgender individuals. Transgender friends are also seen as providing needed counseling unavailable from the traditional health care system. Benefits of friendships with other transgender individuals were largely seen as filling in the gaps of support and services not otherwise provided by traditional family, friends, and institutions. In particular, transgender–transgender friendships have been shown to have unique benefits not experienced to the same degree with sexual-minority individuals. When compared to their friendships with LGBQ individuals, transgender individuals find that with their transgender friends they are more likely to have shared experiences, be able to talk about transgender issues, receive support via mentoring and shared resources, and are more comfortable being themselves. As important as within-community friendships may be for some transgender individuals, it is important to note that not all transgender individuals see themselves as part of the LGBTQ community, or even as part of a transgender community. There is great variation in how individuals experience their transgender experience. Some

Friendships

individuals view it less as an identity and more of a status or history. For some, it is important that their transgender identity is acknowledged within social relationships whereas others do not see it as relevant. All of these factors can greatly impact the type of support transgender individuals may actually receive in their friendships from both within and outside the LGBTQ community. Similar to LGBQ individuals, transgender persons socially navigate identity disclosure and/or coming out. Transgender individuals may also experience a transition in their gender presentation and ask friends to address them with different names and gender pronouns. These factors may impact friendships dynamics and may even lead to loss of friendships.

Friendships Outside the LGBTQ Community Initial research on the topic suggested that friendships outside the LGBTQ community are tenuously constructed around a number of barriers. Barriers to such friendships include the stigma surrounding having a sexual- or gender-minority friend, sexual tension, or even reduced comfort (for both the LGBTQ and heterosexual individual). When friendships do occur outside of the community, they often do so at the expense of the LGBTQ individual’s identity, where they cannot be fully open about their experiences or where they experience microaggressions or misunderstandings within the friendship. Benefits of friendships outside the LGBTQ community have also been considered. For example, sexual-minority women report that through their friendships with heterosexual women they gain an understanding that acceptance from heterosexuals is possible, gain an objective perspective in their lives, are able to break down stereotypes, and experience increased closeness and trust within the friendship accompanying sexual orientation disclosure. The literature on the friendships of transgender individuals also details a variety of benefits to friendships outside of the LGBTQ community. These include fostering a feeling of normalcy, offering more diverse perspectives and interactions, and helping transgender individuals to

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present as their identified gender as well as validating transgender identity and experience. Additionally, these friendships serve as an educational tool for transgender individuals about their identity and experience. Friends as Allies

Friendships outside the LGBTQ community provide both sexual-minority and transgender individuals the opportunity to educate individuals about LGBTQ experience and discrimination. Friendships, then, may be an important avenue for developing allies to the LGBTQ community. The research literature has long connected interpersonal contact—inclusive of friendship—as being related to positive attitudes toward LGBTQ individuals. More recently, friendships with LGBTQ individuals have been shown to be important in the development of heterosexual allies to the LGBTQ community. LGBTQ allies can serve to both personally support LGBTQ individuals and advocate for larger acceptance and rights of LGBTQ individuals within the larger culture.

Conclusion Friendship experience of LGBTQ individuals challenges the notion of friendship as being secondary to romantic relationships. The emphasis on friends as “family” or as chosen family illustrates that for LGBTQ individuals, friendships both within and outside the LGBTQ community serve important roles. Research on the experiences of individuals within transgender communities indicate that friendship fulfills an even broader role by providing support and services not otherwise provided by traditional family, friends, and institutions. Likewise, friendships with individuals outside the LGBTQ community provide a sense of acceptance and an opportunity for developing allies to the LGBTQ community. Although the research emphasizes a unique and potentially broader role of friendship for LGBTQ individuals than for their heterosexual counterparts, it is important to note that this is, in part, due to the fact that friendships are experienced within a larger system of

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discrimination and inequality still present in family and other societal institutions. M. Paz Galupo and Shane B. Henise See also Ally Experience; Cross-Category Friendships; Families of Choice; Romantic Friendships; Workplace Friendships

Further Readings Baiocco, R., Laghi, F., Di Pomponio, I., & Nigito, C. S. (2012). Self-disclosure to the best friend: Friendship quality and internalized sexual stigma in Italian lesbian and gay adolescents. Journal of Adolescence, 35, 381–387. Diamond, L. M. (2002). “Having a girlfriend without knowing it”: Intimate friendships among adolescent sexual-minority women. Lesbian Studies, 6(1), 5–16. Galupo, M. P. (2009). Cross-category friendship patterns: Comparison of heterosexual and sexual minority adults. Journal of Social and Personal Relationships, 26, 811–831. Galupo, M. P., Bauerband, L. A., Gonzalez, K. A., Hagen, D. B., Hether, S. D., & Krum, T. E. (2014). Transgender friendship experiences: Benefits and barriers of friendships across gender identity and sexual orientation. Feminism & Psychology, 24(2), 193–215.

Hines, S. (2007). TransForming gender: Transgender practices of identity, intimacy, and care. Bristol, England: Policy Press. Morgan, E. M., & Thompson, E. M. (2006). Young women’s sexual experiences within same-sex friendships: Discovering and defining bisexual and bi-curious identity. Journal of Bisexuality, 6, 7–34. Muraco, A. (2012). Odd couples: Friendships at the intersection of gender and sexual orientation. Durham, NC: Duke University Press. Nardi, P. M. (1999). Gay men’s friendships: Invincible communities. Chicago, IL: University of Chicago Press. Stanley, J. L. (1996). The lesbian’s experience of friendship. In J. S. Weinstock & E. D. Rothblum (Eds.), Lesbian friendships (pp. 39–59). New York, NY: New York University Press. Ueno, K., Wright, E. R., Gayman, M. D., & McCabe, J. M. (2012). Segregation in gay, lesbian and bisexual youth’s personal networks: Testing structural constraint, choice homophily and compartmentalization hypotheses. Social Forces, 90, 971–991. Weinstock, J. S. (1998). Lesbian, gay, bisexual and transgender friendships in adulthood. In C. J. Patterson & A. R. D’Augelli (Eds.), Lesbian, gay, and bisexual identities in families: Psychological perspectives (pp. 122–155). Oxford, England: Oxford University Press. Weston, K. (1991). Families we choose: Lesbians, gay, kinship. New York, NY: Columbia University Press.

G LGBTQ characters in video games relied on the presumed comedic value of stereotypes. For example, male characters were sometimes portrayed as highly effeminate and flamboyant, possessing traits more closely aligned with society’s view of the prototypical woman. Similarly, female characters were designed to physically resemble males, often engaging in stereotypically hypermasculine behaviors. Gender confusion was prevalent in these early depictions insofar as many characters thought they were or wanted to be a gender they were not. Despite this overall tendency, many game developers did successfully sidestep heteronormativity during this era by casting LGBTQ characters in a more affirmative light.

GAMING Gaming is defined as the act of interacting with or playing video games. But what exactly is a video game? Traditionally, video games have been conceptualized as electronic games that present interactive visual stimuli to players for the primary purpose of entertainment. Although entertainment-oriented video games continue to dominate contemporary gaming culture, recent advances in technology have extended the scope and utility of gaming to an array of nonentertainment contexts such as education and health. This entry discusses the concept of gaming as it specifically relates to the LGBTQ community. Gaming is relevant to LGBTQ studies because members of this community affect gaming culture just as video games affect LGBTQ culture. A historical discussion of LGBTQ representation in video games is followed by examples of relevant scholarly research and future directions.

Contemporary Representations of LGBTQ Characters in Video Games As attitudes toward LGBTQ people have changed over time, so has this community’s on-screen representation. The 1990s saw a marked increase in the number of positive video game portrayals, and this trend has continued in recent years. It is now rather commonplace for independent developers as well as major studios to consistently include LGBTQ characters and storylines in their titles. This representation has spanned many genres including fighting games, racing games, and adventure games, to name a few. Of particular note within the genre of role-playing games is the development company BioWare. This developer has

Early Representations of LGBTQ Characters in Video Games LGBTQ characters, storylines, and themes first appeared in video games in the 1980s, just as gaming culture began evolving into the mainstream phenomenon it is today. Paralleling early representations of sexual minorities in other forms of mass media, some of the first attempts at depicting 425

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taken the lead in terms of increasing the visibility of sexual minorities within mainstream gaming culture. For example, players have the option of making choices that lead to same-sex romance in the Mass Effect and Dragon Age franchises, which are among the gaming industry’s best selling. Further signaling inclusivity, BioWare included a trans man named Krem in Dragon Age Inquisition. Response to this game was mixed. Although many critics applauded the inclusion of LGBTQ themes, some considered the game to be rather scandalous and inappropriate for certain markets. Indeed, Dragon Age Inquisition was preemptively withdrawn from sale in India in order to avoid a breach of local content laws. Customers who preordered the game were ultimately given refunds. Although many have speculated that this decision was directly related to the LGBTQ content, it should be noted that local obscenity laws were vague, and the game included other racy elements as well.

game research involves a health-oriented “serious” game designed to reduce HIV risk behaviors among young men who have sex with men. This video game, which was developed by Lynn Miller and her research team, successfully reduced players’ perceptions of stigma and sexual shame, which in turn led to reductions in risky sexual behavior.

Scholarly Research and “Serious” Games

See also Film; Leisure; Media Representations of LGBTQ People; Visual Arts

Video games and gaming culture are increasingly attracting the attention of academics, particularly in the fields of social psychology and communication. However, research exploring games as they relate to LGBTQ people is sparse. This is perhaps because video game scholars have largely focused their efforts on understanding the downstream effects of gameplay such as aggression and hostility. As LGBTQ themes become increasingly visible, more relevant research is likely to emerge. Of note is the research program of Adrienne Shaw, who has conducted extensive work in this area. In a seminal article titled “Putting the Gay in Games: Cultural Production and GLBT Content in Video Games,” Shaw analyzed press coverage and interviews with game developers and journalists in an attempt to better understand this group’s representation in video games. Shaw concluded that important factors include attitudes toward this group held by members of the video game industry and the market and institutionalized risks associated with presenting non-normative sexualities on screen. A very different example of LGBTQ video

The Future of LGBTQ Gaming and Culture Video games have the power to affect the player’s attitudes, feelings, and behavior—for better or worse. Considering the potential impact of characters, storylines, and dialogue content during the design process benefits the LGBTQ community. It is clear that video games and gaming culture are becoming increasingly inclusive and, if this trend endures, people identifying as LGBTQ will continue to be positively affected by gaming. John L. Christensen

Further Readings Christensen, J. L., Miller, L. C., Appleby, P. R., Corsbie-Massay, C., Godoy, C. G., Marsella, S. C., et al. (2013). Reducing shame in a game that predicts HIV risk reduction for young adult men who have sex with men: A randomized trial delivered nationally over the web. Journal of the International AIDS Society, 16(3 Suppl. 2). Miller, L. C., Christensen, J. L., Godoy, C. G., Appleby, P. R., Corsbie-Massay, C., & Read, S. J. (2009). Reducing risky sexual decision-making in the virtual and in the real-world: Serious games, intelligent agents, and a SOLVE Approach. In U. Ritterfeld, M. Cody, & P. Vorderer (Eds.), Serious games: Mechanisms and effects (pp. 429–447). New York, NY: Routledge. Shaw, A. (2009). Putting the gay in games: Cultural production and GLBT content in video games. Games and Culture, 4(3), 228–253. Shaw, A. (2010). What is video game culture? Cultural studies and game studies. Games and Culture, 5(4), 403–424.

Gangs

GANGS This entry explores both the participation of LGBTQ persons in heterosexual street gangs and the recent emergence of exclusively gay and lesbian gangs. Street gangs are visible, violent groups that engage in regular criminal activity. Members represent their gangs through communication rituals such as complicated handshakes and the public display of gang-like attributes, such as tattoos and graffiti. Although there is a large body of research in the general area of gangs, there is scant information on LGBTQ gang members. Existing gang prevention and intervention programs do not address the needs of sexual minorities. For this reason, it is important to identify pathways into and out of gangs, as well as the roles and activities of LGBTQ members. Street gangs have some stability over time. They typically claim an area, or turf, which they protect from rival gangs. This may be a housing project, a school, or an area they claim to be exclusively their own for drug distribution. Street gangs rely on violent entry and exit rituals—vicious beatings for men, beatings or gang rapes for women—to protect them from outsiders. Marginalized ethnic and racial minorities, including indigenous peoples, dominate membership. While some gangs have members mainly from a single group, an increasing number of gangs have a multiracial and multiethnic membership. Many gang members, not just LGBTQ members, talk about the identity, sense of belonging, and acceptance they get from their gangs. They talk about their gangs as “family.” Although rare, there are some documented examples of lesbian and gay gangs. Dykes Taking Over (DTO) was an African American lesbian youth gang in a school in Philadelphia, created by lesbian students in early 2000s to retaliate against homophobic peers and also to express their gender. The DTO bullied and harassed those female students who had victimized them. The Gay Boy Gangsters (GBG) is a prison gang in California active in “sensitive needs yards,” which are designated for inmates who require special protection, including

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gay men. Members of the GBG are typically former members of other, mainly heterosexual gangs. Lesbian relations among members of all-female gangs have also been documented. The 1960s Vice Queens of Chicago was the African American female auxiliary to the male-dominated Vice Kings. The Vice Queens reported a preference for samesex intimate relations as an avenue out of chronic sexual violence and forced prostitution by the Vice Kings. Other qualitative research suggests that there are LGBTQ members of male-dominated heterosexual gangs. These members seem to go to great lengths to hide their identities and fear that they will be severely harmed if discovered by other gang members. Interestingly, they participate in violent victimization and sometimes homicides of persons perceived to be sexual minorities. Canadian researchers have identified a number of pathways into gang life: victimization by chronic and severe violence at a young age, particularly in families; multiple placements in child welfare and youth justice facilities; being born into “super-gang families”; economic and racial marginalization; experiencing brain injuries and serious mental health and behavioral disorders; addictions; and the formation of hypermasculine and sexualized feminine gender identities. Gang involvement is typically the result of a multitude of risk factors across many domains (e.g., family, peer, school, community, and psychological). LGBTQ youth who are gang-involved typically have experienced many of these risk factors, which predispose them to gang behavior. Further, there is the added risk of suffering homophobic bullying, violence, and harassment. This victimization takes place at school, in the community, and in the family. The impacts of homophobic bullying described in almost all studies include suicide and emotional problems, addictions, and school failure, among others. Recent studies suggest that LGBTQ youth are more likely than heterosexual youth to carry weapons, fight, and be involved in gangs. Physical fighting by LGBTQ youth is likely a response to homophobic victimization. Fighting serves to counter disrespect and create a violent

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Gay, Lesbian & Straight Education Network (GLSEN)

identity. Fighting also serves as a strategy to construct and express gender identity. Displaying violent identities in the gang can thus enhance personal safety and provide LGBTQ members with alternative strategies of “doing” gender. Some lesbian gang members display hypermasculine behavior, where the traditional male gender role is pursued to the extreme. There is an emphasis on violence, toughness, independence, and sexuality. The gang is a space to construct nontraditional identities. Lesbian gang members resist and negotiate gender roles outside of traditional femininity. Many gang members—both those who are LGBTQ and those who are heterosexual—bash persons perceived to be gay. How can we understand this violence? Sexual minority gang members are concerned about self-preservation. They protect their own self-image and personal safety by publicly denying any affiliation with gay culture. They may also have internalized homophobia— that is, a hatred for themselves. Feelings of guilt, shame, and self-hatred are rooted in rejection by their families and experiences of bullying and other forms of intolerance. Heterosexual members could be motivated to victimize gays because of repressed same-sex urges. Bashing may represent a strategy to cover up sexual and gender anxieties. Thus, the gang provides a social space to construct and express alternative gender roles—a very complex matter with many variations. Theories must take into account the distinct differences in these gender strategies displayed by LGBTQ gang members. Their construction and doing of gang identities is likely distinct from their relations with others outside of the gang context. Their actions can be seen as a means of resisting gender oppression within and outside of gangs. The dynamics of LGBTQ involvement in hardcore street gangs need further exploration. Evidence-based counseling approaches are needed. Counselors require information on strategies known to work to resist gang recruitment and safely support gang exit. This is inherently risky, however, given the severity of violence engaged in by many gang members. Mark Totten

See also Bullying, Rates and Effects of; Criminal Legal System and LGBTQ People; Hypermasculinity; Internalized Homophobia; Violence and Victimization of Youth

Further Readings Johnson, D. (2007). Taking over the school: Student gangs as a strategy for dealing with homophobic bullying in an urban public school district. Journal of Gay and Lesbian Social Services, 19(3/4), 87–104. Panfil, V. (2014). Gay gang- and crime-involved men’s experiences with homophobic bullying and harassment in schools. Journal of Crime and Justice, 37, 79–103. Totten, M. (2012). Gays in the gang. Journal of Gang Research, 19(2), 1–24. Totten, M. (2012). Nasty, brutish, and short: The lives of gang members in Canada. Toronto, ON, Canada: James Lorimer.

GAY, LESBIAN & STRAIGHT EDUCATION NETWORK (GLSEN) GLSEN, the Gay, Lesbian & Straight Education Network, is the leading national education organization focused on ensuring safe schools for all students. Established in 1990, GLSEN envisions a world in which every child learns to value and respect all people, regardless of sexual orientation or gender identity/expression. This entry explores GLSEN’s major contributions to advancing LGBTQ issues in K–12 education. GLSEN works toward school climates in which differences are valued for their contributions toward a more vibrant, diverse community, and strives to assure that each member of every school community is valued and respected. GLSEN works with educators, policy makers, community leaders, parents, and students on the urgent need to address anti-LGBTQ behavior and bias in schools. GLSEN provides public education about LGBTQ experiences in K–12 schools, protects students from bullying and harassment, advances safe schools laws and policies, and empowers educators to make their schools safer.

Gay, Lesbian & Straight Education Network (GLSEN)

Organizational History GLSEN formed in 1990 as the Gay and Lesbian Independent School Teachers Network (GLISTN). A group of teachers from Massachusetts independent schools dedicated themselves to improving an education system that frequently allowed its LGBTQ students to be bullied, discriminated against, or marginalized at school. At that time, LGBTQ-inclusive education resources were rare: There were only two gay–straight alliances (GSAs) in the United States; only one state with legislation in place to protect LGBTQ students; and few, if any, LGBTQ-related training and curricula available for teachers. The organization grew quickly and expanded to include educators from all types of private and public K–12 schools. Like-minded educators and advocates began to establish GLISTN chapters all across the country, advocating locally for LGBTQ students. In 1995, GLISTN became a national organization and hired its first full-time staff person, cofounder and executive director Kevin Jennings. To better reflect the organization’s focus on safe schools for all students, the organization changed its name to the Gay, Lesbian & Straight Education Network, or GLSEN, in 1997. The national office currently supports local chapters across the United States that bring educator training, days of action, resources, events, and expertise to over 35 regions of the country.

Research In 1999, GLSEN responded to a paucity of national research on LGBTQ adolescents by launching its first biennial National School Climate Survey. It remains one of the few studies to examine the school experiences of LGBTQ secondary students nationally, documenting the occurrence and impact of negative aspects of school climate such as biased language, victimization, and discrimination, as well as the availability and effects of supportive school resources such as GSAs and supportive educators. GLSEN’s research has expanded the knowledge base on LGBTQ issues in education by examining the attitudes, beliefs, and

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experiences of other education community members, including general populations of elementary and secondary students, teachers, and principals; LGBTQ parents and their children; and others. GLSEN also assesses the effectiveness of the organization’s programs.

Public Education GLSEN’s research and evaluation efforts serve as a foundation for public education efforts about LGBTQ issues in K–12 education and recommended interventions for creating safer schools. Findings are disseminated to the public via freely available reports, media coverage, and public service announcements (PSAs), including a national, multiyear partnership with the AdCouncil: Think B4 You Speak, featuring print, radio, television, and web messages discouraging the use of anti-LGBTQ language among young people.

Student Activism GLSEN supports student advocates and their adult allies organizing in their schools and communities by providing free resources, products, and events for fostering inclusive school environments for all, including providing resources and activities for GSAs, initiating activist campaigns on social media, supporting student-led initiatives such as Transgender Student Rights, and sponsoring national days of action such as the National Day of Silence and No Name-Calling Week.

Curricular and Training Resources GLSEN is a preeminent provider of educator training, tools, and resources to combat anti-LGBTQ bias and promote respect in schools, and it provides professional development for thousands of educators each year, both directly and in partnership with national and local agencies. Offerings range from curriculum guides to national training programs and cover a wide variety of topics related to developing safe, respectful, and inclusive schools, including the Safe Space Kit, for educators supporting LGBTQ middle and high school

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students, and Ready, Set, Respect!, a toolkit for fostering respect in elementary schools.

Public Policy GLSEN believes that a quality K–12 education is a fundamental right of every American. It works with policy makers at the local, state, and federal level to ensure that the best and most inclusive safe schools policies are considered, passed, and implemented, including nondiscrimination and antiharassment policies that contain protections for LGBTQ students. GLSEN’s National Safe Schools Partnership includes more than 100 member organizations that support and participate in GLSEN’s work to pass federal anti-bullying legislation, the Safe Schools Improvement Act.

International Efforts GLSEN’s safe schools work in the United States has earned the organization an international reputation for its expertise on LGBTQ issues. GLSEN has spearheaded the creation of an international network of nongovernmental organizations (NGOs), scholars, and advocates to make the world safer for LGBTQ youth. In 2013, GLSEN convened a meeting in partnership with the United Nations Educational, Scientific, and Cultural Organization (UNESCO) to discuss homophobic and transphobic prejudice and violence in schools worldwide. Madelyn J. Boesen and Joseph Kosciw See also Bullying, Legal Protections Against; Bullying, Rates and Effects of; Bullying, School-Based Interventions for; Education; Gay–Straight Alliances (GSAs); No Promo Homo Policies; School Climate; School Professionals’ Responses to LGBTQ Training

Further Readings Gay, Lesbian & Straight Education Network. http://www .glsen.org GLSEN. (2013). The Safe Space Kit: Guide to being an ally to LGBT students. New York, NY: Author. Harris Interactive. (2012). Playgrounds and prejudice: Elementary school climate in the United States. New York, NY: GLSEN.

Kosciw, J., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools. New York, NY: GLSEN.

GAY EXCLUSION IN THE U.S. MILITARY: EVOLUTION AND DEMISE OF DON’T ASK, DON’T TELL Title 10 of the U.S. Code, Section 654, entitled “Policy Concerning Homosexuality in the Armed Forces,” was passed into law in 1993 and became commonly known as Don’t Ask, Don’t Tell (DADT). DADT expressly forbade open homosexuality in the U.S. military. It required that a member of the U.S. armed forces be separated from military service if she or he had (1) engaged in, attempted to engage in, or solicited another to engage in a homosexual act; (2) had stated that she or he was homosexual or bisexual; or (3) had married or attempted to marry a person known to be of the same biological sex. During the 17 years in which DADT was in force, more than 13,000 gay, lesbian, and bisexual service members were forcibly separated under the policy. DADT was not a spontaneous political issue from the 1990s, but rather a deep-seated cultural issue that began to emerge after World War II and continued to evolve over the next six decades. In September 2012, after certification by the commander in chief, secretary of defense, and chairman of the Joint Chiefs of Staff, DADT was finally rendered obsolete, at which point it became permissible to serve openly in the U.S. military irrespective of one’s sexual orientation. This entry describes the historical context that gave rise to the evolution and decline of DADT and related legislation from 1949 to 2011.

Early History Active exclusion of gay, lesbian, and bisexual service members prominently emerged during the middle of the 20th century at the onset of the Cold

Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell

War. With manpower overages at a peak following the conclusion of World War II, the U.S. military became increasingly selective about who would be allowed to serve. In 1949, the U.S. Navy implemented the first regulation expressly prohibiting homosexuality within its ranks. Secretary of the Navy Directive 1620.1 stated that “homosexuals were liabilities to the service, and must be discharged.” Army Regulation 635–443 (in 1950) and Air Force Regulation 35–66 (in 1951) soon followed with similar prohibitions. Although military policy continued to prohibit gay and lesbian military members from serving openly, results from legal challenges to the gay exclusion policy in the decades to follow would serve to establish a precedent toward acceptance.

Legal Challenges By the time the Vietnam War had drawn to a close in 1975, legal challenges to the military’s gay exclusion policy began to assert that homosexual service members were worthy of the same legal safeguards that heterosexual service members enjoyed. At the same time, federal court decisions began to identify problems in how the Pentagon enforced its gay ban. In one landmark case, Leonard Matlovich, a Vietnam veteran and Purple Heart recipient, openly admitted that he was gay. Despite his exemplary record, he was immediately discharged in 1975. However, in 1978, a U.S. Court of Appeals ruled against the Pentagon that Matlovich had, in fact, been wrongly dismissed from the military due to his sexual orientation. In a second landmark case, Miriam Ben-Shalom was discharged from the military in 1975 based on her admission to a reporter that she was a lesbian. Consistent with the previous standard set by the Matlovich case, the court ruled in favor of BenShalom that discharging her on her statements alone was a violation of her right to free speech.

Formalized Policy In the wake of these landmark cases, Pentagon leaders quickly acknowledged that the current gay exclusion policy was legally unenforceable because

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it could not be applied in a consistent fashion. In a proactive move to strengthen the policy, then– Deputy Secretary of Defense Graham Claytor announced a change, proclaiming that “homosexuality is incompatible with military service” and that anyone who “engages in, has attempted to engage in, or has solicited another to engage in a homosexual act” be immediately discharged without exception. By 1982, the Pentagon formalized the gay ban using the following rationale: The presence of [homosexuals] adversely affects the ability of the Military Services to maintain discipline, good order, and morale; to foster mutual trust and confidence among servicemembers, to ensure the integrity of the system of rank and command; to facilitate assignment and worldwide deployment of servicemembers who frequently must live and work under close conditions affording minimal privacy; to recruit and retain members of the Military Services; to maintain the public acceptability of military service; and to prevent breaches of security. (DoD Directive 1332.14, January 28, 1982)

For the next several years, the issue faded from the political spotlight, as the revised policy seemed to be congruent with public sentiment.

Public Sentiment Until the late 1980s, public attitudes toward homosexuality in the military were sufficiently subdued as to exert very little pressure on military leaders to change the policies toward gays in the military. It was generally assumed that because military leaders deemed the exclusion of gay men and women from service as in the best interests of the military, it was logical that such a policy position was also likely in the best interests of the U.S. public. However, public sentiment changed in 1989 with the release of the Crittenden Report. Commissioned more than 30 years prior, in 1957, and named for the senior U.S. naval officer who served as committee chairman, the Crittenden Committee had been charged to investigate potential military-security risks posed by gay sailors. In its final analysis, the Crittenden Report concluded there was no evidence

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to “support the contention that homosexuals are a greater risk than heterosexuals.” Questions emerged as to why the military had concealed the report from public view until a federal court ordered it to be released in 1989. The controversy rekindled the discussion over the efficacy of the current exclusionary policy toward gay and lesbian military members. This rekindled debate quickly became part of the national political dialogue once more.

The Rise of DADT In 1992, Bill Clinton, then a presidential candidate, announced at a campaign stop that if he were to be elected, he would ensure that all men and women, regardless of sexual orientation, would be permitted to serve openly in the U.S. military. This campaign pledge became a rallying cry among members of Congress who opposed such a change in policy. Knowing that a sitting president, as commanderin-chief of the U.S. military, could make good on such a promise, opposition legislative leaders preemptively began drafting legislation to prevent such unilateral action. Later that year, Bill Clinton was elected president and the issue of “gays in the military” became a top priority—for both major political parties. As the national debate over the efficacy of open homosexual military service continued, two key studies were released in 1993. The first was a report by the Government Accountability Office (GAO), which reviewed experiences of four Western allied nations—Canada, Germany, Israel, and Sweden—countries that had previously banned open homosexual service and had since reverted to more inclusive policies. The GAO report stated that “military officials in all four countries said that the presence of homosexuals in the military is  not an issue and has not created problems in the  functioning of military units.” Likewise, a study conducted in the same year by the RAND Corporation reviewed all available data pertaining to unit cohesion from six foreign militaries. The  RAND report concluded that “none of  the  militaries studied for the report believed their  effectiveness as an organization has been impaired or reduced as a result of the inclusion of

homosexuals.” Nevertheless, despite the growing evidence to the contrary, Congress passed, and the president signed, legislation that codified into law the gay exclusion policy (10 USC 654 or Public Law 103–160, 1993) that became commonly known as Don’t Ask, Don’t Tell. This compromise policy permitted military service, without questioning the issue of sexual orientation, for any person otherwise deemed qualified to serve, just so long as no admission of being gay or evidence of homosexual behavior was made known. Gay and lesbian members of the military would be allowed to serve, but they would have to do so in silence about their orientation, or risk administrative separation. Although unknowable at the time it was passed in 1993, DADT would persist as the governing policy for the next 17 years.

Data-Driven Analysis By the mid-1990s, researchers who examined data gathered from allied Western nations concluded there were no negative impacts from repeals of laws similar to DADT in other countries such as Australia, Canada, and Israel. When the British government finally lifted its ban on gays in the military in 2000, both advocates and opponents of DADT repeal in the United States paid very close attention. Great Britain provided a direct test of the claims on which the U.S. policy had been built, regarding the effects on unit cohesion, morale, and military effectiveness. Nine months after the British repeal took effect, Britain’s Ministry of Defence published a report that found policy implementation to be better than anticipated and to have “fewer problems than might have been expected.” There were “no reported difficulties of note concerning homophobic behavior amongst Service Personnel.” The report concluded that “there has been a marked lack of reaction” to the change. In essence, the biggest story regarding repeal of the ban was no story at all.

The Demise of DADT Despite the growing evidence refuting claims that open homosexuality would harm unit cohesion,

Gay Gentrification

military effectiveness, and morale, societal attitudes toward open homosexuality in the military began to change. Trends among public opinion polls that had originally showed a majority of American citizens opposed to openly gay service in 1993 showed a marked change by 2008, with a significant majority of Americans supporting a move to repeal DADT. In light of this changed attitude, Congress ordered the Pentagon in 2010 to evaluate potential effects of repealing DADT. During the next 9 months, in one of the largest studies ever conducted by the military, the 68-member committee, which formed the Comprehensive Review Working Group (CRWG), solicited the opinions of nearly 400,000 individuals. In its final 266-page report submitted to Congress, the Pentagon’s CRWG concluded that the risk to repealing the law was “low.” Almost 70% of the 115,000 respondents believed that DADT repeal would have a positive or neutral result. As a result, in December 2011, Congress passed and President Barack Obama signed the Don’t Ask, Don’t Tell Repeal Act of 2010 (Pub.L. 111–321, 2011), making the United States the 36th country in the world to allow open homosexual service in the military, and the 26th NATO nation (out of 28) to do so.

Conclusion Since the full implementation of the DADT repeal in September 2012, several studies have been conducted to identify negative effects of open homosexual service in the United States. To date, no such negative effects have been found. James E. Parco See also Military and LGBTQ People; Military and Transgender People

Further Readings Belkin, A. (2011). How we won: Progressive lessons from the repeal of “Don’t Ask, Don’t Tell.” New York, NY: Huffington Post Media Group. Don’t Ask, Don’t Tell Repeal Act of 2010. Pub. L. 111-321, 124 Stat. 3515 (2010).

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Frank, N. (2010). Unfriendly fire: How the gay ban undermines the military and weakens America. New York, NY: Thomas Dunne Books. Ham, C., & Johnson, J. (2010). Comprehensive Working Group report on the issues associated with a repeal of Don’t Ask, Don’t Tell. Washington, DC: Government Printing Office. Parco, J. E., & Levy, D. A. (Eds.). (2011). Attitudes aren’t free: Thinking deeply about diversity in the U.S. armed forces. Montgomery, AL: Air University Press. Parco, J. E., & Levy, D. A. (Eds.). (2014). Evolution of government policy towards homosexuality in the U.S. military: The rise and fall of DADT. London, England: Routledge. Policy Concerning Homosexuals in the Armed Services. Pub. L. 103-160, Sec 654, Title 10 (1993). Seefried, J. (2008). Our time: Breaking the silence of “Don’t Ask, Don’t Tell.” New York, NY: Penguin Books.

GAY GENTRIFICATION Gentrification is a contentious dimension of urban renewal. The term describes the process whereby rundown, industrial, marginal, low-income, or working-class neighborhoods are transformed into middle-class, wealthy residential neighborhoods or desirable entertainment or commercial precincts. Economic, demographic, and lifestyle shifts are bound up in the process. Gentrification entails transformations in the material aesthetic of the neighborhood, an increasing share of wealthier residents and commercial premises, rising rent and property prices, and the displacement of long-term residents and businesses unable to afford the increasing costs of local living. It is most commonly associated with changes, which started in the 1960s and are ongoing, in inner-city neighborhoods of large cities in the Global North. While gentrification is a broad urban renewal process, since the early 1980s a diverse range of commentators, planners, scholars, media outlets, and public officials have circumscribed a reputedly distinct gentrification trend associated with gay communities and the formation of “gayborhoods” (i.e., gay neighborhoods). This has been denoted as

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gay gentrification, and it is controversial within and beyond academia. The relationship between gay gentrification and broader gentrification trends is complex, yet it is often reduced to a simple narrative in mainstream discourse whereby gay men, in particular, are narrowly perceived as pioneers of gentrification and a bellwether of urban regeneration. This logic suggests that when gay men move into a neighborhood, gentrification follows. This notion has become embedded in popular culture across a range of countries, including the United States, the United Kingdom, Canada, and Australia, and is propagated by the discourse of estate agents, lifestyle media, property developers, and scholars who are influential in urban and regional planning (e.g., Richard Florida). Simultaneously, this rhetoric—if read within a critical framework—nevertheless draws attention to some catalysts, trends, and outcomes that can be understood to generate a specific set of gentrification experiences linked to LGBTQ people and communities. The initial point to emphasize is that while LGBTQ people in general are participants in gentrification, there is an especially strong association between gay men and urban renewal, as highlighted in popular discourse. This mainstream rhetoric stereotypes gay men as affluent, stylish, and domestically inclined, and therefore centrally concerned with the aesthetic-cum-economic revaluation of inner-city neighborhoods and their heritage housing stock. But those who have studied the postwar history of gay men’s involvement in gentrification find more sobering reasons for their role in urban change. Research on gay gentrification in the 1970s and 1980s in the United States, the United Kingdom, Canada, and Australia finds that the involvement of gay men in the renovation of housing and commercial premises in marginal or rundown innercity areas was not primarily a matter of economic need. Rather, it was a crucial part of the process of claiming a territorial base for subcultural definition and political organization. Gay territorialization (i.e., the territorial demarcation of gayborhoods, albeit porous, through the concentration of gay residents and institutions) and regeneration of inner-city neighborhoods was as a

response to wider social oppression. Gay men were prepared to pay a financial cost in order to create urban neighborhoods over which they might have some control, and thus contest their marginalization. These early gay gentrifiers included workingclass as well as middle-class men, itinerant service workers as well as professionals. While most gay gentrification processes are associated with gay men, there is also research on lesbian involvement in gentrification and in the creation of lesbian neighborhoods. Lesbian processes of territorialization were, and remain, limited, however, by generally lower incomes and more restricted access to finance. Nevertheless, neighborhoods such as Park Slope, Brooklyn (New York), and Northampton (Massachusetts) attained association with lesbian identities through women’s participation in urban renewal. Economic factors were thus important foundations for enabling gay men to pursue place-making through gentrification. Often free from responsibilities of marriage and children, gay men tended to have higher disposable incomes than oppositesex couples or lesbians. This enabled them to purchase cheap residential and commercial premises. But they were not alone in doing so; artists and bohemians have also been considered pioneer gentrifiers, in search of low-cost work and living spaces. What made these groups gentrifiers—gay men, artists, bohemians—was their embodiment of middle-class aesthetics of style and taste, or at least the assumption that they embodied and conveyed such aesthetics. These groups arguably changed the material environment, social life, and ambience of neighborhoods by bringing in new tastes and lifestyles. This shift to middle-class aesthetics made neighborhoods desirable to wealthier people, triggering property price rises. The result was the displacement of long-term working-class and low-income residents. Gay gentrification has thus been accompanied by negative impacts on existing residents and businesses. Gentrification, however, is a multifaceted and ongoing process. Pioneer gentrifiers are often followed by ever-wealthier gentrifiers as neighborhood desirability and property costs continue rising. This is called super-gentrification or

Gay Sperm Donors

resurgent gentrification, and research has examined its effects on gayborhoods, that is, on neighborhoods regenerated through gay gentrification, which came to be identified as gay neighborhoods. In these contexts, middle-class gayborhoods take on a cultural cache, a cutting-edge coolness, which attracts wealthy heterosexual residents. The influx of heterosexual couples and “family values” again changes the lifestyle and atmosphere of the neighborhood and further exacerbates the rise of property and living costs. Consequently, just as gay gentrifiers initially displaced existing residents, they too are often displaced by super-gentrification. Resurgent gentrification has been identified as a critical threat to gayborhood longevity, contributing to “de-gaying” neighborhoods. Andrew Gorman-Murray See also Gayborhoods; Spatial/Social Location of LGBT Persons

Further Readings Brown, M. (2014). There goes the gayborhood. Progress in Human Geography, 38, 457–465. Collins, A. (2004). Sexual dissidence, enterprise and assimilation: Bedfellows in urban regeneration. Urban Studies, 41, 1789–1806. Doan, P., & Higgins, H. (2011). The demise of queer space? Resurgent gentrification and LGBT neighborhoods. Journal of Planning Education and Research, 31, 6–25. Forsyth, A. (1997). NoHo: Upscaling Main Street on the metropolitan edge. Urban Geography, 18, 622–652. Knopp, L. (1995). Sexuality and urban space: A framework for reference. In D. Bell & G. Valentine (Eds.), Mapping desire: Geographies of sexualities (pp. 149–161). London, England: Routledge.

GAY SPERM DONORS Since the 1970s, gay men have acted as sperm donors, primarily for lesbian recipients. This entry outlines the reasons for this history and the legal complexities that arise from it for both donors and recipients. Specifically, the entry suggests that the

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assumption that gay men may constitute ideal donors for lesbian recipients overlooks the competing motivations that may lead gay men to donate sperm. The entry then examines some of the motivations that lead gay men to act as sperm donors as documented in empirical research, and the challenges that may arise for some men (and the women to whom they donate sperm) as a result of these motivations. The entry ends by considering what the future holds for the role of gay men as sperm donors. As a whole, this entry highlights both the vulnerabilities that gay men face as donors in wider heteronormative contexts, and also the privileges they hold as men living in patriarchal societies.

Historical and Legal Background Until relatively recently, lesbian women in Western societies (both single women and couples) were unable to access donor sperm in clinics due to legislation that prevented them. In many jurisdictions, this has also been the case for single heterosexual women. For these reasons, various groups of people, including lesbians, have historically sought options outside of clinics to achieve a pregnancy. Although socially the prohibitions placed on lesbian women outlined above were also placed on gay men (in terms of donating sperm to clinics), this has not prevented lesbian women (and in some instances heterosexual women) from negotiating with gay men to donate sperm to them in private arrangements outside of clinics. There are a number of reasons why gay men have been seen as likely and supportive sperm donors to lesbian women. The first is the assumption that, given that both lesbians and gay men experience homophobia, there would be unity or a sense of community in the face of that homophobia, which would lead gay men to support lesbian women’s reproductive desires. The second reason is the assumption by many gay men that identifying as gay meant that they would not have children. For some gay men, then, donating sperm offered the possibility of fulfilling a desire to have children, or to at least leave a genetic record of themselves in the world.

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The two reasons why some lesbian women have considered gay men viable sperm donors are, it may be suggested, to a degree contradictory. On the one hand, gay men are often seen by lesbian women as altruistic and politically motivated, while on the other hand, they are potentially seen as fulfilling their own desires (that is, wishing to have a child or leave a genetic record of themselves in the world). These contradictory motivations have in some cases led to disputes between gay sperm donors and lesbian recipients over the custody of children conceived of the donation, specifically where lesbian recipients have presumed that the gay man would have no involvement in the child’s life, whereas after the birth of the child the gay man has petitioned for access to the child. In Australia, the United States, and the United Kingdom, high-profile cases have demonstrated that allegiances between gay sperm donors and lesbian recipients are not always successful, and that some courts may display an investment in “finding a father” for children conceived by lesbian women, leading them to rule that gay men are entitled to access to children conceived of their sperm.

Motivations and Challenges for Gay Men Donating Sperm Research on gay men’s motivations to donate sperm has consistently highlighted the altruism– self-motivated binary outlined above. That is, gay men may be motivated to help others by donating sperm but may also be motivated to fulfill their own desire to have children or leave a genetic record of themselves in the world. In terms of some gay men’s desire to be involved with children conceived of their sperm, empirical research suggests that this is a positive aspect of gay men’s role as sperm donors, given momentum across Western countries toward the release of identifying information to donor-conceived children. Yet at the same time, research also suggests that gay men who agree to act as sperm donors with the motivation that they would like to be a parent (or at least have a relationship to a child) may find themselves challenged when it comes to respecting

the agreement they have entered into with recipients (which in most cases does not involve a coparenting arrangement). Further, it has been suggested that as sperm donors gay men must negotiate forms of “emotion work” specific to them as gay men. The first of these is highlighted above, in terms of gay men who may feel that identifying as gay prevents them from having children. Donating sperm, then, may be challenging in that it activates parental desires that may potentially remain unfulfilled. For gay men who donate in the context of clinics (which is now possible in many countries), there is the possibility of heterosexism. Research has suggested that clinic staff may discriminate against gay men in explicit ways, or that gay men may experience more subtle forms of marginalization (such as the lack of gay-specific information or materials). Finally, in terms of challenges, gay men may find that the regulation of their sexuality and sexual activity when donating sperm contributes to a broader sense of sexual regulation that arises from living in heteronormative societies. While it is often presumed that sperm donation is simply a physical act, research has consistently reported that there is emotion work attached to sperm donation. Although this is true for all men, it may be especially exacerbated for gay men who may already feel like their sexuality and sexual activity are not recognized or condoned.

The Future Regarding the future of gay men as sperm donors, in part this will continue to be mediated by changes to legislation. In most Western countries, lesbians or single women can now access donor sperm in clinics, and to a degree this has lessened the demand upon such women to identify and negotiate with donors in private arrangements. Nonetheless, some women continue to prefer private arrangements, and some women cannot afford access to clinics. Beyond legislation, and as has long been the case in terms of lesbian and gay kinship formation, some lesbians and gay men will likely continue to enthusiastically and intentionally

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enter into coparenting arrangements. Finally, and given legislative changes allowing gay men to donate sperm to clinics, there has been a rise of promotional materials by clinics targeting gay men as donors. The role of gay men as sperm donors is thus likely to continue, and it warrants ongoing attention. Damien W. Riggs See also Coparenting; Heterosexism; Sperm Donor, Choosing a; Sperm Donors, Known; Sperm Donors’ Involvement in Children’s Lives

Further Readings Dempsey, D. (2012). More like a donor or more like a father? Gay men’s concepts of relatedness to children. Sexualities, 15, 156–174. Riggs, D. W. (2009). The health and well-being implications of emotion work undertaken by gay sperm donors. Feminism & Psychology, 19, 517–533. Ripper, M. (2008). Australian sperm donors: Public image and private motives of gay, bi-sexual and heterosexual donors. Health Sociology Review, 17, 313–325. Van Reyk, P. (2007). Baby love: Gay donor father narratives of intimacy. Gay and Lesbian Issues and Psychology Review, 3, 44–52.

GAYBORHOODS Gayborhood is a term used to describe neighborhoods, especially urban neighborhoods, that are populated by and associated with LGBTQ people and communities. Arguably, the term is most commonly used in North America, and is equivalent to descriptions deployed in other places, including gay ghetto, gay village, or simply a gay and/or lesbian neighborhood. A neighborhood can be understood to be a gayborhood if it (a) contains a cluster of LGBTQ institutions, both commercial (bars, clubs, cafes, bookstores, shops) and service-oriented (legal, health, and community organizations); (b) houses a substantial residential LGBTQ population; and (c) has conspicuous, locally dominant

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LGBTQ subculture(s). The LGBTQ presence is sufficiently embedded and visible in society that gayborhoods have mainstream recognition. Owing to the spatial concentration of LGBTQ populations, institutions, and subcultures, gayborhoods have symbolic as well as physical significance for LGBTQ people. They provide a touchstone of LGBTQ community and placemaking, and are perceived as beacons of acceptance and social connection for—at least some—LGBTQ people. This symbolism is essential for the development and consolidation of gayborhoods, drawing LGBTQ migrants through gravitational migration (i.e., attraction to like-minded others, subculture(s), and support institutions). Indeed, most internationally recognizable examples of gayborhoods are located in inner-city areas in the Global North, and this urban characteristic underpins their material fabric, symbolism, and centrifugal force; they include the Castro (San Francisco, USA), Greenwich Village (New York, USA), West Hollywood (Los Angeles, USA), Soho (London, UK), The Village (Manchester, UK), Church-Wellesley Village (Toronto, Canada), and Oxford Street, Darlinghurst (Sydney, Australia). These gayborhoods began developing in the post–World War II era, during the 1950s, 1960s, and 1970s. Catalysts varied from country to country and between cities, depending on national and regional circumstances. San Francisco, for instance, became home to a gayborhood in the Castro partly due its role as the demobilization site for dismissed American armed services personnel. Sydney, however, began to house a gayborhood around Oxford Street in the 1960s due to low rent costs and a reputed libertine culture vis-à-vis other Australian cities. Both economic and social conditions contribute, even if specific catalyzing circumstances vary. This is noted in Alan Collins’s model of gayborhood evolution in a 2004 article in Urban Studies: from LGBTQ people and institutions occupying cheap, marginal inner-city areas; to consolidation and expansion; to possible mainstream colonization and property price increases that may force out LGBTQ people and institutions and lead to gayborhood decline.

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As well as socioeconomic models of gayborhood development, researchers have examined their political dimensions. Work conducted across the Global North documents the consolidation of gayborhoods as a form of social and political territorialization (i.e., territorial demarcation, albeit porous, through concentration of gay residents and institutions) based on economic capacity. The materialization of a gayborhood provides a site of social inclusion vis-à-vis the heteronormative mainstream, and a concentrated voting bloc. In this sense, social and political territorialization is a way of creating a geographical base for rights claims at various levels of government, from local to national. These same LGBTQ social and political territories are also sites of exclusion. Commentators have pointed out that most gayborhoods have been created by and for gay men—largely White, middleclass gay men who are able to afford residential and/or commercial property, with surplus income to spend in local businesses. Both subtle and overt exclusions operate along lines of gender, race, and class, as well as age and ability, and many gayborhoods are seen as places primarily for the comfort and privilege of White, middle-class gay men. The gender, race, and class exclusions of gayborhoods have impelled the development of alternative neighborhoods for fractions of LGBTQ communities. For instance, scholars have documented the development of lesbian neighborhoods in the Global North, including Park Ridge, Brooklyn (New York); Northampton (Massachusetts); Hebden Bridge (West Yorkshire, UK); West End (Vancouver, Canada); Leichhardt (Sydney, Australia); and Alice Springs (Northern Territory, Australia). Lesbian neighborhoods are less visible in terms of commercial venues, but nevertheless demonstrate a residential concentration. The fewer commercial premises are attributed to women’s lesser economic resources and different modes of social interaction. A range of studies in the Global North also find race- and age-based exclusions operable in gay (male) neighborhoods and institutions. Forms of socialization and subculture in gay commercial venues often favor White, youthful bodies. In some gayborhoods, this has led to the development of

community organizations with services specifically for older men and men from diverse racial, ethnic, and linguistic backgrounds. The early 21st century has seen media and community concern over the “de-gaying”—the decline and “death”—of notable gayborhoods, including the Castro, Greenwich Village (New York), and Oxford Street (London). In his evolutionary model, Collins forecasts the possible decline of gayborhoods when mainstream popularity pushes property costs beyond the means of most LGBTQ people and businesses. The community and subculture cannot be sustained under such economic conditions. Other factors also impel decline. Mainstream acceptance renders gayborhoods unnecessary for territorial protection. The uptake of online social media (the Internet, mobile apps) makes it possible for LGBTQ people to meet and socialize without need for physical gathering spaces. In this context, scholars are now researching new forms that gayborhoods are beginning to take, as post-gay or queer-friendly neighborhoods, where LGBTQ people and communities are present and visible as part of a broader social mix. Places such as Newtown (Sydney, Australia); London’s East End (UK); and Parkdale (Toronto, Canada) might be emblematic of new materializations. A  range of possibilities remains open, however, including gayborhood revival, queer-friendly alternatives, and mainstream assimilation. Andrew Gorman-Murray See also Gay Gentrification; Spatial/Social Location of LGBT Persons

Further Readings Brown, M. (2014). There goes the gayborhood. Progress in Human Geography, 38, 457–465. Collins, A. (2004). Sexual dissidence, enterprise and assimilation: Bedfellows in urban regeneration. Urban Studies, 41, 1789–1806. Nash, C. J., & Gorman-Murray, A. (2014). LGBT neighborhoods and “new mobilities”: Towards understanding transformations in sexual and gendered urban landscapes. International Journal of Urban and Regional Research, 38, 356–372.

Gaydar Nash, C. J., & Gorman-Murray, A. (2015). Lesbians in the city: Mobilities and relational geographies. Journal of Lesbian Studies, 19, 173–191.

GAYDAR Gaydar, in its most general sense, refers to the ability (or inability) to sense whether someone is homosexual based on observation or intuition. Gaydar judgments can be made explicitly and deliberately, or unintentionally and outside of conscious awareness. Gaydar is deeply relevant in contemporary society because many arguments against legal nondiscrimination protections for homosexual people center on the premise that a homosexual person cannot be discriminated against if the person does not explicitly state his or her sexual orientation. Gaydar is also part of the daily lives of many people, regardless of sexual orientation, who are seeking to identify friends, mates, sexual competitors, sexual noncompetitors, and so on. Gaydar may be even more relevant to the daily lives of the targets of gaydar perceptions, who may or may not want their sexual orientation to be readily perceived, or who may be concerned that people will make incorrect gaydar judgments about them. Gaydar is a term of international significance, with presence as “gaydar” in languages including Spanish, French, Dutch, German, and Portuguese, and a transliterated presence in languages with non-Roman alphabets such as Hebrew, Russian, and Korean. Gaydar—a portmanteau comprising gay and radar that many dictionaries claim was first observed in the English language in the 1980s— can be informed by nearly any behavioral cue, verbal or nonverbal. However, basing a perception of a target’s sexual orientation on a target’s explicit declaration of sexual identity or on observed or recounted sexual behaviors violates the spirit of gaydar and does not constitute a gaydar judgment. For a perception to qualify as gaydar, it should be based only on cues that do not generally define sexual orientation. That is, a style of dress or manner of speaking may be associated with a certain

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gender or sexual orientation, but these cues are not accepted as defining sexual orientation. A person’s self-identification or sexual behaviors generally define his or her sexual orientation. Although the word gay is sometimes strictly defined as referring to gay men (and not as referring to gay men or lesbians), gaydar can refer to perceptions of men’s or women’s sexual orientation. Gaydar, like many informal or slang words, has been defined in many ways, both in scientific literature and in popular media, due to lack of consensus or historical basis. Some definitions of gaydar are so limited that they refer only to the ability of gay men to gauge other men’s sexual orientation. Other definitions are more generous about the perceivers (i.e., men or women of any sexual orientation) but still limit the definition of gaydar to apply only to perceptions of male targets. Going forward, ideally, the definition of gaydar should include perceivers of any gender or sexual orientation and any heterosexual or homosexual perceptual targets. Perceptions of people who do not identify as straight or gay/lesbian (such as those who identify as bisexual or pansexual) are not generally accepted as gaydar judgments. To date, there is no specific term for judgments of a person’s sexual orientation if that target person cannot be categorized as straight or gay. (Throughout this entry, gay refers to gay men and lesbians unless otherwise noted.) Published experimental research from the behavioral sciences has confirmed that gaydar exists, and that a perceiver’s gaydar can be fed by a variety of cues from the target person. These cues range from completely uncontrollable (e.g., distance between facial features) to completely controllable and subject to the target’s self-presentation preferences (e.g., clothing, hairstyle), or even the target’s environment and surroundings. Experiments have found gaydar abilities in both male and female perceivers, and for both male and female perceptual targets. Studies generally have not found consistent gender differences in gaydar abilities (neither in perceiver gender nor in target gender). However, it is important to note the limitations of most extant research. Current research has primarily or exclusively used heterosexual

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participants in the 18- to 25-year-old age range to make judgments, and has primarily used people of the same age range as perceptual targets. It is not yet known if people of other age groups can make gaydar judgments with above-chance accuracy, or if people can do so when the perceptual targets are of a different age group than the perceivers. It is likewise not currently known if gay perceivers’ gaydar accuracy is superior to the accuracy of their straight counterparts; researchers have faced challenges addressing this question owing to difficulty in recruiting gay people to participate in studies without causing them to suspect they were selected due to their sexual orientation. Gaydar judgments have been found to rely substantially on stereotypes of sexual orientation. The predominant stereotype of gay men is that they are relatively feminine, and the predominant stereotype of lesbians is that they are relatively masculine. These stereotypes are so prevalent in perceivers’ judgment processes that some experiments have shown that virtually any relatively feminine man’s face and virtually any relatively masculine woman’s face will be labeled as gay, regardless of the target person’s actual sexual orientation. Gaydar judgments do not, however, require stereotyped cues for them to be made with above-chance accuracy. For example, studies in which perceivers were shown only small portions of targets’ faces—with some facial portions small enough (e.g., the eye area) and controlled enough (e.g., no makeup, neutral facial expression) that they could not reasonably be believed to contain stereotyped content—still do yield gaydar judgments with above-chance accuracy. Joshua A. Tabak See also Coming Out, Disclosure, and Passing; Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Masculinity Stereotypes; Nondiscrimination Protections, State and Local; Sexual-Identity Labels; Strategic Disclosure

Further Readings Ambady, N., Hallahan, M., & Conner, B. (1999). Accuracy of judgments of sexual orientation from thin

slices of behavior. Journal of Personality and Social Psychology, 77, 538–547. doi:10.1037/0022-3514 .77.3.538 Freeman, J. B., Johnson, K. L., Ambady, N., & Rule, N. O. (2010). Sexual orientation perception involves gendered facial cues. Personality and Social Psychology Bulletin, 36, 1318–1331. doi:10.1177/ 0146167210378755 Johnson, K. L., Gill, S., Reichman, V., & Tassinary, L. G. (2007). Swagger, sway, and sexuality: Judging sexual orientation from body motion and morphology. Journal of Personality and Social Psychology, 93, 321–334. doi:10.1037/00223514.93.3.321 Rule, N. O., Ambady, N., Adams, R. B., Jr., & Macrae, C. N. (2008). Accuracy and awareness in the perception and categorization of male sexual orientation. Journal of Personality and Social Psychology, 95, 1019–1028. doi:10.1037/a0013194 Tabak, J. A., & Zayas, V. (2012). The roles of featural and configural face processing in snap judgments of sexual orientation. PLoS ONE, 7, e36671. doi:10.1371/ journal.pone.0036671

GAY–STRAIGHT ALLIANCES (GSAS) Gay–Straight Alliances (GSAs) are school-based student clubs that aim to make schools safer for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth. This entry discusses the historical context and growth of GSAs in North America, in addition to describing the characteristics of schools and communities where GSAs are typically located as well as their members. Next, the entry discusses the various roles that GSAs play in schools and for students, and it ends with a summary of how GSAs contribute to youth development and well-being.

GSA History and School and Member Characteristics The sections below provide a brief history of GSAs, including their beginnings on the East and West Coasts of the United States, and the legal challenges encountered when students were blocked from forming or continuing GSAs in their

Gay–Straight Alliances (GSAs)

schools. In addition, sociodemographic characteristics of the schools and communities where GSAs are located are described. Finally, a description of the types of students that typically join GSAs is provided. These descriptions provide insight for readers specific to when, where, and why students may face challenges in forming or joining a GSA, and opportunities for future research on how to ensure that GSAs are accessible to all students who would benefit from membership. History

GSAs and similar clubs, such as Project 10, were first organized in the late 1980s in Massachusetts (GSAs) and California (Project 10) by educators and community-based organizations. Today, there are more than 4,000 GSAs in middle schools and high schools in all 50 U.S. states and Puerto Rico; in addition, GSAs have been formed in Canada and Mexico, although there are fewer of them. Nonetheless, while GSAs are now present in schools across the United States, students and adult advocates (e.g., the club’s advisor, community and parent advocates) have encountered several barriers that have impeded or slowed the formation of GSAs in particular schools or school districts. In 1998, the American Civil Liberties Union (ACLU) and the National Center for Lesbian Rights (NCLR) filed a groundbreaking court case against the Salt Lake City (Utah) School District Board of Education after it prohibited students from forming a GSA. The ruling on this case—in addition to others that have followed— found that the U.S. Federal Equal Access Act of 1984 guarantees the right of students to form GSAs if their school receives federal funding and has at least one additional school-based extracurricular activity, thereby prohibiting exclusionary resistance by school administrators and school boards or districts. Notably, even though these initial court cases were settled in the late 1990s and early 2000s, LGBTQ students still encounter barriers that prohibit the formation of GSAs. For instance, other efforts to ban the formation of GSAs in schools have included allowing parents to decline permission for their children to

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participate in certain school clubs (e.g., Georgia state law), requiring parental permission forms to participate in all school-based extracurricular activities (e.g., Utah state law), or threatening to remove all school-based activities (e.g., Municipal School Board of Education in Farmington, New Mexico). In addition to efforts by the ACLU and NCLR to ensure the rights of LGBTQ students to form a GSA, three additional organizations have been critical to the GSA movement, including Lambda Legal, which has filed several legal cases against school districts that have attempted to ban the formation or continuation of GSAs; the Gay, Lesbian & Straight Education Network (GLSEN); and the GSA Network. Neither GLSEN nor the GSA Network officially organize or direct the dayto-day functions of GSAs, but both organizations do provide support and help to build capacity for students to form and sustain GSAs in their schools and to advocate for safer schools via various campaigns/actions (GLSEN’s Day of Silence), programs (GLSEN’s Changing the Game), and events (GSA Network’s Queer Youth Advocacy Day). Finally, several statewide coalitions have formed that provide support and advocacy for LGBTQ students and GSAs (e.g., New Mexico GSA Network). School and Community Characteristics

U.S.-based research has identified several unique characteristics of schools and communities that have GSAs, as compared with those that do not. Specifically, in the United States, GSAs are more likely to be formed in suburban or urban areas than in rural areas, and are predominantly located in the northeastern United States and on the West Coast. GSA formation has also been linked to schools’ financial capital (i.e., greater economic resources) and social capital (i.e., larger student enrollment). Finally, GSAs in the United States are more likely to be present in schools that have adopted nondiscrimination policies that include sexual orientation and in states that have organized coalitions that advocate for LGBTQ youth.

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GSA Member Characteristics

As with any other voluntary school-based extracurricular activity, GSAs include students and an adult advisor (typically a teacher or a school counselor). Given limited sampling frames (e.g., studies using convenience samples of a single GSA, or retrospective reports of young adults), the demographic makeup of GSAs is relatively unknown, although research does suggest that GSAs typically include large numbers of straight (heterosexual) students. Additional research suggests that LGBTQ youth who have already disclosed their sexual orientation or gender identity to others, youth who do not conform to societal gender norms, and White youth are more likely to be members of GSAs. The following paragraphs describe these characteristics in greater depth. Given that expectations of heterosexuality and conformity to binary gender roles and expressions are still enforced in schools and other societal institutions via bias-based bullying and harassment, the probability of a student joining a GSA may depend on the level of disclosure of his or her sexual orientation or preferred gender identity to other students, school personnel, and parents, guardians, or other family members (e.g., siblings). Thus, it may be “less risky” for students who have disclosed their orientation to others at school and home to be involved in GSAs, whereas those who have not disclosed this information to others may fear being “outed” if they attend a GSA meeting or event. Similarly, youth who are perceived to be LGBTQ because of their gender expression may already be the target of sexual orientation– or gender expression–based bullying or harassment, and therefore, membership in the GSA is less risky than for youth who conform to gender norms and are not read by others as a sexual or gender minority. Finally, research suggests that youth of color are less likely to join a GSA compared to their White, non-Latino counterparts. Several potential explanations for this disparity in involvement exist, including that youth of color need to perceive that they are represented in school-based clubs and other activities in order to feel like they belong. Thus, students of color may witness the lack of

racial and ethnic diversity within GSAs and be less likely to join. In addition, given that the focus of GSAs has traditionally been on promoting school safety and well-being for LGBTQ students, LGBTQ youth of color may need to seek out different clubs and activities that focus on their salient developmental needs, such as contexts that foster a sense of ethnic identity or ethnic pride. A third explanation for this disparity is the belief that communities of color conflate LGBTQ sexual and gender identities with “acting White,” and because the need for peer belonging and acceptance is particularly salient during adolescence, LGBTQ youth of color may avoid GSAs in order to be accepted by their peer group. Finally, and perhaps most importantly, if GSAs are predominately White, there may be actual or perceived barriers that exclude participation by youth of color in GSAs. Much more research is needed that examines how the intersection of sexual orientation and gender expression with race or ethnicity informs youths’ participation in GSAs, in addition to factors such as socioeconomic status.

Roles of GSAs GSAs serve several different roles for students and their schools, such as providing a safe place for LGBTQ youth and their straight allies in school environments that enforce compulsory heterosexuality and hegemonic masculinity. Because LGBTQ youth experience relatively high levels of biasbased bullying, victimization, and harassment at school, GSAs can and do serve as a place for LGBTQ youth to gather, have fun, provide support, and engage in advocacy efforts to increase safety and decrease bias-based incidents in the school context. The actual roles and functions of a particular GSA likely shift over time, depending on the needs of its members at any given time; for example, support may be more salient when a student member has recently disclosed his or her sexual orientation or gender identity to others and was met with resistance or rejection. Alternatively, advocacy efforts may be needed when school policies exclude members of the LGBTQ student

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community from student events (e.g., prom). Lastly, education efforts may be needed when students or school personnel have little understanding of sexual orientation or gender identity and expression. Notably, little research has been conducted on the variability of how GSAs spend their resources and time, and the implications of those roles for student well-being and school climate.

GSA Contributions to Student and School Outcomes Most of the scholarship on GSAs has focused on understanding whether GSAs promote well-being among LGBTQ students, and whether the presence of a GSA or GSA participation protects LGBTQ students against the harmful contribution of bias-based bullying, victimization, and harassment to poor academic and health outcomes. Research on the benefits of GSA presence in a school and GSA participation for students is discussed next, with the caveat that most research in this area is retrospective or cross-sectional and has not examined the prospective influence of GSAs on student well-being or school climate. Compelling evidence suggests that the presence of a GSA is associated with more positive student outcomes, such as greater academic achievement and fewer psychosocial and behavioral problems (e.g., lower suicide ideation and attempts). Further, the presence of a GSA has also been linked to more positive school climates for LGBTQ youth (e.g., less sexual orientation– or gender identity/expression– based bullying, victimization, and harassment; greater school safety). This evidence suggests that GSAs may positively contribute to the school environment via efforts to increase education and awareness of issues related to sexual orientation and gender identity and expression. At the individual student level, the presence of a GSA may be associated with more positive academic and psychosocial well-being because the mere presence conveys a message of belonging and acceptance by the school. Finally, the presence of a GSA may confirm that there are supportive adults in the school environment for LGBTQ students, which is a

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known promotive and protective factor for all youth, regardless of their sexual orientation or gender identity and expression. Although the promotive nature of GSAs has been well established, findings pertaining to whether the presence of a GSA protects against LGBTQ minority stress, such as school-based bullying, have been mixed: Some findings suggest that the presence of a GSA does buffer LGBTQ-related bullying, victimization, or harassment, whereas others have not found evidence for such protection. Relatedly, findings specific to GSA participation and youth outcomes have been somewhat mixed. Most of the research focused on GSA participation has not found that it is related to student academic or psychosocial well-being or that it protects against LGBTQ-related bullying, victimization, or harassment. Many of these studies utilized a dichotomized report of participation (any participation versus no participation). Thus, given the variability that likely exists in membership and actual levels of participation, it will be important for future research to capture how varying levels of participation, ranging from occasional participant to GSA leader, contribute to youth academic and psychosocial outcomes. Russell B. Toomey See also Bullying, Rates and Effects of; Gay, Lesbian & Straight Education Network (GLSEN); Resilience and Protective Factors, Youth; School Climate; Sexualities at School

Further Readings Fetner, T., & Kush, K. (2008). Gay–straight alliances in high school: Social predictors of early adoption. Youth & Society, 40, 114–130. Goodenow, C., Szalacha, L., & Westheimer, K. (2006). School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools, 43, 573–589. Griffin, P., Lee, C., Waugh, J., & Beyer, C. (2004). Describing roles that gay–straight alliances play in schools: From individual support to school change. Journal of Gay & Lesbian Issues in Education, 1, 7–22.

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Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: GLSEN. Poteat, V. P., Sinclair, K. O., DiGiovanni, C. D., Koenig, B. W., & Russell, S. T. (2012). Gay–straight alliances are associated with student health: A multischool comparison of LGBTQ and heterosexual youth. Journal of Research on Adolescence, 23, 319–330. Russell, S. T., Muraco, A., Subramaniam, A., & Laub, C. (2009). Youth empowerment and high school gay– straight alliances. Journal of Youth and Adolescence, 38, 891–903. Toomey, R. B., Ryan, C., Diaz, R. M., & Russell, S. T. (2011). High school gay–straight alliances (GSAs) and young adult well-being: An examination of GSA presence, participation, and perceived effectiveness. Applied Developmental Science, 15(4), 175–185.

GENDER BINARIES This entry explores gender binaries, the division of gender into two discrete and apparently separate categories of male–female. Unlike the term dichotomy, the term binary does not attribute a value to each side of the division. Thus, a gendered dichotomy is often a way of discussing the hierarchies that pertain to male–female, although binaries do assume that there are opposite sides. Therefore, a gendered binary presumes that men and women are opposite to each other, but does not necessarily suggest that one side of the binary is inferior or superior to the other. This entry will first outline normative gender binaries before moving on to explore how these binaries are destabilized. Then, it will look at how gendered binaries are recreated.

Normative Gender Binaries Gender binaries are pervasive in our contemporary society, through what is called the heterosexual matrix. The heterosexual matrix is used to name the ways that men and women are made to be

opposite to each other and are meant to come together within heterosexual relationships, in order to “complete” themselves. People often understand themselves and make life choices on the basis of gender binaries. This can include embodied aspects of gender such as how individuals stylize their bodies both to fit into the gender they understand themselves to be, and also to be attractive to the “opposite” sex. Gender binaries can also influence individuals’ academic interests (including the selection of subjects to be studied), careers, and household divisions of labor and child care. This is all based on what women and men “should” do as complementary opposites. As the heterosexual matrix makes clear, gender binaries are the key ways in which not only gender and sex come into being, but also sexualities. Without gender binaries, the categories heterosexual, lesbian, gay, and bisexual would not exist, and neither would trans identities. For this reason, gender binaries are central to the contemporary configurations of our worlds and also the reason that they have been subject to much political and scholarly critique and deconstruction.

Challenging Gender Binaries Once the binary of male–female, man–woman is seen to be constructed and produced, we can look at how this is occurring, by whom, and for what ends. Not only that, but it is also possible to identify how worlds might be created differently, in ways that create genders that are less constricted and associated with normative heterosexualities. Some scholars and activists have contended that there are more than two genders (including studies of third and multiple genders that exist often outside of dominant groups in the Global North); that intersexed individuals are often forced into gender binaries, despite contesting the binaries themselves; and that trans individuals question the necessary links between sexed bodies and gendered identities and lives. Some people are nonbinary, an umbrella term for those who don’t conform to gender binaries. These, and other contestations of gender

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binaries, have shown gender to be fluid and socially created. From this, the gender scholar Judith Butler has argued that we should see gender as performative. If gender binaries are fluid, then how they are created is not “natural” or pre-given; instead, they are produced through actions and power relations. This conceptualization frees us from having to be either male or female, and also disrupts sexualities that can be contained within heterosexual/homosexual binaries. Bi (bisexual) activists and theorists have been key in developing critiques of this binary, insomuch as bi desires, identities, and practices query the ways that sexual binaries polarize sexual identities into either heterosexual or homosexual, and challenge the ways in which gender binaries are seen to dictate sexual desires.

Recuperating Gender Binaries Despite the theorization of gender binaries as fluid and subject to disruption, gender binaries continue to be pervasive and normalized. The majority of people conform to, rather than disrupt, gendered binaries. Indeed, crossing gendered binaries is still understood as transgression, and those who do not conform to normative gender roles can be subject to discrimination, marginalization, and abuse. This comes in multiple forms including gender bashing (where people are subject to violence because of their gendered presentation/enactment) and genderism (where people are subject to multiple forms of discrimination and marginalization because they do not fit into normative gender binaries). Trans people are often the focus of these discussions, but gender-nonconforming people also include those who choose not to define themselves by gender, to live between genders or as genders other than male–female. Even where individuals do understand themselves within particular genders, if these are not displayed and enacted in the ways that are socially recognizable and approved, those who do not conform can also be subject to genderism and gender bashing. This includes women who are mistaken for men and effeminate men.

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By making those who do not conform different, “other,” and unusual, the gendered binaries of male–female are recuperated and the norm reestablished. Although some see transgressions of gender binaries as “playing” with gender, these recuperations remind us of how dangerous and physically/emotionally painful it can be to contest dominant gendered norms. However, gender is not only recuperated through violence, discrimination, and abuse. Trans activists and theorists have challenged those who see trans people as contesting gender binaries and rendering them fluid. They have argued that for many trans people, gender is not fluid. Rather, their gender is fixed; it was simply wrongly ascribed at birth (with some believing that they were born into the “wrong body”). Thus, trans people can see themselves within gender binaries as male or female and in this way recuperate gendered binaries. Kath Browne See also Bisexualities; Heteronormativity; Intersexuality; Nonbinary Genders; Queer; Transgender Identities

Further Readings Bowes-Catton, H. (2007). Resisting the binary: Discourses of identity and diversity in bisexual politics 1988–1996. Lesbian and Gay Psychology Review, 8(1), 58–71. Browne, K. (2004). Genderism and the bathroom problem: (Re)materialising sexed sites, (re)creating sexed bodies. Gender, Place & Culture, 11(3), 331–346. Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Doan, P. L. (2010). The tyranny of gendered spaces—Reflections from beyond the gender dichotomy. Gender, Place & Culture, 17(5), 635–654. doi:10.1080/0966369X.2010.503121 Namaste, V. K. (2000). Invisible lives: The erasure of transsexual and transgendered people. Chicago, IL: University of Chicago Press. Nestle, J., Howell, C., & Wilchins, R. (2002). Gender queer: Voices from beyond the sexual binary. New York, NY: Alyson Books.

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Gender Clinics

GENDER CLINICS Gender-variant persons—that is, persons whose gender expression does not match the sex that was assigned at birth—may require or feel more comfortable with specialized health, social, and legal services that are tailored to their unique gender needs. In some countries and some U.S. states, a variety of services are offered together, such as in an integrated gender clinic. In other locations, services are separated by type, or are offered within other existing frameworks such as by a primary care provider or housing authority. This entry summarizes briefly the history of service provision for trans persons and describes the existing service structures internationally, as well as specifically within the United States.

History of Gender Clinics In the early 1900s, medical experimentation for gender reassignment surgeries (GRSs) began first on animals. There are some concurrent reports of individuals (then labeled “inverts”) in the United States and Europe requesting and receiving surgeries such as removal of testicles, breasts, or uteri, but the surgeries were not labeled as GRS. Until 1933, GRS was developed and practiced on humans mostly based in the Institute of Sexual Science in Berlin, until the institute was looted in May 1933 by the National Socialist Party police and Nazi student groups. There are a few reports of continuing surgeries in Europe (Norway and Denmark) during WWII, but more commonly gender-variant persons were prosecuted and subjected to experimentation under Nazi rule. After the war, clinics outside of Germany moved to prominence in providing GRS. In the 1940s, treatments began to include hormones; legal alterations of name or sex; and an understanding that sex transition was an element of one’s identity, or sense of self, rather than simply a feature of sexuality. Throughout the 1940s and 1950s, U.S. treatments were more focused on hormonal approaches. During this time, grassroots organizations to

support trans persons in the United States began to develop. In the 1960s, U.S. surgical centers began to provide GRS. Over time, a number of nonEuropean countries have also served historically important roles in providing GRS, including a French-run clinic in Casablanca, Morocco, and programs in Thailand. Clinics across Europe and in Australia and Canada have continued to develop as integrated programs with team-centered systems of care, and these have in many ways defined treatment protocols for adults, adolescents, and children. Notably, clinics in the Netherlands, United Kingdom, Canada, and Belgium have played active roles in developing standards of care for trans persons worldwide.

International Clinics Given the divergent evolution of services between international and U.S. contexts, it is not surprising that structural differences exist today in the ways that services are provided. In contexts where medical and psychological care is covered through nationalized insurance programs, as in much of Western Europe, Australia, Canada, and some Asian countries, clinics have developed that provide assessment and diagnosis, and hormonal, psychological, and surgical care all in one integrated system. In most of these countries, as well as many others throughout the world, treatment for gender dysphoria—that is, the condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex—is covered by medical insurance, and treatment decisions are made collaboratively with an individual and a team of treatment providers. At the time of this writing, there are at least 40 clinics worldwide (not in the United States) that provide different constellations of gender-related care. Some clinics provide services that are only accessible for those living in that country, and as such may have a low profile internationally, such as those in Cuba and Iran. Other clinics are more surgically specific and cater to international “medical tourists,” like the multiple clinics in Thailand. The European, Canadian, and Australian clinics

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Gender Identity Discrimination as Sex Discrimination

offer far more comprehensive services including psychological support, hormone therapy, individual and group therapy, and HIV support, and some even provide speech and language therapy and body hair removal.

United States Clinics In the United States, care systems vary considerably by locality, and individual medical care is often funded by the individual gender-variant person and occasionally by third-party insurers or government systems. Some clinics function in an integrated manner, but most individuals also have the possibility of non-clinic-based providers for things like hormonal and psychological care. Services like name change support, housing support, and other anti-discrimination support may be provided in the same context where HIV testing and hormonal care are provided. Currently, at least 45 unique treatment centers advertise varying constellations of medical transgender support services for children, adolescents, and adults. Services provided include things like trans-positive primary care, behavioral health support, gynecological services, hormones, HIV support, and family planning, and in some cases other services such as support for victims of violence, a name change clinic, acupuncture, and hair removal. Most do not provide GRS services, but may refer individuals and provide preoperative and postoperative care. In countries with limited or expensive GRS options, such as the United States, individuals may opt to travel for surgical care to a country that allows nonresidents to seek surgery at a price cheaper than the home country. Thailand and Belgium are both countries that currently accept nonresidents for surgical gender-reassignment procedures. Jenifer K. McGuire See also Therapy With Transgender, Transsexual, and Gender-Nonconforming People; Transgender Health Care; Transgender Identities; Transgender Youth and Cross-Sex Hormones; Transgender Youth and Puberty Suppression

Further Readings Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Gooren, L. J. (2008). The treatment of adolescent transsexuals: Changing insights. Journal of Sexual Medicine, 5(8), 1892–1897. Pleak, R. R. (2011). Gender-variant children and transgender adolescents. Child and Adolescent Psychiatric Clinics of North America, 20(4), xv–xx. Stryker, S. (2009). Transgender history. Berkeley, CA: Seal Press. University of California, San Francisco. Center of Excellence for Transgender Health. http://transhealth .ucsf.edu/ World Professional Association for Transgender Health. http://www.wpath.org/

GENDER IDENTITY

AND

PREGNANCY

See Masculinity and Pregnancy

GENDER IDENTITY DISCRIMINATION SEX DISCRIMINATION

AS

Federal and state law in the United States prohibit sex discrimination in employment, education, housing, places of public accommodation, and other settings. Sex discrimination is discrimination motivated by a person’s sex or gender. This entry discusses the idea that courts and governmental entities charged with enforcing anti-discrimination laws in the United States are increasingly concluding that prohibitions on sex discrimination prohibit discrimination motivated by an individual’s gender identity or expression. Before describing this trend, this entry discusses some background concepts, the prevalence of discrimination against transgender and gender-nonconforming individuals, and the status of laws explicitly prohibiting discrimination on the basis of gender identity or expression. Generally in the context of anti-discrimination law, “sex” refers to a person’s biological status and

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is typically categorized as male or female. “Gender” refers to the behaviors and characteristics that society delineates as masculine or feminine and typically associates with one sex but not the other. “Gender identity” refers to a person’s innate psychological identification as male, female, transgender, or other gender. “Gender expression” refers to the ways in which people express or represent their gender identity, such as mannerisms, clothing, and grooming. Broadly speaking, “transgender” individuals’ gender identity or expression is different from those typically associated with the sex assigned to them at birth. Each of these concepts is distinct from sexual orientation, which refers to sexual and romantic attraction. The best available data indicate pervasive and persistent discrimination against individuals who are transgender or do not conform to gender norms. For example, in the U.S. National Transgender Discrimination Survey, 78% of respondents reported harassment, mistreatment, or discrimination on the job; 47% reported an adverse employment outcome, such as being fired, not hired, or not promoted; 19% reported being refused a home or apartment; 11% reported eviction; and 53% reported verbal harassment and disrespect at public accommodations, such as hotels, restaurants, buses, airports, and government agencies. Analyses of complaints filed with administrative agencies charged with enforcing anti-discrimination laws also indicate widespread discrimination based on gender identity and expression, as do compilations of specific instances of such discrimination. As of 2015, a total of 19 states, the District of Colombia, and numerous localities explicitly prohibit, by statute, discrimination on the basis of one’s gender identity or expression in private and public employment. The federal government and 31 states do not. A similar number of jurisdictions prohibit/do not prohibit these types of discrimination in other settings such as housing and public accommodations. For many years, Congress has considered, but not enacted, federal legislation to prohibit gender identity discrimination in employment (recently known as the Employment Non-Discrimination Act). In 2015, a bill was introduced in Congress—the Equality Act—that would

prohibit gender identity discrimination in not only employment but also the other settings reached by existing anti-discrimination laws. At the federal level and in five states without explicit statutes, executive orders or other nonstatutory laws prohibit gender identity discrimination in public (but not private) employment. In addition, in 2014, President Barack Obama issued an executive order prohibiting federal contractors from discriminating on the basis of gender identity. While federal and many state statutes do not explicitly enumerate gender identity or expression as prohibited forms of discrimination, federal and state law do prohibit sex discrimination in a variety of settings. Unlawful sex discrimination includes, for example, denying someone a promotion, an apartment, or schooling because she is a woman or he is a man. Courts—including the U.S. Supreme Court in Price Waterhouse v. Hopkins (1989)—have clarified that sex discrimination includes gender discrimination, such as penalizing or harassing someone for not conforming to gender stereotypes. In other words, in the employment context, for example, gender must be irrelevant to employment decisions (except in narrow exceptions), and employers cannot consider gender-based norms, stereotypes, expectations, or preferences in making employment decisions. Even before Price Waterhouse, the Supreme Court invalidated laws resting on or perpetuating sex or gender stereotypes. Nonetheless, for many years courts consistently rejected sex discrimination claims brought by transgender or gender-nonconforming individuals, concluding that they had been discriminated against because they were transgender or gay and that those forms of discrimination were not prohibited. These courts often conflated gender identity and expression with sexual orientation. However, following Price Waterhouse and as our understanding of gender and transgender people has increased, a growing number of courts, administrative bodies, and government agencies are concluding, in both constitutional and statutory contexts, that sex discrimination includes discrimination based on an individual’s gender identity or expression, including transition from one gender

Gender Nonconformity, Youth

to another, identification as transgender, or nonconformity with gender norms. As the court in Glenn v. Brumby (2011) reasoned, “the very acts that define transgender people as transgender are  those that contradict stereotypes of genderappropriate appearance and behavior.” Most courts and governmental entities that have interpreted existing sex discrimination protections to cover discrimination based on gender identity or expression have relied on a gender stereotyping theory—that transgender and gendernonconforming individuals are protected from discrimination based on their deviation, or perceived deviation, from gender stereotypes. However, in Macy v. Holder (2012), the U.S. Equal Employment Opportunity Commission clarified that a person facing gender identity or expression discrimination may—but need not—rely on evidence of gender stereotyping. The ultimate question is whether sex or gender was a motivating factor in the discrimination. Thus, for example, a transgender job applicant may prove sex discrimination with evidence that her prospective employer was willing to hire her when the employer thought she was a man, but was unwilling to hire her once discovering she was now a woman, regardless of whether the employer acted upon gender stereotypes. Adam P. Romero and Brad Sears See also Employment Non-Discrimination Act (ENDA); Gender Transition at Work; Housing, Protection Against Discrimination in; Nondiscrimination Protections, State and Local; Sexual Orientation Discrimination as Sex Discrimination; Workplace Discrimination

Further Readings Pizer, J. C., Sears, B., Mallory, C., & Hunter, N. D. (2012). Evidence of persistent and pervasive workplace discrimination against LGBT people: The need for federal legislation prohibiting discrimination and providing for equal employment benefits. Loyola of Los Angeles Law Review, 45, 715–779. Rao, D. (2013). Gender identity discrimination is sex discrimination: Protecting transgender students from

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bullying and harassment using Title IX. Wisconsin Journal of Law, Gender & Society, 28, 245–269. Sears, B., Hunter, N. D., & Mallory, C. (2009). Documenting discrimination based on sexual orientation and gender identity in state employment. Los Angeles, CA: Williams Institute. Retrieved October 22, 2015, from http://williamsinstitute.law.ucla.edu/ research/workplace/documenting-discrimination-on-thebasis-of-sexual-orientation-and-gender-identity-instate-employment/ Turner, I. M. (2007). Sex stereotyping per se: Transgender employees and Title VII. California Law Review, 95, 561–596.

GENDER NONCONFORMITY, YOUTH There are many terms for referring to gendernonconforming youth, that is, young people whose gender identity or gender expression falls outside of a heteronormative man–woman gender binary. These include terms that are more or less politicized, such as agendered, dual gender, gender fluid, intergender, genderqueer, and transgender; as well as psychomedical terms such as gender dysphoric and gender disordered; and terms that perhaps seek a more neutral position such as gender diverse, gender variant, and gender nonconforming. Many of these terms are also used by, or about, adults. A key advantage of the term gender nonconformity, in relation to children and young people, is its relative neutrality and nonjudgmental tone: This term allows us to avoid the politicized and medicalizing connotations of terms like trans youth. This entry will address issues of emotional distress, psychiatric diagnosis, and therapeutic interventions, as well as young people’s own experiences and ways of identifying.

Gender Nonconformity and Mental Illness Gender nonconformity among youth has become a research topic and a politicized issue largely in relation to the psychiatric classification of gender identity disorder in 1994 in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This has now been relabeled as

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gender dysphoria in the fifth edition of the DSM, which was published in 2013. The move, in 1994, to establish the diagnostic category Gender Identity Disorder in Childhood prompted critical responses from researchers who saw this as a move to pathologize diversity. Critics mindful of such categorizations are wary of pathologizing diversity in general, and particularly concerned about pathologizing the gender diversity that is expressed by children and young people. Critiques have been specifically directed to therapeutic approaches that aim to guide children and young people toward heteronormative, binary gender expression. Particular concern has been raised about the extent to which this normalizing kind of therapeutic work effectively polices the gendered behavior and identity of boys who could possibly later emerge as gay or bisexual. It is not uncommon for gay and bisexual people to recall gender-nonconforming childhoods. Historically, the focus of gender normalizing therapeutic efforts has been on boys who prefer feminine ways of being, although the diagnostic category applies to both boys and girls, and contemporary treatment approaches work with both. In previous decades, research with gendernonconforming boys focused on what proportion of them later came to identify as transsexual, gay, or bisexual. Parallel studies were not done on girls, and girls’ gender nonconformity has tended not to cause the same degree of cultural anxiety as that of boys. Pivotal psychological publications authored by Richard Green, Kenneth Zucker, and Susan Bradley, among others, are examples of research that has been critiqued for being pathologizing toward gender-nonconforming children and youth. Such work focused primarily on boys’ gender expression and identity. Key critiques have included work by Karl Bryant, who provides an incisive historical analysis of the production of gender identity, and by Susan Langer and James Martin, whose tonguein-cheek title “How Dresses Can Make You Mentally Ill” captures the simultaneous incredulity and seriousness with which the psychiatric diagnosis of gender-nonconforming children and youth has been met by critics.

Early Gender Reassignment While the earlier impetus was for psychological “correction” of gender nonconformity, more recent years have seen the development of attempts to facilitate early transition (i.e., gender reassignment) for a selected group of gender-nonconforming youth. This is physical transition that can begin in early puberty (e.g., around the age of 11) with hormonal blockers to halt the progress of pubertal development, then transition can proceed with cross-sex hormones from the age of 16 and surgical reassignment from the age of 18 years. The process of selecting which gender-nonconforming youth may access these interventions is guided by DSM criteria but has been developed within specialist centers. The clinic led by Peggy Cohen-Kettenis in Amsterdam, the Netherlands, has been the most prolific at publishing information about early reassignment and the outcomes of this kind of intervention. While this is the very kind of health care that some trans adults have been arguing for (i.e., health care by professionals who acknowledge the psychological pain that pubertal changes can bring when one feels completely at odds with one’s assigned sex), this kind of care necessarily only reaches a select few, and the way it is presented has raised some concerns. Most likely, it only reaches those who happen to live in geographic regions where such intervention is available, who happen to have parents willing to support them in seeking intervention, and who are sufficiently articulate and convincing to pass through diagnostic and screening processes. Other gender-nonconforming youth are less likely to find tailored support available to them as they navigate their way through the years of their lives when their family’s and peers’ tolerance for their gender nonconformity may become dramatically reduced.

Youth Experiences and Identities Gender nonconformity among children is relatively popularly accepted as a phase that will be passed through, and there are terms such as sissy boy and tomboy pointing to the wider societal acknowledgment that this exists as a childhood

Gender Nonconformity, Youth

phenomenon. Gender-nonconforming youth, however, repeatedly report that any tolerance they experienced from others during childhood lessens dramatically as they enter their teens and are expected to begin performing explicitly heteronormative roles, in terms of gender expression, gendered interests, and romantic attractions. Among some contemporary youth, the use of concepts such as genderqueer and trans* currently opens an array of identificatory possibilities that would make it foolhardy to try and measure percentagewise what proportion of gendernonconforming children later come to identify within any fixed sexuality or gender identity. Rather, what we now see (in some urban centers and Internet-based groups) is a movement to create a fluid and diverse range of gendered possibilities that challenge both the binary man–woman system as well as the very assumption that one must ultimately identify within any category at all. The term genderqueer suggests a critical perspective on identification within the man–woman binary. The term trans* allows for diverse identifications that do not presume to fit within categories such as man, woman, or transsexual, but that do suggest a fluid or transgressive approach to gender categories. While some young people respond to the psychomedicalization of their gender nonconformity and their feeling of being at odds with their sexed development by embracing the opportunity of early transition, other young people respond with an articulate, politicized rejection of the very frameworks of meaning that surround gendered expectations and gender identity.

Alternative Therapeutic Approaches Almost in step with these more recent developments, some health professionals have been speaking out, offering alternative approaches to working with gender-nonconforming youth. Some scholars, such as Bernadette Wren, bring feminist poststructuralist thinking about gender to working with gender-nonconforming youth, highlighting the importance of not foreclosing questions of identity. Some health professionals, such as Edgardo Menvielle, take an inclusive

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approach to supporting a diverse range of children, youth, and families, using face-to-face and online support groups, and allowing for a celebration and acceptance of gender nonconformity, rather than seeking solutions that involve fixing gender (or fixing the body). Other explicitly nonpathologizing approaches to gender nonconformity have been written about by therapists; for example, Diane Ehrensaft, who has proposed an alternative taxonomy of gender among children, including terms like transgender children, gender-fluid children, gender Priuses, gender Tauruses, protogay children, and prototransgender youth. Another interesting contribution of Diane Ehrensaft has been to point to the severe difficulties faced by gender-nonconforming children and youth whose parents are passionately and determinedly against gender nonconformity. She raises the topic of emotional abuse by parents to point to the seriousness of the situation faced by some gender-nonconforming youth in unsupportive families, and this would seem to be an important topic to be explored further. It seems likely that existing research has focused heavily on youth whose families are sufficiently resourced and invested in their well-being to at least seek psychological support, whereas the larger pool of gendernonconforming youth are undoubtedly not living in such families, do not have access to such support, and may be facing situations of severe emotional abuse. Ongoing debates about how to understand gender nonconformity among youth, and how to best work with gender-nonconforming youth, have been explored in two recent special issues of journals. The first of these is edited by Richard Pleak, who explains that the articles in the special issue work with the terms cross-gender, gender variant, gender atypical, and gender nonconformity, which may be viewed as equivalent in that context. The second special issue, edited by Jack Drescher and William Byne, is published by the Journal of Homosexuality and includes papers by some of the key commentators in this field, as well as an analysis of their underpinning conceptual frameworks.

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Distress and Resourcefulness The fact that a proportion of gender-nonconforming children and youth face substantial psychological distress has been used as an argument for maintaining Gender Dysphoria in the DSM as a classification used specifically for children and adolescents. Yet psychological research suggests that the distress tends not to be caused by the gender nonconformity itself. Instead, it has been shown that psychological distress stems from the social pressures that children and young people are under to conform to gender norms. Children who are supported and encouraged to express themselves freely, including expressing gender-nonconforming interests, are less likely to manifest the levels of distress that would warrant a psychiatric diagnosis. This point is relevant for children, but in instances where gender nonconformity persists beyond childhood, and includes distress about the sexually developing body, the situation is quite different. This is where early physical interventions come into play for some gender-nonconforming youth. Research on trans* or gender-nonconforming youth points clearly to the alarming emotional consequences of refusing or failing to fit in with gender norms: Studies on bullying, abuse, self-harm, and suicidality paint a consistent picture of gendernonconforming youth being much more likely to suffer in these ways than their gender-normative and heteronormative peers. At the same time, it is important to avoid a stigmatizing, risk-oriented approach. It is worth recognizing the substantial (face-to-face and online) community building that is being done among gender-nonconforming youth, as well as their creativity and resourcefulness. Katrina Roen See also Gender Binaries; Genderqueer; Therapy With Transgender, Transsexual, and Gender-Nonconforming People; Transgender and Gender-Nonconforming Individuals and Bathrooms; Transgender and Gender-Nonconforming Youth and the Legal System; Transgender and Gender-Nonconforming Youth of Color; Transgender Identities; Transgender Youth and Cross-Sex Hormones; Transgender Youth and Family Relationships; Transgender Youth and Well-Being

Further Readings Bryant, K. (2006). Making gender identity disorder of childhood: Historical lessons for contemporary debates. Sexuality Research & Social Policy, 3(3), 23–39. Drescher, J., & Byne, W. (2012). Introduction to the special issue on “The treatment of gender dysphoric/ gender variant children and adolescents.” Journal of Homosexuality, 59(3), 295–300. Ehrensaft, D. (2011). Boys will be girls, girls will be boys: Children affect parents as parents affect children in gender nonconformity. Psychoanalytic Psychology, 28(4), 528–548. Green, R. (1987). The “sissy boy syndrome” and the development of homosexuality. New Haven, CT: Yale University Press. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. New York, NY: Haworth. Menvielle, E. (2012). A comprehensive program for children with gender variant behaviors and gender identity disorders. Journal of Homosexuality, 59(3), 357–368. Pepper, R. (Ed.). (2012). Transitions of the heart: Stories of love, struggle and acceptance by mothers of transgender and gender variant children. Berkeley, CA: Cleis Press. Pleak, R. R. (2011). Gender-variant children and transgender adolescents. Child and Adolescent Psychiatric Clinics of North America, 20(4), xv–xx. Zucker, K., & Bradley, S. (1995). Gender identity disorder and psychosexual problems in children and adolescents. New York, NY: Guilford.

GENDER SPECTRUM This entry examines the complex nature of gender. Rather than a rigid, binary concept grounded in biology, it presents a model for understanding gender that incorporates a spectrum of characteristics, including an individual’s sex, gender expression, and gender identity. In the process, a more nuanced understanding of this core aspect of self emerges, accounting for each person’s unique gender experiences.

Gender Spectrum

Beyond Biology When someone has a baby, the question most frequently asked is “Is it a boy or a girl?” This seemingly innocent query reinforces the ubiquitous notion of the binary gender system, which rests on two deeply held, but nonetheless flawed assumptions: that gender is binary, and that this core aspect of self is biologically determined. Rarely challenged, this notion has a significant and costly consequence. Not only are individuals who fail to meet narrowly defined criteria frequently marginalized, but society as a whole risks losing access to the potential contributions of many of its members as they choose or are needlessly forced to cast off aspects of themselves to fit narrowly prescribed expectations. The binary gender system typically conflates “gender” and “sex.” One’s sex includes physical attributes such as external genitalia, sex chromosomes, gonads, sex hormones, and internal reproductive structures. At birth, this “biology of gender” is used to answer the “boy or girl?” question. For many, this is cause for little or no dissonance. By default, most environments are designed around this simplistic model. However, beyond typically “male” or “female” bodies, there are naturally occurring conditions (often referred to as “intersex”) that occur in all species, including humans. Rather than just two distinct boxes, sex exists across a continuum of anatomical variation that by itself should be enough to discredit the simplistic notions of a binary gender system. Yet gender is neither inherently nor solely connected to one’s physical anatomy. Gender biology (sex) and gender are not one and the same. Beyond anatomy, there are multiple dimensions influencing gender. Put simply, gender is the complex interrelationship between an individual’s sex (gender biology); one’s internal sense of self as male, female, or something else (gender identity); and one’s outward presentation and behavior (gender expression) related to that perception. In turn, each of these can be independently characterized across a range of possibilities.

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Gender Identity: Can You See the Real Me? Beyond biology, another dimension of gender is gender identity, which can be defined as an individual’s deeply held sense of self as male, female, or another gender altogether. Most people have an early sense of their gender identity, and if it is not congruous with their anatomical sex, they may begin voicing this between the ages of 2 and 4. If you ask individuals when and how they recognized themselves as male or female (or perhaps something else), most will reply that they have simply always known. This core aspect of one’s identity is internally driven. Gender identity is believed to be an inherent aspect of a person’s makeup, most likely formed in the brain. A variety of factors, such as prenatal hormonal exposure, neurogenital development, and environmental influences, may play a part in its formation, but most agree that one’s gender identity is determined prior to birth. Individuals do not choose their gender identity; rather, gender identity emerges from within.

Gender Expression The third dimension of gender is gender expression, which can be defined as the way we show our gender to the world around us. Given the prevalence of the binary gender system, children face great pressure to conform to narrow definitions of “boy” or “girl.” Expectations around gender expression are taught to us from the moment we are born. Social constructs of gender are communicated through every aspect of our lives, including family, culture, peers, schools, community, media, and religion. Like other social constructs, gender expression is closely monitored and reinforced by society. Practically everything is assigned a gender—toys, colors, clothes, and activities are some of the more obvious examples. Through a combination of social conditioning and personal preference, by age  3, most children prefer activities and exhibit behaviors typically associated with their sex. Accepted social gender roles and expectations are so entrenched in our culture that most people

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cannot imagine any other way. As a result, individuals fitting neatly into these expectations rarely if ever question what gender really means. They have never had to, because the system has worked for them. But children who express gender in ways that transgress these social norms often have a very different experience. Boys seen as feminine at any age, and girls thought to be too masculine (especially as they move into their teens), face a variety of challenges. Pressures to conform at home, mistreatment by peers in school, and condemnation by religious or other institutions are just some of the difficulties facing a child whose expression does not fall into line with the binary gender system. For many young people, whether typical in their presentation or not, gender expression is the most immediately experienced aspect of gender, impacting them in most if not all of their interactions with others. Yet norms around gender expression change across societies and over time. One need only examine the history related to men wearing earrings or women sporting tattoos to quickly see the malleability of social expectations about gender. Even the seemingly intractable “pink is for girls, blue is for boys” notions are relatively new. It is well documented that not until the mid–20th century were notions of pink for girls and blue for boys so firmly ensconced.

Gender Versus Sexual Orientation One final distinction to make is the difference between gender and sexual orientation, which are often incorrectly conflated. When someone’s gender expression or identity is perceived to be inconsistent with others’ expectations, the person is frequently assumed to be gay. But gender is about who we are, and sexual orientation is about our physical, emotional, or romantic attractions to others. Sexual orientation is a distinct aspect of self. Why is it so critical to distinguish these two notions? First of all, they are simply different, and accuracy of language is critical as we discuss issues of identity. Further, it is not uncommon to “read” a

young person’s gender expression and assume it tells us something about his or her sexual orientation. The boy who loves to play princess is assumed to be gay, and the adolescent girl who buys clothes in the boys’ section and favors a short haircut must be a lesbian. These are faulty conclusions. What someone plays with, or wears, or does is about gender expression, not orientation. Finally, when we think about gender identity as sexuality, we are attaching a meaning that may well have nothing to do with the young person’s authentic assertion of self. This error, however, can have significant impact on the manner in which others interpret the child’s gender identity or expression.

Gender in 3-D Alone, each dimension of gender challenges the binary model so common in many cultures. But when considered as a whole, the diversity of gender truly unfolds. Just as three dimensions of space provide a more detailed landscape for understanding physical objects, the three dimensions of gender provide a much richer model for exploring this misunderstood concept. When thinking about gender, it is the interaction of the three dimensions that really captures gender’s complexity. For many individuals, gender is “aligned.” That is, gender biology (assigned gender), gender expression (presentation of gender), and gender identity (internal sense of self) line up. An adjective sometimes used to capture this alignment is cisgender. The prefix cis- comes from Latin and means “on the same side as” or “on this side of.” While perhaps the most common pattern, even within this arrangement there is tremendous room for variation. Nonetheless, the term cisgender is an important one in that it names the dominant experience, rather than simply assuming it to be the default or “normal” way to be. However, being cisgender is not the only description available for capturing individual experiences of gender. Another possibility is for biology and identity to line up, but for expression to be seen as inconsistent. A child assigned and identifying as female who is seen by those around her to gravitate toward the masculine is often

Gender Spectrum

referred to as a “tomboy.” A child assigned and identifying as male who is seen by those around him to gravitate toward the feminine has no comparable name. These two young people may well face drastically different experiences as they grow up. Particularly when young, a tomboy is sometimes celebrated by the adults around her, and the term tomboy is not necessarily negative. However, there is no widely used positive or neutral term for a child assigned male who is perceived to be feminine in some way. Pejorative words that immediately come to mind in the form of schoolyard taunts are “faggot,” “sissy,” “homo,” or “gay.” Though the norms for expression that are seen as “male” or “female” are artificially created, many are nonetheless deeply invested in making sure they are adhered to. Finally, some individuals are labeled as a particular sex based on biology while identifying as the “other” gender. Where cisgender refers to someone whose identity is “on the same side as” their assigned sex, transgender refers to someone whose identity is “across from” their assigned sex. Expression for transgender individuals can be anywhere along the spectrum. There are transgender individuals who express gender in very stereotypical ways, and others who do not. In part, this may be about preferences, and in part this may be indicative of the context in which they find themselves. In other words, a transgender boy may wear skirts and blouses because the people around him will not allow a more typically masculine style. However, he may also simply prefer to dress this way.

Beyond the Binary: About Gender Expansiveness Gender expansive is an umbrella term used for individuals who broaden commonly held definitions of gender, including its expression, associated identities, and other perceived gender norms, in one or more aspects of their life. These individuals expand common definitions of gender through their own identity and expression. Some individuals do not identify with being either male or

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female; others identify as a blend of both; while still others identify with a gender, but express their gender in ways that differ from stereotypical expectations. A gender-expansive person’s preferences and self-expression may fall outside commonly understood gender norms within his or her own culture; or the person may be aligned with them even as his or her internal gender identity doesn’t align with the sex assigned at birth. This diversity of gender is a normal part of the human experience, across cultures and throughout history. Nonbinary gender diversity exists all over the world, documented by countless historians and anthropologists. Examples of individuals living comfortably outside of typical male–female expectations or identities are found in every region of the globe. The calabai and calalai of Indonesia, twospirit Native Americans, and the hijra of India all represent more complex understandings of gender than allowed for by a simplistic binary model. Put simply, gender expansiveness as a concept recognizes that it is society’s narrow perceptions of gender and the consequent limitations it imposes that must be questioned, rather than the individuals who don’t conform to them.

Gender Spectrum: The Organization These expanded notions about gender inform the work of Gender Spectrum, an organization whose mission is the creation of gender-inclusive spaces for all children and teens. Recognizing the limitations and pressures that the binary gender system places on young people, its work takes place in four distinct ways: (1) Through education and training, they work with schools and other organizations to build their capacity to support the gender diversity of every child. (2) They provide direct services to parents and caregivers through support groups, resources, and consultations. (3) Each year, the Gender Spectrum Conference brings these two elements together for a weekend of learning and engagement for families, professionals, and young people of all ages. (4) Finally, the organization seeks to lead a deeper conversation about the evolving understandings of gender and how it affects young people.

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Conclusion The multidimensional model presented here provides a far more dynamic way to think about the complex subject of gender. Instead of the static, binary model produced through a solely physical understanding of gender, a far richer tapestry emerges with recognition of gender as the intersection of biology, expression, and identity. Quite simply, the gender spectrum represents a more nuanced and accurate model of the diversity of human gender, affirming each person’s unique and authentic experience of this core aspect of self. Joel Baum See also Cisgenderism; Gender Binaries; Gender Nonconformity, Youth; Genderqueer; Intersexuality; Masculinity Stereotypes; Nonbinary Genders; Transgender Identities; Transgender Youth and Well-Being

Further Readings Ainsworth, C. (2015). Sex redefined. Nature, 518, 288–291. Brill, S. A., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleis Press. Ehrensaft, D. (2011). Gender born, gender made: Raising healthy gender-nonconforming children. New York, NY: The Experiment. Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., et al. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56, 285–290. Kennedy, N. (2012). Transgender children: More than a theoretical challenge. Graduate Journal of Social Science, 7(2). Kosciw, J. G., Greytak, E. A., Palmer, N. A., & Boesen, M. J. (2014). The 2013 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: GLSEN. Marksamer, J., Spade, D., & Arkles, G. (2011). A place of respect: A guide for group care facilities serving transgender and gender non-conforming youth. San Francisco, CA: National Center for Lesbian Rights and Sylvia Rivera Law Project.

Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Developmental Psychology, 46(6), 1580–1589.

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This entry outlines the key issues that transgender individuals may encounter when undergoing a gender transition in their place of employment. It explains motivations for starting a gender transition at work and elucidates potential trajectories of this experience, including reactions from coworkers and institutional ramifications. The entry then discusses identity management strategies that transgender employees may use with their colleagues and some logistical “nuts and bolts” related to the gender transition process. The entry concludes with strategies for employers to facilitate gender transition at work.

Transgender Workplace Experiences Transgender is an umbrella term used to capture a range of gender identities, such as gender nonconforming, transsexual, male-to-female (MtF), female-to-male (FtM), cross-dresser, or genderqueer. In contrast, people whose assigned birth sex matches with their gender identity are described as cisgender. Though most research on workplace climate has focused on the experiences of cisgender lesbian, gay, and bisexual people (LGB), a growing body of literature is beginning to attend to the experiences of transgender employees. Parallel to studies with LGB participants, research on workplace climates for transgender employees find that jobs often feel “chilly,” as a result of transphobia from coworkers. Only a few studies have focused specifically on transgender employees, but this available research has highlighted that transgender individuals face a high prevalence of prejudice, discrimination, and harassment at work, and at the very least, almost all individuals who come out as transgender are

Gender Transition at Work

treated differently after their disclosure. One largescale national study by Jaime Grant and colleagues reported that 90% of transgender and gendernonconforming respondents experienced harassment or mistreatment on the job or took action to avoid it. Further, 47% of these same respondents indicated that they had experienced a negative job outcome, including being fired, not hired, or denied a promotion as a result of their gender identity. In another study, Stephanie Budge and colleagues found that about half of their participants had been physically threatened or emotionally abused by coworkers because of their gender identities. These negative job outcomes must be contextualized within the legal landscape of the United States, where there is currently no federal employment protection for transgender employees and only 19 out of 50 states and the District of Columbia provide legal protection at the state level. Considering the bleak legal landscape for transgender employees, it is not surprising that many individuals may think twice before “coming out” as transgender or undergoing a gender transition while employed. Identities under the transgender umbrella such as transsexual, MtF, and FtM suggest a transition from one gender to another. Transgender employees may undergo some form of gender transition to more accurately live their identity or express their experience of gender. The phrase gender transition can be used to refer to medical and physical transformations (e.g., sex hormone treatments, gender affirmation surgery, and facial feminization or masculinization surgeries) or to encompass a larger variety of steps toward presenting one’s authentic gender identity. As such, the broad dimensions of gender transition may encompass appearance-based changes (e.g., wearing different clothing, weight-training to build muscle); social changes (e.g., adopting different gender pronouns to refer to oneself, creating a new e-mail handle to reflect a different name); and legal changes (e.g., changing one’s gender or name on legal documentation). While parallels have been drawn between the workplace coming-out processes of cisgender LGB people and transgender employees, two important

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differences should be noted. First, cisgender LGB employees may choose to disclose or conceal their sexual minority identities at work, whereas undergoing a gender transition essentially discloses one’s transgender identity. Thus, if a transgender individual opts to undergo a gender transition while employed, the individual cannot easily control who knows about his or her identity. Illustratively, data from a national study by Jaime Grant and colleagues found that 71% of transgender employees attempted to hide their gender transition, and 57% delayed their transition to avoid negative reactions from coworkers. Second, cisgender LGB employees typically do not face the same complications from gendered work environments as transgender employees. Specifically, many work environments require gender-specific or stereotypic uniforms for male and female employees and have spaces that are segregated by gender such as bathrooms or locker rooms. For some transgender employees whose gender presentation is more fluid, ambiguous, or androgynous, such genderspecific spaces often become points of confusion, awkwardness, and hostility for transphobic coworkers. As a result of these factors, transgender employees often use identity management strategies to navigate their workplace environments.

Transgender Identity Management Strategies To date, most literature regarding workplace identity management strategies has focused on cisgender LGB employees. Scott Button and other scholars have discussed that opting to disclose or conceal one’s LGB identity at work may manifest in the use of different strategies—being explicitly or implicitly out, passing, or covering one’s sexual orientation—and is partially dependent on perceived climate of the organization and personal comfort levels. These LGB-specific identity management strategies were recently tailored to the experiences of transgender employees by Melanie Brewster and colleagues. A transgender employee may be explicitly out at work by displaying affirmative symbols related to his or her identity (e.g., a trans-pride logo)

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or talking openly about the individual’s gender transition. Another option may be to be implicitly out by being open about one’s life experiences and past, but not explicitly coming out as transgender— in other words, letting coworkers assume whatever they like. Other identity management strategies may include passing as cisgender (e.g., not disclosing that one has undergone a gender transition) or covering (e.g., deliberately censoring, withholding, or fabricating information that would reveal that one is transgender). These passing or covering strategies have often been referred to as stealth (choosing to only be known by one’s current gender presentation) or deep stealth (severing all ties to the transgender community to ensure that one is not outed) outside of the vocational literature. For transgender employees, being explicitly out is positively related to job satisfaction and more positive perceptions of workplace environment, whereas having to cover one’s transgender identity is related to perceiving more discrimination and having lower levels of job satisfaction. However, it is important to note that the aforementioned workplace identity management strategies are limited by nature, as they cannot capture the experiences of transgender individuals who are early in their transition process, those who have not yet transitioned, or people who identify as gender nonconforming.

Key Issues in Gender Transitions at Work As discussed by Melanie Brewster and colleagues, several distinct topics to consider emerge within workplace gender transitions including interpersonal factors, intrapersonal factors, systemic and organizational issues, and logistics and planning. Interpersonal Factors

Unless they are self-employed, transgender employees regularly interact with coworkers; thus, interpersonal dynamics drastically shape a workplace gender transition. Commonly, cisgender colleagues may initially struggle with name and pronoun change requests from transgender coworkers. Without on-the-job education about

gender transitions, cisgender employees may be confused or feel awkward when interacting with their transgender colleagues at work. Hostilities or tension surrounding gender-specific spaces (e.g., bathrooms) may also emerge. Intrapersonal Factors

Psychological literature suggests that keeping secrets can be detrimental to mental and physical health. As such, being able to “come out” and live genuinely as one’s preferred gender identity is a critical component of health and job satisfaction for transgender employees. Many transgender employees find that after transitioning at work, they feel liberated, free, and empowered to be themselves. However, some individuals may also find the prospect of transitioning genders at work very overwhelming or frustrating because of the climate of their workplace. As a result, experiencing anxiety or depression is not uncommon during a transition. Systemic and Organizational Issues

As mentioned previously, there is no federal protection for transgender employees, and few states offer legal protection. As a result of these sparse protections, transgender employees are disproportionately at risk for career crises—being terminated, denied promotions, or unable to advance further in their careers—if they transition at work. Similarly, medical benefits for gender transitions are highly variable and may be applied haphazardly. Considering the significant cost of gender affirmation procedures, without full or partial medical coverage, many transgender employees may accrue significant debt or be unable financially to undergo such procedures. Further, many of the surgeries that some transgender employees may elect to undergo (e.g., mastectomies, phalloplasties) not only are cost prohibitive but also yield a lengthy recovery time. Without ample sick leave, disability coverage, or paid medical leave, missing work to recuperate from these invasive procedures may result in termination.

Gender Transition at Work

Logistics and Planning

Considering the numerous uncertainties surrounding job security and discrimination that one may face if one undergoes a gender transition while employed, preparation and forethought prior to “coming out” are crucial. Steps to prepare may range widely from researching legal protections and knowing one’s rights to ironing out technical details (e.g., changing one’s e-mail address, getting a new name propagated through IT systems). One important part of a successful workplace transition may be to do a trial run, or selectively come out as transgender to a couple of workplace friends or allies prior to telling everyone. Relatedly, working closely with human resources before coming out could help to gauge organizational climate and safety with less risk than coming out to a direct supervisor or someone in an evaluative position. Most importantly, if possible, transgender employees should be prepared to weather—financially, emotionally, and logistically—almost any reaction from employers and coworkers. In this way, available literature on workplace gender transitions points to a general theme of “plan for the worst, hope for the best.”

Strategies for Employers While gender transitions may be stressful at times, research by Ellen Riggle and colleagues highlights the many positive aspects of identifying as transgender. When a gender transition is complete, individuals often feel that they have grown personally, are more resilient, have more empathy, and are more self-aware. Employers should take note of these benefits of a successful transition and work to facilitate the process for their transgender employees. One concrete way to facilitate this process is by actively working to improve workplace climate toward transgender individuals through challenging negativity that emerges. Other more logistical changes—such as implementing gender neutral or single-stall restrooms and eliminating gendered uniforms—would circumvent some of the common points of interpersonal tension between transgender and cisgender coworkers. At

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the structural level, implementing workplace nondiscrimination policies and providing psychoeducation to employees could help to combat harassment and hostility. Finally, working with medical and health insurance providers to make sure gender transition procedures are covered would help to defray much of the financial stress that transgender employees accrue when transitioning without this support. Melanie E. Brewster See also Employment Non-Discrimination Act (ENDA); Gender Identity Discrimination as Sex Discrimination; Stealth (Transgender Passing); Transgender Identities; Transgender People and Division of Labor; Transphobia; Work Environments; Workplace Discrimination; Workplace Policies

Further Readings Brewster, M. E., Velez, B., DeBlaere, C., & Moradi, B. (2012). Transgender individuals’ workplace experiences: The applicability of sexual minority measures and models. Journal of Counseling Psychology, 59, 60–70. Brewster, M. E., Velez, B. L., Mennicke, A., & Tebbe, E. (2014). Voices from beyond: A thematic content analysis of transgender employees’ workplace experiences. Psychology of Sexual Orientation and Gender Diversity, 1, 159–169. Budge, S. L., Tebbe, E. N., & Howard, K. A. S. (2010). The work experiences of transgender individuals: Negotiating the transition and career decision-making processes. Journal of Counseling Psychology, 57, 377–393. Button, S. B. (2004). Identity management strategies utilized by lesbian and gay employees: A quantitative investigation. Group & Organization Management, 29(4), 470–494. Dispenza, F., Watson, L. B., Chung, Y. B., & Brack, G. (2012). Experience of career-related discrimination for female-to-male transgender persons: A qualitative study. The Career Development Quarterly, 60, 65–81. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

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Schilt, K., & Connell, C. (2007). Do workplace gender transitions make gender trouble? Gender, Work & Organization, 14, 596–618. Waldo, C. R. (1999). Working in a majority context: A structural model of heterosexism as minority stress in the workplace. Journal of Counseling Psychology, 46, 218–232.

GENDERQUEER This entry describes the experiences of individuals who identify as genderqueer. First, the entry discusses the concept of genderqueer, explaining what it means to have a gender identity that is on a spectrum of male and female, rather than a gender identity that conforms to the male–female binary. The next section discusses the role of culture in gender identity, and the distinctions between sexual and gender identity are then addressed. Next, gender identity development is examined, specifically noting the lack of models to encompass genderqueer identity. Finally, relationships with others are reviewed by considering genderqueer individuals’ anticipated reactions from loved ones and other individuals within their social networks.

The Concept of Genderqueer The concept of being genderqueer is not currently well understood within most Western cultures. Genderqueer is a term that typically describes one of three gender identity categories: (1) an individual who feels their identity falls in between male and female, (2) an individual who may feel male or female at distinct times, or (3) an individual who rejects gender completely. The following terms may be used by individuals who feel that their gender identity falls somewhere in between male and female: gender variant, intergender, androgene, genderfluid, and pangender (this list is constantly growing and changing, so these are several examples of a longer list). The term bi-gender is typically used for individuals who may feel male or female at distinct times, meaning that a person may feel male on a specific day and will use male pronouns and dress in masculine clothing, but on

another day the same person will feel female and use female pronouns and dress in feminine clothing. There are several terms that are used for individuals who reject gender entirely, of which agender and neutrois are the most common. Other than bi-gender individuals, who will often use male (he/him/his) or female pronouns (she/her/hers), most genderqueer individuals will use gender-neutral pronouns. Many genderqueer individuals will use they/them/their as a singular pronoun. Other common pronouns include zie/hir/ hirs, xe/xem/xyr, and ey/em/eir. It is common for genderqueer individuals to use a name in lieu of pronouns or to use the pronouns they were socialized with. Typically, pronouns are chosen based on what feels most comfortable and aligns with the gender identity of the genderqueer person. Genderqueer has been used as a term that broadly describes individuals who have a wide range of experiences of gender—often referred to as the gender spectrum. In most Western cultures, both gender and sex have been conceptualized as being solely man–woman or male–female. These identities are primarily considered to be the only two possible options for humans and are portrayed as opposites to one another; as such, they are referred to as binary gender identities. The terms gender and sex are used interchangeably, even though they are distinct constructs. Sex refers to biological characteristics (e.g., chromosomes, reproductive organs, secondary sex characteristics, and hormones) that usually are used to categorize an individual as male or female. Gender refers to traits and identities that are usually considered masculine or feminine based on social and cultural stereotypes and norms. Even though the concept of gender may be more easily considered to be a spectrum of feelings and expressions, sex should also be given the same consideration. There are many variations of chromosomal makeups. Indeed, XY and XX are the most common, but there are numerous other combinations (for example, X, XXY, XXX) that provide biological evidence that there is a range of sex possibilities. Except for rare situations, all infants are assigned a male or female sex in utero or when they are born. This assignment is most often based on

Genderqueer

perceptions of the infant’s external genitalia, but it is also sometimes based on chromosomal tests that are conducted during pregnancy. When infants are assigned male or female, societal expectations of how they should act, be treated, and raised arise. For genderqueer individuals, the assignment of one of two sexes and the social implications of this assignment can contribute to the difficulty of understanding and coming to terms with their own gender identity.

Gender Identity and Culture Although the term genderqueer may not yet be one that is well understood in broader Western cultures, most non-Western cultures incorporate more than two genders. Many groups that are indigenous to what is now the United States describe a two-spirit identity for individuals who feel both masculine and feminine; there are many terms for a two-spirit identity, based on the culture (e.g., nádleehí nádleehí—Navaho; niizh manidoowag manidoowag—Ojibwe; Bote/Bate/Bade—Apsáalooke [Crow]). Outside of the United States, there are numerous examples of individuals who may be considered to have a “third gender” that often translates similarly to the concept of Western genderqueer identity (e.g., the Chuckchi in Siberia, Bakla in the Philippines, Hijra in India, and Quariwarmi in Peru).

Gender Identity and Sexual Orientation Sexual orientation and gender identity are often conflated. Just as gender is portrayed as a binary concept, so too is sexual orientation (e.g., gay/ straight). Gender identity is an internal sense of how masculine, feminine, or nongendered an individual feels. Sexual orientation includes a person’s attractions, behaviors, and fantasies. Even though these two concepts are not the same, they tend to be related to how individuals are socialized. Most cultures are considered to be heteronormative— that is, most people will be raised and assumed to be heterosexual. Adding to the complexity, assuming that an individual will be heterosexual is also assuming that the person will be cisgender (the individual’s gender identity will be congruent with

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his or her sex assigned at birth). As an example, a person is raised as a boy from birth due to the presence of a penis when born. This person will be socialized as a boy in all aspects, including specific commentary about performing masculinity with women, such as how to treat girlfriends and a future wife. For many genderqueer individuals, their gender identity does not conform to whom they are attracted or with whom they are romantically involved. Sexual orientation is composed of romantic/sexual attractions, behaviors, and fantasies, whereas genderqueer identity is rooted in feelings (or lack of feelings) of masculinity/femininity. Sexual orientation labels such as gay and lesbian often reinforce a gender binary. For instance, labeling someone a lesbian communicates that this person identifies as a woman and is attracted to women; the label gay can be used for any individual, but most often is used for men; bisexual communicates the person is attracted only to men and women; and heterosexual communicates the person’s gender by indicating that he or she is attracted to an individual on the other end of the gender spectrum. While some genderqueer individuals will use these common labels (lesbian, gay, bisexual, straight), many others will use sexual orientation terms that allow for less constricted communication of gender. For example, most genderqueer individuals will identify their sexual orientation as queer, pansexual, or omnisexual, or they may not use a label at all. Even if a genderqueer person is exclusively attracted to women or exclusively attracted to men, they will likely choose a sexual orientation label that will not confine them to a binary gender identity.

Identity Development To date, there is very little research on identity development for genderqueer individuals. Most identity development models indicate that there is a beginning process that will lead to some endpoint. For gender identity development, earlier models focused on children understanding how to identify men and women and the permanence of gender (also called gender consistency) based on the sex assigned at birth. Newer research has

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started to focus on transgender individuals’ identity development. It typically follows a pattern of an individual transitioning from male to female or female to male and the social and medical procedures involved in that process. It is clear that the earlier models of gender identity development were incorrect, in that they assumed two genders. Not only are there more than two genders, but gender is also not necessarily fixed. Because there is a lack of popular culture understanding of genderqueer identity, most individuals who feel genderqueer do not have the terminology or the understanding of what is going on internally to communicate with others about how they are feeling regarding their gender identity. Individuals who do not conform to gender norms are often dismissed or ignored; nonconformity is considered shameful in most Western cultures. Even though transgender men and women will experience the same amount of internal shame as genderqueers, there are systems that are set up in order to assist them with their gender identity process (more language in the media, therapeutic guidelines, etc.). However, genderqueer identity is often misconstrued as the middle phase of transgender identity, whereby the individual will eventually “choose” a more binary identity. Because genderqueer identity is often not talked about, individuals typically find out about the identity label from the Internet. Genderqueer individuals will usually assess whether or not they feel they can come out to loved ones and at school or work. Typically, individuals who are able to be fully authentic about who they are with other people usually feel more actualized in their identities, but for reasons outlined in the next section, they may not feel comfortable communicating their genderqueer identity with others.

Relationships With Others The assumption that everyone’s identity will align with their sex assigned at birth (i.e., cisnormativity) can influence genderqueer individuals’ fears of coming out to others. This fear occurs for several

reasons, including worry about rejection by loved ones, concern about being diagnosed with a mental disorder, and feeling like one is deviating from societal gender norms. The fear of a negative response from family members is often the primary worry for genderqueer individuals. If the genderqueer individual is planning on communicating their identity to their family, there is typically a fear that the family member will respond with grief (“I’m losing the child/parent/sibling/partner I thought I had”) and shame (“It is dysfunctional to have a genderqueer identity”). Family members often have the most difficulty with using a different name or gender-neutral pronouns because they have typically known this individual longer than anyone else. Being rejected by family members after coming out as genderqueer can be extremely painful and may lead to fear and distrust about how others will respond. Outside of family, genderqueer individuals will need to navigate coming out at school/work and to friends. Though this can be a difficult process for some individuals, recent research suggests that genderqueer individuals are positively surprised by the affirming response they receive from others. Stephanie Budge See also Cisgenderism; Gender Spectrum; Queer; Transgender Inclusion in the LGBTQ Rights Movement; Transgender Inclusion on College Campuses; Transphobia

Further Readings Ault, A. (1996). Ambiguous identity in an unambiguous sex/gender structure. Sociological Quarterly, 37, 449–463. Budge, S. L., Rossman, H. K., & Howard, K. A. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of coping and social support. Journal of LGBT Issues in Counseling, 8, 95–117. Burdge, B. J. (2007). Bending gender, ending gender: Theoretical foundations for social work practice with the transgender community. Social Work, 52(3), 243–250.

GLAAD Harrison J., Grant J., & Herman J. L. (2012). A gender not listed here: Genderqueers, gender rebels, and otherwise in the National Transgender Discrimination Survey. LGBTQ Policy Journal at the Harvard Kennedy School, 2, 13–24. McPhail, B. A. (2004). Questioning gender and sexuality binaries: What queer theorists, transgendered individuals, and sex researchers can teach social work. Journal of Gay & Lesbian Social Services, 17(1), 3–21. Shotwell, A., & Sangrey, T. (2009). Resisting definition: Gendering through interaction and relational selfhood. Hypatia, 24(3), 56–76.

GLAAD This entry describes the formation, development, and current configuration of GLAAD, a nongovernmental media-monitoring organization based in the United States. This entry covers the history of GLAAD from 1985, when the organization was founded, to the present. The entry ends by examining the controversial significance of GLAAD to the production, distribution, and reception of mediated representations of LGBTQ individuals, suggesting the organization’s industrial, social, cultural, and even economic impact.

The Formation of GLAAD By the mid-1980s, a number of mainstream American publications were regularly reporting on the HIV/AIDS crisis using derogatory language, often appearing to support multiple forms of discrimination against those suffering from or assumed to be susceptible to sexually transmitted diseases. Perhaps the most prominent and persistent culprit in such AIDS-themed journalistic alarmism was the New York Post, which frequently rankled AIDS activists by employing a range of apparent scare tactics, printing headlines suggesting the threats posed to straight families by gay men, and generally reducing the global HIV/AIDS crisis to the contours of gay male “deviance.” GLAAD, then known as the Gay & Lesbian Alliance Against

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Defamation, formed as a response to the Post’s coverage, aligning itself with the broad goals of AIDS activism while honing a commitment to monitoring popular media for signs of homophobic biases. By 1987, GLAAD had successfully lobbied a range of publications, including the New York Times, to end their reliance on the term homosexual, with its clinical connotations, and to replace it with the word gay—a word whose affirmative, liberationist associations had long since been advanced within activist communities. Later, in 2002, GLAAD would help inspire the Times to include, for the first time, same-sex couples on its “Weddings & Celebrations” page. GLAAD’s first decade witnessed the organization’s focus on print journalism as a source of misleading, obviously prejudiced portrayals of nonheterosexual citizens and the medical, legal, and cultural crises believed to be derivative of their very identities. With a number of mainstream publications casually referring to gay bars and clubs as “AIDS dens,” and suggesting that any concentration of gay men was inevitably generative of HIV infection, GLAAD orchestrated a multipronged campaign to combat such offensive, heterosexist reductionism, in the process helping to popularize words and phrases that were free of antiquated or otherwise undesirable connotations. The organization thus played a key role in conditioning producers of print media to accept a greater responsibility for protecting the rights of sexual minorities not to be identified with disease and destruction, as well as for employing an affirmative or at least equitable parlance. As part of this process, GLAAD has contributed to the creation and maintenance of various reference standards, including The Associated Press Stylebook, which was revised in 2006 to reflect a terminological broadening among LGBTQ individuals. Such revisionist impulses have extended to GLAAD itself and include the organization’s racial, ethnic, and transnational diversification (in terms both of critical purview and of active personnel), as well as its 2013 decision to officially discard its foundational designation as the Gay & Lesbian Alliance Against Defamation.

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GLAAD and American Television Ten years after successfully lobbying the New York Times to adopt the word gay, GLAAD orchestrated a wide-ranging campaign centered on Ellen DeGeneres, the performer who publicly selfidentified as lesbian in 1997, shortly before her character on the network television sitcom Ellen similarly came out of the closet. GLAAD’s “Let Ellen Out” campaign, which commenced when DeGeneres began negotiating with ABC/Disney regarding the sexuality of her television avatar, led to the creation of a webpage—part of GLAAD’s broader organizational website—devoted to information about DeGeneres’s process of emerging from the closet. Long before the explosion of online platforms for celebrity gossip, GLAAD’s DeGeneres–themed webpage, titled “Ellen Watch,” provided frequent updates on DeGeneres’s path to prominence as a lesbian-identified cultural figure. In April 1997, DeGeneres made the cover of Time magazine, along with the notably colloquial, nonchalant headline “Yep, I’m Gay”—a headline whose language and tone were traceable to GLAAD’s efforts to combat clinical and alarmist designations. Since the cancellation of DeGeneres’s sitcom in 1998, GLAAD has maintained a pronounced commitment not merely to scrutinizing representations of LGBTQ characters on television, but also to advocating for the expansion of such representations.

GLAAD “On the Ground” GLAAD has frequently attempted to preempt negative or erroneous media portrayals of LGBTQ individuals through a range of interventionist measures. In 1998, the organization dispatched experts to Laramie, Wyoming, where the gay youth Matthew Shepard had recently been murdered in an evident hate crime, to survey the local conditions in which television, print, and online journalists were composing some of the first Shepard-themed news stories. GLAAD’s active presence in Laramie contributed to the organization’s growing reputation as the type of watchdog group whose members were willing to conduct far-flung fieldwork. Bolstering this image, GLAAD has consistently

expanded its media-monitoring practices to include productions in Latin America and Asia, implementing specific Spanish- and Chinese-language measures in 2004 and 2007, respectively. One of GLAAD’s most famous interventions occurred in 2001, when the organization accelerated its efforts to curtail the trans-media spread of Dr. Laura Schlesinger, a pop therapist whose radio program had long provided a platform for her homophobic opinions and rhetoric. Thanks in large part to GLAAD’s efforts, production on Schlesinger’s television talk show did not continue as planned, and Schlesinger herself soon faded into relative obscurity. More recently, rather than petitioning media producers to ban particular individuals, GLAAD has orchestrated campaigns to “educate” those celebrities, such as Kobe Bryant and Tracy Morgan, who have publicly employed antigay slurs or sought to advance antigay sentiments. GLAAD’s operations have not been immune to controversy, however, and the organization has periodically been the object of criticism among those who perceive considerable conservatism in its methods, objectives, and leadership. Beyond the heterosexist circles whose media productions GLAAD had pledged to address, criticism has often come from LGBTQ individuals who see certain hierarchies among the organization’s personnel and critical concerns, as well as an aversion to nuance. For instance, GLAAD’s resistance to the television series RuPaul’s Drag Race on the basis of its use of allegedly transphobic slurs has drawn opposition from several of the program’s participants, including its eponymous host (and cocreator), who has proclaimed an affirmative queer position from which to speak, seeking to reclaim the term tranny in particular. Others, including writers for the website Queerty, have critiqued what they see as GLAAD’s exclusionary practices, including the organization’s ongoing commitment to terminological standardization. Noah Tsika See also Bisexualities; Homophobia; Homosexuality, Female; Homosexuality, Male; Media Representations of LGBTQ People; Queer; Queer Politics; Queer Theory; Sexual-Identity Labels; Transgender Sexualities

GLAAD

Further Readings GLAAD. http://www.glaad.org James, A. (2014). The GLAAD board’s ‘tranny’ trouble: How its trans takeover is reshaping LGBT politics. Retrieved October 24, 2015, from http://www.queerty .com/the-glaad-boards-tranny-trouble-how-itstrans-takeover-is-reshaping-lgbt-politics-20140724 Schiavi, M. (2011). Celluloid activist: The life and times of Vito Russo. Madison: University of Wisconsin Press.

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Shilts, R. (1987). And the band played on: Politics, people, and the AIDS epidemic. New York, NY: St. Martin’s Press. Strub, S. (2014). Body counts: A memoir of politics, sex, AIDS, and survival. New York, NY: Scribner.

GSAS See Gay–Straight Alliances (GSAs)

The SAGE Encyclopedia of

LGBTQ Studies 2

Edited by Abbie E. Goldberg Clark University

H counts do not capture all the types of violence, discrimination, and harassment experienced by vulnerable group members. Instead, bias crime laws have been implemented as a means of recognizing the additional harms that bias victimization imposes on individual victims, their families and communities, and society at large, and as a means to deter future bias crimes by clearly identifying them as a type of crime worthy of attention. Great variation in tracking bias crimes across the globe can be attributed in part to the differences in bias crime definitions. For example, many countries throughout Europe include some types of bias speech in their bias crime laws, while the United States protects the freedom of speech, including bias speech, more broadly, making comparisons across countries difficult. Many jurisdictions also do not include sexual orientation or gender identity/expression in their bias crime definition, adding further challenges in estimating bias crime prevalence globally.

HATE CRIMES LGBTQ people are frequent targets of biasmotivated crimes (i.e., hate crimes). This entry addresses the topic of hate crimes based on sexual orientation and gender identity. First, the entry provides a legal definition of hate crimes, maintaining a global perspective on how this legal definition is constructed. Second, the entry presents data from official legal sources that outline the characteristics and prevalence of bias crimes based on sexual orientation and gender identity.

Defining Hate Crimes Hate crimes, also called “bias crimes,” are a 20th-century legal concept that has emerged primarily in the United States, Commonwealth countries, and Europe. Despite variation in definition, the Organization for Security and Co-operation in Europe and the Office for Democratic Institutions and Human Rights outline two basic features of bias crimes: (1) There is a base offense (e.g., vandalism, assault), and (2) bias is a motive for the crime. In other words, perpetrators selected targets because of their membership in a protected group or based on a particular social characteristic, and victims were selected because of the group or characteristics they represent rather than their individual identity. Bias crimes are a legal definition of one type of bias-motivated behavior, and official

Hate Crimes Against LGBTQ People Due to fears of being victimized again by law enforcement and criminal justice personnel, many LGBTQ people choose not to report incidences of bias, although cases in which the victim sustained great injury and when the perpetrator was a stranger are more likely to be reported to law enforcement. Therefore, official reports of bias crimes are at best estimates, and they are in fact an 467

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undercount of the true number of bias crimes committed each year. Even given these limitations, there is still evidence that LGBTQ people are frequent targets of bias-motivated crimes. For example, over 1,000 sexual orientation–motivated bias crimes are reported to the Federal Bureau of Investigation in the United States each year. Both the United States and Canada have reported that sexual orientation bias crimes are particularly violent, as compared to other types of bias crimes, and more likely to result in physical injuries. Research also suggests that sexual-minority men are more likely to be targeted for bias-motivated violence than are sexual-minority women. Bias crimes based on gender identity or expression tend to be more violent than even crimes based on sexual orientation, to occur in public places, to involve perpetrators who are strangers, and to have multiple perpetrators. In addition, people who are transgender or gender nonconforming in their identity or expression have a high rate of becoming victims of murder due to gender identity– motivated violence. Studies conducted in the United States that examined relative risk of victimization based on official reports of bias crimes and estimates of overall population have found that LGBTQ people bear a disproportionate burden. For example, in the United States, bias crimes based on race/ ethnicity are the most common numerically, but when dividing the reported number of bias crimes by the population estimates of each victim group (e.g., dividing the total number of reported crimes against Latinos by the estimated number of Latinos in the population, or the total number of reported bias crimes against gay men divided by the estimated number of gay men in the population), results suggest that sexual minorities face a greater chance of being the victims of bias crime than any other group, and the victims of biasmotivated physical violence in particular. Because of variance in cultural values, stereotypes, and historical understanding of varying sexualities and gender, this finding may not be true in all jurisdictions and societies. However, given the high rates of violence reported globally against sexual

minorities and gender-nonconforming people, these results suggest that LGBTQ people are at least as vulnerable as other historically vulnerable groups, if not more vulnerable to bias-motivated violence. Bias crime perpetrators have been identified as primarily young White men, often those with a criminal history who are crime “generalists” rather than “specialists.” Although there are many theories that attempt to explain bias-motivated offending, most theories take into account the masculinized nature of bias crimes against LBGTQ people, such as the high degree of violence used in the crimes, the presence of “overkill” in many antigay and anti-transgender murders, the high frequency of multiple male perpetrators “performing” their masculinity in front of other men by gay bashing in groups, and the reports that many perpetrators experienced intense feelings of peer pressure to participate in biasmotivated crime to “prove” their masculinity. In addition, gay bashers have reported that they believe society condones their behavior, suggesting the importance of reducing societal stigma in order to reduce bias-motivated crimes against LGBTQ people. Rebecca L. Stotzer See also Discrimination Against LGBTQ People by Law Enforcement; Sexual Minorities and Violence; Transgender People and Violence; Violence and Victimization of Youth

Further Readings Hall, N., Corb, A., Giannasi, P., & Grieve, J. (Eds.). (2014). The Routledge international handbook on hate crime. New York, NY: Routledge. Peterson, D., & Panfil, V. R. (Eds.). (2014). Handbook of LGBT communities, crime, and justice. New York, NY: Springer. Turner, L., Whittle, S., & Combs, R. (2009). Transphobic hate crime in the European Union. ILGA-EUROPE and Press for Change. Retrieved October 26, 2015, from http://www.ucu.org.uk/media/pdf/r/6/ transphobic_hate_crime_in_eu.pdf

Health Care Plans

HEALTH CARE PLANS A health care plan is the mechanism used to pay for and deliver health care. Health care is unique when compared with other goods and services because people generally lack knowledge of what kind of health care they need; health care prices are frequently unknown to patients; and health care services are either medically necessary or elective, so patients do not change their health care consumption on the basis of price. Consequently, health care plans are in place to help strike a balance between keeping costs affordable and making sure people receive enough care to stay as healthy as possible. Historically, the LGBTQ population has faced unique challenges in their health coverage because of the earlier absence of universal recognition of same-sex marriages affecting spousal coverage under employee benefit plans. In addition, the availability of health care coverage is especially important for the LGBTQ population, because health insurance can mean the difference between having or not having access to HIV treatments if needed, HIV prevention medicines, gender reassignment therapy, and reproductive coverage. The majority of Western countries outside of the United States have government-provided health care. While government-provided health care has been debated in Congress since 1911, the United States has never implemented it and instead has a complex system of alternative health insurance models. The majority of people in the United States rely on a health care plan to subsidize the high cost of medical care. There are four broad categories of U.S. health care plans: direct capitation, government health care, corporate self-insurance, and self-insurance. Each model has its own mechanisms for controlling costs and preventing overuse. Insurance models are systems that pool money by collecting payments from many members, and then paying for the medical costs of members who require care. Insurance models include health maintenance organizations (HMOs), participating provider options (PPOs), and consumer-directed

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health plans (CDHPs). The majority of Americans who do not receive insurance through the government are enrolled in an insurance plan. Insurance is most often provided by an employer, but under the sweeping health care reforms of the 2010 Affordable Care Act (ACA, known colloquially as “Obamacare”), more Americans are able to purchase individual insurance coverage. Insurance plans control costs and prevent overuse by charging co-pays or coinsurance, capping coverage, and including deductibles. Many insurance systems prevent overuse by using a “gatekeeper,” meaning patients are required to get referrals from their primary care providers before seeing specialists. Insurance companies delineate between essential services and inessential services, and coverage often reflects social biases. For instance, sexualminority men generally do not receive any assistance in their reproductive expenses. Sexual-minority women, however, often have medical coverage for costs associated with intrauterine insemination. Purchasing insurance has been simplified and regulated under the ACA. Private insurance plans can be easily compared in terms of both price and services. Importantly, insurers may no longer deny coverage for preexisting conditions. Further, the insurance exchanges use a person’s reported earnings to determine if he or she is eligible for government subsidized health insurance. The Affordable Care Act has partially addressed the problem of having a significant uninsured population in America. Employers under the Affordable Care Act will be required to provide insurance; however, as of this writing, that provision has yet to take effect. Still, the majority of Americans receive health insurance for themselves and their families from their employers. For many years, insurance coverage was not extended to same-sex marriage partners in many states, due to the influence of the Defense of Marriage Act (DOMA) and state laws. The Supreme Court’s adjudication of DOMA as unconstitutional and same-sex marriage recognition have reversed this trend by creating a federal mandate to treat same-sex marriages and domestic partnerships identically to their opposite-sex counterparts. The latter decision also invalidated state and local laws

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that had denied recognition to same-sex marriages. Some cities, municipalities, and states also require employers to extend family health care coverage to unmarried long-term partners. The direct capitation model is a membership system. Members pay to have access to an established network of providers and hospitals that exclusively serve members. Unlike fee-for-service models, the direct capitation model pays doctors a flat rate. Kaiser Permanente is an example of this system. Kaiser members always see Kaiser doctors and go to Kaiser hospitals. Direct capitation systems control costs because, unlike fee-for-service models, doctors do not make more money from ordering more expensive care. The Affordable Care Act has created a new form of direct capitation systems called accountable care organizations (ACOs) that are now spreading to the private market. In an ACO, a collection of health care facilities band together and agree to treat a patient pool for a certain amount of money; consequently, they take any surplus, reflective of efficient care, as profit. Government insurance in the United States is available to select groups only, although under the ACA, the number of people eligible has been significantly expanded. There are four major government health care systems in the United States: Medicare, which is available to all people over 65 and disabled people, and is provided by the federal government; Medicaid, which is available to people who are low earners; the Veterans Administration, which provides care to military veterans; and Tricare, which provides care to people currently in the military. Medicare covers HIV treatment when a person is impoverished and under 65. Starting in 2014, Medicare pays for gender reassignment therapies; because there is a significant transgender, low-income, HIV-positive population who are eligible for Medicare and under 65, this means many more transgender people will be able to receive gender reassignment therapies. Rarely do state programs opt to cover gender reassignment therapies. Many transgender rights groups are pushing for an expansion of Medicaid coverage at the state level. Medicaid, Medicare, and nearly all insurance plans provide coverage for HIV transmission–preventing drugs (PrEP and PEP).

Corporate self-insurance is offered by organizations that are large enough to create an internal health care structure. For example, Boeing selfinsures its employees. A corporate self-insurer does not rely on an outside insurer. Instead, the corporation has its own contracts with health care providers and determines its own co-pays, deductibles, and caps. This system operates similarly to group insurance, because the corporation is able to use its large employee pool to spread risk. It controls overuse and growing costs by aggressively incentivizing healthy lifestyles and providing easy-to-access primary care. While the Affordable Care Act provides a more affordable way for people to get insurance than previously available in America, many people, particularly those with unstable incomes who earn above the subsidy threshold, may not find the health care prices affordable and may instead opt to incur the tax penalty for lack of insurance. People who have no health care plan in place have “self-insurance,” because the individual must pay all costs out of pocket directly to the providers of their care. Under the best conditions, a person who is self-insured has opted to use a government-supported health savings account (HSA), where a person can save for health care costs with pretax income so that when confronted with an illness or injury, he or she has the resources to cover it. Unfortunately, most people who self-insure do not use HSAs and have limited access to primary care. Theoretically, costs should be controlled because a rational consumer will request only necessary services at the best prices. However, uninsured individuals are likely to depend on emergency care for their medical needs, letting their conditions worsen until they become life threatening and then receiving care regardless of their ability to pay. This trend is very costly, and the expansion of Medicaid and individually purchased insurance represents a calculated strategy to reverse this paradigm. Leslie C. Allen See also Aging, Social Relationships, and Support; Chronic Illness; Discrimination Against LGBTQ People, Cost of; Discrimination on the Basis of HIV/ AIDS in Health Care; Domestic Partnership; Health Care System; Health Disparities; HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to

Health Care Providers, Disclosure of Sexual Identity to

Further Readings Blue Cross BlueShield of Illinois. (n.d.). Health plans and provider networks. Retrieved September 2, 2014, from http://www.bcbsil.com/getting_started/health_insurance/ types_plans DeNavas, C., Proctor, B., & Smith, J. (2011, September). Income, poverty, and health insurance coverage in the United States: 2010. Current Population Reports. U.S. Department of Commerce. Retrieved September 2, 2014, from https://www.census.gov/prod/2011pubs/p60-239.pdf How private health coverage works: A primer—2008 update. (2008, April 1). Henry J. Kaiser Family Foundation. Retrieved September 2, 2014, from http:// kff.org/health-costs/issue-brief/ how-private-health-coverage-works-a-primer/ Kates, J., & Ranji, U. (2014, February 21). Health care access and coverage for the lesbian, gay bisexual, and transgender (LGBT) community in the United States: Opportunities and challenges in a new era. Henry J. Kaiser Family Foundation. Retrieved October 20, 2014, from http://kff.org/disparities-policy/perspective/ health-care-access-and-coverage-for-the-lesbian-gaybisexual-and-transgender-lgbt-community-in-the-unitedstates-opportunities-and-challenges-in-a-new-era/ Medicaid expansion: States’ implementation of the Patient Protection and Affordable Care Act. (2012, August). Washington, DC: U.S. Government Accountability Office. Retrieved September 2, 2014, from http://www .gao.gov/assets/600/593210.pdf U.S. Department of Health and Human Services. (2012). Health, United States, 2011. With special feature on socioeconomic status and health. Hyattsville, MD: National Center for Health Statistics. Retrieved September 2, 2014, from http://www.cdc.gov/nchs/ data/hus/hus11.pdf

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In general, LGBTQ people call the process of exploring, accepting, and revealing one’s sexual or gender identities (as LGBTQ or other similar labels) “coming out.” This is an ongoing unfolding of one’s own internal understanding of the meaning of these identities, and making decisions about who should know, how best to tell others, and how to manage the reactions of others. It can be an extremely stressful process because it is hard to predict who might react negatively. The stakes can be very high, including losing a job, being cut off from family, or losing custody of a child. Being visibly LGBTQ or sometimes just being physically within a neighborhood or business identified as LGBTQ can increase the risk for violent victimization. Within this larger context of coming out, disclosure to health care providers is one specific form of coming out that can have a set of possible negative, positive, or mixed consequences and contributes to LGBTQ health disparities. These are explored later in the entry. Disclosure is not a simple yes or no, “out or not out” proposition. One study found that LGBTQ people ranged along four distinct types of disclosure to health care providers: 1. Active disclosure: This person directly revealed information about sexuality and gender to the health care provider. 2. Passive disclosure: This person wore a T-shirt with an LGBTQ slogan, introduced a same-sex partner, or had a visible marker of his or her sexuality/gender and assumed that the provider accurately read the clue. 3. Passive nondisclosure: This is the classic “don’t ask, don’t tell” scenario.

HEALTH CARE PROVIDERS, DISCLOSURE OF SEXUAL IDENTITY

TO

There is debate as to whether or not LGBTQ people should reveal their sexual and gender identities to health care providers, and whether revealing this information leads to better quality health care. This entry explores this debate and examines the barriers and facilitators to disclosure. But first, some definitions are in order.

4. Active nondisclosure: Some LGBTQ people lied about their sexuality or gender to avoid negative consequences.

The Health Care Encounter Any visit to a clinic, doctor’s office, hospital, or other health care setting typically involves interactions with many people, including receptionists, patient navigators, nurses, nursing assistants, doctors, physician assistants, medical social workers,

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housekeepers, students from health care training programs, dieticians, chaplains, and a host of other workers, not to mention other patients/clients. Most research has focused on disclosure to doctors or nurses, ignoring the sheer number of disclosure decisions that need to be made in any health care visit. Most encounters are with strangers, and therefore, the LGBTQ patient/client has no prior knowledge of their attitudes. There is also the stress of the underlying health problems or threats to health and well-being that go along with health care visits. It is a stressful situation under the best of circumstances, and some think that disclosure adds unnecessary stress, but there is research showing benefits of disclosure. Benefits of Disclosure

Some of the benefits of disclosure can arise from coming out in general. Many people report a sense of relief from no longer having to hide their true identity, and not having that big secret overshadowing everything. The person feels more authentic and truthful. There is a sense of integrity, a wholeness, and an improvement in the quality of relationships. Part of the benefit of coming out stems from releasing the shame and guilt that accompanies keeping secrets from others. Letting go of that soul-sucking shame results in better mental health and well-being. Disclosure to health care providers can have additional health benefits in at least five areas: 1. When a person comes out, his or her partner and family may be more readily recognized and acknowledged, increasing the support available for healing. This will take the stress off and alleviate fears that partners may not have access to information, may not be allowed to visit, or may be treated with less respect than significant others of opposite-sex relationships. If health care providers know their patients’ sexual and gender identities, they can inquire about whether the patient has appropriate legal documents to protect his or her relationships/families, and patients will be more satisfied with their care. 2. Health care can be better tailored to one’s needs. For example, a woman in an exclusive

relationship with another woman does not need a lecture about birth control. 3. Honesty fosters more honesty. Sometimes patients need to reveal information about unhealthy behaviors, fears, or vulnerabilities to get the best possible care. Issues not raised to health care providers can increase the feelings of shame and guilt, and may contribute to an avoidance of health care. Disclosing about one’s sexuality or gender identity may pave the way for other difficult sharing, such as experiences of child abuse, intimate partner violence, or substance abuse. 4. When nonbiological or nonlegal LGBTQ parents are out to health care providers, the providers know who cares for the child in case of emergencies, ensuring that all primary caregivers are involved in the child’s care. 5. Some research suggests that men who have sex with men may sometimes fragment their health care. They go to sexual health clinics for anything related to their sexual practices, and to primary care providers for everything else. The result is that their primary care providers do not have the whole picture, and this may compromise the quality of their care. When primary care providers have the full disclosure of patients, they can provide more holistic and comprehensive care in one location, benefiting the patient.

Dangers of Disclosure

There are potential risks with disclosure as well. Far too many LGBTQ people have experienced denial of care, rough treatment, verbal harassment, referrals to psychiatry or religious groups for a “cure,” dismissal of significant others, and “tolerance” rather than acceptance. Tolerance is a form of microaggression, a common experience of not being welcomed or included that can increase the stress level of LGBTQ people because it happens so often, and is dismissed as trivial or not “real” discrimination. Another common problem that can stem from disclosure is becoming the subject of gossip or voyeuristic attention. Some fear that their confidentiality may be breached. Finally, the sexual or gender identity of the individual might become the focus for the health care

Health Care Providers, Disclosure of Sexual Identity to

provider. Many gay and bisexual men, in particular, have reported that their primary care providers often interpret every symptom they have as HIV/ AIDS or other sexually transmitted infections. Most of the time, the health problem that brings LGBTQ patients to a health care visit is not related to their sexuality or gender identity, but they are always entering the system in the context of their LGBTQ identities and relationships. Issues That Might Differ for Transgender Patients/Clients

Transgender people have some unique issues related to disclosure. Imagine the potential for shock/surprise on the part of health care providers doing a physical exam when they are expecting one type of body and find another. In addition, there are some circumstances when the physical body is important. Transgender women still have a prostate; transgender men often still have a cervix, uterus, vagina, and ovaries. They need the appropriate cancer screenings. In addition, hormones can interact with other drugs/treatments, so health care providers need to know the type and dose of hormones. Gender differences seem to provoke even more anxiety and discomfort among health care providers than sexual identity differences, so transgender patients report an even higher likelihood of being denied needed services, being treated roughly, hearing negative comments, and having providers who are uncomfortable and inconsistent with their patients’ preferred names and pronoun choices. Some health care providers insist that gender stems from one’s biology and refuse to acknowledge the gender identity of the patient. The rest of this article combines LGBTQ people together, but in reality, people who identify with each letter in the alphabet soup of sexual and gender identities may have somewhat different experiences. Most of the research has focused on gay men and lesbians, and much less is known about bisexual or transgender people’s experiences with disclosure to health care providers. The section that follows addresses general issues that may be true for many, but not all, LGBTQ people.

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Barriers to and Facilitators of Disclosure to Health Care Providers Often advice is given to LGBTQ people to come out, but the decision is a complex one, and disclosure is not always the safe option. In this section, four sets of factors that might be related to the likelihood of disclosure to a health care provider are considered: (1) the individual patient/client level; (2) factors related to the health care provider; (3) the health care institution level (the agency, clinic, office, hospital, etc.); and (4) the higher societal, legal, and health care systems level. The Individual Patient/Client Level

We know the most about individual-level factors, and there are many things that may play a role in disclosure to health care providers. The following list is certainly not exhaustive. Factors Related to Identities. Every patient is a combination of many identities, and some people of color, people with disabilities, or immigrants may be less likely to disclose. They may think that they already have enough strikes against them for their visible differences without disclosing the hidden identity related to their sexuality or gender. People with higher levels of education and income (more privilege) might be more likely to come out. Youth who are dependent on parents and family may be less likely to disclose for fear of loss of that support, and older adults who grew up in more restrictive times may be less likely to disclose for fear of discrimination. Factors Related to One’s Sexual or Gender Identity Development. These may include the stage of overall coming out (people who are still struggling near the beginning of the process and have not fully accepted their own identities may not be ready to disclose to others), comfort level with one’s own sexuality and gender, degree of internalized oppression, whether partnered or not (there may be someone who needs to be included in health care decisions), whether the person has children (health care providers need to be aware of the relationships of the parents), prior experiences with health care

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in general and with disclosing to a health care provider, and community norms and resources. Several studies found that bisexual men and women were less likely to disclose than gay men or lesbians. Factors Related to the Specific Health Care Visit. These might include the reason for the visit. If the problem is acute, such as a sprained ankle or strep throat, there may be less need to disclose than if the visit is for a chronic health problem, such as heart disease or cancer. Another factor is opportunity. If the health care provider asks a question about sexual and gender identities, or if the written forms have a place to disclose, patients are much more likely to reveal their sexuality or gender than if they must create the opportunity themselves. In studies of both adults and youth, about two thirds of respondents wished that the provider would ask. The Health Care Provider Level

Some LGBTQ patients will seek referrals from friends and people in their communities, or use online resources such as the GLMA (Gay and Lesbian Medical Association) Provider Directory to find health care providers who are known to be LGBTQ-sensitive. Many do not have the luxury of choice and have to base their decision about whether to disclose on at least two types of health care provider characteristics. These include the following: Provider Demographic Characteristics. This includes whether the provider is known to be LGBTQ or at least has a reputation as LGBTQfriendly, and often includes age and gender. Some LGBTQ people believe that women and younger providers are more likely to be accepting. Provider Behaviors. These include both the language and the nonverbal behavior of a provider. All patients want providers who are good communicators, but LGBTQ patients may be looking for key words that indicate the provider has some knowledge of LGBTQ issues and family structures—for example, asking, “Are you

sexually active with men, women, both, or neither?” and using words like partner instead of, or in addition to, spouse or husband/wife. Nonverbal cues include personal space, tone of voice, touch, and body language that send messages about the provider’s level of comfort with the situation. Most providers automatically assume that their patients are heterosexual (a concept called heteronormativity) and this assumption makes it harder for the LGBTQ person to disclose because it renders their sexuality or gender invisible. A parallel assumption is that all people are clearly male or female and have been that way since birth, a concept called gender normativity. If the patient does disclose, the individual will carefully monitor the provider’s response. Sometimes silence is the hardest reaction to interpret. It would be beneficial if providers acknowledge the disclosure, because it may have been an act of courage. A simple statement such as, “Thank you for sharing that. Is it okay if I mention it in your written records?” signals both acceptance and an awareness that it still may not feel safe to have sexual orientation and gender identity information on formal paperwork. The Local Health Care Agency/System Level

At the local community level, the clinic, office, hospital, or other health care setting (called the “agency” for the rest of this section) is located in a neighborhood, and sometimes physical locations have reputations as LGBTQ-friendly or -hostile. The agency may have a tie with a religious group that is not generally welcoming of LGBTQ people. The agency may have a bad reputation among the LGBTQ community because of a negative experience only one person had years ago. If the agency is not aware of the bad reputation, they do nothing to change it. Once patients enter the agency, they will scan the environment for clues that this agency recognizes that it serves LGBTQ people. Such clues include posters, flyers, patient information brochures, magazines, newsletters, the patient rights statements, and the forms that the receptionist

Health Care Providers, Disclosure of Sexual Identity to

hands over, as well as many other visual cues. Some agencies or individual providers will have stickers that declare “safe zone,” “straight but not narrow,” or have symbols like pink triangles or rainbows that indicate some awareness of LGBTQ communities. The patient will look to see if there are any visible, openly LGBTQ employees. Some patients may do research on the agency before deciding whether to make an appointment, and may search to find whether the agency has a human rights policy that explicitly names sexual orientation and gender identity; whether they have domestic partner benefits, LGBTQ committees, and LGBTQ people on the board of directors; whether they advertise their jobs or services in the LGBTQ press; and so on. It is important for agency websites to use inclusive and welcoming language for all the communities they serve. The Human Rights Campaign (HRC) collects information from health care institutions about LGBTQ-inclusive policies using a survey tool called the Health Equality Index. The HRC website has a database of inclusive agencies for individuals who have choices in their health care systems and providers. Societal Level

Local systems and individuals that work within these systems are influenced by the broader context. Although the U.S. Supreme Court ruled in June 2015 that same-sex couples have the same right to marry as heterosexual couples throughout the country and that these unions must be recognized nationwide, a given locality may differ in other respects, including health care policy. Does it have legal protections for LGBTQ people in employment, housing, and education? Is there agency oversight by a government regulatory body like the Joint Commission (the organization that accredits and monitors hospitals) that now requires LGBTQ-inclusive policies? What is the overall political climate of the region or state? These often invisible forces can have profound influence over individual health and well-being, but they are often not recognized or acknowledged as sources of stress. It is easier to focus on the individual’s behavior than to study the effects of laws, policies, or

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political campaigns. However, state and federal laws and policies related to health care are profoundly important. A good example of widespread impact was when President Obama issued an executive order mandating that health care agencies that accept federal money must grant visitation rights to same-sex partners. These messages from the top down must be balanced with bottom-up provider and agency-level changes to make systems more hospitable to LGBTQ people. This will shift the likelihood of disclosing in major ways.

Conclusion The decision to disclose sexual or gender identity to a health care provider is complex and multilayered. Some of the factors lie within individual patients’ personal characteristics and experiences, but the bulk of them come from higher-level influences. If the societal level promoted policies that included LGBTQ people as full citizens and valued the diversity of the population, more education about LGBTQ issues would be found in health care training programs (and elsewhere), partners and families would be recognized, forms would be inclusive, and disclosure would be simple and straightforward. Although much progress has been made in the past 10 years, there are still dangers associated with disclosure that will keep some LGBTQ people from getting the highest possible quality of health care. LGBTQ political campaigns that urge individuals to disclose to health care providers need to also work on the higher-level factors that make disclosure uncomfortable or even dangerous for individuals. Michele J. Eliason See also Chronic Illness; Closet, The; Coming Out, Disclosure, and Passing; Health Care System; Heteronormativity; Physicians

Further Readings Durso, L. E., & Meyer, I. H. (2012). Patterns and predictors of disclosure of sexual orientation to health care providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy. doi.10.1007/s13178-012-0105-2

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Eliason, M. J., & Schope, R. (2001). Does “Don’t Ask, Don’t Tell” apply to health care? Lesbian, gay, and bisexual people’s disclosure to health care providers. Journal of the Gay and Lesbian Medical Association, 5(4), 125–134. Gay and Lesbian Medical Association (GLMA). Provider directory. https://glmaimpak.networkats.com/ members_online_new/members/dir_provider.asp Human Rights Campaign (HRC). (n.d.). Healthcare equality index. Retrieved December 7, 2015, from http://www.hrc.org/hei McNair, R. P., Hegarty, K., & Taft, A. (2012). From silence to sensitivity: A new identity disclosure model to facilitate disclosure for same-sex attracted women in general practice consultations. Social Science & Medicine, 75, 208–216. Mosack, K. E., Brouwer, A. M., & Petroll, A. E. (2013). Sexual identity, identity disclosure, and health care experiences: Is there evidence for differential homophobia in primary care practice? Women’s Health Issues, 23(6), e341–e346. Neville, S., & Henrickson, M. (2006). Perceptions of lesbian, gay, and bisexual people of primary health care services. Journal of Advanced Nursing, 55(4), 407–415.

HEALTH CARE SYSTEM A health care system supplies health-related resources corresponding to the health demands of a population. Health care systems are made up of the complex structures of hospitals, clinics, doctors, nurses, support staff, pharmaceutical products, medical devices, emergency response services, and payment systems that come together to improve the health of a population. Health care systems, as discussed here, are limited to direct interventions aimed primarily at improving health. This entry will first identify the components of a health care system and then move on to model different systems of health care delivery. Health care systems that fail to provide universal health coverage, like the system in the United States, generally underserve the LGBTQ population. In part, this underservice is a direct result of the ban on gay marriage that was still in effect in many states until

the Supreme Court ruled in June 2015 that samesex couples have a right to marry anywhere in the United States. Until that ruling, many people in same-sex relationships were unable to extend their health insurance coverage to their partners. The LGBTQ population also experiences a higher prevalence of HIV, substance use, and smoking, which all require medical interventions.

Components of a Health Care System Medical infrastructure such as hospitals, clinics, doctors’ offices, long-term care facilities, and ambulances are the skeleton of a health system. The ability of the medical infrastructure to promote health in an area depends on the access to, and quality of, service. Health care providers are a key part of the system. Physicians, psychiatrists, psychologists, nurses, advanced practice registered nurses, midwives, pharmacists, physician’s assistants, nursing aides, traditional healers, and medical support staff are all part of the health care system at large. Medical devices and pharmaceuticals play a crucial role in a health system. Having stable access to appropriately prescribed medicines is an essential component to maintaining a high quality of health. For example, for those with HIV, having access to a stable source of antiretroviral medication can mean the difference between life and death. Because developing new medicines is an extremely long and costly process, pharmaceutical drugs often carry high price tags. Drug companies protect their developed medicine by filing a patent, making it illegal for anyone else to produce the same drug for a set period so they have an opportunity to recoup their costs. In countries with a low average income, governments may choose to produce their own generic versions of lifesaving medicine, even when a patent is still in effect.

Health Care System Models In the modern world, governments play a very important role in the health of their respective populations. Economically and socially, illness has a negative impact that is costly to society. An

Health Care System

unhealthy population is prone to missing days of work due to illness and disability; consequently, public health issues can reinforce poverty and make running a business, school, and government more difficult. Having a healthy population creates stability and social cohesion. Further, health is an essential component of a happy, well-balanced life. For these reasons, many countries have come to consider access to health care a basic right, and therefore believe the government should be its primary provider. Because of widespread discrimination, when health care is not a universal right, the LGBTQ population feels the impact disproportionately. There are three models that various countries use to deliver health care to all: the Beveridge model, the Bismarck model, and the national health insurance or single-payer model. Other countries, either from lack of resources or for philosophical reasons, treat health care more like a traditionally consumed good where people have access to it only if they can pay for it—known as the out-of-pocket model. Next, all four of these models, plus the American model, are explored. The Beveridge Model

Under the Beveridge model, the government finances and provides health care through taxation. Philosophically, this model sees health care as a public good and basic right for all. The Beveridge model is named after its creator, William Beveridge, who developed this model and oversaw its implementation in the United Kingdom. In the Beveridge model, the government owns the majority of hospitals and clinics. For the private facilities that do exist, payment is still rendered by the government. There is no significant private health care market supplementing the publicly available care. Doctors may be government employees or may work for a private group. Private groups are still paid by the government. The Beveridge model is characterized by the fact that only the government pays for health care. Patients do not receive bills and do not cover any percentage of their own health care. This model is in practice throughout the world; for example, it has been implemented in Great Britain, Hong

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Kong, Taiwan, Australia, Cuba, New Zealand, and Spain. In some of these countries, the government owns the majority of hospitals and clinics; in others, hospitals and clinics are mostly privately owned and the government pays them for services rendered. Countries where the government owns more of the hospitals and clinics are more socialized systems than those that have significant private sector contributions. Countries using this model tend to have a low cost per capita. This is because the model is successful at controlling costs from both the supply side and the demand side. The supply side is controlled because the government is the sole purchaser of services and can negotiate doctor fees, pharmaceutical prices, and hospitalization costs very effectively. This ability to bargain should be contrasted with a free market system where patients, often facing death or suffering if they go without care, are willing to pay any price, resulting in skyrocketing care costs. Under the Beveridge model, the demand for expensive health services is reduced because everyone has access to health care absolutely; therefore, price never prevents them from seeking care. Consequently, people receive early interventions, which results in enough preventive care to reduce the amount of crisis care needed in the long run. This model takes away consumer choice to a large degree. Care delivery can be cold and impersonal; because the government pays, consumer demand does not shape the care experience. On the worst side of it, there can be long waits to receive nonemergency care. While these systems boast a rather good average quality of care, receiving exceptional care is difficult because one does not have the option to hire the best specialists and innovators for a specific illness. Further, becoming a physician or nurse is not a highly prestigious and profitable career, and consequently these countries may see their best and brightest choosing other fields where they can generate greater financial returns. Countries with this model are vulnerable to “brain drain,” where the most innovative and cutting-edge doctors leave the country to pursue careers where they can make more money and devote more resources to research. Critics of

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collective drug bargaining argue that governments buy pharmaceuticals at negotiated prices; thus, they drive down prices below what it costs to develop new drugs. As a result, some believe that if all countries adopted this system, the rate of medical innovation could slow down. The Beveridge model is mostly positive for the LGBTQ population because it provides services universally. In most Beveridge systems, many treatments for gender dysphoria are covered entirely. However, the system is not flawless; indeed, waiting lists for gender reassignment surgery can be staggering. LGBTQ people can also be frustrated by a lack of choice in providers, making it more difficult to receive culturally competent care. The Bismarck Model

The Bismarck model is an insurance system whereby all employers and employees contribute to health care through payroll taxes, and the government fills in the health insurance gap for the unemployed and retired. Bismarck models are distinct from the American health insurance system because contributions are not optional and everyone is covered. Further, the government prohibits insurance providers from seeking a profit. The government still plays a heavy role in cost control, and prices for services and pharmaceuticals are negotiated. Countries using the Bismarck model have what is still an example of a multi-payer system, and employers use higher-end plans to attract talent. In these systems, insurance is called sickness plans. The Bismarck model has been adopted by Germany, Switzerland, Belgium, and Japan. This is a hybrid model where there is mandatory insurance with public and private providers. This model is a premium-funded, mandatory insurance model. In general, it has been very effective at keeping costs reasonable, though not quite as effective as the Beveridge model. This model provides health care for all citizens, and it treats health care as a basic right, but it has many different payers, including a safety net government payment system, all closely regulated. By keeping hospitals almost entirely private and competing for

patients, the Bismarck model is thought to do a better job than the Beveridge model at creating a positive patient experience. Further, by having many different insurance companies participating, but preventing them from generating large profits, the marketplace rewards competition without exploiting inelastic consumer demand. The Bismarck system has shorter waiting times to see providers than the Beveridge system, as well as high-quality care and overall low per-capita costs. Unlike the U.S. insurance system, Bismarck model insurers rarely deny insurance coverage for services rendered, they do not require a copay, and the government independently heavily subsidizes pharmaceuticals. This system is overwhelmingly positive for LGBTQ patients, who benefit from universal coverage and the ability to choose their providers. The Bismarck model, like the Beveridge model, may not provide significant enough profit incentives to attract the most talented minds to medicine or breed the kind of pharmaceutical innovation that the highly profitable U.S. system does. Other negatives of this system are that costs and medical outcomes are, on average, worse than in countries with a Beveridge model. The reason for this is rising costs, which tend to be addressed by increasing premiums instead of controlling costs, because the government does not have control over the providers. The National Health Insurance Model/ Single-Payer Health Care Model

This system relies on private sector health care providers and is paid for by the government-created insurance plan supported by taxes. It is a hybrid of the Beveridge and Bismarck system because it uses a single, government-run, health insurance provider, and relies entirely on the private sector to give care. However, it is distinct from these systems in that health care can still be purchased beyond what the government provides, outof-pocket. Care providers who offer elite or innovative care may accept only out-of-pocket payment. Consequently, the “brain drain” is less of

Health Care System

a risk under this system. Canada, South Korea, and Argentina all have implemented this system. This system provides universal care and keeps costs contained because the government is a powerful bargaining entity. In particular, this model is highly effective at purchasing pharmaceutical drugs. There are no incentives for the government to reject claims, and there are no marketing costs associated with health care because there is no competition. There are negatives to this model due to budget constraints. This system suffers from significant wait times and coverage caps. Consequently, consumers may have to settle for care that is not their preferred method and may need to enroll in waitlists. LGBTQ populations may be particularly likely to be affected by these shortcomings because of biases existing within the system toward LGBTQ individuals, especially those who are HIV-positive or transgendered. For example, a person with HIV may have to settle for an antiretroviral therapy that has more side effects than other similar drugs. Out-of-Pocket Model

Only 40 of 200 countries have implemented a national health care system. For those that have failed to do so, their system is referred to as an outof-pocket system. In these countries, those with money have access to health care, and those without money do not. Limited government programs and charity programs fill the gaps with crisis care. Some countries with nominally socialized health care have de facto out-of-pocket systems. In China, for example, most nonrural citizens are uninsured, and the major form of aid in receiving health care is a direct subsidy. In Vietnam, government subsidies cover only about 20% of care, with the remainder paid out of pocket. This system results in many people, including the LGBTQ population, being underserved in all areas of health care. Because some of the countries with this system are impoverished, lifesaving medicines, including antiretrovirals, may be made by the government under an international, need-based suspension of pharmaceutical patents, which drives down the prices

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significantly. Even with this allowance under patent law, countries with an out-of-pocket system still see too few people receiving antiretroviral drugs, largely because testing is not done before the illness progresses to AIDS. The American System

The United States has the ultimate hybrid model. Americans may experience their health care similarly to those living under a Bismarck system, national health insurance model, Beveridge model, or an out-of-pocket model. Many Americans receive health care from their employer. For them, American health care is a lot like the Bismarck model, because both they and their employer pay into a private insurance pool. Notably, unlike Bismarck countries, not all employers provide insurance, and insurance companies are profit seeking. The Affordable Care Act, passed in 2010, reformed the American insurance model to require organizations that employ 50 full-time workers or more to provide insurance to their employees or pay a penalty. To date, the change in policy has not dramatically changed the availability of employer-provided health insurance, and unlike a Bismarck system, employees do not have to buy insurance from their employer. Employer-provided health insurance varies tremendously in terms of quality and fee mechanisms. Many employers offer traditional insurance, which often requires partial payment for services rendered, through copays, deductibles, and coverage capitations. Employers also may choose to offer managed-care health insurance, where doctors and hospitals join as a collaborative entity that takes a single fee per patient and provides care exclusively to patients in the system, and that offers no coverage if employees choose to leave the organization. In between these two examples exist health management organizations (HMOs), where a patient may get care from providers who have entered into a contract with the insurance company. American insurance plans are notoriously and intentionally complex, and they have been criticized for using bureaucracy and opaqueness to deny claims and

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drive down their costs by placing them more squarely on the patient. Proponents of the system say that Americans with insurance are very satisfied with their health care and enjoy the autonomy to choose their care. LGBTQ families have been excluded in some jurisdictions under this model because, until June 2015, not all states have had marriage recognition or have created a proxy institution (e.g., domestic partnership). Many employers who were not bound by law to recognize same-sex relationships as equivalent to marriage have opted to extend spousal health insurance benefits as a recruitment tactic. An increasing number of Americans are receiving their health care from the government through Medicare and Medicaid. Americans who get coverage this way experience health care the way that people who have the national health insurance model do. Only Americans who have disabilities or are over age 65 are eligible for Medicare. The federal government consistently administers Medicare all across the United States. Medicaid is intended for people who have low income; however, the income threshold varies tremendously from state to state. Medicaid is administered by each state independently, and the way the care is structured varies. Under the Affordable Care Act, the federal government has hoped to both expand and converge state Medicaid plans by offering federal dollars to states that agree to offer certain programs and expand coverage. Typically, Medicare offers better coverage and reimbursement for providers than Medicaid, but both operate similarly. Neither Medicare nor Medicaid operates its own facilities, and instead they both simply provide insurance; patients can choose their own providers. Unfortunately, some providers limit the care they offer to those on federal government plans, because state plans typically promise lower reimbursement rates. Impoverished LGBTQ populations living in areas that, prior to the June 2015 Supreme Court decision, did not recognize same-sex marriage, have received an unintentional benefit from this discrimination. Because spousal earnings are used to determine if an individual is eligible for Medicaid, individuals in unrecognized same-sex relationships were more likely to qualify for Medicaid.

Medicare covers half of the HIV population in America because HIV treatment receives special coverage under Medicare. While Medicare is traditionally available only to those over 65, it has a specific expansion for patients who are found to be disabled by the Social Security Administration. For a very small percentage of Americans, health insurance is delivered similarly to the Beveridge model. The U.S. Department of Veterans Affairs (VA) and TriCare both offer governmentpaid care at government-owned facilities. The VA provides care to military veterans, and the TriCare system provides care to those who are active military. TriCare is known to provide top-quality care, including covering treatment with private specialists, while the VA is often accused of providing subpar care. This contrast illustrates that the quality of Beveridge coverage is highly dependent on the resources supporting it. Those in the United States who do not have any insurance live in an out-of-pocket system. One notable difference from this model in some other countries is that, in the United States, emergency care must be provided. Consequently, Americans without insurance often leave routine illnesses untreated, getting treatment only when the illness has progressed far enough to require emergency hospital admission. Emergency care is not free; the cost is still billed to the patient, so these visits can leave visitors with high bills. Medical debt is often crippling and is the leading cause of bankruptcy in America. Before 2010, many Americans were uninsured because buying private insurance was exorbitantly expensive. Further, insurers refused to provide coverage for those with preexisting conditions; as a result, people with a chronic illness could not purchase insurance that covered them. Because LGBTQ people are more likely to live in poverty, the community has been disproportionately affected by this problem. In 2010, the Affordable Care Act was passed, changing the way insurance companies could exclude buyers and charge for coverage. The anticipated effect is that fewer Americans will be uninsured in the future. Many of the previously uninsured are obtaining health insurance in a quasi-public fashion, because the Affordable Care

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Act provides people who earn less, but not so little as to make them eligible for Medicaid, with significant sliding-scale subsidies that can be used to purchase insurance of the consumer’s choosing. In theory, this hybrid approach will address the number of uninsured without destroying the advantages that the American health care system has in terms of innovation and consumer choice. Leslie C. Allen See also Aging, Social Relationships, and Support; Chronic Illness; Discrimination Against, LGBTQ People, Cost of; Discrimination on the Basis of HIV/ AIDS in Health Care; Domestic Partnership; Health Care Plans; Health Disparities; HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to

Further Readings Bloomberg. (2014, August 25). Most efficient health care 2014: Countries. Retrieved September 2, 2014, from http://www.bloomberg.com/visual-data/best-andworst/most-efficient-health-care-countries Centers for Medicare and Medicaid Services. (n.d.). National health expenditures 2013 highlights. Retrieved September 2, 2014, from https://www.cms .gov/Research-Statistics-Data-and-Systems/StatisticsTrends-and-Reports/NationalHealthExpendData/ downloads/highlights.pdf DeNavas, C., Proctor, B., & Smith, J. (2011, September). Income, poverty, and health insurance coverage in the United States: 2010. Current Population Reports. U.S. Department of Commerce. Retrieved September 2, 2014, from http://www.census.gov/prod/2011pubs/ p60-239.pdf Kates, J., & Ranji, U. (2014, February 21). Health care access and coverage for the lesbian, gay bisexual, and transgender (LGBT) community in the United States: Opportunities and challenges in a new era. Henry J. Kaiser Family Foundation. Retrieved October 20, 2014, from http://kff.org/disparities-policy/perspective/ health-care-access-and-coverage-for-the-lesbian-gaybisexual-and-transgender-lgbt-community-in-the-unitedstates-opportunities-and-challenges-in-a-new-era/ Lameire, N., Joffe, P., & Widmann, M. (1999). Healthcare systems—an international review: An overview. Nephrology Transplant Dialysis Journal, 14, 3–9.

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Mills, A. (2014, February). Health care systems in lowand middle-income countries. New England Journal of Medicine, 370, 552–557. Physicians for a National Health Program. (n.d.). Health care systems—Four basic models. Retrieved September 2, 2014, from http://www.pnhp.org/single_payer_ resources/health_care_systems_four_basic_models.php Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. Milbank Quarterly, 83, 457–502. Van Deusen, L., Holmes, S., Cohen, A., Restuccia, J., Crammer, I., Shwartz, M., et al. (2007, October/ December). Transformational change in health care systems: An organizational model. Health Care Management Review. Retrieved September 2, 2014, from http://www.rwjf.org/en/research-publications/ find-rwjf-research/2007/10/transformational-changein-health-care-systems.html World Health Organization. (2000). World health report: Why do health systems matter? Retrieved September 2, 2014, from http://www.who.int/whr/2000/en/ whr00_ch1_en.pdf?ua=1

HEALTH DISPARITIES Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals make up a population that is heterogeneous and diverse in terms of a wide range of demographic factors including age, race, ethnicity, geographic location, socioeconomic status, gender expression, and gender identity. Despite these differences, LGBTQ individuals face some common problems, including both minority stress and psychosocial inequities that are unique to sexual and gender minorities. These problems are implicated in the health disparities experienced by these groups when compared with heterosexual and cisgender counterparts on both physical and mental health indicators. This entry will first outline some explanatory theories of health disparities including individual factors, psychosocial components, and other protective and risk factors. Next, mental and physical health research with LGBTQ populations will be reviewed, and issues related to access to healthcare for LGBTQ individuals will be discussed. Finally, some conclusions based on the review of the literature will be provided.

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To date, a majority of the research on LGBTQ populations indicates that these groups experience elevated levels of mental health symptoms, higher rates of some psychiatric disorders, higher levels of health-risk behaviors, and greater risk for some physical health problems. The consensus in the field is that it is not something inherent in diverse sexual and gender identities that causes these disorders. Indeed, despite elevated risk in the overall LGBTQ population, most LGBTQ individuals are relatively healthy and resilient. Still, the undeniable pattern of disparities between LGBTQ and heterosexual/cisgendered populations indicates that something about these groups’ experiences contributes to these results. If it is not something inherent in nonheterosexual or gender-nonconforming identity itself, then it must be something in this population’s life experiences.

Theories Explaining Health Disparities Health disparities for LGBTQ people are situated in a long history of stigmatization and discrimination toward this group. Recent medical and social science literature has framed LGBTQ health disparities within the context of this inequality, which underlies society’s inattention to the unique experiences and health needs of this population. To encourage and facilitate understanding of how LGBTQ individuals’ identities and experiences interact with their health, health care access, and health care outcomes, the Institute of Medicine (IOM) reviewed four conceptual frameworks: (1) the life-course perspective, (2) the minority stress model, (3) the intersectional perspective, and (4) the social ecology model. The life-course perspective attends to development between as well as within age cohorts, considering relevant historical contexts. Sexual-minority stress theory seeks to understand an individual’s experiences with both internal and external stressors within a social and community context. Intersectionality focuses on the interaction of multiple stigmatized identities, considering the ways in which related experiences adversely affect health. Finally, the social ecology perspective considers the various influences in

people’s lives, emphasizing social connections, societal factors, and how these may impact health. A full discussion of these models is outside the scope of this entry. However, each of these frameworks provides perspective to improve understanding of health needs, status, and disparities in LGBTQ populations. The IOM report notes that these models complement each other, enabling a comprehensive approach to understanding LGBTQ individuals’ experiences and the subsequent impact on health issues. As the health disparities between LGBTQ and heterosexual/cisgendered populations have emerged in the literature, efforts have shifted to understanding why these disparities exist. Several theories and models seeking to explain these effects have been posited. The most researched and widely recognized of these models, Ilan Meyer’s minority stress model, delineates a complex interaction of both proximal and distal stressors as well as protective and supportive factors that, together, contribute to the mental health of the individual. To understand the health disparities only with regard to prevalence rates would be to only understand half the issue—the effect without the cause. Recent reports from the American Psychological Association and the IOM have highlighted the importance of understanding the role of these risk and protective factors in this population. With regard to LGBTQ youth, research has consistently revealed higher levels of minority stressors such as victimization, harassment, and other forms of overt discrimination. These experiences are predictive of increased rates of emotional and behavioral issues. Research in this domain is disproportionately focused on the experience of sexual-minority adolescents rather than gender minorities and younger children. However, results have been remarkably consistent in revealing that increased minority stressors are associated with depression, anxiety, suicidal ideation and attempts, self-image issues, interpersonal issues, and behavioral problems including substance use. In addition, research has consistently suggested that prevalence of childhood abuse, including physical and sexual abuse, may be higher among LGBTQ

Health Disparities

youth, which may also be causally linked to health disparities. A disproportionate number of homeless youth identify as LGBTQ; in turn, their homelessness may in part reflect family rejection. Both homelessness and family rejection may exacerbate already deleterious health consequences for these youth. Recent research has suggested that young transgender females may be most at risk for becoming homeless, which can disrupt medical services if they have already begun the transition process. Conversely, acceptance and support from peers, school mentors, and especially family have been revealed to be protective against mental health problems. LGBTQ youth who experience family acceptance, particularly during the coming-out process, report significantly lower symptoms of depression as well as suicidal ideation and attempts than those who experience family rejection. While few studies have directly examined the impact of inclusionary and protective school policies and organizations, it may be that these serve to ameliorate the risk associated with an unsafe environment and promote the protective effects of safety and being supported. To this end, a limited number of studies have revealed that students in schools with such policies report feeling safer and experiencing fewer incidents of harassment. Among LGBTQ adults, the roles of discrimination, violence, and victimization as they relate to mental and physical health have also been evaluated. For most LGBTQ people, living in a society in which one’s sexual and gender identity places them in the minority can create internalized stigma and elicit day-to-day microaggressions that have implications for health and well-being. LGBTQ adults are more likely to be the victim of discrimination, both overt and covert, over their lifespan than are their heterosexual and cisgender counterparts. These lifetime experiences are even more prominent in the lives of older LGBTQ adults, who came of age during a time when societal attitudes toward LGBTQ people were even more negative and restrictive. Negative events that are perceived by the victim to be directly related to his or her sexual or gender identity are even more

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deleterious to mental health than those events that are less clearly linked. Although policies and laws are changing in the United States, LGBTQ adults still face institutional discrimination in the workplace and within the larger context of society. In particular, those living in regions or cities with fewer protections for LGBTQ people may experience disproportionate minority stress and resulting health problems. In sum, while all LGBTQ people are subject to the negative health impact of minority stress, there is research evidence that variations in exposure to these stressors are related to variations in depression, anxiety, suicidality, substance abuse, and other health-related concerns. The research on protective factors among adults is more limited and is an area for future study. Social support and connection to a supportive LGBTQ community may be important protective factors against certain negative problems. Another protective factor is the development of a positive LGBTQ identity. Self-acceptance and the formation of a positive belief about oneself as an LGBTQ person may protect against the negative mental health sequelae of a poor self-image. Among transgender individuals, developing this positive selfimage may entail utilizing medical interventions to achieve congruence between one’s physical body and gender identity. Some limited research has suggested that obtaining these interventions can play a role in mental health.

Mental Health For years, even after homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM), research on this topic was tainted by its former classification as a psychiatric disorder. Over the past two decades, research on mental health of LGBTQ populations has grown due to greater societal acceptance of this topic as well as methodological advances in the field. The inclusion of questions about sexual and gender identity on national, population-based health surveys has allowed researchers to systematically examine differences between populations without the bias inherent in uneven sampling

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methods. Results have indicated higher levels of psychological distress and higher rates of several mental health disorders in LGBTQ populations. Findings are at times inconsistent and may vary based on sampling methods and measurement issues. For example, disparities tend to be greater among samples that are recruited using probability methods than among those recruited directly from LGBTQ communities, indicating that perhaps those who are “out” and connected to these communities are less vulnerable. In addition, disparities tend to be greater when sexual orientation is defined in terms of sexual behavior rather than self-identification as LGBTQ. This may indicate that there is something protective about self-identification for those with same-sex behaviors. Still, the overall picture is clear that LGBTQ populations are at greater risk and warrant further study. Awareness of a minority sexual or gender identity often develops in adolescence, and this is also the period in which mental health disparities emerge. In addition to the typical developmental tasks facing all teenagers, LGBTQ youth are faced with the challenge of developing an identity that does not conform to societal expectations. To date, the majority of research has focused on lesbian, gay, and bisexual youth, and not on those who are transgender-identified. Results indicate an increased risk for depression, suicidal ideation, and suicide attempts relative to heterosexual peers. These disparities appear to transcend sex, age, race, and ethnicity differences within LGBTQ populations. Very recently, greater attention has been paid to the unique issues for transgender and gender-nonconforming youth, and similar disparities have been found with respect to depression and suicidality. In addition, some research has also suggested that both sexual and gender minority youth may be at greater risk for anxiety-related disorders, substance use and abuse, as well as disordered eating and body dysmorphic disorders. Even as LGBTQ youth enter adulthood and gain more control over their environments and mastery over their lives, mental health disparities persist. A considerable amount of research with population-based samples has documented the

elevated prevalence of mental health disorders among lesbian, gay, and bisexual adults, with a focus on depressive, anxiety, and substance use disorders. Lesbian, gay, and bisexual (LGB) adults are also significantly more likely than heterosexual adults to have experienced suicidal ideation or have attempted suicide in their lifetime and in the past year, indicating that suicide is a risk that persists into adulthood. Though the empirical research with transgender and gender-nonconforming adult samples is sparse, studies have revealed that gender minority individuals, similar to sexual-minority individuals, experience higher rates of depressive symptoms as compared to cisgender individuals. Suicidal ideation and attempts are a particular risk among this highly stigmatized population, with rates among transgender adults even higher than those of LGB and cisgender people. Demographic, environmental, and individual factors all play a role in the risk and resilience of LGBTQ people with respect to suicide. In particular, recent research has elucidated the critical roles of social support and acceptance as well as of the individual’s own experiences of successful identity formation and self-acceptance in supporting mental health and reducing suicidal ideation.

Physical Health The physical health of LGBTQ individuals has received less attention than the mental health of this population. Thus, the research in this domain is less consistent and thorough. The preponderance of the research has focused on sexual health outcomes including HIV and other sexually transmitted infections, which has disproportionately impacted gay and bisexual men since the first cases were discovered in the late 1970s and early 1980s. Presently, it is estimated that approximately 20% of gay and bisexual men in urban areas are living with HIV. Though incidence rates of new infections have notably decreased, men who have sex with men are still at greater risk for contracting the disease, particularly in early adulthood. HIV rates may also be elevated among young, male-to-female transgender individuals. Among older adult men

Health Disparities

who have sex with men, HIV still continues to represent a substantial medical concern. In addition to higher prevalence in this population overall, older gay and bisexual male adults are more likely to contract HIV compared with their heterosexual counterparts. As with youth, little research has been done with transgender and female adults with regard to HIV; however, some small studies suggest that transgender and bisexual females may be at greater risk of contracting the disease. Other research on physical health of LGBTQ people is limited, particularly among LGBTQ youth. Most of the research focuses on health risk behaviors rather than disease. For example, some research has revealed that adolescent lesbian and bisexual girls are more likely than their heterosexual peers to experience a teen pregnancy, which in part may be due to greater risk behaviors overall and a higher prevalence of childhood sexual abuse. Among adults, LGB individuals are 1.5 to 2 times more likely than their heterosexual counterparts to use tobacco, which is associated with a number of chronic and terminal diseases. Similarly, LGB adults and particularly lesbian and bisexual women are more likely to consume alcohol and to do so in larger quantities over the lifespan and, thus, may experience greater risk for alcohol-related disease. Lesbian and bisexual women also tend to have higher body mass index (BMI) scores than their heterosexual counterparts, which can be associated with disease risk. Among the LGBTQ adult and older adult populations, physical health concerns have received slightly more attention from researchers, as health and disease become more salient with age. With respect to disparities in actual diseases, less is known about sexual and gender identity–related disparities, in part due to the historical lack of information about sexual orientation in national disease registries and health records. This makes population-based morbidity and mortality information difficult to track. There is some evidence that gay and bisexual men have elevated risk for anal cancer, and lesbian and bisexual women may have elevated risk for breast cancer. In terms of sexual and reproductive health, limited research

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indicates that gay men may experience higher rates of erectile dysfunction. Data regarding most of these physical health issues are relatively sparse and not yet conclusive, particularly with regard to the mechanisms causing or contributing to these health disparities. It is important to note that the small body of literature on physical health focuses almost exclusively on lesbian, gay, and bisexual populations, with little attention to transgender people. Understanding the physical health of transgender people, who may undergo medical interventions in order to have their physical body reflect their gender identity, is particularly important. Recently, evaluation of the long-term effects of hormone treatments indicates that this may have some physical health consequences. In addition, transgender individuals face significant barriers to accessing culturally competent care.

Access to Care The onset and persistence of LGBTQ health disparities is closely tied to access to care. Access to care is an important consideration in understanding health disparities among LGBTQ people. Access may be understood as the ability to obtain health care and may be impacted by personal as well as institutional factors. The issue of access among LGBTQ people is a complex one, and the degree to which disparities in access are problematic may vary according to the type of care. For example, a number of studies have demonstrated that LGBTQ people are more likely to seek mental health services over their lifespan. This may be due in part to elevated rates of mental health problems that necessitate care. In addition, many LGBTQ people seek professional help during the process of coming out and coming to terms with their sexual or gender identity. Perhaps relatedly, there is generally a greater sense of peer acceptance and “normalizing” of psychotherapy in LGBTQ communities, thereby reducing a barrier that is present in other segments of the population. Regarding physical health care, the picture is less clear. Population-based studies of access to

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routine, preventive care indicate that gay and bisexual men use such services with equal or greater frequency than their heterosexual counterparts. This is likely due in part to the HIV/AIDS epidemic and the greater awareness of and need for preventive services. For lesbian and bisexual women, however, seeing a medical provider is less common. Fear of discrimination and traumarelated issues from a sexual abuse history can serve as psychological barriers among this segment of the population. Cultural competency is a key factor in health care access disparities. Although attention is increasingly being paid to LGBTQ health in medical, nursing, psychological, and other training programs, many professionals lack the knowledge and skills to adequately address the concerns of this unique population. Cultural competency problems can arise from negative attitudes about LGBTQ people, stereotypical beliefs, and unfamiliarity with the actual lives and concerns of LGBTQ people over the lifespan. Broader, policy-based problems include lack of availability of programs and services tailored to LGBTQ people’s needs. Another notable barrier to health care access for some LGBTQ people is lack of health insurance. For many people in the United States, health care benefits are available through a spouse’s employment. Although the recent change in samesex marriage laws has also increased access, it is still true that many companies and insurance providers do not recognize same-sex partners for the purposes of health care coverage. Data from 2014 revealed that LGBTQ Americans were more likely to be uninsured and less likely to have a personal doctor than non-LGBTQ people. Recent health care reform has reduced these disparities slightly; however, observable discrepancies persist.

Conclusion There are three primary conclusions that may be drawn from this discussion of LGBTQ health disparities. The first is that sexual and gender minorities experience health disparities with their heterosexual and cisgender counterparts across

health domains over the lifespan. Disparate rates of mental and physical health problems are supported by a rapidly growing body of empirical research in the fields of psychology, medicine, and sociology. With regard to mental health, LGBTQ individuals are more likely to experience depression, suicidal ideation and attempts, as well as substance use problems. They may also be at increased risk for anxiety, eating disorders, and body dysmorphic disorders. With regard to physical health, more research is needed in many areas; however, there is some research to suggest that LGBTQ individuals experience greater risk for certain types of cancers. HIV is most prevalent among gay and bisexual men as well as male-tofemale transgender individuals. The second conclusion is that the source of these disparities is linked to the social and cultural oppression experienced by LGBTQ people. As research has made the shift to understanding why these health disparities exist, models for organizing and understanding the roles of risk and protective factors have been developed. Important risk factors include experiences of violence, victimization, harassment, and discrimination. Rejection by friends and family, institutional discrimination, societal stigma, and lack of community connectedness also play a role. These problems may be further exacerbated by a lack of access to competent care for LGBTQ individuals due to actual and perceived stigma among providers and structural barriers such as lack of health insurance. The third conclusion is that protective factors can make a difference. Family acceptance, community connectedness, and positive LGBTQ identity achievement all play a role in preventing and ameliorating the negative health consequences of living in a society in which one’s sexual and gender identity is not the norm. It is important to note that while consistent and statistically significant health disparities have been found, these disparities are often relatively small. Indeed, we must not overlook the fact that the majority of LGBTQ people are relatively mentally and physically healthy, even in the context of such ongoing challenges. Thus, it will be critical for future researchers to continue to

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ask questions about resilience and thriving in the face of adversity in order to fully understand the health of LGBTQ people. Kimberly F. Balsam See also Health Care System; Health Disparities, Transgender People; HIV and Treatment; Minority Stress

Further Readings Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71(1), 53–61. doi:10.1037/0022-006X.71.1.53 Hatzenbuehler, M. L. (2010). Social factors as determinants of mental health disparities in LGB populations: Implications for public policy. Social Issues and Policy Review, 4(1), 31–62. doi:10.1111/j.1751-2409.2010.01017.x Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press. King, M., Semlyen, J., Tai, S., Killaspy, H., Osborn, D., Popelyuk, D., et al. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8(1), 70. doi:10.1186/1471-244X-8-70 Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi:10.1037/0033-2909 .129.5.674

HEALTH DISPARITIES, TRANSGENDER PEOPLE Health disparities and inequities arise from systematic exposure to social stressors that are a result of being part of a socially marginalized group (e.g., transgender). This entry describes health disparities from a social epidemiologic

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perspective, reviews key health disparities facing transgender people, identifies barriers to documenting and understanding health disparities, and reviews recommended measures to identify transgender people in health surveys in order to further future research in health disparities.

Definitions In this entry, the term transgender refers to people who have a current gender identity or expression that is different from their sex assigned at birth. Transgender comes from the Latin prefix trans— which means “across” or “beyond” (gender and sex different). The term cisgender refers to people who have a gender identity or expression that is the same as their assigned sex at birth (i.e., not transgender). Cisgender comes from the Latin prefix cis—meaning “on this side of” (gender and sex consistent). A health disparity, also known as a health inequity, refers to a difference in health in which disadvantaged social groups—such as transgender and gender-nonconforming people; racial/ethnic minorities; poor people; and other groups who have experienced and continue to experience systemic social disadvantage and exclusion, marginalization, or discrimination—systematically experience more adverse health outcomes or health risks than do more advantaged social groups. Health disparities and inequities arise from systematic exposure to social stressors that are a result of being part of a socially marginalized group. Not all differences in health represent health disparities. Health inequities are avoidable, remediable, unfair health inequalities between populations. For example, on average in the population, males are taller in height than females. Is this difference a health disparity? No. The difference in height between males and females is not attributable to unfair treatment, a social inequity, or a disadvantaged social status. However, females tend to suffer more disease and disability in their lifetime than males, including a two- to threefold increased risk of depression. Is this difference a health disparity? Yes. Depression is predicted to be

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a leading cause of disability in females by 2020 due largely to gender inequities, including differential access to socioeconomic and health resources, status, roles, options, and treatment in society. In addition, the prevalence of depression varies markedly among countries, suggesting that macro social factors and social determinants (e.g., country-level gender inequality) are important to consider when examining health disparities.

(a)

Transgender X (b)

Social Stress M

Transgender X

Transgender Populations Are Burdened by Health Disparities Despite methodological limitations of existing research, studies show that transgender populations across the world are burdened by more health disparities compared to cisgender (non-transgender) people. Documented health disparities include the health areas of HIV and other sexually transmitted infections (STIs), particularly among transgender women, who are at 49% increased odds of being HIV-infected compared with all adults of reproductive age, according to a recent meta-analysis across 15 countries. Disparities are also present in mental health distress, including suicidality, depression, nonsuicidal self-injury, and anxiety; and substance use and abuse, including alcohol, tobacco, marijuana, and non-marijuana illicit drugs. Many areas of health are underresearched in relation to transgender health disparities, including chronic diseases, cancer, general preventive health screening and behaviors, and patterns of health care utilization. A gender minority stress framework can be used to conceptualize and understand health disparities that burden transgender people compared to nontransgender (cisgender) people. This framework posits that experiences of social stress across the life course disproportionately affect transgender people relative to cisgender people due to their disadvantaged social status and are largely responsible for health inequities. This is shown in Figure 1, where (a) there is an association between transgender status and health disparities (top), and (b) social stressors explain (i.e., mediate) the association between transgender status and health disparities.

Health Disparity Y

Figure 1

Health Disparity Y

Gender-Minority Stress Model of Health Disparities

Source: Sari L. Reisner. Notes: (a) Transgender people experience health disparities. (b) Social stressors related to transgender status explain these health disparities.

Stressors such as experiences of discrimination, stigma, violence and victimization, and social and economic exclusion are all too common among transgender people. Social stressors can include family rejection, peer bullying victimization, intimate partner violence, inability to access needed medical care, and poverty and lack of economic opportunity, leading many transgender women in particular to engage in transactional sex (i.e., sex in exchange for money, food, housing, or other goods and services; also known as sex work); discrimination in employment, housing, and health care (i.e., experiences of enacted stigma); and gender invalidation (i.e., being mispronouned or misgendered). This framework can also be applied to understand health-promoting, salutogenic (beneficial to health and well-being), and resilience-related factors that are protective for disparities in transgender populations. For example, positive growth-fostering coping processes may mitigate health disparities.

Limits to What We Know About Health Disparities in Transgender Populations Very little population-level data exist to document transgender health disparities worldwide. This is because routine national health surveillance efforts

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in the vast majority of countries do not typically include questions to identify transgender survey respondents. This is a major gap in furthering an understanding of the health inequities burdening transgender people. Documenting and understanding transgender health disparities at a population level necessitates having adequate data by which to compare the health of transgender and cisgender people. Such data allow comparison of the health of transgender people with cisgender people to document health disparities, and provides the opportunity to unpack the mechanisms and pathways (i.e., mediators and potential intervention points) that cause poor health differentially by gender identity, including social stressors such as discrimination. Without comparative data, we cannot state that “transgender people are disproportionately burdened by or experience a disparity or inequity in depression.” This is important to consider and ensure accuracy of inferences in health research. A study consisting of a sample of exclusively transgender people allows us to examine health outcomes and state that “transgender people bear a high burden of depression” or that “depression is highly prevalent among transgender people.” Without a comparison group, however, we cannot call this a health disparity.

Measuring “Transgender” in Surveys to Document and Understand Health Disparities Transgender health reminds us of the importance of explicitly considering sex- and gender-specific pathways in health outcomes and health disparities. Sex and gender are robust social determinants of health. In the broad, social scientific literature, sex and gender are often used interchangeably, resulting in a lack of clarity about sex and gender differences in health. The recommended approach to identifying transgender people in health surveys in order to document health disparities is using the two-step method. In this approach, Step 1 captures assigned sex at birth, and Step 2 queries current gender identity. Respondents are then cross-classified based on their assigned sex at birth and their current identity.

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An illustration of implementing a two-step approach is shown in Figure 2 using survey items from the Growing Up Today Study (GUTS). The top of the figure shows the two questions: natal sex (two response options: “male” and “female”) and current gender identity (four response options: “male”; “female”; “transgender”; and “do not identify as male, female, or transgender”). Cross-tabulating these questions gives a two-by-four (2 x 4) contingency table with eight cells demonstrating different sex and gender combinations. Column A (left column) is people assigned a male sex at birth, cross-tabbed with four genders. Column B (right column) is people assigned a female sex at birth, cross-tabbed with four genders. How does this schema help us document health disparities? That depends on the research question. Here are three examples: 1. A researcher is interested in disparities in depression by transgender status. The researcher can compare people with concordant sex/gender responses (i.e., cisgender males and females) to those with discordant sex/gender responses (i.e., assigned male sex and identify as female, transgender, or do not identify; assigned a female sex at birth and identify as male, transgender or do not identify). 2. A researcher is interested in sex-linked processes in depression and hypothesizes that people who have a female sex assigned at birth have a higher prevalence of depression compared to people assigned a male sex at birth, regardless of current gender identity. The researcher can compare all natal sex females to natal sex males, ignoring current gender identity; or the researcher could compare by natal sex, and adjust for gender identity in statistical analyses to isolate the effects of sex. 3. A researcher wants to conduct a health study about preventive screening for prostate cancer. The researcher would only include the people in column A in the study. Why? Because only natal males (e.g., those with male assigned sex at birth) have a prostate gland; natal females (i.e., those with female assigned sex at birth)—even those

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STEP 1: NATAL SEX What sex were you assigned at birth, on your original birth certificate? (check one) Male Female STEP 2: GENDER IDENTITY How do you describe yourself? (check one) Male Female Transgender Do Not Identify as Male, Female, or Transgender Assigned Sex* Column A Male (Male birth sex)

Column B Female (Female birth sex)

Cisgender Male± (male birth sex, male gender identity)

Male Identity (female birth sex, male gender identity)

Female

Female Identity (male birth sex, female gender identity)

Cisgender Female (female birth sex, female gender identity)

Transgender

Transgender Identity (male birth sex, transgender identity)

Transgender Identity (female birth sex, transgender identity)

Do Not Identify (male birth sex, other diverse gender identity)

Do Not Identify (female birth sex, other diverse gender identity)

Current Gender Identity Male

Do Not Identify as Male, Female, or Transgender

Figure 2

Conceptual Overview of Natal Sex and Current Gender-Identity Measurement Using a Two-Step Method in the Growing Up Today Study (GUTS) to Document Health Disparities

Source: Sari L. Reisner. Note: *Infants born intersex are assigned either a female or male sex by a medical provider at birth.

who are transgender men or male-identified—do not have a prostate.

When we are thinking about health disparities— and sex- or gender-linked differences—it is important to be accurate about who is and is not in the sample. The two-step approach to survey health

research can help us not only understand health inequities facing transgender people but also better understand sex and gender differences—and health disparities that may be due to assigned sex, current gender, both, or neither. Sari L. Reisner

Health Insurance Coverage for Transgender People, Access to See also Substance Abuse/Dependence and Transgender People; Therapy With Transgender, Transsexual, and Gender-Nonconforming People; Transgender Health Care; Transgender Identities; Transgender Sexualities

Further Readings Baral, S. D., Poteat, T., Stromdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. Lancet Infectious Diseases, 13(3), 214–222. Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27, 167–194. Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. (2012). Transgender health in Massachusetts: Results from a household probability sample of adults. American Journal of Public Health, 102(1), 118–122. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467. Reisner, S. L., Conron, K. J., Tardiff, L. A., Jarvi, S., Gordon, A. R., & Austin, S. B. (2014). Monitoring the health of transgender and other gender minority populations: Validity of natal sex and gender identity survey items in a U.S. national cohort of young adults. BMC Public Health, 14, 1224. Reisner, S. L., Greytak, A., Parsons, J. P., & Ybarra, M. (2015). Gender minority social stress in adolescence: Disparities in adolescent bullying and substance use by gender identity. Journal of Sex Research 52(3), 243–256. doi:10.1080/00224499.2014.886321

HEALTH INSURANCE COVERAGE FOR TRANSGENDER PEOPLE, ACCESS TO Transgender people sometimes need medical or surgical care as part of a gender transition. According to the Standards of Care described by the World Professional Association for Transgender Health (WPATH), medical and surgical care for gender transition is considered medically necessary when clinically indicated for an individual. However, health insurance plans in the United States

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often exclude transition-related health care, meaning that services related to a gender transition are not covered. The costs associated with medical and surgical care for gender transition, which can reach into the tens of thousands of dollars, may prevent individuals from getting the medically necessary care they need if they are not covered by insurance. This entry describes the current status of health insurance coverage for gender transition, barriers to increasing coverage available to transgender people, and the shifting public policy environment that impacts the availability of transition-inclusive health insurance coverage. Health insurance coverage for gender transition has been very rare in the United States in both private and public health insurance plans, but the number of plans that cover gender transition is increasing. Since 2009, the Human Rights Campaign (HRC) has tracked the availability of transition-inclusive health benefits plans for employees of Fortune 1000 companies and AmLaw 100 law firms. In 2009, a total of 49 of these employers reported that they provide transition-related health care coverage for employees. As of 2015, a total of 418 of these employers reported providing this coverage, representing an 850% increase over 6 years. In May of 2014, the federal government removed the exclusion for transition-related care from Medicare, which is the U.S. public insurance program for people 65 and older. State Medicaid programs, which are state-run plans that provide health coverage for people with low incomes and some other groups of people, generally do not cover transition-related care. However, several states, such as California, Massachusetts, Vermont, Oregon, and the District of Columbia, have removed exclusions for transition-related care from their Medicaid plans. Overall, there are an increasing number of employers and public insurance plans that are providing transition-related health care coverage. A barrier to increasing the availability of transition-related health care coverage is the perception by employers and policy makers that the cost to provide the coverage would be high. Employers who have provided the coverage for several years, including the city and county of San Francisco and the University of California, have reported that in

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fact there has been little to no cost for providing the coverage. One reason the costs are generally low is that the number of people who will need transition-related health care is small. The transgender population is relatively small, and not all transgender people will need transition-related health care. The best available estimate of the transgender population shows that 0.3% of the U.S. adult population, or around 700,000 adults, identify as transgender. Another barrier to the availability of transitionrelated health care coverage is the type of insurance products made available to employers to purchase. Employers who purchase health insurance plans for their employees from health insurance providers (i.e., the employer is “fully insured”), such as Aetna, Cigna, and others, are sometimes limited to the products the provider offers them. For instance, if an employer wants to add transition-related health care to the employee health benefits plan, the health insurance provider may or may not offer that type of coverage for the employer to purchase. If an employer pays for the full cost of the employees’ health care coverage (i.e., the employer is “self-insured” and does not pay a premium to a health insurance provider), the employer has much more flexibility in the scope of the coverage that can be offered to employees. One way that state governments are currently trying to increase the availability of transitionrelated health care coverage is by requiring that health insurance plans that are under the regulation of the state, such as private plans sold by health insurance providers within the state, remove exclusions to transition-related health care. States such as California, Oregon, Vermont, and the District of Columbia have put in place insurance regulations or directives to remove transition-related health care exclusions from health insurance plans that the states regulate. These regulations do not apply to plans that are regulated by the federal government. For instance, an employer who is selfinsured would not be subject to state regulations to remove transition-related health care exclusions. Though coverage for transition-related health care is increasing in availability in the United States, currently most plans do not provide this

type of coverage. Those plans that do provide some coverage may not cover the entire scope of care that would be considered medically necessary according to the WPATH Standards of Care. Both the availability of health insurance plans that cover transition and the scope of coverage provided in plans will need to increase to improve transgender people’s access to transition-related health care. Jody L. Herman See also Health Care System; History of Transgender Medicine in the United States; World Professional Association for Transgender Health

Further Readings Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., et al. (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13, 165–232. Gates, G. J. (2011). How many people are lesbian, gay, bisexual, and transgender? Los Angeles, CA: Williams Institute. Herman, J. L. (2013). Costs and benefits of providing transition-related health care coverage in employee health benefits plans: Findings from a survey of employers. Los Angeles, CA: Williams Institute.

HETERONORMATIVITY Heteronormativity refers to the Western social norm, or assumption, that the overwhelming majority of sexual relationships in society are heterosexual. Further, heteronormativity is the dominant sexual model of social, cultural, political, and economic organization, including the way it organizes identities, experiences, regimes of truth and knowledge, and ideologies of gender and sex.

History of Usage According to the Oxford English Dictionary, the term heteronormativity was first used by queer theorist Michael Warner in 1991 in the

Heteronormativity

introduction to his book Fear of a Queer Planet, where he suggested that embedded within most sociological concepts is an unspoken set of heteronormative assumptions. Direct precursors to the term heteronormativity include compulsory heterosexuality, coined by lesbian feminist poet and theorist Adrienne Rich in 1980; the heterosexual contract, coined by feminist Monique Wittig; and the heterosexual matrix, used by gender theorist Judith Butler, terms that all explain how individuals are socially coerced into, and rewarded for, participating in heterosexuality. Poststructuralist Michel Foucault also challenged assumptions of heteronormativity, as he wrote about discursive “regimes of truth” that constructed and reinforced knowledge about heterosexuality and homosexuality. A related term is homophobia, which Eve Sedgwick argued was the key social behavior that needed to be challenged by Lesbian and Gay Studies. However, this term has been critiqued for embedding a justification of its own oppressive action within the term itself, as it is framed from a heterosexual perspective implicitly rationalizing a fear of homosexuality, which has been used legally to justify antigay violence. The term has thus been critiqued as being itself heteronormative, leading queer activists and scholars largely to reject it because it focuses on the individual while ignoring systemic effects of the heterosexual imperative. Moving beyond the focus of early lesbian and gay movements on challenging homophobia, queer theory and activism have as their goals to challenge heteronormativity and heterosexism.

Heterosexuality: Norm Versus Privilege Implicit in the term heteronormativity is the notion that we can define what is normal in terms of a sexual practice, identity, or expression. This norm is then called heterosexuality, which is routinely taken for granted to be the form of sexual, emotional, or intimate partnering that everyone in society will partake in—a male partnering with a female (both cisgender and cis-sex) in a lifelong, monogamous married couple. This heteronormative view presumes that sexual relations are deemed normal when they take place between two people

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of “opposite” sexes, men and women, and moreover, that their sex can be determined definitively by an analysis of chromosomes and genitalia. Heteronormativity forms part of a worldview promoting heterosexuality as the preferred sexuality, in relation to homosexuality, which is deemed, sometimes through a biological determinist lens, to be abnormal. Nonheteronormative practices including bisexuality are ignored, silenced, or presumed not to exist. The term heteronormativity presumes that heterosexuality is the dominant or privileged subject position or identity, and that homosexuality is the dominated or inferior subject position. However, it has also been noted that homosexuality only becomes coherent or intelligible through heterosexuality. If heterosexuality is the norm, then homosexuality is automatically non-normative, as it is defined in relation to heterosexuality. Conversely, heterosexuality only becomes coherent through homosexuality. If homosexuality is the transgression, then heterosexuality is automatically normative through its definition in relation to homosexuality. However, heterosexuality is privileged over homosexuality, so this mirror relationship is inherently unequal, which is signaled by the terms heterosexism and heterosexual privilege. These terms signify different elements of the same system of unequal power allocated to people in society based on their real or perceived sexual practices, expressions, or preferences. Moreover, heteronormative discursive and material practices organize categories of identity into binary pairs that privilege and invest social, cultural, political, and economic power in one of the categories over the other (e.g., male–female, masculine–feminine, heterosexual–homosexual). Heterosexual privilege can be defined as the invisible advantages that accrue to people, whether currently in a couple or not, who are—or profess to be—heterosexual. This privilege is guaranteed through most of society’s social and institutional structures and systems, which ensure that straight or straight-acting people will have more status, power, rights, and privileges, including accessing specific economic benefits, than those with nonnormative or nonheterosexual expressions of sex

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or gender or sexuality. These advantages are sometimes called the “heterosexual bribe,” whereby people gain cultural and social capital or rewards by properly performing heterosexuality within a strict and narrow frame.

Heteronormative Institutional Practices Heterosexuality is in need of constant affirmation as the dominant category, through performance of normative heterosexual practices such as getting married, having a stable gender expression consistent with one’s sexed body, and reproducing biological children. It is further reinforced in middle-class economic expressions of heterosexuality such as buying a house together, having a joint bank account, accessing spousal benefits or insurance through employment, and the like. Queer theorist Nikki Sullivan has suggested that these dominant discourses and institutional practices tend to have the effect of ignoring or eradicating sexual difference. Historically, those practicing queer sexualities were medicalized, hospitalized, and subjected to various technologies to attempt to “cure” them of their non-normative sexual desires, a practice now widely acknowledged to have been barbaric and ineffectual. Eve Sedgwick, largely credited with being the first queer theorist, famously stated that sexually everyone is different, which is contrary to the implicit assumption of similar sexualities among all heterosexuals, and instead emphasizes the naturalness of sexual diversities. Through institutional practices, heteronormativity is actively created and perpetuated in the education system, media and culture, the government (through ID cards, passports, marriage and birth laws, etc.), religion, and other institutions. Postcolonial feminist Gayatri Spivak notes that reproductive heterosexuality is in fact the main pillar of global political and social structures, which are also patriarchal or male-dominated, thus reproducing both heterosexism and heterosexual privilege.

Heteronormativity in Law Heteronormativity is inscribed in the legal system of many countries. Denial of legal rights to

same-sex or nonheterosexual partners is common. Prison visitation rights are often denied. Prisons are divided into male and female populations, and trans people are frequently placed in dangerous situations. International borders control for heteronormativity in issuing family passports, demanding a stable gender identity inscribed in a passport, and using scanners that reveal one’s body to the border guard. In some countries, such as Saudi Arabia, Yemen, Mauritania, Sudan, and Iran, as well as parts of Somalia and Nigeria, homosexuality is illegal and punishable by death. Legislation pertaining to same-sex rights has emerged in the past two decades, with countries such as Norway, Sweden, Iceland, South Africa, Portugal, Spain, Canada, and the United States offering both same-sex marriage and antidiscrimination laws. A range of legal positions along the spectrum between the death penalty and same-sex marriage exist in different countries, including imprisonment with a variety of sentences from 14 years to life, the provision of inferior marriage-like alternatives, a lack of explicit legislation, and legal gray areas.

Sociological Effects of Heteronormativity Heteronormativity creates a social context in which nonheterosexual people are marginalized, which can result in persecution, discrimination, or violence toward those engaged in sexual diversities. It is inherently injurious as a limit on available expressions of sexuality, which can result in coerced closeting of sexuality. Heteronormativity is present in geographies of space marked heterosexual; in psychologies of internalized norms; in our social practices, from familial to friendship and from intimacies to sexualities; in our cultural practices and media representations; and in our epistemological or knowledge systems that shape how we come to understand sexualities. Heteronormativity is also socially constructed through media and culture, which repeatedly depict the heterosexual imperative in film, news media, dating websites, sexting, comics, radio, and the like through both underrepresentation, and representations of non-normative expressions of sexuality as

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deviant, weird, criminal, or problematic. These socalled transgressions may even be discursively constructed as warranting death through legal processes such as incarcerating a transwoman in a male prison population, which often results in her violent and brutal gang rape, serial rape, suicide, or murder; and through extralegal processes such as trans bashing. Heteronormativity can mean that basic human rights are denied to those who do not conform to the hetero norm, and these rights are differently inscribed, legalized, and enacted across the globe. In queer relationships, there is often a sense that the relationship needs to be made legible to the straight world in order for it to be considered legitimate. Examples include the emphasis on gay marriage, the question of who is the male/dominant/ masculine and who is the female/submissive/ feminine person in a queer relationship, and the binary notions of butch–femme or top–bottom.

Queer Challenges to Heteronormativity Queer movements focus on disrupting heteronormative thinking, assumptions, and behaviors by revealing and challenging the heterosexual imperative. An anti-heteronormative politics interrupts the continued narrative of the heterosexual category as a norm, attempts to remove the heterosexual bribe, and assigns value to diverse sexualities. Sexuality is reframed as a narrative, or a fluid and dynamic expression that takes place in relation to others, rather than a fixed and stable category. Heteronormativity is considered by queer theorists to be one axis of a series of intersectional identities, including gender, racialized and colonial identities, social class, religion, immigration status, and disability. Furthermore, everyone (not just those in marginalized groups but also those in dominant groups) has an identity based on these axes, which they experience at all times, rather than experiencing one axis of identity independent of the others in specific situations. Strategies for dealing with this in order to make positive change in people’s lives often include organizing in nonmixed or caucus-based groups, developing modes of self-representation to correct media

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misrepresentations, creating safe(r) spaces for specific groups, and organizing spaces for advocacy for specific rights for certain groups of people such as same-sex marriage. Some argue there is a need to move beyond identity politics of the individual to also consider systemic oppressions and privilege. Rather than considering the identity of an individual, we can examine systemic oppression caused by heteronormativity in relation to other systems of oppression and strategies for activism developed to challenge root systems of oppression. For example, activists have challenged gay pride for being capitalist, a system that reinforces White middle-class dominance of the queer scene, known as homonormativity; others argue that gay marriage is rooted in patriarchy, which reinforces sexism and the gender binary; still others have recognized the importance of gay marriage to queer migrants and immigrants who might access citizenship or legal status through marriage. Using an intersectional approach may result in different political strategies, depending on the interlocking systems being addressed.

Critiques of the Term Heteronormativity Some critics suggest that the term heteronormativity is problematic because it relies on a binary formulation of homosexual–heterosexual and may inadvertently uphold this binary as an inequality, privileging the heterosexual and ignoring the possibility of bisexuality. This formulation needs to be challenged, as it results in a static interpretation of sexuality based on a gender binary system. For example, for trans people, it is hard to define a relationship as homosexual or heterosexual when it cannot be easily determined whether the object of a person’s desire has the “same” gender or sex, or the “opposite” gender or sex. Challenges to this binary by male-bodied women and female-bodied men, as well as genderqueer, pangender, transgender, transsexual, and other diverse bodies, can interrupt not just the gender binary but also the heterosexual matrix, thereby disrupting the link between sex, and gender and sexuality—that is, the assumptions that (a) men have male bodies and women have female bodies,

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that sex is equal to gender; and (b) therefore men only have sex with women, and women only have sex with men, that is, sex/gender determines sexuality. These critiques suggest that queer theories and practices must move beyond the term heteronormativity to account for diverse genders, sexes, and sexualities. Sandra Jeppesen See also Bisexualities; Cisgenderism; Gender Binaries; Genderqueer; Heterosexism; Heterosexist Bias in Research; Homonormativity; Homophobia; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ Social Movements (Assimilation vs. Liberation); Queer Politics; Schools as Heteronormative Spaces; Transgender Sexualities

Further Readings Butler, J. (1999). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Foucault, M. (1978). The history of sexuality. New York, NY: Vintage. Rich, A. (1980). Compulsory heterosexuality and lesbian existence. Signs, 5(4), 631–660. Sedgwick, E. K. (1990). Epistemology of the closet. Berkeley: University of California Press. Sullivan, N. (2003). A critical introduction to queer theory. New York, NY: New York University Press. Warner, M. (Ed.). (1993). Fear of a queer planet. Minneapolis: University of Minnesota Press. Wittig, M. (1992). The straight mind. Boston, MA: Beacon.

HETEROSEXISM Heterosexism refers to the cultural ideology that reproduces the normative and privileged status of heterosexuality in most aspects of people’s lives, vilifying and stigmatizing nonheterosexual (referred to in this entry as LGBTQ) behaviors, identities, relationships, and communities. Heterosexism includes institutionalized negative attitudes and beliefs about LGBTQ sexualities as inferior, unnatural, and deviant, thereby reproducing sexual stigma. Heterosexism may also include sexual

prejudice, the harmful attitudes and beliefs individuals hold about LGBTQ people. It is manifested in a range of behaviors, the most extreme being violent and murderous hate crimes against LGBTQ people—that is, criminal acts perpetrated on the basis of an individual’s perceived sexual orientation. This entry discusses heterosexism in conjunction with homophobia, a term with which it is often used interchangeably, before examining aspects of two types of heterosexism most frequently discussed: cultural and psychological heterosexism.

Heterosexism and Homophobia One of the most influential scholars associated with the study of heterosexism is Gregory M. Herek, an eminent and openly gay psychologist in the United States. His research on heterosexism has been motivated, in part, by the inadequacy of the term homophobia for explaining the ideological dimension of sexual prejudice. Homophobia has often been conceptualized as an irrational fear and hatred of gay men and lesbians; in turn, scholars have criticized this concept for reducing the problem of discrimination and prejudice against LGBTQ people to a problem of individual-level panic and fear of individuals who are attracted to those of the same sex. When viewed in this way, homophobia has been used to excuse attacks on LGBTQ people. For example, a “gay panic defense” was deployed in the murder trial of Matthew Shepard, a gay university student who in 1998 was pistol-whipped and left to die in Wyoming. The defendants claimed they had acted in a state of homosexual panic, wherein they had been panicked by Matthew’s homosexuality to the point of murder. In this case, the judge rejected the claim as a legitimate strategy for defense. The gay panic defense is one instance of how homophobia is constituted as an uncontrollable, individual psychological disorder that requires treatment, thereby shifting attention away from analysis of the ideological origins and reproduction of sexual prejudice against LGBTQ people. Scholars have also argued that homophobia is a misleading term, not

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least because there is no justification for the -phobia suffix on any clinical grounds. Officially, homophobia is neither a phobia nor something that is inevitably irrational. While the irrational fear of people who are attracted to others of the same sex has produced problematic outcomes for LGBTQ people and is a severe social problem, homophobia cannot account for the nub of the problem: the societal and cultural privileging of heterosexuality. As such, homophobia is a problematic term in how it individualizes the origins of sexual prejudice, while heterosexism is regarded as a term with greater explanatory power for accounting for the institutionalized and informal beliefs that denigrate LGBTQ identities, behavior, relationships, and communities. Despite the conceptual differences between homophobia and heterosexism, these terms are often used interchangeably. Recent scholarly interest in both terms indicates that the relationship between homophobia and heterosexism is not always clear-cut. In principle, an individual may be homophobic but not heterosexist, while someone else may be heterosexist but not homophobic. The basis for this argument rests on the premise that the two phenomena are wholly independent from one another, although this is disputed. Homophobia may work alongside heterosexism to enforce beliefs and practices within societies that institutionalize and privilege heterosexuality. Heterosexism is generally viewed as a sociological term that draws attention to the ideological system that favors heterosexuality over LGBTQ sexualities, thereby bringing heterosexuality into the frame of analysis. On this point, Gregory M. Herek’s research on heterosexism has elaborated this focus of study in specific ways, allowing us to speak of different types of heterosexism: namely, cultural and psychological.

Cultural Heterosexism Parallels are sometimes drawn between cultural heterosexism and institutionalized racism and sexism in the way that they originate from the same social, cultural, and political foundations. Seen in

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this way, cultural heterosexism is embedded in and pervades numerous societal norms, practices, and institutions (e.g., in the fields of law, medicine, psychology, education, and religion), making it ubiquitous but invisible. In other words, cultural heterosexism can be understood to be so ingrained into the fabric of everyday life that heterosexuality is routinely taken for granted and accepted as the norm. As such, cultural heterosexism is invisible because it is so widely accepted that it is largely unquestioned. Indeed, institutions have provided various ideological rationales for stigmatizing LGBTQ sexualities. For instance, scientific and medical institutions have pathologized homosexuality as deviant and abnormal. It took until 1973 for the American Psychiatric Association to declassify homosexuality as a mental disorder and the World Health Organization until 1990 to follow suit. At the same time, institutionalized forms of cultural heterosexism have sought to render LGBTQ sexualities invisible through societal customs and practices that criminalize homosexuality. Cultural heterosexism is a sophisticated means by which societies can entrench cultural ideologies about the relative status of LGBTQ persons as inferior to heterosexuals and less deserving of social recognition. This is evident in the widespread difficulty that samesex couples have faced in achieving formal recognition for their relationships (e.g., in terms of marriage and civil partnerships). In other instances, LGBTQ people are denied access to fertility services on the basis of sexual orientation, curbing the place and role of LGBTQ parenting within society. In these cases, cultural heterosexism is symbolically powerful, sending out a clear message to LGBTQ people about their inferior status relative to heterosexuals, and it shapes the material circumstances under which LGBTQ people are able to live meaningful lives. Moreover, when LGBTQ sexualities are made visible in order to challenge cultural heterosexism, such as when individuals openly identify as LGBTQ, defy laws that prohibit homosexuality, and create their own family arrangements and partnerships, these individuals can become public targets for persecution and

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punishment. This reinforces the superiority of heterosexuality, positioning heterosexuality and homosexuality in a hierarchical binary opposition (i.e., heterosexuality–homosexuality, with the former term privileged over the latter) that refuses to validate LGBTQ sexualities and genders. Scholarly interest in the multiple manifestations of cultural heterosexism in everyday life, and the challenges this creates for LGBTQ people, has produced highly illustrative research. Two examples are provided. LGBTQ Personnel in the Military

The enduring prohibition of LGBTQ persons from openly serving in the military in many countries has been and continues to be a highly controversial issue. The enforcement of such bans reinforces a cultural belief that homosexuality is not fit for purpose in the theater of war, despite countless LGBTQ people who opt for nondisclosure (i.e., not sharing information about their sexuality) in order to gain employment serving their country as loyal and brave military personnel. Indeed, some scholars have extended their efforts to recover the lost and silenced voices of LGBTQ people who have fought and died in military service, so their contributions within the theater of war are duly acknowledged. Even when concessions around the role of LGBTQ personnel in the military have been made, some policies continue to reflect dominant cultural ideologies about LGBTQ sexualities as morally suspect and potentially disruptive in the workplace. One of the most infamous concessions of this type was introduced and later repealed in the United States. The Don’t Ask, Don’t Tell (DADT) policy, which from 1994 to 2011 outlined the position of the United States government on gay, lesbian, and bisexual people in the military, conveyed a contradictory message about the role played by existing and potential LGBTQ service personnel. On the one hand, the DADT policy banned military personnel from discriminating against existing closeted lesbian, gay, and bisexual (LGB) military personnel while, on the other hand, it barred openly LGB people from military service. In so

doing, it reflected and reproduced cultural anxieties within the United States about the place of homosexuality in military service, fueling further speculation about its supposedly negative influence on morale and discipline. Although President Barack Obama put an end to the policy in 2011, some political leaders and military members continue to argue that accepting LGB people in the military will have a negative impact on military discipline and morale, despite scholarly evidence showing that ending the ban on service by openly LGB personnel is unlikely to damage military effectiveness, recruitment, or unit cohesion. Heterosexism in the Workplace

Cultural heterosexism is evident in the absence of legal employment protection for LGBTQ employees in many countries. In these contexts, employers can legally discriminate against LGBTQ people in hiring and employment on the grounds of sexual orientation. The absence of antidiscrimination employment legislation signals clearly to LGBTQ people that they are abnormal, deviant, and second-class citizens who are undeserving of a basic level of protection against discrimination in the labor market afforded to other groups of employees (e.g., on the basis of class, race, ethnicity, disability). As such, many LGBTQ employees may choose nondisclosure as a way to keep their jobs and evade discrimination in the workplace. Such disclosure decisions carry additional salience in regard to issues of personal safety within countries where homosexuality is criminalized and carries severe penalties for those who are prosecuted. Under these circumstances, cultural heterosexism serves to legitimate hostility toward LGBTQ people at and outside work, constraining opportunities for LGBTQ people to flourish as human beings. Even in countries where legal employment protection has been enforced on the grounds of sexual orientation and gender identity, cultural heterosexism still influences the disclosure decisions of LGBTQ employees in the workplace. This is partly due to the fact that employment antidiscrimination legislation cannot function as a single strategy to combat how cultural heterosexism

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variously manifests itself in the workplace. By itself, it cannot alter people’s negative attitudes toward LGBTQ people and thus eliminate sexual prejudice, the means by which cultural heterosexism is articulated and sustained. The United States is a case in point. At the time of this writing, despite repeated attempts to pass the Employment Non-Discrimination Act (ENDA), no federal antidiscrimination employment regulation has been successfully introduced and enforced across the country. In many U.S. states, sexual minorities can be fired for disclosing their lesbian, gay, bisexual, or trans (LGBT) status. Although an increasing number of states and a large number of cities have passed statutes that prohibit employment discrimination on the grounds of sexual orientation and gender identity expression, scholarly research continues to show that many LGBTQ employees experience sexual prejudice in the workplace. The fight against cultural heterosexism in and outside the workplace continues.

Psychological Heterosexism Psychological heterosexism is a multifaceted construct that incorporates personal feelings, attitudes, and beliefs of disgust and hostility toward LGBTQ people, as well as behaviors that are motivated by and reflect these sorts of attitudes and beliefs. Although psychological heterosexism is manifested at the level of the individual, it is intimately bound to cultural heterosexism. The types of psychological needs and benefits some individuals experience from expressing sexual prejudice toward LGBTQ people can only function as such if they are aligned with the cultural ideology that legitimates this type of sexual prejudice. For instance, psychologists have argued that if an individual feels the need to belong to a social group or connect with an individual such as a friend or family member, the person may express specific attitudes known to be endorsed by that group or individual. For example, articulating the same anti-LGBTQ attitudes and beliefs shared by a family member or a group of friends can help to demonstrate alignment and connection. In that regard, psychological heterosexism can have a negative socially expressive

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function, only because it is legitimated by a wider cultural ideology that denigrates and disempowers LGBTQ people. The effects of psychological heterosexism on the mental and physical health of LGBTQ people can be devastating, as illustrated in the next section. The study of psychological heterosexism typically focuses on the following components. Attitudes and Beliefs

Attitudes are understood as positive and negative evaluations that individuals make about other people, issues, relationships, and so on. Beliefs represent conceptualizations regarding the relationships among phenomena in everyday life. As such, within the study of psychological heterosexism, the expression of attitudes and beliefs is an important focal point for comprehending how LGBTQ people have come to be viewed negatively and stigmatized. The formation of attitudes, the functions they serve, and the manner in which they can be changed have occupied scholarly interest for well over the last three decades. Recent surveys in the United States and the United Kingdom appear to show that heterosexuals’ attitudes toward LGBTQ people have become more positive, showing greater tolerance and acceptance of the roles LGBTQ people play in society. Be that as it may, sexual prejudice and sexual stigma persist even in “liberal” countries and communities. This bears testimony to the argument that changing attitudes is challenging, and may be possible only when anti-LGBTQ attitudes no longer yield benefits for the individuals holding them. Behavior

The investigation of negative behavior toward LGBTQ people has routinely produced shocking results. For example, in the UK, The Gay British Crime Survey 2013, published by the LGB charity organization Stonewall, found that hate crimes against LGB people (criminal actions such as physical assault, emotional suffering, and property damage perpetrated on the basis of someone’s perceived sexual orientation) are a serious social

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problem. Of the 2,500 LGB survey respondents, 1 in 6 people reported having experienced a homophobic hate crime over the last 3 years. The survey revealed a wide range of hate crimes, from physical assaults and threats of violence to harassment, verbal insults, and damage to property. The survey showed that 1 in 10 respondents reported being physically assaulted, while 1 in 8 respondents experienced unwanted sexual conduct. Survey research carried out in continental Europe and the United States reveals similar findings, indicating the pervasiveness and malicious dimensions to hate crimes against LGBTQ individuals. When psychological heterosexism is articulated through hate crimes, explanations have been sought as to how they benefit the perpetrators of these crimes. One explanation, noted above, is that individuals who carry out hate crimes against LGBTQ people do so in order to connect with or reinforce a sense of belonging with dominant groups that hold negative attitudes about or enact similar behaviors toward LGBTQ people. Another explanation is that such hate crimes allow perpetrators to express values they hold dear such as the superior status of heterosexuals within society, which is used to justify the penalization of LGBTQ people. This appeal to moral authority, although potentially divorced from codified liberal moral conventions within society, is used to rationalize the constitution of LGBTQ people as valid targets for punishment. One extreme example has been documented within urban communities in Bogotá, Colombia, where reports emerged in 2013 of “social cleansing” practices targeted at LGBTQ people, among others, by means of murder, death threats, and disseminating anti-LGBTQ literature. Another explanation relates to what psychologists have dubbed the “ego-defensive” motivation for hate crimes against LGBTQ people, whereby perpetrators use violence as a way of reasserting their heterosexuality in light of an aspect of their own personality they find distasteful, such as effeminacy or sexual feelings toward individuals of the same sex. In these cases, the psychological motivations for perpetrating are sometimes unconscious and unknown to the individual, but the use of violence helps the individual

to negate anxiety and other negative emotions associated with threats to self-identity. The study of psychological heterosexism also focuses on who holds anti-LGBTQ beliefs. The principal culprits are heterosexuals who may internalize heterosexist attitudes. However, LGBTQ people may also hold heterosexist attitudes and beliefs. This assertion is supported by evidence that some LGBTQ people give credence to social beliefs that their sexual or gender identity is unnatural, abnormal, and problematic. One explanation for this seeming paradox is that LGBTQ live their lives within communities that hold heterosexist attitudes, beliefs, and values, so it is expected that they will internalize some of these stigmatizing views. The toll that internalized heterosexism can take on LGBTQ individuals ranges from self-doubt and mild anxiety to self-hatred, self-harm, and suicidal ideation, although psychologists maintain that internalized heterosexism can be unlearned. Of great concern is the personal toll internalized heterosexism exacts on LGBTQ individuals and how LGBTQ people may act as unwitting and complicit agents in its perpetuation.

Conclusion Heterosexism influences how LGBTQ individuals go about their everyday lives because they experience sexual stigma in a way that heterosexuals do not, due to the fact that nonheterosexuality is widely considered abnormal, deviant, and unnatural. Heterosexism’s negative effects on the material circumstances of LGBTQ people’s lives as well as on their mental and physical health are deep and far-reaching. Heterosexism creates interpersonal dilemmas for LGBTQ people who must repeatedly decide whether and to whom to disclose their LGBTQ status. As such, disclosure becomes a personal act with political consequences because it can bring LGBTQ people into direct opposition with heterosexist ideologies that endorse and protect the normative status of heterosexuality. Yet heterosexism has negative effects on heterosexuals as well, evident in the fact that many heterosexuals (especially men) choreograph their behavior and interactions to specifically

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avoid being labeled homosexual. This can have a profound effect on experiences such as same-sex friendships, many of which have been plagued with anxieties about circumscribing emotional closeness to fend off accusations of homosexuality. Crucially, the fight against heterosexism is an ongoing, global endeavor that concerns both LGBTQ people and heterosexuals as allies committed to its eradication. Nick Rumens See also Biphobia; Defense of Marriage Act (DOMA); Gay–Straight Alliances (GSAs); Gender Binaries; Hate Crimes; Heterosexist Bias in Research; Homophobia; Homosexuality, Female; Homosexuality, Male; Minority Stress; No Promo Homo Policies; Transphobia

Further Readings Frei, D. (2014). Challenging heterosexism from the other point of view: Representations of homosexuality in Queer as Folk and The L Word. Bern, Switzerland: Peter Lang. Herek, G. M. (1990). The context of anti-gay violence: Notes on cultural and psychological heterosexism. Journal of Interpersonal Violence, 5, 316–333. Herek, G. M., Cogan, J. C., & Gillis, J. R. (2002). Victim experiences in hate crimes based on sexual orientation. Journal of Social Issues, 58, 319–339. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43. Herek, G. M., & McLemore, K. (2013). Sexual prejudice. Annual Review of Psychology, 64, 309–333. Kuvalanka, K. A., Leslie, L. A., & Radina, R. (2014). Coping with sexual stigma: Emerging adults with lesbian parents reflect on the impact of heterosexism and homophobia during their adolescence. Journal of Adolescent Research, 29, 241–270. Ragins, B. R., Cornwell, J. M., & Miller, J. S. (2003). Heterosexism in the workplace: Do race and gender matter? Group and Organization Management, 28(1), 45–74. Stonewall. (2013). Homophobic hate crime: The Gay British Crime Survey 2013. London, England: Author.

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Szymanski, D. M., Kashubeck-West, S., & Meyer, J. (2008). Internalized heterosexism: A historical and theoretical overview. Counseling Psychologist, 36, 510–524.

HETEROSEXIST BIAS

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RESEARCH

Heterosexist bias systematically limits what we know and imagine about the world as a result of conceptualizing human experience in strictly heterosexual terms. The term bias describes a prejudice against or an inclination toward some ideas or people over others, and as a result, bias creates prejudices within social structures, policies, and conventions. Heterosexism is a foundational system that oppresses nonheterosexually identified individuals. Heterosexism stems from the assumption that heterosexuality is natural, universal, and therefore inevitable. In turn, sexualities and identities such as lesbian, gay, bisexual, transgender, and queer (LGBTQ) are assumed to not be natural, universal, or inevitable. As a result, heterosexism ignores, rejects, and stigmatizes nonheterosexual identities, behaviors, and relationships. It is important to note that heterosexist bias does not rely on whether an individual considers him- or herself to be antigay or homophobic. Rather than an individual’s personal beliefs, heterosexism derives from implicit norms that are present in formal and informal social institutions. Paired with bias, heterosexism becomes a system of prejudicial attitudes against nonheterosexual individuals, behaviors, and relationships. The concept of heterosexism is often compared with or used in place of the concept of homophobia; however, there are important differences between the two concepts. Homophobia refers to a negative attitude or fear regarding nonheterosexual people. These negative attitudes and fears are held at an individual or interpersonal level. An example of homophobia would be using antigay slurs or calling something “gay” as an intentional form of denigration. Homophobia involves intentionally prejudicial words, beliefs, and actions.

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Heterosexism, in contrast, involves a set of practices, norms, and conventions that may not be seen or intended to be prejudicial, but are prejudicial nevertheless. For example, whereas homophobia might be expressed through gay slurs, heterosexist bias might be expressed through school policies that do not punish gay slurs, thereby reinforcing homophobic attitudes in the classroom, school, family, and community.

Heterosexist Biases and Assumptions in Empirical Research Research on sexual identities, attractions, and relationships is important for developing public policies and, in particular, evaluating whether policies negatively impact some groups more than others. High-quality research is necessary to evaluate the impact of institutional practices and laws that regulate individuals, including, for example, in the areas of schooling, health care, and commerce. Heterosexist bias in research can hinder the collection of such data. One example of heterosexist bias in research can be found in the U.S. Census definition of “household.” When collecting data on all of the individuals living in the country, the U.S. Census has recognized households only as “married,” “widowed,” “divorced,” “separated,” or “never married.” These categories demonstrate how heterosexist forms of data collection can systematically obscure alternative family structures, particularly among families that have been historically denied access to the institution of marriage. Under the U.S. Census definition of “household,” many different forms of family, including but not limited to same-sex couples, have been made invisible. As a result of the heterosexist bias embedded in this research design, social policies and other forms of support have been made less available to LGBTQ individuals and families because they were not recognized through the available categories in U.S. Census data. Heterosexist bias must be examined in the process of conducting research, although because such biases have become well integrated into the systems, terminology, and norms of research

practices, they are sometimes hard to discern. Several recommendations have been developed for ways to observe and avoid heterosexist bias in research. These are discussed in the following sections.

Research Question Development Heterosexist bias can affect any point in the research process, beginning with the development of a research question. For example, the consistent development of research questions that focus on marriage, childbearing, and monogamous romantic relationships assumes that all individuals have the same values, the same relational norms, and the same access to social and religious institutions such as marriage. When researchers describe marriage and childbearing as the primary goals of adulthood, they systematically exclude those who are legally banned, or even simply discouraged, from participating in these and other activities. To avoid heterosexist bias, researchers should, therefore, consider and study a diverse set of relationships and forms of intimacy in youth and adulthood and should resist making assumptions about the normalcy and universality of certain social and family practices. Another way to reduce heterosexist bias is to resist assuming that sexual identity represents a primary source of group difference. This theoretical position implies that being heterosexual or LGBTQ leads to fundamentally different experiences or beliefs. While there may, of course, be important differences between those who do and do not have same-sex relationships, desires, or fantasies, the development of research questions that assume group difference based on sexual identity, attraction, or behavior may be shortsighted. It is essential to acknowledge that group differences may be driven by factors outside of the individual, such as exposure to discriminatory policies, media images that focus on heterosexual relationships, or lack of family support for samesex desires. Researchers are encouraged to develop research questions that do not assume that sexual identity creates group differences in and of itself, and to develop a set of broader questions that

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theorize a range of factors that shape how heterosexual and nonheterosexual individuals behave, relate, and develop.

Sampling The process of developing a study sample often follows from the development of a research question; it is the way that a researcher decides who will be asked to participate in a study. Heterosexist bias in sampling has been an area of concern because bias at this stage of a study systematically reduces the number of people and the diversity of experiences that are represented in research. Some researchers mistakenly conclude that there are few or no LGBTQ individuals in a particular neighborhood or community when LGBTQ participants have been reluctant to participate in research studies. There are, however, several reasons why LGBTQ individuals might be reluctant to participate in research studies. Some individuals may fear being publicly identified as LGBTQ. Other individuals may find that conventional sexual identity labels (which vary significantly by region, race/ethnicity, generation, and education level) do not adequately describe them. Researchers must recognize the range of factors that can impact how often, when, and under what conditions LGBTQ individuals may participate in research. Without such awareness, researchers risk incorporating heterosexist bias into their sampling designs and underrepresenting the experiences of nonheterosexual individuals. To avoid this, researchers should consider several recruitment strategies when sampling nonheterosexual populations, including using community informants to understand local sexual identity and behavior terminology and accessing samples through community networks that enable participants to understand the risks (and rewards) of participation. Researchers should also consider the sampling biases that can be introduced when LGBTQ individuals are sampled largely from specific locations such as bars, hospitals, or clinics. LGBTQ individuals sampled primarily from such locations will have specific concerns, characteristics, and behaviors that do not necessarily reflect the diversity of all LGBTQ individuals. As a result,

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policies developed from these specialized samples might reinforce prejudices (e.g., assumptions that all nonheterosexual individuals use drugs or abuse alcohol) and could potentially limit social support for LGBTQ individuals and communities.

Research Design Heterosexist bias can also be introduced into a study through the questions a researcher asks, the way these questions are posed, and the options for response provided. For example, providing only the options of “male” or “female” to describe one’s gender ignores those who do not identify with either of these gender choices. Researchers should also avoid using language that positions heterosexual individuals as the primary group and LGBTQ people as “other.” Such positioning suggests that heterosexuality is easily understood, whereas only nonheterosexuality requires explanation. Even simple language choices such as using the term “other” to describe nonheterosexual gender or sexual identities can communicate heterosexist bias, given that the term suggests a non-normative and “strange” status. A preferable approach is to allow participants to endorse a less stigmatizing category, such as “a gender not listed here,” “a sexual identity not listed here,” or “none of these options describes me/ my experience” rather than “other.” Similarly, demographic questions that refer to a person’s “spouse” or “husband/wife” have typically assumed that all participants are heterosexual or have the legal right to be married. Researchers are encouraged to use the term “partnered” or “un-partnered” instead of “married” or “single” and avoid response options that do not provide same-sex couples an option to indicate a partner status. It is also important to avoid creating an implicit hierarchy among partner statuses, with married as the prioritized status. Lastly, researchers should consider whether their study implicitly presumes that participants are heterosexual and that all participants have equal access to or desire for “traditional” partnering activities. For example, a study that asks participants to imagine a scenario in which they are on a romantic date at the movies presumes that all participants can

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equally imagine such a date, occurring safely in public with a partner of their choice. Another strategy for avoiding heterosexist bias involves the use of continuous dimensions rather than dichotomous categories to measure characteristics such as gender(s), sexual identity, sexual orientation, and relationship status. Researchers should consider how dichotomous categories systematically represent and reinforce majority groups, while systematically excluding or inaccurately representing sexual-minority groups. Lastly, LGBTQ individuals should not be described as a single homogenous group (“the gays”), but rather in reference to a relevant characteristic (e.g., “individuals who identify as gay or lesbian” or “individuals in a same-sex relationship”), to avoid suggesting that an individual’s sexual identity or orientation is the person’s single most important and defining characteristic. Researchers that examine sexual health, sexual function, and sexual relationships have additional considerations to make in order to avoid heterosexist bias. In addition to considering terminology for gender and relational status, researchers should describe sexual activities in such a way that penile– vaginal intercourse is not presumed to be participants’ sole or primary form of sexual activity. Researchers should use measures that allow participants to describe a range of sexual activities and avoid terminology that prioritizes heterosexual intercourse or makes non-intercourse behaviors secondary. In assessments of sexual function, for example, researchers should consider how questions focusing solely on experiences of penetration or vaginal dryness might be more relevant to participants who engage in vaginal intercourse and may exclude participants who engage in other sexual activities. Considering such factors can help reduce heterosexist bias and can allow participants— regardless of sexual identity—to imagine and share aspects of their sexual lives in research settings.

Analysis At the analysis stage in research, heterosexist bias emerges in the process of forming explanations,

making interpretations, and deriving meanings from data. Researchers are encouraged to resist the common practice of comparing heterosexual and LGBTQ groups, and positioning heterosexual experiences as the implicit norm and LGBTQ experiences as “the effect to be explained.” Instead, researchers are encouraged to consider analytical strategies that position majority groups (e.g., heterosexuals, Whites) as requiring just as much explanation as minority groups. For example, researchers should analyze the causes and prevalence of gender conformity among heterosexual men and women, rather than simply analyzing the causes and prevalence of gender nonconformity among lesbians and gay men. Such an approach provokes new and valuable questions and interpretations. Researchers should consider whether they have inadvertently analyzed group differences in a manner that implicitly privileges a heterosexual norm and presumes this norm to be stable and to require no explanation.

Research Dissemination Finally, there is the issue of how heterosexist bias can influence the reception and support of research. For example, journal editors and reviewers are encouraged to recognize the legitimacy of research on issues relevant to sexual identity, relationships, and communities. Most importantly, this body of research should not be dismissed as overly specialized or only relevant to LGBTQ individuals. An especially pernicious form of heterosexist bias is the assumption that all individuals should find research about heterosexuals relevant and useful, while research about LGBTQ individuals or issues is only relevant to other LGBTQ individuals. There is a compelling and important history of researchers working to reduce heterosexist bias. In 1985, the American Psychological Association (APA) formed the Task Force on Non-Heterosexist Research; this group developed a set of guidelines for psychologists to avoid heterosexist bias in their research and clinical practice. Specifically, the task force recommended that researchers include more nonheterosexual individuals in their studies; employ

Historically Black Colleges and Universities, LGBTQ Students at

research methods that lead to a greater understanding of sexual identities, relationships, and behaviors; and change current attitudes and assumptions about gay people. One of the most important statements of the task force was that these efforts are not only the responsibility of nonheterosexual psychologists or those studying LGBTQ people but also the responsibility of the entire research community. Sara I. McClelland and Harley Dutcher See also Defense of Marriage Act (DOMA); Gender Binaries; Heteronormativity; Homonormativity; Homophobia; Legal Recognition of Nonmarital SameSex Relationships; Sampling

Further Readings Ansara, Y. G., & Hegarty, P. (2012). Cisgenderism in psychology: Pathologising and misgendering children from 1999 to 2008. Psychology & Sexuality, 3(2), 137–160. Badgett, M. V. (2009). Best practices for asking questions about sexual orientation on surveys. Los Angeles, CA: Williams Institute. Harrison, J., Grant, J., & Herman, J. L. (2012). A gender not listed here: Genderqueers, gender rebels, and otherwise in the National Transgender Discrimination Survey. LGBTQ Public Policy Journal at the Harvard Kennedy School, 2(1), 13–24. Hegarty, P. (2006). Undoing androcentric explanations of gender differences: Explaining “the effect to be predicted.” Sex Roles, 55(11–12), 861–867. Herek, G. M., Kimmel, D. C., Amaro, H., & Melton, G. B. (1991). Avoiding heterosexist bias in psychological research. American Psychologist, 46(9), 957–963. Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56(1), 23–31. Rothblum, E. D., Factor, R., & Aaron, D. J. (2002). How did you hear about the study? Or, how to reach lesbian and bisexual women of diverse ages, ethnicity, and educational attainment for research projects. Journal of the Gay and Lesbian Medical Association, 6(2), 53–59. U.S. Census Bureau. (2014). America’s family and living arrangements: 2013. Retrieved October 14, 2014, from http://www.census.gov/hhes/families/data/ cps2013.html

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HISTORICALLY BLACK COLLEGES AND UNIVERSITIES, LGBTQ STUDENTS AT There are 105 historically Black colleges and universities (HBCUs) in the United States, as reported by the U.S. Department of Education. HBCUs are institutions chartered prior to 1964 with the principal mission to educate and advance African Americans and the communities surrounding HBCUs. African American students who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) have increasingly become a topic of discussion among administrators at HBCUs, as these institutions address diversity and inclusivity. Observers note, however, that regarding formalized attention to the needs of LGBTQ students who attend HBCUs, the development of major campaigns, centers, and programs has been lacking. The explanations for the lack of widespread and visible institutionalized extracurricular programming, curriculum development, and programs of advocacy and visibility for LGBTQ students at HBCUs involve the obvious issues of religiousbased prohibitions, and the beliefs that HBCUs and African American communities in general have other issues that are perceived to be more urgent. For LGBTQ students who are African American and attending an HBCU, however, such beliefs about the significance of students’ identities and religious-based constraints fail to consider intersectionality. Intersectionality theorists have been most vocal about the developmental significance of individuals’ acknowledged multiple marginalized identities. In the case of LGBTQ students who attend HBCUs, the students have the challenge of integrating at least two core aspects of who they are within the greater society, as well as within the “Black spaces” where they bring not just their blackness, but also their minority sexual identity, transgender identity, and/or gender-nonconforming expression. For these emerging adults, the negotiation of their multiple marginalized identities may at times be stressful.

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Allies do exist within the HBCU context. For example, Fayetteville State University in North Carolina is one example of an HBCU that has taken steps to show visible support of LGBTQ students. The university’s grand opening of a Safezone Office occurred on National Coming Out Day, October 11, 2013. Yet LGBTQ college students may still experience microaggressions from other students, faculty, and staff within HBCU environments that remain socially conservative spaces.

Finding Community LGBTQ students attending HBCUs are likely to find their sense of community via primarily informal networks and leisure activities at their institution. As examples, students who are athletes, members of modeling troupes, or choir members often find opportunities to connect with other students who are LGBQ or gender nonconforming. This occurs even though such organizations are not specifically in existence for the purpose of LGBTQ student networking and advocacy. Students develop romantic attractions, dating opportunities, and friendships via such outlets and social networking. Leisure activities and social interactions that are often informal provide opportunities for LGBTQ students, including those at HBCUs, to find a sense of community, as well as aid them in affirming their identities. In addition, there is literature available that details the resilience of African American LGBTQidentified persons relative to their non-Black LGBTQ counterparts. HBCU contexts, and collective consciousness among Black students who have chosen to attend HBCUs, may further foster resilience among the LGBTQ students attending these institutions. This may occur for LGBTQ students despite a relative lack of formal and widespread targeted programming to address their needs.

HBCUs Are Not Monolithic The literature of higher education includes discussions of educational environments, institutional issues, and strategies for university personnel

attempting to serve the needs of LGBTQ students. In the context of these ongoing discussions, HBCUs have sometimes been viewed as monolithic; yet they are not. Commonality lies in the history of HBCUs’ purpose, and their relationship to historically socially conservative ideals of Black churches; yet HBCUs’ relevant campus incidents, their active LGBT student organizations, and their responsiveness to the needs of LGBTQ students may vary. For example, while Bowie State University, Fayetteville State, and Alcorn State University have created safe zones and resource centers for their gender and sexual-minority students, some other HBCUs have received negative media attention such as the following: • Tragedy: the hazing death of openly gay drum major Robert Champion at Florida Agricultural and Technical University • Harassment: a Twitter-leaked photo of Aaron McCorkle of Winston-Salem State University shown in drag during his campaign for title of Mr. Winston-Salem State • Controversy: four male-identified gendernonconforming Morehouse men who wore makeup, hair weaves, and dresses sparked the creation of a dress code policy of prohibition at the college

Sometimes, even following negative publicity, there may be no public forums or workshops on campus to educate and advocate for social justice for LGBTQ members of HBCU communities. A major progressive move occurred in 2011 when Spelman College hosted a first-of-its-kind conference, titled Facilitating Campus Climates of Pluralism, Inclusivity, and Progressive Change at HBCUs. The focus was on LGBTQ communities and creating a more open campus climate. HBCUs joining Spelman College at the conference were Bennett College, Howard University, Clark Atlanta University, Southern University, North Carolina Central University, Philander Smith College, Morehouse College, and Morgan State University. Invited HBCUs represented a sample of schools having active LGBTQ student organizations on their campuses at the time.

History of Transgender Medicine in the United States

Conclusion At historically Black colleges and universities, there are LGBTQ students who possess a strong sense of themselves and expect acceptance. More than 200 HBCU students have gained lobbying and leadership skills related to issues important to LGBTQ people of color, through participation in the Human Rights Campaign’s HBCU LGBT Leadership and Career Summit. At the same time, other HBCU students are in a nascent stage of embracing their identities. Increasingly, HBCUs are recognizing the importance of broadly examining aspects of students’ identities beyond race. Accordingly, strategic planning at HBCUs will likely move toward establishing multicultural, institutionalized, full-time centers with directors or coordinators to provide resources and support to their LGBTQ students. Michele K. Lewis See also Campus Climate; College Students; Education; LGBTQ People of Color

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health providers have spent the last hundred years developing an understanding of transgenderism, as well as language that accurately reflects patient experience and that can be used to guide treatment. The history of transgender health in the United States is tied to the history of medical research and technology, the popular press, academic thought, and various human rights movements. It is peppered with accounts of extraordinary individuals whose voices have shaped social change, often at great personal risk. Despite evidence that transsexuality (the process of medically changing oneself to the opposite sex) occurs naturally across time, cultures, and socioeconomic/ethnic groups, a constant theme has been the struggle to legitimize medical care, and hence legitimize the lives of transgender people themselves. Patients have been and continue to be labeled mentally ill, and the providers who treat them considered suspect. This entry provides a brief history of transgender medicine in the United States, and explores how treatment for this population has moved from the margins toward mainstream medical care.

Further Readings Lewis, M. K., & Marshall, I. (2012). LGBT psychology: Research perspectives and people of African descent. New York, NY: Springer. Petrosino, F. J. (2003). HBCUs tackle homophobia with diversity initiatives. Crisis, 110(4), 10. Prichard, E. (2007). HBCUs have a responsibility to LGBT students. Diverse Issues in Higher Education, 24(7). Retrieved November 2, 2015, from http:// diverseeducation.com/article/7335/

HISTORY OF TRANSGENDER MEDICINE IN THE UNITED STATES Although transgender people have been described throughout the world since early humans began keeping records, the history of medical intervention for individuals with gender dysphoria (distress caused by a discrepancy between assigned sex at birth and gender identity) dates back just to the start of the 20th century. Medical and mental

Early Twentieth Century The first medical descriptions of cross-gendered individuals date to the early 1900s, when British and German sexologists Havelock Ellis and Magnus Hirschfield published texts describing various types of sexual inversions, which they presented as ubiquitous, natural, and inborn, including hermaphroditism (medical term for individuals born with both ovarian and testicular tissue), homosexuality, androgynism (state of having both feminine and masculine characteristics), and transvestism. They described individuals who crossdressed or demonstrated cross-gender identification, labeling them transvestites or eonists. The idea that these conditions were normal variations on human experience was controversial, despite the fact that concepts of universal bisexuality were prevalent among European intellectuals at this time. Scholars, including Charles Darwin, Sigmund Freud, and Otto Weininger, presented evidence on the overlap of masculine and feminine traits, and tended to view gender as a continuum rather than

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a binary. Their theories led to more open cultural attitudes about gender and sexuality, compared with those then common in the United States. Hirschfield first coined the word transsexual when he described seelischen Transsexualismus (psychic transsexualism, a form of homosexuality), although the term was not used to distinguish those who wished to physically transform their bodies to align with their internal gender identity until popularized by Drs. Harry Benjamin and David Cauldwell in the 1940s and 1950s. In the 1910s, Eugen Steinach, an Austrian physiologist, conducted the first sex reassignment experiments in animals. Steinach transplanted ovaries into castrated male rodents, and testicles into neutered females, to demonstrate that the surgically altered animals developed secondary sex characteristics and behaviors associated with the transplanted gonads. Steinach concluded that secretions from the gonads were responsible for sexuality, a claim that led to the identification of estrogen and testosterone as the feminizing and masculinizing hormones, and eventually to their synthetic production and use for a number of medical conditions. Prior to the 1950s, experiments with human gender-altering surgeries were largely confined to countries in Europe, where physicians and sexologists began to distinguish between those who cross-dressed and those who desperately wished to physically change their sex. Magnus Hirschfield became one of the first proponents of gender reassignment surgeries, and many of the original procedures took place in his Institute for Sexual Science in Berlin in the 1920s and 1930s. In 1922, Dorchen Richter started her male-to-female transition with an orchiectomy (removal of testicles), completing her surgical reassignment in 1931 when she underwent penectomy (removal of the penis) and vaginoplasty (reconstructive surgery to form a vagina). Lili Elbe, a Danish male-to-female transsexual, also went through a series of genderaltering surgeries at this time, including transplantation of ovaries and a uterus, complications of which ultimately led to her death. Her story was widely published and captured the interest of the Western world. Dr. Felix Abraham, a surgeon in

Hirschfield’s institute, published the first professional paper describing the surgical technique for male-to-female sexual reassignment. Gender surgeries were performed in Berlin until 1933, when the Nazis destroyed Hirschfield’s institute and burned the archives. Stories from Europe reached the United States through the popular press, garnering the fascination of the American people, particularly transgender individuals, who previously had no language to describe their experiences or hope for relief. Dr. David Oliver Cauldwell, an army contract surgeon and neuropsychiatrist for the U.S. War Department, left patient care in 1946 to become the editor of the Q & A section of a trendy, quasi-scientific magazine called Sexology. In the 1940s and 1950s, he published extensively about sexual issues, breaking traditional taboos and creating a more liberal climate for discussion on gender diversity. Cauldwell wrote at length about transsexuality, transvestism, and hermaphroditism. His early work pathologized transsexuality as mentally unhealthy, but as he matured, he began to promote tolerance and understanding. Though considered one of the pioneers of transgenderism, Cauldwell opposed sex reassignment surgery, stating that it fell short of effecting a true change in sex and that it was unethical to remove healthy tissue. When Christine Jorgensen returned to the United States from Denmark in 1952 after successful gender reassignment under the care of Dr. Christian Hamburger, the ensuing media blitz brought the possibilities of gender transition to the forefront of American culture. Christine had been born and raised in the Bronx as a boy named George, but was driven to seek gender-altering treatment abroad by her profound cross-sex identification. Captured by accounts of the ex-GI’s transformation into a “blonde bombshell,” and fascinated by Christine’s refined matter and the sober, dignified way in which she presented herself, the American people continued to follow her story for years. Patients with gender dysphoria began to seek medical care in droves, and American doctors were suddenly faced with requests for treatment for a condition they knew nothing about. The press also turned to the medical community, asking

History of Transgender Medicine in the United States

questions about issues raised by Jorgenson’s story. As a result, doctors and scientists in the United States began to discuss and debate the etiology, biology, and psychology of transsexualism, and were forced to explore the available treatments and develop language to reflect increasingly complex ideas about sexuality and gender. Dr. Harry Benjamin, considered the father of transgender medicine, was the first U.S. medical provider to bring gender-affirming medical treatment into the spotlight. Benjamin, a Germantrained endocrinologist, studied with Dr. Hirschfield at the Berlin Institute for Sexual Science before coming to the United States, and traveled to Europe during his summers to continue this work. In the 1930s, he spent time in Austria studying with Eugen Steinach. In the 1920s, Benjamin agreed to treat a dysphoric “transvestite” who requested an experimental trial of the recently developed feminine hormone medication Progynon®. Benjamin agreed, and over a short period of time, his patient developed gynecomastia (swelling of breast tissue in males) and significant relief from her gender dysphoria. Over the next 29 years, Benjamin met several patients he later identified as transsexuals, though he did not focus on medical care for this population until he became Christine Jorgensen’s physician in 1952. As American transsexuals began to request treatment, Benjamin was inundated with referrals. For many years, he was the only doctor in the United States prescribing hormones. Benjamin was known for his kindness to patients and his conviction that transsexualism was not a mental illness, but a concrete, psychopathological entity that caused intense suffering and deserved care. He observed that cross-gender identification wasn’t changed by psychotherapy, and instead recommended hormone therapy and sexual-reassignment surgery to change the body to match the mind. In 1953, Benjamin presented a paper on “Transvestism and Transsexualism” at the first medical symposium in the field. This conference included lectures on hormonal, psychiatric, surgical, and legal aspects of care, and sparked professional interest across the nation. In 1966, Benjamin published The Transsexual Phenomenon, the first major medical publication on the

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subject, which he wrote with the expressed hope that his work would promote scientific objectivity, open-mindedness, and compassion. Transsexuals who sought medical care in the 1950s faced considerable barriers, many of which were related to this socially conservative period in history. Americans were struggling with the emerging Cold War and a fear of communists and others who strayed from traditional narratives. Most providers opposed treatment on ethical, religious, and legal grounds. For many years, gender surgeries were illegal due to the antiquated “mayhem statutes,” which prohibited the intentional mutilation of body parts that could handicap a soldier in combat. These legal statutes codified a more profound fear that ambiguity in biological sex (e.g., intersex) or gender identity might potentially rupture social order. Psychoanalysts agreed that psychotherapy could not change someone’s gender identity, but concluded that transsexuals were mentally ill and warned against complying with their deranged desire to mutilate healthy tissue. There was no training or medical literature to assist providers in the care of these patients, medical insurance did not cover treatment, and providers who did offer care were viewed with suspicion. Only the very wealthy and determined found appropriate care, often traveling overseas for treatment. Most were forced to lead secretive double lives or exist on the margins of society.

Mid- to Late Twentieth Century In 1963, Reed Erickson, a wealthy transman, became a patient of Dr. Benjamin’s and underwent masculinizing hormone transition under his care. Their subsequent collaboration led to radical changes in the field of transgender health. Erickson, with his fortune and vision for social change, established the Erickson Educational Foundation (EEF) in 1964, a nonprofit philanthropic organization with the mission “to provide assistance and support in areas where human potential was limited by adverse physical, mental or social conditions, or where the scope of research was too new, controversial or imaginative to receive traditionally oriented support” (University of Victoria

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Libraries, http://www.transgenderarchives.uvic.ca/ the-collection/reed-erickson). For the next 20 years, the EEF supported scores of programs on transsexuality, specifically related to patient care resources, referrals, advocacy, education, medical research, and the creation of professional infrastructure. The EEF developed lists of providers who served transgender patients; launched campaigns to educate the general public through media presentations; and sponsored a series of international professional symposia, which ultimately lent credibility to the field. The Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA), the first professional organization devoted to the understanding and treatment of transsexuals, was formed in 1979 in London at a conference sponsored by the EEF. The EEF financed the Harry Benjamin Foundation, a professional organization devoted to case review and research, as well as the first U.S. gender clinic, which opened at Johns Hopkins University in 1966. The EEF also supported many of the other university-affiliated gender clinics, which opened shortly thereafter. Although providers for transsexuals were generally felt to be practicing on the fringe, the creation of the clinics and development of professional infrastructure led to collaboration, research, and some grudging respect in the medical community. The Harry Benjamin Foundation held monthly meetings, attended by a number of prominent sexologists, providers, and researchers from across the country, including Dr. John Money and Dr. Richard Green, who coedited the book Transsexualism and Sex Reassignment (1969), the first collection of scholarly articles dedicated to the professional care of transsexual patients. The goals of the Johns Hopkins gender clinic and the other university clinics included provision of care for transsexuals and the opportunity for research. However, due to a general lack of knowledge, the professionals who staffed the clinics had little or no training in gender diversity, and the treatments offered were experimental. Desperate patients applied to the clinics by the thousands, but were often disappointed by the strict criteria used to determine treatment eligibility. In some clinics, surgical and hormonal treatment was only

offered as a last-ditch effort to assist those who had failed all other interventions, while better adjusted, more successful people were turned away. Others were denied treatment because their providers decided they would never pass well in their preferred gender. To qualify for treatment, clinicians expected male-to-female transsexuals to hate their male genitalia, be sexually attracted to men, and present themselves in a hyperfeminine manner. Patients quickly learned what the clinics expected and coached one another on how best to present, thus reinforcing a narrow, heteronormative binary. Patients were required to leave their jobs, divorce their spouses, and move to new towns as part of the social transition process. As a result, few patients received appropriate care, most did not thrive, and providers were often disappointed by outcomes. In 1979, Dr. Jon Meyer and his secretary Donna Reter, members of the Psychiatry Department at Johns Hopkins, grew concerned about the lack of controversy surrounding the surgical removal of healthy reproductive organs in their institution, and published an outcome study that demonstrated no long-term improvement in adjustment between operative and nonoperative transsexuals. Due to political pressure, the Johns Hopkins gender clinic closed shortly afterward, followed by the closing of most of the other U.S. gender clinics. The psychoanalysts renewed their attacks on the gender surgeons, warning of severe consequences from acquiescing to the psychotic delusions of transsexual patients. In the 1970s, sociocultural academics who had been influenced by the recent civil rights movement began to challenge the beliefs and practices of the medical community with their contributions to the field. Sociologist Deborah Feinbloom contested the clichéd view of transgender people promulgated by the gender clinics, describing a wide range of gender identity and expression in her subjects. Psychologists Suzanne Kessler and Wendy McKenna questioned the binary definition of gender and offered an interpretation of gender as existing along a continuum, determined by behavioral and expressive attributes. Anthropologist Ann Bolin criticized the rigid eligibility criteria

History of Transgender Medicine in the United States

imposed by the gender clinics, arguing that they forced patients to lie to get treatment. She debunked the idea that trans women were universally hyperfeminine, attracted only to men, and demonstrated heterogeneous clinical presentations; she also railed against literature that stigmatized transsexuality as a mental illness. Transgender people avidly read the studies of these and other academics, resented the restrictions imposed by the medical community, and began to demand systemic change. In 1979, HBIGDA published the first Standards of Care for diagnosis and treatment, guidelines designed to regulate and standardize psychological evaluation and medical treatment. In 2007, HBIGDA changed its name to the World Professional Association for Transgender Health (WPATH), an organization whose mission continues “to promote evidence-based care, education, research, advocacy, public policy and respect in transsexual and transgender health” (http://www .wpath.org). In 2010, WPATH issued a statement on the medical necessity of gender-confirming surgeries, thus exerting pressure on insurance companies to include these procedures as a covered benefit. The seventh edition of the WPATH Standards of Care, published in 2012, offers flexible clinical guidelines that reflect further evolution of treatment guidelines, particularly the move to destigmatize, referring to gender nonconformity as a form of diversity, not pathology.

Recent Developments The classification of gender nonconformity as described in successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) reflects a persistent resistance to incorporate changing views of transsexualism. In 1980, the diagnosis of transsexualism was included for the first time in the DSM-3, under the heading of gender identity disorders (GID). Providers hoped that inclusion in the DSM would legitimize transgender identities and facilitate access to medical care, including insurance coverage. This occurred to some extent, but diagnostic inclusion also reinforced the popular notion of transsexualism as a mental illness, which led to further marginalization

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and discrimination. Ironically, in 1980, the diagnosis of homosexuality was removed from the DSM3, on the grounds that it was not a disorder. In 2014, GID was removed from the DSM for similar reasons and replaced with the term gender dysphoria. There is ongoing discussion about the diagnostic and coding terms used to describe variance—a constant battle to balance the need for medical treatment against language that implies pathology and leads to stigmatization. The treatment of transgender youth with pubertal-blocking medications is a relatively new historical development. Medical providers have begun to use GnRH analogues, medications previously used for the treatment of precocious puberty, to halt puberty in trans youth soon after it begins, thus preventing the irreversible effects of passing through puberty in the natal gender (assigned gender at birth). Treatment protocols were developed by the Dutch in the early 2000s and were quickly adopted for use in the United States. This powerful intervention allows individuals to be less visibly transgendered, and prevents the need for costly procedures such as facial feminization surgery, electrolysis, and masculine chest reconstruction. There has been public controversy over the use of pubertal blockers in young patients, but medical research has proven it to be safe and effective. Since 2010, the popular media and professional literature in the United States have frequently referred to reaching a tipping point around acceptance of transgenderism. Although civil rights abuses and rampant discrimination persist, slow but noticeable progress has been made with regard to media attention to transgender issues, legal advocacy, social support, and the provision of medical care. As research now clearly demonstrates the efficacy of medical interventions, insurance companies have been challenged to cover transgender health services. In 2014, Medicare removed its reflexive denial of coverage for trans health, and it is expected that over the coming years, other private and public insurance will follow. Professional journals now devote space to scholarly articles on transgender research and care. Numerous professional associations

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have voiced support for access to health care, including the American Medical Association, the American Psychiatric Association, and the American Public Health Association. Professional organizations are holding conferences to train providers, and pressure is mounting to include care of transgender people as part of medical education curricula. There is still much work to be done before transgender people in the Unites States are able to easily access the health care that will enable them to live authentic lives, but small steps have been made away from marginalization and toward incorporation into mainstream medical practice. Concerted efforts are underway to build on those steps to create a health care system that recognizes and embraces our gender-diverse citizens. Carolyn Wolf-Gould See also Affirmative Therapy; Health Care System; Health Disparities; Hormones and Surgery During Gender Transition; Transgender Health Care; World Professional Association for Transgender Health

Green, R., & Money, J. (1969). Transsexualism and sex reassignment. Baltimore, MD: Johns Hopkins University Press. Jorgensen, C. (1967). Christine Jorgensen: A personal autobiography. New York, NY: Paul S. Eriksson. Kessler, S., & McKenna, W. (1978). Gender: An ethnomethodological approach. New York, NY: Wiley. Meyerowitz, J. (2002). How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard University Press. Stryker, S. (2008). Transgender history. Berkeley, CA: Seal Press.

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HIV and treatments for it have had a tremendous impact on the LGBTQ population. This entry first examines HIV and AIDS from a medical perspective, and then looks at the evolution of treatment for the disease and its effect on the LGBTQ community from the 1980s until the present.

HIV and AIDS Further Readings Benjamin, H. (1966). The transsexual phenomenon. New York, NY: Julian Press. Bolin, A. (1988). In search of Eve: Transsexual rites of passage. South Hadley, MA: Bergin & Garvey. Denny, D. (1991). The politics of diagnosis and a diagnosis of politics. Chrysalis Quarterly 1(3), 9–26. Retrieved November 3, 2015, from http://dallasdenny .com/Writing/2013/10/05/the-politics-of-diagnosisand-a-diagnosis-of-politics-1991/ Devor, A., & Matte, N. (2007). Building a better world for transpeople: Reed Erickson and the Erickson Educational Foundation. International Journal of Transgenderism, 10(1), 47–68. Ekins R., & King, D. (2001). Pioneers of transgendering: The popular sexology of David O. Cauldwell. International Journal of Transgendering, 5(2). Retrieved November 3, 2015, from http://www.iiav.nl/ezines/web/ ijt/97-03/numbers/symposion/cauldwell_01.htm Feinbloom, D. (1976). Transvestites and transsexuals: Mixed views. New York, NY: Delacorte Press/Seymore Lawrence.

Human immunodeficiency virus, or HIV, is the retrovirus that causes acquired immune deficiency syndrome (AIDS). As of 2011, there are 34 million HIV-infected persons in the world. In the United States, 79% of all HIV diagnoses are of gay and bisexual men. HIV enters the host’s body and attacks immune cells known as T-helper cells. When a viral or bacterial infection or cancer is present, these cells trigger the body’s full immune response. Without T-helper cells, there is no immune response. Eventually, HIV causes the body to lose its cellular response to infection, at which point the person has AIDS. AIDS is a pandemic disease that has claimed 30 million lives since 1980 by making the HIV-infected person’s body unable to fight external infections caused by other bacteria and viruses. In addition, AIDS inhibits the body from providing an adequate response to its own cellular mutations, resulting in cancers. A person is diagnosed with AIDS when he or she either has a very

HIV and Treatment

low immune response, one or more opportunistic infections, or opportunistic cancers. When HIV is untreated, it takes up to 10 years to progress into AIDS, but current medicines can prevent progression. HIV is transferred between people through the exchange of breast milk, blood, semen, or vaginal fluids. HIV exists in these fluids and is contagious, both when inside of a host’s T-helper cells and when freely distributed in the fluid.

History of HIV Treatment 1980s

In 1981, gay and bisexual men in California and New York began to come into hospitals with mysterious illnesses. The disease’s appearance varied, but young healthy men were being admitted with rare forms of cancers and pneumonias normally only seen in the elderly with compromised immune systems. There were no treatments when AIDS cases were first diagnosed in the 1980s. For the first part of the decade, AIDS was a mysterious disease that shook the medical profession. In 1982, the disease was known as GRID (gay-related immune deficiency), and colloquially as “gay cancer” and “gay compromise syndrome” because the people coming in with the illness were, in large part, gay. It took until 1984 for HIV to be discovered as the root cause of AIDS. As other groups began to suffer from the disease, the Centers for Disease Control and Prevention (CDC) identified the “Four H Club”—homosexuals, hemophiliacs, Haitians, and heroin addicts—as the groups most at risk for the disease. The Gay Men’s Health Crisis organization was formed to help raise money for research. They ended up forming a group (now called the GMHC) providing everything from social work services, to advocacy, to legal aid. Because of prejudices and government inaction, there was very little immediate research into the disease. The LGBTQ population mobilized to press the federal government to take action. The Reagan administration was notably silent on HIV, and early AIDS activists responded by adopting the slogan “Silence Equals Death.” The advocacy

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organization ACT UP took the national stage, advocating for public education about the spread of AIDS, AIDS treatments, and an end to AIDSbased discrimination. The Food and Drug Administration approved the first HIV treatment in 1987, called zidovudine/ azidothymidine (AZT). AZT slows the progression of HIV to AIDS, preventing the HIV from replicating at its normal pace by inhibiting a key enzyme used to replicate DNA. AZT is still prescribed today and has provided the backbone to other treatments. AZT both delayed HIV’s progression to AIDS and prevented the transmission of HIV between mother and fetus. Unfortunately, to be effective, AZT must be taken every four hours indefinitely. After AZT was released, ACT UP rallied for a significant relaxation in FDA policies to accelerate testing. This was followed by a wave of secondary HIV treatments to address specific cancers and opportunistic infections experienced by HIV patients. The first fast-tracked therapy was an alternative treatment for pneumonia for AIDS patients who could not tolerate traditional treatments. Later came injections for the treatment of Kaposi’s sarcoma (cause of the skin lesions commonly associated with AIDS cases). A treatment was also developed for AIDS-related cytomegalovirus retinal infection, which causes sight-threatening inflammation of the eye. Alternative therapies to AZT, preliminary medicines for pediatric patients with HIV, and treatment for AZT-caused anemia also came out during this time. Over 100,000 cases had been reported in the United States by the end of the 1980s. 1990s

HIV treatment continued to improve, but costs were incredibly high. Patents for these novel medications were still enforced, and insurance companies would deny coverage, or deny insurance altogether, to people with HIV. Medicaid filled the gap for some, but often only took effect once patients had entirely depleted their savings and were so sick they were regarded as having a disability. ACT UP pushed heavily to stop profiteering

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at the expense of marginalized populations. The therapies frequently cost over $7,000 a year, and many of those infected did not have insurance. In 1990, a young boy named Ryan White was infected with HIV through a blood transfusion he had received for his hemophilia. In response, the federal government created the national Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. This had a huge impact on the gay community because federal resources were finally available to provide quality care for those who were uninsured or underinsured. During the 1990s, a new array of treatments for opportunistic infections and cancers emerged. Each specific treatment had to be targeted at the unique profile of diseases experienced by people with AIDS. One of the early 1990s treatments with the most far-reaching benefits was Epogen, which provided relief from the AZT-induced anemia that affected many HIV-positive people and alleviated some of the weakness caused by the treatment. Throughout this period, AZT remained the best and most used antiretroviral therapy. HIV management was bolstered by the creation of additional antiretrovirals. In 1991, Didanosine was approved by the FDA. It was followed by Salcitabine, which, like many HIV medicines, was fast-tracked through approval, yet ultimately proved ineffective. Stravudine had better success, and provided an alternative to AZT. During the 1990s, ACT UP continued to play a major role in driving what would become national trends to combat the spread of HIV. They started illegal needle exchanges, which were highly controversial but continue to be present today in most major cities. In 1995, Epivir was approved for use alongside AZT. Epivir was the first major support drug that, when used in combination with AZT, created significantly better HIV suppression therapy. The release of Epivir was the start of what is known as the “AIDS cocktail,” a combination of antiretroviral drugs that work together to prevent HIV from transitioning into AIDS. At the same time, the Gay Men’s Health Crisis began offering its own HIV testing clinic. Other antiretroviral medicines added to the AIDS cocktail throughout the 1990s. Medicines

released include the first wave of protease inhibitors (such as Invirase), which attack HIV’s protease enzyme that is essential for its ability to reproduce. Invirase was so promising that the FDA approved it only 97 days after the application was submitted. The addition of protease inhibitors to the AIDS cocktail transformed the syndrome from a death sentence to a chronic condition. With more developed medicines, HIV’s progression could be delayed indefinitely, but the medicines often carried many side effects. In 1998, Sustiva was released. It is still one of the preferred treatments among non-nucleoside reverse transcriptase inhibitors (NNRTIs). While this drug is not used alone, its importance in HIV suppression is so great that it is included in the World Health Organization’s list of essential drugs. Another essential drug, Siagen, was granted approval in 1998. It successfully suppresses AZTresistant strains of HIV. During this time, many fraudulently labeled over-the-counter medicines that promised either HIV suppression or a cure were on the market. The FDA aggressively brought suits against these medicines because they endangered consumers by making them believe that they were suppressing their HIV, allowing the disease to progress into AIDS. Troublingly, some FDA-approved medicines ultimately showed very low efficacy because HIV medicines were being rapidly fast-tracked. Also during this time, despite the combination therapies and lower doses available, HIV treatment still wreaked havoc on the body. Many patients suffered from end-stage liver disease induced by a combination of HIV medicine and hepatitis, a frequent comorbidity with HIV, making cirrhosis of the liver the leading cause of death for those with HIV. Even people who have a low viral load (i.e., a low level of HIV in the blood) were frequently struggling to sustain a normal quality of life. HIV medications also caused the disappearance of fat from the extremities and face, while depositing large quantities of fat to the midsection. In the LGBTQ community, this pouch was referred to as a “protease paunch,” because it is caused by protease inhibitor medication. HIV still had a striking visual profile even as the disease was controlled.

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2000s

The 2000s saw a further proliferation of therapies as well as many tested therapies becoming more widely available. The decade also brought a surge in the number of once-a-day treatments, as coated drugs became more reliable in emergency release and extended-release form. The therapies work by placing medicine in an isolated core that dissolves hours after the drug is ingested. This way, people taking medicine for HIV no longer have to take many pills throughout the day. Further, common combinations of drugs used in HIV therapy were combined into one pill. These innovations made treatment easier. The most prominent example of these extendedrelease combination therapy pills is Trizivir (a fixeddose combination of AXT, Epivir, and Retrovir). During the early 2000s, new technology emerged, allowing patients to monitor the effects of the medicine by measuring plasma HIV-1 RNA. Viral load, or the level of HIV in a patient’s blood, is tested every few weeks until it stabilizes. When the viral load is high, then the number of immune cells a person has is typically low. Conversely, a low viral load signals a healthy immune system. Importantly, this gives patients more flexibility in when they take medicine. Someone who is recently infected can delay taking large doses of antiretroviral medicines, and a person who once had a high viral load can monitor the success of the medication in bringing that load down, and eventually reduce the number of medications the person is taking. The LGBTQ community brought state and federal suits to ask the courts to consider HIV a disability under the Americans with Disabilities Act. There was a proliferation of cases challenging the legitimacy of denying insurance coverage to someone because the person was HIV-positive. In 2008, Congress explicitly codified HIV as a disability under the Americans with Disabilities Act. 2010–Present

A preexposure prophylactic (PreP), Truvada, gained approval in 2012, changing the way people thought about HIV therapy. Truvada is a combination of antiretrovirals taken four times a week to prevent the contraction of HIV. In multiple

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studies, it is shown to have a 100% success rate when taken as prescribed. PreP has surged in popularity with gay and bisexual men as well as transwomen. In major cities, PreP is available on a sliding scale in lesbian, gay, bisexual, and transgender (LGBT) wellness centers. The drug is a breakthrough therapy in decreasing the rate of HIV transmission. Current HIV treatment breakthroughs have focused on potential cures and vaccines. Recently, two people were thought to be cured once they reached a zero viral load after having received a bone marrow transplant. Unfortunately, HIV returned in both cases. Similarly, an aggressive antiretroviral therapy was used in a newborn, and the child’s viral load hit zero. While the viral load stayed at zero for a sustained period of time, eventually HIV reappeared in the child’s system. HIV continues to be a chronic condition with no cure. The Affordable Care Act compels insurance companies to provide HIV treatment coverage. HIV therapies have come a long way, and the treatments have never been as readily available as they are now. Still, HIV and AIDS cost more than a million lives around the world every year. Gay and bisexual men are still the group most affected in the United States by HIV; however, the community’s strong outreach, advocacy, and support networks have steadily driven down the rate of transmission and increased the life expectancy for those with the condition. Leslie C. Allen See also Aging, Social Relationships, and Support; Chronic Illness; Discrimination Against LGBTQ People, Cost of; Discrimination on the Basis of HIV/ AIDS in Health Care; Health Care System; Health Disparities; HIV/AIDS and Aging; HIV/AIDS and Gay Masculinity; HIV/AIDS and Racial/Ethnic Disparities; HIV/AIDS and Social Support; HIV/AIDS in Prison; HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to

Further Readings AIDS.gov. (n.d.). What is HIV/AIDS? Retrieved November 3, 2015, from https://www.aids.gov/hiv-aids-basics/ hiv-aids-101/what-is-hiv-aids/World wide HIV

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AVERT. (2014). Global HIV and AIDS statistics. Retrieved November 3, 2015, from http://www.avert .org/worldwide-hiv-AIDS-statistics.htm AVERT. (n.d.). History of HIV & AIDS overview. Retrieved November 3, 2015, from http://www.avert .org/history-hiv-aids-us.htm Catz, S., Kelly, J., Bogart, L., Benotsch, E., & McAuliffe, T. (2000, March). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology. Retrieved September 2, 2014, from http://psycnet.apa .org/journals/hea/19/2/124/ Centers for Disease Control and Prevention. (n.d.). Living with HIV. Retrieved November 3, 2015, from http:// www.cdc.gov/hiv/living/ Günthard, H., Aberg, J., Eron, J., Hoy, J., Telenti, A., Benson, C., et al. (2014). Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA. Retrieved September 2, 2014, from https://www .iasusa.org/content/antiretroviral-treatment-adult-hivinfection-2014-recommendations-internationalantiviral-society-usa-panel U.S. Food and Drug Administration. (2014). Timeline/ history. Retrieved November 3, 2015, from http:// www.fda.gov/ForPatients/Illness/HIVAIDS/History/ default.htm

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According to the Centers for Disease Control and Prevention (CDC), there are approximately 1.1 million people in the United States with the human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS). AIDS is defined by the collapse of the immune system (CD4 T-cell counts of 200 or less) or the presence of an AIDS-defining illness, such as Kaposi’s sarcoma. HIV is contracted through exposure to an infected individual’s bodily fluids (most specifically blood, semen, vaginal/cervical secretions, and breast milk), most often through unprotected sexual intercourse, intravenous drug use, or childbirth. The World Health Organization (WHO) estimates that 35.3 million people are

infected worldwide. When first identified in the early 1980s, HIV was equivalent to a death sentence, and life expectancy was a few years at best. In the United States, gay, bisexual, and other men who have sex with men remain disproportionately affected by this disease. Approximately 60% of new infections occur in this group, yet these men account for only 2% to 3% of the U.S. population. In the mid-1990s, access to highly active antiretroviral therapy (HAART) transformed HIV/AIDS into a manageable although still serious chronic disease. As a result, in the United States and other parts of the world where there is access to HAART, and adherence support, people with HIV are growing older and challenging the lengths of normal lifespans for people with this disease. In the United States, the CDC estimates that half of those living with HIV/AIDS will be age 50 or older by 2015. The same pattern is occurring in the developing world as access to HAART improves. In addition to long-term survivors, this aging HIV population is growing because people 50 and older are sexually active and engage in other behaviors that put them at risk for HIV; approximately 1 in 6 HIV infections are diagnosed in this age group. Thus, the graying of the HIV epidemic poses challenges with regard to how to care for a population aging with the virus and how to reduce or prevent new infections.

The Challenges of Success The aging of people with HIV is a success story, but there remain significant challenges. People with HIV in their 50s and 60s report health problems that are typically observed in one’s 70s and 80s. Research finds that older adults with HIV report, on average, five comorbid health conditions in addition to HIV. These conditions include cardiac disease, certain types of cancers, bone and joint problems, kidney disease, and depression. While not conclusive, existing research suggests that these multiple comorbid conditions, or multimorbidity, result from HIV itself rather than toxicities from ART medications.

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Some have attributed this phenomenon of multimorbidity to accelerated aging, or the early onset of age-related conditions. However, Amy Justice has described this process as “accentuated” aging. Namely, people with HIV are not developing these conditions at younger ages compared to those without HIV, but they are developing a greater number of diseases relative to others the same age. Data suggest that starting a person on ART as soon as possible after HIV infection reduces the likelihood of multimorbidity by restoring immune function. But because older adults and their health care providers do not usually consider themselves to be at risk for HIV, older adults tend to be tested later after infection when significant damage to the immune system has already occurred. Adults 50 and older are significantly more likely than younger adults to receive a concurrent HIV/AIDS diagnosis, meaning that they receive an AIDS diagnosis within 1 year of testing positive for HIV. This is further complicated because the immune system tends to weaken naturally with aging, a process known as immunosenesence. Many symptoms of HIV, such as poor appetite or insomnia, may be seen as signs of “normal” aging.

Behavioral Health Concerns Depression ranks as one of the most commonly reported comorbidities, and older adults with HIV have been found to have rates of depression 5 times greater than noninfected adults. The reasons for these high rates of depression are not clear, but are likely related to a history of depression prior to HIV diagnosis, the impact of the HIV diagnosis and associated HIV stigma, as well as ongoing stress and anxiety related to coping with a serious illness. Depression in this population is a concern because it is one of the most reliable predictors of nonadherence to HIV treatments and medications, as well as to medications for other conditions. In addition to health problems and stigma, depression among older adults with HIV has been linked to low levels of social support and associated loneliness. Alcohol and substance use are also a concern for gay or bisexual men and transgender

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adults aging with HIV. Use of these substances may not only lead to behaviors that increase the risk of HIV transmission but also interfere with the effectiveness of ART and impede the ability to control one’s HIV infection. Lastly, many older adults with HIV continue to use tobacco, with some studies reporting current smoking rates at greater than 50%. Given the issues of multimorbidity and associated cardiac and respiratory problems, smoking cessation programs targeting this population are warranted.

Social Care for Those Aging With HIV These multiple comorbid conditions, or multimorbidity, impose a significant burden of disease that suggests a need for caregiving both now and in the future. Generally speaking, older adults rely heavily on family and sometimes friends to provide the care and support they need as they age. But on closer examination, many older adults with HIV lack the social support resources necessary to address their caregiving needs. Andrew Shippy and Stephen E. Karpiak characterized the social networks of older HIV-positive adults as “fragile” and truncated, with greater reliance on friends as compared to biological family members. In addition, older gay and bisexual men in this group are much less likely to have a spouse/partner or children compared to heterosexuals. In addition, many of these men have lost partners and friends to HIV in the last decades, further shrinking their social networks. These types of friend-centered networks typify those of older gay and bisexual men in general, but the reliance on friends may be exacerbated in the context of HIV. Older HIV-positive gay and bisexual men are more likely to report that instrumental help with the tasks of daily living (e.g., shopping, running errands) and emotional support (e.g., getting advice, talking about problems) is both unavailable and inadequate compared with older adults in general. While many of these men say that they will rely on their friends in times of need, many of these friends also have HIV/AIDS and may not be in a position to provide assistance due to their own health problems.

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Social care also includes government and community-based agencies that provide services to older adults that are necessary for independent community living, and these often come into play when the needs of the older adults exceed the capacity and skills of their family and friends. Evidence suggests that older adults with HIV use a high volume of non-HIV-related services. There are concerns about the readiness of these agencies to serve an aging population with HIV. AIDS service providers have typically focused on younger populations and may be unfamiliar with the needs of an HIV-positive older adult. Senior service providers typically lack training in HIV or experience providing services to the lesbian, gay, bisexual, and transgender (LGBT) community. Training, technical assistance and capacity-building will be needed to ensure that these agencies can effectively serve older gay or bisexual men and transgender women with HIV.

Sexual Activity and Risk Older adults remain sexually active well into their later years given good health and the availability of a partner. The same is true for older gay and bisexual men and transgender adults, including those who have HIV. According to published reports on community-based samples, nearly two thirds of LGBT adults 50 and older were sexually active in the past year. Among samples of older gay and bisexual men with HIV, upwards of half report being sexually active in the previous year, and 1 in 5 report unprotected anal or vaginal intercourse. Higher rates of substance use are reported among older HIV-positive adults who engage in unprotected sex. Among older gay and bisexual men, the use of erectile dysfunction medications along with the legal and widely available stimulant amyl nitrate (aka “poppers”) has been found to increase the odds of unprotected intercourse by approximately 150%. Considering that nearly 1 in 10 new HIV infections occurs after the age of 50 and that some older HIV-positive adults continue to engage in unprotected sex, the need to develop primary and secondary prevention programs is critical to address sexual risk in this population.

However, less than one fifth of older LGBT adults report discussing sexual health matters with a health care provider after the age of 50.

Coping, Adaptation, and Resilience Resilience is an individual’s tendency and ability to cope with stress and adversity and may be manifested in a number of ways. An individual may “bounce back” to a previous state of normal functioning, or the person may simply not show negative effects. In some cases, a person may undergo posttraumatic growth, in which the experience of adversity leads to better functioning. Resilience is best understood as a process and not a trait of an individual. Resilience may be drawn from a variety of personal and social resources. One important personal resource is a person’s spirituality. Spirituality, in contrast to religiousness, which involves prescribed sets of beliefs, is defined as one’s sense of purpose and meaning in life, the ability to transcend one’s immediate situation, a feeling of connectedness with others and the world, and feelings of inner strength or resources. Spirituality has been found to be an important buffer to the stigma still faced by many older adults with HIV, and may help to optimize well-being in this population, as it has been associated with lower levels of depression and social isolation. Other important resilience factors include social support from family and friends. Thus, despite the myriad challenges faced by LGBT adults aging with HIV, many demonstrate considerable resilience in coping and adapting to the challenges of growing older with the virus.

Future Directions While research on the biological and medical impact of aging with HIV is burgeoning, more needs to be done to provide an evidence base to address the psychosocial needs of this population, including behavioral health and social care needs. Such an evidence base is needed to effectively craft policies and programs that will meet the demands of aging with HIV. In addition, education and outreach to health care providers and older adults

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themselves concerning sexual and other risks for HIV transmission in later life are imperative if we are to reduce the number of new infections in this age group, particularly among high-risk groups such as gay and bisexual men and people of color. Public health expert and gerontologist Linda Fried has posited that the lessons we learn in caring for an older population with HIV will be extremely beneficial in terms of informing policies and programs designed for all adults as they face the challenges of aging. Mark Brennan-Ing See also Depression; Disabilities Among LGBT Elders; Health Disparities; HIV/AIDS and Racial/Ethnic Disparities; HIV/AIDS and Social Support; Resilience and Protective Factors, Youth; Sexual Risk-Taking; Substance Abuse and LGBTQ People

Further Readings Brennan, M., Karpiak, S. E., Shippy, A. R., & Cantor, M. H. (Eds.). (2009). Older adults with HIV: An in-depth examination of an emerging population. New York, NY: Nova Science. Brennan-Ing, M., Porter, K. E., Seidel, L, & Karpiak, S. E. (2014). Substance use and sexual risk differences among older bisexual and gay men with HIV. Behavioral Medicine, 40(3), 108–115. doi:10.1080/08 964289.2014.889069 Brooks, J. T., Buchacz, K., Gebo, K. A., & Mermin, J. (2012). HIV infection and older Americans: The public health perspective. American Journal of Public Health, 102(8), 1516–1526. Golub, S. A., Tomassilli, J. C., Pantalone, D. W., Brennan, M., Karpiak, S. E., & Parsons, J. T. (2010). Prevalence and correlates of sexual behavior and risk management among HIV-positive adults over 50. Sexually Transmitted Diseases, 37(10), 615–620. Halkitis, P. N. (2013). The AIDS generation: Stories of survival and resilience. New York, NY: Oxford University Press. High, K. P., Brennan-Ing, M., Clifford, D. B., Cohen, M. H., Currier, J., Deeks, S. G., et al., for the OAR Working Group on HIV and Aging. (2012). Report on the Office of AIDS Research (OAR) Working Group on HIV and Aging. Journal of Acquired Immune Deficiency Syndromes, 60(Supplement 1), S1–S18.

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Justice, A., & Falutz, J. (2014). Aging and HIV: An evolving understanding. Current Opinion in HIV and AIDS, 9, 291–293. Masten, J., & Schmidtberger, J. (2011). Aging with HIV: A gay man’s guide. New York, NY: Oxford University Press. Shippy, R. A., & Karpiak, S. E. (2005). The aging HIV/ AIDS population: Fragile social networks. Aging & Mental Health, 9(3), 246–254.

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Gay, bisexual, and other men who have sex with men (GBMSM) may access gay-specific norms of masculinity via their social and sexual relationships with other GBMSM. These alternative, or subordinate, forms of masculinity may inform GBMSM’s romantic and sexual relationships and thus shape the HIV epidemic. This entry summarizes how gay masculinities are situated in relation to hegemonic masculinity, and it lays out what is known about the role of gay masculinity with regard to the transmission of HIV, living with HIV/ AIDS, and HIV interventions designed to stop the spread of the virus among GBMSM.

Hegemonic and Gay Masculinities Gender, or the social roles ascribed to men and women, is one of the key organizing structures of society. A shared understanding of the meanings of gender shapes individuals, institutions, and society at large. The term masculinity refers to the social roles and attributes ascribed to the male sex. The counterpoint to masculinity is conventionally thought to be femininity, or the social roles and attributes ascribed to the female sex. Hegemonic masculinity is a term used to describe the dominant or idealized way of being a man in society. This term was developed to describe the relational nature of gender, and it refers not only to the attributes expected of men, but also to the social imbalance of power between men and women and the structure of power dynamics within groups of men. Although the form or expression of hegemonic masculinity

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changes across history and cultural context, its defining feature is that it is the form of masculinity that offers men the most social power. Gender scholar Sandra Bem researched individuals’ perceptions of the ideal man and woman, and found several characteristics to be aligned with idealized masculinity. These characteristics included traits such as “assertive,” “competitive,” “dominant,” “independent,” and “self-sufficient”—attributes that can be said to reflect hegemonic masculinity in contemporary Western culture. Others have sought to explain the characteristics of hegemonic masculinity by pointing to examples of idealized manhood, such as professional athletes or famous male actors. Of course, not all men can or desire to meet the parameters of hegemonic masculinity, and some may express their masculinity in alternate forms. Cultural forms of masculinity that deviate from the idealized or dominant form are referred to as subordinate masculinities. The qualities of subordinate masculinities vary across other salient social identities such as race, class, and sexuality. Current characterizations of gay masculinity are rooted in a long history of the conflation of gender and sexual orientation. Prior to the 20th century, same-sex attractions were understood as a form of gender inversion. A sexual attraction to the opposite sex was believed to be a central part of what it meant to be a man or woman, and thus any man who expressed same-sex attractions was also presumed to be effeminate. While contemporary understandings of gender and sexual orientation define these as two distinct conceptual categories, the history of their conflation lingers in how gay masculinity gets understood both in and outside of gay communities. Raised as men in a culture that prizes hegemonic masculinity, GBMSM identify what it means to be a man in much the same way as heterosexual men. Yet because hegemonic masculinity presumes heterosexuality, as GBMSM explore same-sex attractions, engage in sexual behavior with other men, or claim a nonheterosexual identity, they may find that their understanding of masculinity evolves. The presence of the gay community offers up a conduit through which

GBMSM can and do find access to alternate representations of gender and room to construct a masculinity that allows for same-sex desire. Sociologist Peter Nardi, a scholar of men’s studies, refers to these as gay masculinities and notes that the spectrum of available archetypes of masculinity for GBMSM varies widely from very butch, “straight-acting” men to drag queens and high femmes. For most GBMSM, these forms of gay masculinity represent extremes, and many GBMSM opt to blend conventionally feminine and masculine characteristics to create their own unique masculinity.

Gay Masculinities and HIV/AIDS Transmission In the global epidemic of heterosexually transmitted HIV, power imbalances between men and women are implicated. Women’s subordinate status to men due to the sexual division of labor, the sexual division of power, and the sexual division in social norms puts women at risk for conditions such as economic dependence on and fear of violence from male partners. These in turn place women at risk for HIV/AIDS because women may not feel able to negotiate sexual safety in terms of monogamy, partner selection, or consistent condom use. Departing from the heteronormative (i.e., the belief that heterosexuality is the only natural form of sexuality) framework, scholars have sought to understand whether gay masculinities relate to power imbalances among GBMSM that might play a role in the transmission of HIV in this population. In particular, there has been interest in how gay masculinity may shape sexual positioning and condom use among GBMSM. This line of inquiry is important given that unprotected anal intercourse is the primary route of transmission of HIV among GBMSM. The receptive partner or “bottom” has roughly 5 times the risk of contracting HIV when engaging in condomless sex without preexposure prophylaxis (PrEP) with an infected sexual partner as the insertive partner or “top.” Addressing how men decide whether to top or bottom during anal sex

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may aid in the development of culturally relevant HIV interventions. Power and Sexual Positioning

Heteronormativity informs the way that GBMSM think and talk about sexual positioning. Because anal sex between men has two actors (top, bottom), and heterosexual intercourse also has two actors (man/top, woman/bottom), men engaging in anal sex frequently are interpreted in terms of masculine and feminine characteristics. Research with male couples finds that GBMSM may use gendered language to refer to one another, describing the partner who more frequently is the bottom in terms of feminine characteristics and the partner who more frequently is the top in terms of masculine characteristics. In the context of casual sex, perceived masculinity or femininity of a sexual partner may be used by GBMSM in their sexual decision making. Men who believe their partners possess more masculine characteristics (e.g., taller, older, larger penis, etc.) than they do may opt to bottom. Because gender does appear to play a role in GBMSM’s decision making around anal sex, scholars have raised concerns about whether bottoms have the power in sexual scenarios to negotiate condom use or other HIV prevention strategies. Yet GBMSM indicate that while perceived masculinity and femininity of a partner can aid in decisions around sexual positioning, the power dynamics found within heterosexual intercourse (i.e., masculine/dominant, feminine/submissive) do not necessarily transfer. Men who bottom discuss their preferred sexual position primarily as a choice related to pleasure—both theirs and their partners’. For many, the decision to bottom does not result from a more masculine partner’s coercion. On the contrary, power bottom is a common identity among GBMSM, describing those who enjoy taking control of a sexual encounter as the receptive partner. The existence of power bottoms poses a direct challenge to using heterosexual gender dynamics to understand anal sex between two men. Heteronormative understandings of gender, power, and HIV transmission may be inappropriate for GBMSM.

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Gay Masculinities and Living With HIV/AIDS HIV and its burden among GBMSM have shaped gay masculinities. Scholars who have discussed masculinity with HIV-positive GBMSM note that many value maintenance of their physique as a way in which to showcase both their health and their manhood. Before the advent of highly active antiretroviral therapy (HAART), HIV/AIDS was associated with severe physical wasting. As such, maintenance of strength and size became indicators of health, well-being, and masculinity among GBMSM, and a sculpted, muscular body became prized in gay communities. While HAART has transformed HIV into a manageable long-term illness, this image of fitness has persisted in the gay community and remains the aspirational standard for masculine beauty for many.

HIV-Related Sexual Safety The Centers for Disease Control and Prevention (CDC) recommend limiting the number of sexual partners and using condoms consistently as two key strategies to protect oneself from HIV infection. Hegemonic masculinity has been linked to health risk-taking among men in general—for example, it has been associated with high rates of substance use and unintentional injury. Notably, a key attribute of hegemonic masculinity is sexual prowess, and men who seek to uphold such norms may engage in sexual behaviors that place them at risk for HIV, such as forgoing condoms or seeking out multiple sexual partners. Because gay masculinities are multifaceted, their relationship to condom use and seeking multiple partners is also multifaceted. For young GBMSM who may not yet be out in their sexual identity or who may feel unsafe openly identifying as gay or bisexual, acting in an overtly masculine way can be an act of self-preservation, as masculinity is presumed to be heterosexual. Given the centrality of sexual performance in hegemonic masculinity, young GBMSM attempting to maintain an appearance of heterosexuality may engage in condomless sex with multiple female and male partners to prove their masculinity and keep

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their nonheterosexual attractions or identity hidden. These behaviors can put them at risk for HIV. Barebacking, or the intentional act of engaging in condomless anal sex, has also been a point of interest for those seeking to understand the relationship between gay masculinities and HIV risk. While the term barebacking refers to a sexual act, some subcultures of GBMSM define themselves as barebackers. For barebackers, participation in condomless sex is a central part of their social identity. Examinations into the characteristics of this subculture find that members prize characteristics in line with hegemonic masculinity such as aggression, muscularity, and dominance. Barebackers cite public health interventions aiming to stop the spread of HIV through condom promotion and communication of HIV status as emasculating, believing that these acts sanitize and feminize gay sexuality. In protest, those in the barebacking subculture may celebrate silence and the willingness to take on the risk of HIV as ways to reclaim their manhood. Despite the link between condomless sex and HIV transmission, not all condomless sex contains the same degree of risk. GBMSM engaging in intentional condomless intercourse frequently employ alternative harm-reduction strategies to prevent the spread of HIV. Some studies suggest that HIV-positive men may be more likely to bottom when barebacking than HIV-negative men, and that many are sero-sorting (i.e., partnering with other men based upon shared HIV status, negative or positive), thus containing the spread of HIV. As such, the performance of masculinity portrayed by barebackers may not be a driving factor in the transmission of HIV among GBMSM. While forms of gay masculinity have been linked to condomless sex and multiple partners among some GBMSM, these patterns cannot be generalized to this population broadly. For many, gay masculinities offer a route to reject many of the qualities of hegemonic masculinity. GBMSM may have room to construct masculinity that prizes egalitarian qualities like open communication and honesty. As such, gay masculinities may invite the possibility of men valuing those interpersonal attributes that actually stymie the transmission of HIV.

Conclusion Recently, scholars have called for more purposeful inclusion of gay masculinities into HIV/AIDS interventions targeting GBMSM. The inclusion of candid discussions of masculinity may make HIV/ AIDS interventions more culturally relevant to GBMSM and increase participant willingness to take part in these interventions. Interventions that address gay masculinities may also allow for men to integrate their sexual identity and masculinity in a safe and supportive environment. Future research on GBMSM and masculinity should continue to explore both risk and protective factors that align with the multiple forms of gay masculinity, and seek to find novel ways to include conversations about gender in interventions addressing the burden of HIV among GBMSM. Michelle Marie Johns See also Body Image Disturbance and Eating Disorders in LGBTQ People; Butch–Femme; Dating, SexualMinority Men; Effeminacy; Hypermasculinity; Intersections Between Sex, Gender, and Sexual Identity; Racialized Masculinity; Sexual Risk-Taking

Further Readings Carballo-Diéguez, A., & Bauermeister, J. (2004). “Barebacking”: Intentional condomless anal sex in HIV-risk contexts. Reasons for and against it. Journal of Homosexuality, 47(1), 1–16. Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19(6), 829–859. Davis, S. (2009). Bem sex role inventory. In J. O’Brien (Ed.), Encyclopedia of gender and society (pp. 59–61). Thousand Oaks, CA: Sage. Dowsett, G. W., Williams, H., Ventuneac, A., & Carballo-Diéguez, A. (2008). Taking it “like a man”: Masculinity and barebacking online. Sexualities, 11(1–2), 121–141. Haig, T. (2006). Bareback sex: Masculinity, silence, and the dilemmas of gay health. Canadian Journal of Communication, 31(4). Halkitis, P. N. (2001). An exploration of perceptions of masculinity among gay men living with HIV. Journal of Men’s Studies, 9(3), 413–429.

HIV/AIDS and Racial/Ethnic Disparities Halkitis, P. N., Parsons, J. T., & Wilton, L. (2003). Barebacking among gay and bisexual men in New York City: Explanations for the emergence of intentional unsafe behavior. Archives of Sexual Behavior, 32(4), 351–357. Harper, G. W. (2007). Sex isn’t that simple: Culture and context in HIV prevention interventions for gay and bisexual male adolescents. American Psychologist, 62(8), 806–819. Hoppe, T. (2011). Circuits of power, circuits of pleasure: Sexual scripting in gay men’s bottom narratives. Sexualities, 14, 193–217. Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health, 6(6), 505–518. Kippax, S., & Smith, G. (2001). Anal intercourse and power in sex between men. Sexualities, 4(4), 413–434. Lopata, H. Z. (2006). Gender and social roles. In J. S. Chafetz (Ed.), Handbook of the sociology of gender (pp. 229–246). New York, NY: Springer. Nardi, P. (2000). Gay masculinities. Thousand Oaks, CA: Sage. Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27(5), 539–565.

HIV/AIDS DISPARITIES

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RACIAL/ETHNIC

This entry describes the racial/ethnic disparities in HIV infection among gay, bisexual, and other men who have sex with men (GBMSM). The entry begins with an overview of epidemiological trends in HIV infection across race/ethnicity. Next, it leads into a discussion on factors contributing to the disproportionate rates of HIV infection among Black and Latino GBMSM, with a particular focus on Black GBMSM, as this population suffers the heaviest burden of HIV. These factors will be explored across multiple socioecological levels, including individual, community, and sociostructural levels. The entry concludes with a brief

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discussion on current avenues for culturally mediated approaches to public health intervention.

Epidemiologic Trends More than 30 years have passed since the emergence of HIV, and GBMSM continue to be disproportionately represented in the epidemic. Following decades of aggressive HIV prevention campaigns, and with the introduction of highly active antiretroviral therapy (HAART), the overall prevalence and incidence of HIV in the United States has undergone a steady decline. In spite of these downward trends, GBMSM remain at the highest risk for HIV infection, having accounted for roughly 75% of new infections between 2008 and 2010, according to reports from the Centers for Disease Control and Prevention (CDC). These incidence rates have been especially pronounced for GBMSM of color, and most notably for Black and Latino GBMSM. Black GBMSM accounted for half of new infections among young GBMSM in 2010, and the rate of infection for Black GBMSM was 7 times the rate of infection for White GBMSM. For Latino GBMSM, the rate of infection was 3 times greater than for White GBMSM. Although Latinos only comprise 17.1% of the U.S. population, Latino GBMSM accounted for 23% of new infections in 2011, compared to White GBMSM, who accounted for 34% of new infections. Black GBMSM, however, have been the most affected group, accounting for 39% of new infections in 2011, despite only comprising 13.2% of the population. In addition, the CDC notes that Blacks accounted for almost half of HIV-related deaths in the United States in 2010, and that Blacks experience the lowest survival rates of any other racial/ ethnic group after receiving an AIDS diagnosis.

Individual-Level Correlates of HIV Risk Sexually Transmitted Infections

As has been well established, sexual intercourse serves as the primary mode of individual-level transmission of HIV and other sexually transmitted infections (STIs). Having an STI makes it easier to become infected with HIV, as sores around the

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genital region provide a gateway for HIV to enter the body. Having an STI also makes an individual more likely to transmit HIV, as coinfection increases the likelihood of the virus being present in sexual fluids. Black and Latino GBMSM have disproportionate rates of STIs—including syphilis, gonorrhea, and chlamydia—and are also more likely to be undiagnosed or untreated for STIs relative to other racial/ethnic groups. For these reasons, researchers have implicated untreated STI infections as a factor contributing to higher rates of HIV infection and transmission among Black and Latino GBMSM. Age of Partners

For younger Black GBMSM, researchers have found an association between having older sexual partners and being more susceptible to HIV infection. This may be due in part to higher rates of HIV infection among older Black men, and researchers also consider issues related to power dynamics, sexual roles, and perceptions of masculinity within an older–younger dyad that may influence behavioral health risk. Researchers have noted that some young Black GBMSM seek out older partners for a wide variety of reasons, including emotional security, financial/social support, and the experience/wisdom that older men can provide about living as a gay Black man. Age at Sexual Debut

Researchers have noted that having an earlier age at sexual debut is associated with sexual risk behavior and greater susceptibility to infection with STIs and HIV. This may be due in part to having been exposed to less sex education at a young age, having less access to HIV prevention options (e.g., condoms), and being less informed about ways to negotiate safer sex. Black GBMSM, as well as Black males as a whole, experience the earliest ages of sexual debut when compared to other groups, and are therefore considered to be especially at risk for negative sexual health outcomes associated with early-age debut.

Key Risk Behaviors

While individual-level factors are always important to consider when discussing HIV risk, researchers have provided strong evidence that Black GBMSM do not engage in key individual risk behaviors to any greater degree or frequency than other racial/ethnic groups. Such behaviors include having sex under the influence of alcohol or other drugs, having sex without a condom, and having multiple sexual partners. Other issues often considered to be more prevalent among Black GBMSM, such as choosing not to disclose sexual behavior (i.e., being “in the closet” or being “on the downlow”) and maintaining a nongay identity, also fail to explain the disparate rates of infection among this group. Furthermore, Black GBMSM have actually reported less risky sexual behaviors at the individual level than non-Black GBMSM in a number of recent studies, and have endorsed more positive condom attitudes than other racial/ethnic groups. For these reasons, researchers have suggested that individual behavior does not account for the racial disparities observed in the incidence and prevalence of HIV.

Community Correlates of HIV Risk Sexual Networks

Beyond individual-level risk behavior, researchers have pointed to a number of social, cultural, community, structural, and economic factors that may be associated with disparate rates of HIV infection among Black and Latino GBMSM. In particular, discrimination and racism may facilitate the spread of HIV in multiple ways. At the community level, sexual network restrictions may serve as a key contributor to the elevated rates of HIV among Black GBMSM. In one study, researchers found that non-Black GBMSM regarded Black GBMSM as their least preferred sexual partners. Non-Black GBMSM also perceived Black GBMSM to be less welcome to LGBT social venues and were less likely to have Black GBMSM within their friendship circles. These factors may serve to restrict Black MSM’s sexual networks, such that

HIV/AIDS and Racial/Ethnic Disparities

Black GBMSM have exclusive sexual contact with other Black men. Given that there is already a higher concentration of HIV within the Black community, these sexual network restrictions may allow HIV to spread at a considerably faster rate, even if individual risk behavior is comparable to or lower than those outside of the network. Sexual network restriction thus serves to illustrate how the interplay of multilevel factors can contribute to health disparities, with racism (structural) and sexual networks (community) interacting to produce a social context for Black GBMSM that places them at greater risk for HIV infection. Cultural Context

A number of in-group community dynamics may also contribute to health risk for both Black and Latino GBMSM. Stigma around HIV and homosexuality is a shared concern within these communities, as fear of disclosing sexual behavior with other men may prevent Black and Latino GBMSM from seeking out HIV testing and healthrelated resources for GBMSM. Cultural norms and gender role expectations related to machismo and Black masculinity may also contribute to behavioral health risk in each of these communities. Among Latino GBMSM in particular, researchers have found that acculturation is significantly associated with more risky sexual behaviors. Such findings point to the unique experiences of Latinos within a U.S. cultural context, and highlight the importance of developing culturally appropriate health interventions that consider the specific challenges across different racial/ethnic groups.

Sociostructural Correlates of HIV Risk Access to Health Services

Lack of access to health care, education, preventive health services, and HIV testing are all important structural barriers contributing to the disparate rates of HIV among Black and Latino GBMSM. Researchers have shown barriers to gaining access to a primary care physician and receiving consistent, quality treatment for Black and Latino

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GBMSM who are already infected with HIV. Moreover, Black men infected with HIV tend to have lower rates of medication adherences when compared to Whites, with researchers citing conspiratorial beliefs around HIV, medical mistrust due to an institutionalized history of racism, and challenges around initial linkage and retention in care as factors contributing to lower adherence rates. Among Latino GBMSM, some may avoid seeking health care services due to cultural and language barriers, as well as fears around immigration status and deportation. Furthermore, both Black and Latino GBMSM experience difficulty in accessing health care and health insurance due to poverty and economic hardship. Homelessness

Researchers have shown that homelessness is associated with elevated risk for HIV infection. Lesbian, gay, bisexual, and trans (LGBT) youth in particular experience disparate rates of homelessness, and this is especially true for LGBT youth of color. Young Black and Latino GBMSM often experience homelessness due to socioeconomic difficulties, as well as being thrown out of the home by family members who reject them on the basis of their sexual orientation. In many cases, the social infrastructure to protect homeless gay youth is considerably underdeveloped and poorly resourced. As a result, a large number of homeless Black and Latino young GBMSM may turn to sex work as a means of survival. Many are unable to fully dictate the terms of these sexual encounters, therefore placing them at higher risk for HIV and STI infection. Fundamental Health Determinants

Overall, researchers have suggested that broad fundamental determinants of health—including racism, homophobia, and poverty—overlay many, if not all, of the discussed socioecological factors contributing to HIV. While examining these factors empirically is a challenging task for sexual health investigators, the current direction of research in HIV risk and prevention, as well as the present

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discourse surrounding race-based health disparities, continues to be fueled by sociostructural frameworks of health risk.

Avenues Toward Intervention In recent years, a small number of researchers have been pursuing innovative health promotion initiatives to address the disparities in HIV risk experienced by Black and Latino GBMSM. These pilot intervention studies have utilized unique methodological approaches, such as Internet and cell phone–based methods—and innovative theoretical frameworks, such as critical consciousness. They have also focused on a wide range of health outcomes, such as linkage and retention to health care services; HIV testing; safer sex behaviors; and critical deconstruction of sociocultural forces that contribute to oppression, stereotypes, and discrimination. Initial results from these studies appear promising, and may pave the way for innovative and culturally tailored interventions to be employed on a larger scale in the future. Ryan M. Wade See also African American Sexualities; Health Care System; Health Disparities; HIV and Treatment; Homelessness; Homophobia; Interracial Relationships; LGBTQ People of Color

Further Readings Centers for Disease Control and Prevention (CDC). (2011). Rates of diagnoses of HIV infection among adults and adolescents, by area of residence—United States. HIV Surveillance Report, 23, 1–84. Fuqua, V., Chen, Y., Parker, T., Dowling, T., Ick, T. O., Nguyen, B., et al. (2012). Using social networks to reach Black MSM for testing and linkage to care. AIDS and Behavior, 16(2), 256–265. Garofalo, R., Mustanski, B., Johnson, A., & Emerson, E. (2010). Exploring factors that underlie racial/ethnic disparities in HIV risk among young men who have sex with men. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 87(2), 121–131. George, S., Phillips, R., McDavitt, B., Adam, W., & Mutchler, M. G. (2012). The cellular generation and a new risk environment: Implications for texting-based

sexual health promotion interventions among minority young men who have sex with men. AMIA Annual Symposium Proceedings, 2012, 247–256. Gindi, R. M., Erbelding, E. J., & Page, K. R. (2010). Sexually transmitted infection prevalence and behavioral risk factors among Latino and non-Latino patients attending the Baltimore City STD clinics. Sexually Transmitted Diseases, 37(3), 191–196. Harawa, N. T., Greenland, S., Bingham, T. A., Johnson, D. F., Cochran, S. D., Cunningham, W. E., et al. (2004). Associations of race/ethnicity with HIV prevalence and HIV-related behaviors among young men who have sex with men in 7 urban centers in the United States. Journal of Acquired Immune Deficiency Syndromes, 35(5), 526–536. Harper, G. W. (2007). Sex isn’t that simple: Culture and context in HIV prevention interventions for gay and bisexual male adolescents. American Psychologist, 62(8), 806–819. Hightow-Weidman, L. B., Smith, J. C., Valera, E., Matthews, D. D., & Lyons, P. (2011, January). Keeping them in “STYLE”: Finding, linking, and retaining young HIV-positive Black and Latino men who have sex with men in care. AIDS Patient Care and STDs, 25(1), 37–45. Maulsby, C., Millett, G., Lindsey, K., Kelley, R., Johnson, K., Montoya, D., et al. (2013). HIV among black men who have sex with men (MSM) in the United States: A review of the literature. AIDS and Behavior, 96(6), 1007–1019. Newcomb, M. E., & Mustanski, B. (2013). Racial differences in same-race partnering and the effects of sexual partnership characteristics on HIV risk in MSM: A prospective sexual diary study. Journal of Acquired Immune Deficiency Syndromes, 62(3), 329–333. Raymond, H. F., & McFarland, W. (2009). Racial mixing and HIV risk among men who have sex with men. AIDS and Behavior, 13(4), 630–637.

HIV/AIDS

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SOCIAL SUPPORT

This entry describes the role of social support in HIV prevention and care primarily among gay, bisexual, and other men who have sex with men (GBMSM), which are among the populations most affected by the HIV/AIDS epidemic in the

HIV/AIDS and Social Support

United States. A brief review of social network theory to explain the different types and sources of social support is followed by a discussion of how social support benefits physical and mental health. The entry then describes the importance of social support in relation to HIV prevention and vulnerability to HIV infection. Next, there is a discussion on the importance of social support in relation to the health of people living with HIV/ AIDS (PLWHA). Given the vast body of literature on the role of social support in general physical and mental health, the focus here is on the applicability of social support in HIV/AIDS prevention efforts.

Social Networks, Social Support, and Health Social support has been linked to both physical and psychological health, with both quantity and quality of social relationships being linked to morbidity and mortality. Social network theory provides a framework to begin understanding the relationship between social support and health. Social networks have structural, interactional, and functional characteristics. Structural characteristics indicate the size and density of a social network, whereas interactional characteristics describe the different ways in which people in a network interact or relate to each other. Functional characteristics often refer to the material and psychological resources passed between people in a network. These resources represent different kinds of social support including, but not limited to, emotional, informational, and instrumental support. Examples of emotional support are expressions of care and affection by another person. Informational support may come in the form of advice or guidance received around a particular issue. Material aid such as money, shelter, or assistance with a task constitutes instrumental support. Despite the abundance of evidence, a major challenge in examining the social support literature is the lack of consistency in definition and measurement of social support across research studies. Furthermore, social support may be measured as perceived or received. This variability in

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definition and measurement has hindered our ability to understand the pathways through which social support influences health. Two major pathways, the stress-buffering hypothesis and the direct effects model, have been used to explain how social support impacts health. According to the stress-buffering hypothesis, social support protects health by reducing the presence or negative effects of a stressor such as the death of a loved one, victimization, or loss of employment. The direct effects model suggests that social support is beneficial for health even in the absence of stressors. The extent to which social support is available and accessible, and thus influences health, also depends on the structural and interactional characteristics of a given network. For example, researchers have recently begun to focus on how relationship type (e.g., sibling, parent–child, romantic partnership) influences the availability and effects of certain types of social support. Furthermore, new questions have emerged about the potential importance of matching specific types of social support to corresponding types of stressors in order to maximize the benefits of social support.

Social Support and Vulnerability to HIV/AIDS Among GBMSM In the United States, the majority of HIV infections and AIDS diagnoses occur among GBMSM. According to the Centers for Disease Control and Prevention (CDC), nearly 80% of new HIV infections and 70% of AIDS diagnoses among men in 2011 occurred among men who have sex with men (MSM). Racial, ethnic, and age disparities further characterize the HIV/AIDS epidemic. For example, disparities were greatest among 20- to 24-year-old MSM, with infection rates being 12 times higher for Black (146.9 per 100,000) and 3 times higher for Latino (33.9) young adults compared with White (12.3) young adults. National and local HIV/AIDS surveillance reports also indicate that the proportion of individuals with unrecognized HIV infection is highest among younger and nonWhite MSM populations of low socioeconomic status (SES). These same populations are thus

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more likely to have delayed treatment, have an AIDS diagnosis at the time of initial HIV detection, and subsequently experience higher rates of HIV/ AIDS-related morbidity and mortality. A convergence, or syndemic, of stressors and psychosocial factors such as those related to sexuality and race-based discrimination, poverty, substance abuse, and psychological distress contribute to increased risk of and vulnerability to HIV/AIDS among GBMSM. Given its potential direct effect on health and mitigating effect on stressors, social support becomes a key resource in prevention of HIV infection and in addressing the burden of infection carried by GBMSM populations. Researchers now focus on examining how different sources and types of social support matter in addressing HIV/AIDS disparities. These sources encompass family and friendship networks that may or may not include other GBMSM, and may also include current and former sexual and romantic partners. Family Networks and Social Support

For LGBTQ individuals and youth in particular, expression of their sexual or gender identity to parents and family may result in the loss or gain of different types of social support, which has implications for healthy social and identity development. Compared to those who report little or no rejection from family, LGBTQ youth who experience rejection of their sexual identity or gender expression are more likely to report high levels of depression, use of illegal drugs, and sex without condoms. In this case, the loss of family-based emotional support may result in psychological distress leading to poor long-term health outcomes. Conversely, family acceptance was associated with greater self-esteem and social support, and lower levels of depression, substance abuse, and suicidal ideation. Homelessness resulting from sexualitybased rejection is also more common among LGBTQ youth. This loss of instrumental support is associated with greater use of addictive substances, higher rates of psychopathology, and higher numbers of sexual partners.

Loss of instrumental and emotional support may increase vulnerability to HIV infection in several ways, particularly for younger GBMSM. When individuals lack basic necessities, maintaining healthy behaviors becomes very challenging, as the focus becomes securing food and shelter. Concerns about HIV infection and its long-term consequences become more distal in this scenario, as may be the case for individuals engaging in transactional sex. The stress and isolation related to rejection itself may also lead to maladaptive coping behaviors such as substance abuse, which is associated with HIV-related sexual risk behavior. For some GBMSM, condomless sex may provide a sense of intimacy and security that serves to counter feelings of isolation and loneliness. Collectively, these behaviors translate into increased vulnerability to HIV infection among GBMSM. Friendship Networks and Social Support

Through adolescence and into adulthood, friendship networks gradually become as important as family networks. While friendships in general are important for healthy social development, involvement with LGBTQ networks or communities offers access to many kinds of social support that help GBMSM protect themselves from HIV and reduce or minimize psychosocial factors that would otherwise increase vulnerability to HIV infection. Emotional support from other LGBTQ individuals helps GBMSM process experiences of victimization and discrimination, thus reducing the psychological distress resulting from these experiences, which are also associated with HIV-related sexual risk behavior. Informational support in the form of knowledge about LGBTQ-friendly medical, HIV counseling and testing, and other sexual health services helps GBMSM obtain information about behavioral practices (e.g., strategic positioning and serosorting) and medical technologies (e.g., condoms, PreP [preexposure prophylaxis], PEP [post-exposure prophylaxis]) for reducing and preventing HIV infection. Instrumental support in the form of monetary aid and shelter also helps cover basic needs that in general are necessary for

HIV/AIDS and Social Support

individuals to then implement and sustain healthy behaviors and to concern themselves with the consequences of HIV infection. Social support from friendship networks, however, may also be accompanied by exposure to environments that increase vulnerability to HIV infection. Dance clubs and bars, for example, often become an important and even primary setting for seeing and meeting other LGBTQ people, yet this setting also increases the opportunity for sex while intoxicated.

Social Support and PLWHA Similar to the losses and gains in social support resulting from the sexual identity disclosure of LGBTQ individuals, PLWHA face similar challenges as they consider when and to whom they disclose their HIV-positive status. The impact, however, may be more pronounced if disclosing both an LGBTQ and HIV-positive status. Having social support is associated with better psychological and physical health outcomes among PLWHA. Lack of social support might even result in quicker progression to an AIDS diagnosis. In some cases where disease progression occurs, PLWHA report increases in social support over time. For PLWHA, emotional support may provide the psychological resources necessary for coping with the diagnosis of a disease that is highly stigmatized. Instrumental support may be important for PLWHA with advanced disease as physiological function begins to decrease. Also, informational support may be exchanged between LGBTQ and non-LGBTQ PLWHA regarding choices for medical care and providers. Further exploration is needed to examine the role of different types and sources of social support for PLWHA, including HIV/AIDS-specific support as HIV infection is increasingly treated as a chronic disease.

Conclusion Social support plays an important role for the general health of GBMSM and particularly for their sexual health in the context of HIV/AIDS prevention, treatment, and care. Social support continues

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to be defined and measured in a variety of ways, however, thus underscoring the need for theoretical and conceptual clarity. Understanding how specific types and sources of social support influence GBMSM’s risk and vulnerability to HIV infection contributes toward a framework that situates HIV/AIDS prevention work in a socioecological context. Jorge Soler and José A. Bauermeister See also HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to; Men Who Have Sex With Men (MSM)

Further Readings Centers for Disease Control and Prevention (CDC). (2013). Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas. HIV Surveillance Report, 23, 1–84. Darbes, L. A., & Lewis, M. A. (2005). HIV-specific social support predicts less sexual risk behavior in gay male couples. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 24(6), 617–622. Doty, N. D., Willoughby, B. L. B., Lindahl, K. M., & Malik, N. M. (2010). Sexuality related social support among lesbian, gay, and bisexual youth. Journal of Youth and Adolescence, 39(10), 1134–1147. Edwards, M. R. (2011). Influence of social support on gay men living with HIV. Marriage & Family Review, 47(5), 265–288. Johnson, B. T., Redding, C. A., DiClemente, R. J., Mustanski, B. S., Dodge, B., Sheeran, P., et al. (2010). A network–individual–resource model for HIV prevention. AIDS and Behavior, 14(2), 204–221. Lauby, J. L., Marks, G., Bingham, T., Liu, K. L., Liau, A., Stueve, A., et al. (2012). Having supportive social relationships is associated with reduced risk of unrecognized HIV infection among Black and Latino men who have sex with men. AIDS and Behavior, 16(3), 508–515. Mizuno, Y., Borkowf, C., Millett, G. A., Bingham, T., Ayala, G., & Stueve, A. (2011). Homophobia and racism experienced by Latino men who have sex with men in the United States: Correlates of exposure and

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associations with HIV risk behaviors. AIDS and Behavior, 16(3), 724–735. Mustanski, B. S., Newcomb, M. E., Du Bois, S. N., Garcia, S. C., & Grov, C. (2011). HIV in young men who have sex with men: A review of epidemiology, risk and protective factors, and interventions. Journal of Sex Research, 48(2–3), 218–253. Nelson, M. K. (2013). Fictive kin, families we choose, and voluntary kin: What does the discourse tell us? Journal of Family Theory & Review, 5(4), 259–281. Ramirez-Valles, J. (2002). The protective effects of community involvement for HIV risk behavior: A conceptual framework. Health Education Research, 17(4), 389–403. Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental health. Journal of Health and Social Behavior, 52(2), 145–161.

HIV/AIDS

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PRISON

Globally, 10 million people are held in penal institutions at any given time. The United States has the largest prison population by far, with 2.3 million people incarcerated in its federal and state prisons. In fact, nearly 25% of the world’s inmates are held in American prisons, followed by Russia, Rwanda, several countries in Eastern Europe, and the Caribbean. Individuals detained in prisons have already stood trial and are serving sentences of more than 1 year. Individuals incarcerated in prisons across the United States and globally are disproportionately affected by human immunodeficiency virus (HIV). This entry describes HIV in prisons, how HIV is transmitted, and HIV prevention activities.

Background In the United States, more than 2 million people are incarcerated in state and federal prisons. Racial and ethnic minorities are disproportionately represented in the U.S. correctional system with more than 60% of inmates belonging to racial and ethnic minorities. While Black Americans comprise only 13% of the general U.S. population, they constitute 40% of all inmates held in prisons, and 41% of the population on death row. In addition,

Black men are imprisoned at a rate of 7 times that of White men and almost 2.5 times that of Hispanic and Latino men. In 2010, Black women were incarcerated at rates nearly 3 times that of White women and twice that of Hispanic women and Latinas. American Indians are overrepresented in the federal prisons and are over twice as likely to be incarcerated as Whites. The majority of individuals incarcerated in U.S. state and federal prisons regularly used drugs and alcohol prior to incarceration, and most of their offenses were committed under the influence of drugs and alcohol. Incarcerated populations are also disproportionately affected by viral infections such as HIV. Inmates are more likely to have histories of HIV risk-taking behaviors, including injection drug use, tattooing, and unprotected sexual behaviors. These behaviors often continue, even behind bars. Overcrowding contributes to the spread of HIV, as stress, poor health, drug and alcohol use, and sexual violence among inmates places them at greater risk for the transmission of HIV.

HIV Prevalence and Transmission The prevalence of HIV infection among inmates in many countries is substantially higher than in the general population. For example, the number of HIV infections among sub-Saharan African inmates has been estimated to be 2 to 50 times that of the general population. In the United States, it has also been estimated that 25% of individuals living with HIV pass through the U.S. penal system. Outbreaks of HIV in prisons have occurred and are often associated with sharing contaminated injecting equipment when using drugs, the use of homemade and nonsterile equipment for tattooing, and unprotected sexual intercourse. Injection Drug Use

Sharing contaminated injecting equipment when using drugs is one of the primary routes of HIV transmission in prisons. Injection drug users (IDUs) are of particular concern, because sharing contaminated injecting equipment has contributed to

HIV/AIDS in Prison

the HIV epidemic in prisons and other bloodborne infections, including the hepatitis C virus (HCV). Those who inject drugs in prisons are more likely to share needles and syringes or other injecting equipment. Outbreaks of HIV associated with the use of nonsterile injecting equipment in prison have been documented in Australia, Lithuania, Russia, and Scotland. Tattooing

Tattooing in prison is also a risk factor for blood-borne viruses such as HIV and HCV, because it is illicitly performed by nonprofessional inmates using homemade, nonsterile shared equipment. Inmates with a history of drug injection have been noted as being tattooed in prison and sharing tattooing needles and ink, placing inmates at risk for acquiring HIV through tattooing. Sex in Prison

One of the primary transmission routes of HIV is through unprotected sexual intercourse. In many prisons, same-sex sexual behaviors are common among inmates, although prohibited under prison rules. It is difficult to determine the frequency of sexual activity among inmates. Inmates who reported same-sex encounters with other inmates stated that they had had consensual sex, “exchange sex” (e.g., sex exchanged for food, money, cigarettes, or protection), and/or had raped other inmates. Nonconsensual sex, sexual assaults, and rapes are common in penal facilities, and an estimated 13% of U.S. inmates report being sexually assaulted during their incarceration in prison; the Prison Elimination Rape Act (PREA) was passed in 2003 (Public Law 108-793) to protect inmates from sexual violence. One factor that contributes to HIV infection through sexual intercourse in prisons is the unavailability of condoms in that setting, which leads to unprotected same-sex behaviors. LGBTQ inmates are extremely vulnerable in prisons. Lesbian, gay, bisexual, and queer (LGBQ) inmates who were open about their sexual identity outside of prison typically remain “closeted”

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during incarceration because they are at heightened risk of torture, ill treatment, and sexual violence from other inmates. In addition, transgender inmates are especially vulnerable to sexual violence. Transgender inmates who have not had genital surgery are housed according to their birthassigned gender. This situation places them at great risk of sexual assault. One correctional policy that is used to protect transgender inmates who are at high risk of sexual violence is to separate them from other inmates. This procedure is referred to as “administrative segregation” or “solitary confinement.” The benefit of placing transgender inmates in administrative segregation is to provide them with greater protection than being housed in the general population. The disadvantage, however, is that transgender inmates housed in administrative segregation are locked down in a small cell, sometimes windowless, for 23 hours a day, and are excluded from recreational activities, services, and other programs. Prison officials can mitigate this issue by designing appropriate housing classification systems for LGBTQ inmates to prevent sexual victimization and abuse from other inmates. In other words, separate housing units should be provided to LGBTQ inmates.

HIV Prevention Activities The prison setting is often the first place that incarcerated individuals are either diagnosed with HIV or are able to start antiretroviral therapy. Given the documented benefits of early diagnosis and treatment for people infected with HIV, the Centers for Disease Control and Prevention (CDC) in 2009 provided recommendations on HIV testing in correctional facilities. HIV testing, known as opt-out voluntary testing, is offered to every inmate after his or her arrival to prison. Voluntary HIV testing is also provided when an inmate requests it. Voluntary HIV testing is available to all inmates, regardless of duration of stay. Mandatory HIV testing is performed when there is an indication of risk and when it is clinically indicated or part of surveillance. Involuntary testing is performed following an exposure incident; a written consent from the inmate is required.

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HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to

Correctional facilities are legally required to provide medical care to all inmates, including inmates living with HIV. The goals of HIV therapy in prisons are the following: Reduce or suppress viral load as much as possible and support CD4 cell count, restore or preserve the patient’s immune system, enhance the patient’s quality of life, and reduce HIV-related illnesses and deaths related to AIDS. Improvement of HIV treatment in prisons, as well as access to antiretroviral therapy, has been shown to dramatically decrease AIDS-related deaths. Despite this, the management and treatment of HIV within corrections vary by jurisdiction. In fact, few state prisons have developed comprehensive and coordinated HIV prevention programs and treatment across all correctional facilities. Moreover, there are gaps in HIV treatment when an inmate is transferred to different correctional facilities, when he or she is released from custody, and when prison staff confiscates an inmate’s HIV medication.

Conclusion Prison facilities are prime settings for implementing comprehensive HIV prevention, research, and treatment efforts. Scientific knowledge concerning the best practices for LGBTQ inmates garnered from high-quality biomedical HIV research is critical to advance the health of this population. To date, there are no biomedical HIV research activities in prisons involving LGBTQ inmates. Moreover, the World Health Organization (WHO) recommends that prison officials provide condoms to inmates to prevent the sexual transmission of HIV. Condoms and other HIV prevention strategies such as PreP must be provided to inmates to reduce the likelihood of HIV infection. Providing PreP, condoms, clean syringes, drug substitution therapy, and bleach provisions could reduce HIV infection among various high-risk populations, including LGBTQ inmates. Unfortunately, HIV prevention strategies and programs are rarely available to prison inmates. Finally, the health, safety, security, and wellbeing of LGBTQ inmates in prisons require an

understanding of certain broad areas. Particular areas worth considering include intake protocols, housing classification and assignment, medical treatment and care, policy and research, cultural competence, sexual health, victimization and stigma, and discharge planning. Pamela Valera See also HIV and Treatment; Incarceration; Juvenile Justice System; Prison Rape; Transgender Inmates

Further Readings Brewer, R. A., Magnus, M., Kuo, I., Wang, L., Liu, T. Y., & Mayer, K. H. (2014). The high prevalence of incarceration history among Black men who have sex with men in the United States: Associations and implications. American Journal of Public Health, 104, 448–454. Brown, G. R. (2014). Qualitative analysis of transgender inmates’ correspondence: Implications for departments of correction. Journal of Correctional Health Care, 20, 334–342. Jürgens, R., Nowak, M., & Day, M. (2011). HIV and incarceration: Prisons and detention. Journal of the International AIDS Society, 14, 26. Okie, S. (2007). Sex, drugs, prisons, and HIV. New England Journal of Medicine, 356, 105–108. Rich, J. D., Wohl, D. A., Beckwith, C. G., Spaulding, A. C., Lepp, N. E., Baillargeon, J., et al. (2011). HIV-related research in correctional populations: Now is the time. Current HIV/AIDS Reports, 8, 288–296.

HIV/AIDS TREATMENT AND CARE, PSYCHOSOCIAL AND STRUCTURAL BARRIERS TO HIV care and treatment are critical to maintaining the physical health of people living with HIV and preventing new infections. Although HIV-infected men who have sex with men (MSM) have better health outcomes than do other HIV transmissionrisk groups, there are also lesbian, gay, bisexual, and transgender subpopulations that may experience significant psychosocial and structural barriers

HIV/AIDS Treatment and Care, Psychosocial and Structural Barriers to

to HIV treatment and care. Such barriers are disproportionately prevalent among youth as well as gender and racial/ethnic minorities. The HIV care continuum is a model that is used by federal, state, and local agencies to identify issues and opportunities related to improving service delivery to people living with HIV (PLWH). The continuum has four steps, including HIV diagnosis, linkage and retention in HIV medical care, the uptake of antiretroviral therapy (ART), and achieving viral suppression. The continuum is particularly critical in the context of the “treatment as prevention” initiative that focuses on providing ART to PLWH in order to lower or suppress an individual’s viral load enough to reduce the transmission of HIV infection. Efforts to link PLWH to HIV medical care and encourage the initiation of ART to achieve viral load suppression are therefore essential in reducing new HIV infections, particularly for high-risk populations. Young men who have sex with men (YMSM) of color and transgender women are disproportionately impacted by HIV in the United States. Although HIV-infected MSM typically have better health outcomes compared to other transmissionrisk groups, there is evidence that HIV-infected YMSM of color may experience significant barriers to HIV care and treatment. In a report by the U.S. Centers for Disease Control and Prevention (CDC), younger MSM had lower levels of care at each step of the HIV care continuum compared with older MSM in 2010. Black MSM had the lowest levels of care compared with MSM of all races/ethnicities. Another group, transgender women, has similar health challenges. In metaanalyses, HIV prevalence rates for this population have been estimated to be approximately 19.1% worldwide and 27.7% within the United States. Based on these estimates, transgender women have a 49 times higher likelihood of being HIV-positive compared with all adults of reproductive age. Understanding the multiple barriers to HIV/ AIDS treatment and care for HIV-infected YMSM of color and transgender persons is critical in terms of improving health outcomes in these populations. The aims of this entry are (1) to review the existing literature for HIV-infected

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YMSM of color and transgender persons on barriers to (a) linkage and retention in HIV medical care, (b) ART utilization and adherence, and (c) HIV medical care (e.g., viral suppression); and (2) to provide recommendations for future research, practice, and policy based on these findings.

Linkage and Retention in HIV Medical Care Service-level factors represent some of the barriers to linkage and retention in care for HIV-infected YMSM of color, including provider characteristics (e.g., consistency in provider contact across HIV diagnoses and linkage to care activities, provider knowledge and experience in treating HIV-infected youth); the availability of services that specifically target youth; and intervention length. HIV-infected YMSM of color often experience stigma related to race, sexual orientation, or HIV status, which may function as a barrier to engaging in HIV care. The fear of the negative consequences of disclosing a positive HIV status or the organization’s (e.g., a medical clinic’s) fear of being seen as HIV-identified may delay the initiation of HIV care. There may also be psychosocial and developmental factors that improve linkage to HIV medical care, including stronger connection to the individual’s ethnic identity/community, positive attitudes toward homosexuality, and access to peers that support health-promoting behaviors. HIV-infected transgender persons may have particular difficulty seeking and receiving care, in part because they may be reluctant to disclose their gender identity or HIV status to health care providers. Insufficient provider knowledge/competency, discrimination, and transphobia may also negatively impact retention and linkage in HIV care for this population. Indeed, HIV-infected transgender women report significantly fewer positive interactions with their health care providers compared to HIV-infected non-transgender persons. HIV-infected transgender persons also have unique issues that need to be addressed in the context of HIV care, such as the possibility of adverse interactions between ART and hormone therapy.

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ART Utilization and Adherence

A range of psychological and contextual variables may influence ART utilization and adherence among HIV-infected YMSM of color. Risk behaviors (e.g., frequency and severity of substance use), negative coping styles, and psychological distress may interfere with an individual’s ability to initiate ART or maintain ART adherence. ART adherence may also be impacted by whether or not HIVinfected YMSM of color have made a successful transition to adulthood, such as having plans and concrete goals for the future (e.g., career plans). Those who have may more likely understand the importance of ART adherence as a necessary prerequisite to meeting developmental goals. Research on ART utilization and adherence among transgender persons is currently limited. There is, however, some evidence to suggest that transgender persons are less likely to be on ART compared to non-transgender persons. In one study, transgender women on ART were less likely than other HIV-infected individuals on ART to report 90% ART adherence and also were less confident in integrating ART into their regular routines. In another study of HIV-infected transgender women on ART, optimal ART adherence was associated with the importance of gender affirmation, or the desire for validation of one’s gender identity/expression; lower stress appraisal of transphobic experiences; and adherence to hormone therapy. These findings suggest the potential value of integrating HIV care and hormone therapy to increase treatment engagement in this population. HIV Medical Outcomes

HIV medical outcomes, including unsuppressed viral load and low CD4 counts, are commonly used by federal and local organizations to track the health of PLWH. Existing data indicate that a relatively high number of HIV-infected YMSM of color have poor HIV medical outcomes, including unsuppressed viral loads or low CD4 counts. The existing data are mixed in terms of HIV medical outcomes among transgender persons. Some studies have found that there are no significant

differences between HIV-positive transgender people and HIV-positive non-transgender people in terms of viral suppression or CD4 counts. However, HIV surveillance data from San Francisco and New York City (NYC) suggest that transgender persons have poorer HIV medical outcomes compared with some other transmission-risk groups. In San Francisco, transgender persons have a threefold higher community viral load than MSM and intravenous drug users, while in NYC, transgender women were less likely than non-transgender MSM to achieve viral suppression.

Conclusion Although YMSM of color and transgender persons continue to be disproportionately impacted by HIV in the United States, there has been limited research to date on HIV care and treatment outcomes among these populations. There is some evidence that both HIV-infected YMSM of color and transgender persons may be more likely than other groups of HIV-infected individuals to have poor HIV medical outcomes, particularly in terms of achieving viral suppression. More research is needed that focuses on understanding the individual and system-level factors that impact HIV care continuum indicators. For YMSM of color, there is evidence that service utilization–related variables (e.g., provider experience) may have a particularly critical role in engaging and maintaining this population in HIV care. Information about whether someone is transgender is not currently required by the CDC as a part of jurisdiction-level HIV surveillance; therefore, it is difficult to estimate the number of transgender persons living with HIV or to track HIV care continuum indicators for this population. In 2012, the CDC released guidance for HIV surveillance on capturing gender identity for transgender people, which some jurisdictions have integrated into routine surveillance activities. Collecting this information can be challenging, particularly because of inconsistencies between sources of information on sex at birth or gender identity. Future research on HIV treatment and care interventions should also consider how system-level

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factors, including service delivery and multiple levels of stigma, could ultimately impact HIV medical outcomes in these populations. Matthew B. Feldman and Simon Andrade See also Health Disparities; LGBTQ People of Color; Transgender and Gender-Nonconforming Youth of Color; Transgender Health Care

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transgender persons who are HIV positive. American Journal of Public Health, 96(6), 1034. Sevelius, J. M., Saberi, P., & Johnson, M. O. (2014). Correlates of antiretroviral adherence and viral load among transgender women living with HIV. AIDS Care, 26(8), 976–982. Yehia, B. R., Fleishman, J. A., Moore, R. D., & Gebo, K. A. (2013). Retention in care and health outcomes of transgender persons living with HIV. Clinical Infectious Diseases, 57(5), 774–776.

Further Readings Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases, 13(3), 214–222. Centers for Disease Control and Prevention (CDC). (2012). Guidance for HIV surveillance programs: working with transgender-specific data. Washington, DC: Author. Centers for Disease Control and Prevention (CDC). (2014a). HIV among gay and bisexual men. CDC Fact Sheet. Retrieved November 5, 2015, from http://www .cdc.gov/hiv/group/msm/ Centers for Disease Control and Prevention (CDC). (2014b). Men living with diagnosed HIV who have sex with men: Progress along the continuum of HIV care—United States, 2010. Morbidity and Mortality Weekly Report, 63(28), 829–833. Ellen, J. M., Kapogiannis, B., Fortenberry, J. D., Xu, J., Willard, N., Duval, A., et al. (2014). HIV viral load levels and CD4+ cell counts of youth in 14 cities. AIDS, 28(8), 1213–1219. Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., & Crepaz, N. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12(1), 1–17. Hightow-Weidman, L. B., Jones, K., Phillips, G., Wohl, A., & Giordano, T. P., for the YMSM of Color SPNS Initiative Study Group. (2011). Baseline clinical characteristics, antiretroviral therapy use, and viral load suppression among HIV-positive young men of color who have sex with men. AIDS Patient Care and STDs, 25(S1), S9–S14. Melendez, R. M., Exner, T. A., Ehrhardt, A. A., Dodge, B., Remien, R. H., Rotheram-Borus, M. et al. (2006). Health and health care among male-to-female

HOMELESSNESS Homelessness is a broad term that encompasses a variety of situations in which an individual may have unstable housing; this may range from brief periods or nights in which an individual does not have a secure place in which to sleep to months or years without a stable residence. The prevalence rates of homelessness among LGBTQ youth are of particular concern. Based on data from several studies examining this issue among LGBTQ youth, it is clear that these youth disproportionately experience homelessness and its associated mental and physical health risks, in comparison to heterosexually identified cisgender (i.e., when one’s gender identity coincides with assigned sex) youth. Although most of the research on LGBTQ homelessness addresses youth specifically, it is likely that many of the experiences of LGBTQ homeless youth would also apply to adults; however, this essay focuses primarily on youth, based on the available research literature. Specifically, the entry first reviews general information about LGBTQ youth homelessness, then discusses the potential consequences of homelessness in these populations, and concludes with an overview of the unique experiences of homeless transgender youth. Just as the definition of homelessness includes a broad variety of situations, the reasons that youth experience homelessness may also vary tremendously from individual to individual, from forcible rejection by parents or caregivers to willing participation in a homeless subculture. Because many LGBTQ homeless youth may be fleeing situations where they were marginalized on the basis of their

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Homelessness

sexual orientation or gender identity, it makes sense that they would relocate to urban “gayborhoods,” where the visibility of LGBTQ individuals may hold the promise of a more accepting environment. When considering the specific circumstances surrounding homelessness for LGBTQ youth, many assume a prototypical narrative in which an LGBTQ individual comes out to family, is kicked out of the home by rejecting parents, and then lives on the margins. The reality is that although this situation often exists for LGBTQ youth, homelessness is also influenced by multiple individual and societal factors. In turn, the experiences of these youth are complex and multifaceted. Estimating the number of LGBTQ homeless individuals in a given area is a difficult task. Indeed, getting an accurate count of the general homeless population is complicated by stigma (individuals not wanting to identify as homeless), justified skepticism on the part of homeless individuals toward authority figures, difficulty locating homeless camps or networks, and the frequent mobility of homeless individuals. Of the studies that examine the homeless population in general, very few ask about sexual orientation or gender identity beyond the binary male–female options. Those that do, however, estimate that anywhere from 30% to 43% of homeless youth are LGBTQ. This extraordinarily high proportion of LGBTQ individuals among the homeless population highlights a health disparity that is only addressed by a few specialized service programs, such as the Ali Forney Center in New York City. Only a handful of similar shelters and programs currently exist in the United States, and all are concentrated in urban centers. Homeless shelters that are not LGBTQ-specific often pose additional risks for LGBTQ youth; these may be places where youth experience further victimization and discrimination, and housing quarters often are established on a binary concept of gender, resulting in inadequate services for trans-identified consumers of their services. Accurate counts of the LGBTQ homeless population are imperative for providing funding to assist in the development and maintenance of specialized services. In order to examine the experience of LGBTQ homelessness, it is essential to invoke the concept

of intersectionality, which refers how the various identities people hold interact in different ways that can result in oppressive practices and systems. These identities can include biologically and socially constructed identities such as gender, race, class, and sexual orientation. By definition, LGBTQ homeless youth face simultaneous social pressure from being part of a stigmatized gender or sexualminority group and the economic disadvantage of being homeless. Of course, other intersecting elements may confer additional risk or protective factors that modify the person’s experience, including ethnicity, ability status, national origin, and many others. These intersecting characteristics impact LGBTQ homeless youth’s well-being in a variety of ways that are specific to each individual’s experience.

Consequences of Homelessness Homelessness is associated with numerous mental health risks, including posttraumatic stress disorder (PTSD), substance misuse, depression, and suicidal ideation. Homeless LGBTQ youth experience higher rates of these mental health problems than do homeless youth more generally, which is believed to be associated with the experience of having multiple stigmatized identities. Living on the street exposes youth to many potential traumatic events (through both witnessing these events as they happen to others and directly experiencing them). For many LGBTQ youth, shelters and social service programs designed for homeless youth are often affiliated with organizations that do not support their sexual or gender identities, creating additional obstacles that block access to needed resources. Increased discrimination also contributes to homeless LGBTQ youth facing higher rates of physical and sexual violence than do homeless youth more generally. Mental health conditions, including PTSD, may develop after exposure to such trauma(s). Among other symptoms, the criteria for PTSD include negative alterations in one’s mood and thought patterns that represent looking at the world in a fundamentally different way once a trauma (or traumas) has happened. People with PTSD often believe that the world around them is unsafe, that

Homelessness

they are powerless to change it, and that they are highly vulnerable to future traumatic experiences. It would be difficult to dispute these thoughts for homeless individuals, who lack the safety and security that is related, at least in part, to having a stable and safe place to live. A diagnosis of PTSD may further complicate the mental health of LGBTQ homeless individuals, as it is associated with increased depression, other anxiety disorders, and elevated consumption of alcohol and substances that may be used to self-medicate in the absence of treatment. Indeed, much of the psychological research literature related to homelessness highlights elevated rates of substance misuse among homeless individuals. Homeless youth generally are more likely than other youth to have used illicit drugs, but rates of illicit substance use are even higher for LGBTQ youth within this group. It is important to note that many homeless individuals are further stigmatized on the basis of their substance use; in fact, others often assume that substance use is the reason that individuals become homeless. This simplistic explanation overlooks the factors that may have led to the individual’s substance use in the first place, which may include minority stress, genetics, peer pressure, and a lack of alternative coping skills. Substance use may also be a coping response to homelessness or the risk factors associated with it. In other words, the high rates of substance use among homeless populations can both precede and follow one’s homelessness, in addition to stemming from a variety of complex origins. Although it is impossible to separate mental health risks from physical health conditions, as the two constructs have a great deal of overlap, there are many ways in which being homeless confers additional risk for negative physical health outcomes. Homeless individuals often experience higher rates of unemployment, have less educational resources, and have fewer sources of economic and social support. This combination of limited personal and social resources often makes adequate medical care impossible for homeless youth, particularly homeless LGBTQ youth, who tend to have even fewer social supports. Higher rates of injection drug use and risky sexual behavior also increase rates of HIV, hepatitis, and other

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medical conditions among homeless individuals. Other potential sources of health problems for homeless individuals relate to often unsanitary living conditions, exposure to harsh weather, and difficulties obtaining enough nutritious food. Consequently, physical health problems and inadequate medical care often compound psychological problems for homeless individuals. Higher instances of survival sex, or engaging in sex work in order to attain necessities such as food and shelter, also increase the likelihood that homeless LGBTQ youth experience both physical and psychological difficulties. Engaging in survival sex increases the odds of contracting sexually transmitted diseases and infections, while also increasing the odds of being exposed to physical, sexual, and emotional victimization. Survival sex is also associated with higher rates of suicidal ideation and attempts among homeless youth, regardless of sexual orientation or gender identity. The increased discrimination and barriers to care that LGBTQ youth often face at shelters and when seeking services contribute to the higher rates at which LGBTQ homeless youth engage in survival sex compared with cisgender heterosexual peers. In this way, engaging in survival sex is a particularly relevant risk scenario for homeless LGBTQ youth.

Homeless Transgender Youth Transgender youth represent a population within the LGBTQ umbrella group that encounters additional risks if they are homeless. In addition to increased medical needs due to risk-related scenarios, homeless transgender youth may experience medical complications that result from inadequate medical care. Many transgender youth require hormone or silicone injections, which can lead to health problems if improperly administered, or if poorer quality medications are obtained on the street. Factors that may contribute to these issues include shelter policies and practices that create particularly hostile or unsafe environments for trans-identified youth, creating additional barriers to the already limited services that are available. In addition to relying on binary systems that may exclude many trans youth, some shelters may overtly discriminate or prevent transgender

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individuals from accessing services that may be more available to lesbian, gay, and bisexual (LGB) youth. In this way, not only are unmet medical needs particularly relevant for homeless transgender youth, but also the experiences of these youth often vary substantially from those of cisgender LGB youth.

Conclusion While the exact prevalence rates of homelessness among LGBTQ youth have been difficult to discern, it is clear that homelessness disproportionately impacts sexual- and gender-minority individuals. Researchers have also identified several potential psychological and physical health disparities that are only beginning to be addressed in the literature. Further research is needed to more accurately estimate the prevalence of homelessness as it relates to these populations, as well as clarify the nature and origins of these potential health disparities. Bryan N. Cochran and Kathryn M. Oost See also Community Climate; Demographics and the LGBTQ Population; Gayborhoods; Housing, Protection Against Discrimination in; Minority Stress; Parent–Child Relationships; Social Class

Further Readings Cochran, B. N., Stewart, A. J., Ginzler, J. A., & Cauce, A. M. (2002). Challenges faced by homeless sexual minorities: Comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. American Journal of Public Health, 92(5), 773–777. Corliss, H. L., Goodenow, C. S., Nichols, L., & Austin, B. (2011). High burden of homelessness among sexualminority adolescents: Findings from a representative Massachusetts high school sample. American Journal of Public Health, 101(9), 1683–1689. Gattis, M. N. (2011). An ecological systems comparison between homeless sexual minority youths and homeless heterosexual youths. Journal of Social Service Research, 39(1), 38–49. doi:10.1080/01488376.2011 .63381

Spicer, S. S. (2010). Healthcare needs of the transgender homeless population. Journal of Gay and Lesbian Mental Health, 14, 320–339. doi:10.1080/19359705 .2010.505844 Walls, N. E., Potter, C., & Van Leeuwen, J. (2009). Where risks and protective factors operate differently: Homeless sexual minority youth and suicide attempts. Child & Adolescent Social Work Journal, 26, 235–257. doi:10.1007/s10560-009-0172-2 Yu, V. (2010). Shelter and transitional housing for transgender youth. Journal of Gay & Lesbian Mental Health, 14, 340–345. doi:10.1080/19359705.2010 .504476

HOME–SCHOOL PARTNERSHIPS LGBTQ-PARENT FAMILIES

IN

The entry starts by defining home–school partnerships and describing the factors in such partnerships that promote academic, social, emotional, and psychological well-being among students. Next, the entry highlights the inequality in home– school partnerships among diverse families, which creates systemic barriers that prevent positive partnerships with LGBTQ-parent families. Then, this entry provides an overview of the positive and negative factors in home–school partnerships with LGBTQ-parent families. The entry concludes with recommendations for working with this diverse and marginalized population and a description of the limitations in research and practice when it comes to fully understanding home–school partnerships in LGBTQ-parent families.

Defining Home–School Partnerships While research on home–school partnerships has been explored for decades now, there are different definitions for what this term encompasses. For example, some studies have centered on the idea that parents need to be more active in their child’s education, while other studies emphasize the responsibility of schools in reaching out to parents. In any case, there are key components that characterize this type of relationship between families

Home–School Partnerships in LGBTQ-Parent Families

and schools. As with most studies that explore the effects of home–school partnerships on the success of students, the term home–school partnership is used here to refer to a shared responsibility for collaboration and outcome between families and schools with the goal of advancing students’ learning, development (academically and emotionally), and long-term success (in school and beyond). The term family, as used in the definition of home–school partnership, is intended to be used as an encompassing term to describe all types of families, including, but not limited to, differentsex–parent families, same-sex–parent families, biological-parent families, adoptive-parent families, racially and ethnically diverse–parent families, singleparent families, and multiracial-parent families, among others.

Factors That Contribute to Successful Home–School Partnerships It is clear that home–school partnerships are crucial in promoting academic, social, emotional, and psychological well-being among students. However, much like the different definitions that exist for home–school partnerships, there is a plethora of factors that contribute to the success of such partnerships. These factors seem to evolve with time, as research and interventions advance to match a growing need for understanding diversity in schools in an effort to create a collaborative approach that includes all parties involved in home–school partnerships (students, families, and schools). These factors include engagement, quality of the home–school partnership, and building collaborative relationships between home and school contexts. The specific roles of homes and schools will be discussed further below. Engagement refers to the ability of schools and families to develop a two-way relationship in order to make joint decisions about ways to support students and implement strategies that increase successful academic outcomes. Furthermore, while engagement is a basic step in building home– school partnerships, engagement alone does not necessarily yield positive outcomes. There needs to

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be an element of intentionality in the communication between families and schools. In other words, communication needs to be engaged and goal-oriented in order to allow students to be successful and develop in a healthy environment. A collaborative relationship is best achieved when both families and schools are actively engaged and respect the contributions and suggestions from all parties involved. Regarding the specific role of home in home– school partnerships, research and practice suggest that family is significant to children’s academic, emotional, social, and psychological development. Thus, families need to be receptive to working with schools in advocating for their children by implementing concepts and values taught in school. This includes incorporating lessons taught in the classroom at home. This collaborative effort helps deliver a message of unity and consistency to all students, regardless of the diverse group of which they are a part. If done in an efficient and respectful manner, collaborative relationships will lead to an effective consultation process between families and schools, contributing to students’ healthy academic, social, and behavioral development. Besides the responsibility of home, school personnel (e.g., teachers, administrators, staff) are crucial in developing and fostering home–school partnerships. Under the supervision of caring adults away from home, school personnel provide opportunities that promote the academic, social, and emotional development of students to reach their full potential. Thus, school personnel need to be open to learning and incorporating the values of diverse families in their curriculum to create a welcoming environment, and to ensure open channels of communication such that diverse families feel comfortable expressing their concerns and needs.

Inequality in Home–School Partnerships As discussed, home–school partnerships require more than both parties working individually to promote the well-being of students. Most importantly, home–school partnerships are effective when engaged and collaborative relationships can

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be built. However, oppressive school factors affecting certain diverse families can create systemic barriers to the development of positive home–school partnerships. In the last three decades, researchers and educators have devoted much time and effort to understanding and achieving effective home–school partnerships with diverse students and their families (e.g., special education and linguistically diverse students). However, attention to the development of strong home–school partnerships with LGBTQparent families has been lacking. The lack of research and interventions on how schools can foster positive relationships with LGBTQ parents and their children could lead LGBTQ parents to doubt the intentions of schools toward them and their children. A close analysis of home–school partnerships among special education and linguistically diverse students and their families reveals commonalities that, if enacted effectively, could likely benefit other diverse students and families, including LGBTQ-parent families. The following sections provide an overview of home–school partnerships in LGBTQ-parent families, including positive and negative factors, suggested courses of action for working with LGBTQ parents, and limitations in the literature regarding creating equal home–school partnerships with this understudied population.

Positive Aspects of Home–School Partnerships in LGBTQ Families LGBTQ parents report a high level of involvement in their child’s education, including doing homework assignments with their child and discussing their child’s school progress (e.g., going over school report cards and material being taught in the classroom) as well as frequent interactions with other students and school personnel. However, it is important to note that the available research suggests that LGBTQ parents infrequently discuss with their children how their school incorporates LGBTQ issues in the curriculum. The research thus far has not provided an explanation as to why LGBTQ parents are not actively inquiring about what their children are learning in school regarding LGBTQ issues. Thus, further

research is needed in order to find out why LGBTQ parents seem to avoid talking to their children about how schools integrate issues that directly affect their family unit. In addition, according to the limited research, LGBTQ parents report higher levels of communication with schools than the national average (e.g., they are more likely to inquire about a child’s school performance and to volunteer at the school). In contrast to the negative experiences that LGBTQ parents and their children often experience in school (e.g., lack of inclusive policies and procedures and microaggressions), research shows that schools both initiate and reciprocate communication more frequently with LGBTQ parents than with heterosexual parents, thus potentially creating a more collaborative environment where the children of LGBTQ parents can thrive academically and emotionally in schools. While there is no concrete research to explain this finding, perhaps it may be related to the fact that, as discussed, LGBTQ parents seem to report higher levels of communication with schools. Thus, those schools that are open to and accepting of LGBTQ families might be invested in nurturing a relationship with LGBTQ parents. Furthermore, most LGBTQ parents report being comfortable discussing their family structure with school personnel, specifically school principals and teachers. However, it is noteworthy that, based on the limited research available, public schools are more receptive to having a discussion with LGBTQ parents about their family structure than are private schools, including religious private schools. A possible explanation for this difference may be that public schools are subject to state and federal regulations when it comes to providing equal opportunities to students and their families that private schools may not be required to follow, and this may result in a higher receptivity to working with families of diverse backgrounds.

Negative Aspects of Home–School Partnerships in LGBTQ-Parent Families While schools and LGBTQ parents seem to be communicating effectively with one another,

Home–School Partnerships in LGBTQ-Parent Families

suggesting a level of acceptance and respect from schools toward diverse family structures, this may not be representative of all LGBTQ family experiences. For many LGBTQ parents and their children, schools represent institutions that promote the traditional family structure of one cisgender mother and one cisgender father. This negative school climate creates a disconnect between schools and LGBTQ parents, making it challenging for schools and LGBTQ parents to enact those factors that are crucial for a productive home–school partnership to be established (e.g., engagement, collaborative relationships). The limited research suggests that for a significant percentage of LGBTQ parents, home–school partnerships are hard to form due to schools’ lack of recognition of their family structure and refusal to allow LGBTQ parents to volunteer in school activities. As a result, LGBTQ parents do not have an opportunity to engage in as many school activities and are denied the opportunity to make connections with other parents in order to create support systems that could be beneficial to their child—both in school and in their family structure overall. This lack of respect and inclusiveness affects the children of LGBTQ parents, as schools fail to communicate with LGBTQ parents about their child’s school progress.

Recommendations for Working With LGBTQ-Parent Families While research on home–school partnerships in LGBTQ-parent families is scant, it is possible to make tentative recommendations for schools when working with this population based on the extensive research base on home–school partnerships among special education and linguistically diverse students. These recommendations include professional development opportunities for school personnel, creating first contact with LGBTQ families, and examining collaborative efforts. Most school districts require teachers and school personnel to attend professional development workshops. Thus, implementing workshops to educate school personnel about LGBTQ

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families and how to best serve them in schools could be an effective strategy for school personnel to become aware of the importance of working with all diverse families. Professional development workshops are also a great opportunity for revisiting school policies and rules in an effort to make sure that LGBTQ families are being included in all school functions in which parents participate. In addition, creating first contact, or initiating communication with LGBTQ families, delivers the message to this oppressed population that their family’s well-being is important to the school. Building relationships with parents creates a sense of respect and alliance between LGBTQ families and schools. Creating first contact also facilitates ongoing and meaningful communication and collaboration. Furthermore, while home–school partnerships are the responsibility of all parties involved, schools need to take into consideration the oppressive factors that LGBTQ families are exposed to on a daily basis and need to make sure that parents have a voice in their child’s education. Thus, schools need to be able to examine if LGBTQ parents are being given the opportunity to express concerns and make suggestions for schools to implement. Roberto L. Abreu and Alicia L. Fedewa See also LGBTQ-Parent Involvement and Advocacy in Schools; School Choice in LGBTQ-Parent Families

Further Readings Cox, D. D. (2005). Evidence-based interventions using home–school collaboration. School Psychology Quarterly, 20(4), 473–497. Esler, A. N., Godber, Y., & Christenson, S. L. (2002). Best practices in supporting home–school collaboration. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology IV (Vols. 1–2, pp. 389–411). Washington, DC: National Association of School Psychologists. Fedewa, A. L., & Clark, T. P. (2009). Parent practices and home–school partnerships: A differential effect for children with same-sex coupled parents? Journal of GLBT Family Studies, 5, 312–339. doi:10.1080/ 15504280903263736

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Glueck, C. L., & Reschly, A. L. (2014). Examining congruence within school–family partnerships: Definition, importance, and current measurement approaches. Psychology in the Schools, 51, 296–315. doi:10.1002/pits.21745 Kosciw, J. G., & Diaz, E. M. (2008). Involved, invisible, ignored: The experiences of lesbian, gay, bisexual and transgender parents and their children in our nation’s K–12 schools. New York, NY: Gay, Lesbian & Straight Education Network. Olivos, E. M., Gallagher, R. J., & Aguilar, J. (2010). Fostering collaboration with culturally and linguistically diverse families of children with moderate to severe disabilities. Journal of Educational and Psychological Consultation, 20, 28–40. doi:10.1080/10474410903535372

HOMONORMATIVITY Scholars and activists use the term homonormativity in many ways. Transgender scholars and activists used it to highlight the normalization of gays and lesbians during the lesbian, gay, bisexual, and transgender (LGBT) rights movement in the 1990s. A more prevalent use of the term is associated with heteronormativity and queer theory. Homonormativity has a distinctive relationship with heteronormativity. Queer scholars and activists have examined sites of homonormativity in queer politics and culture, including representations of queer bodies in the media. Critiquing homonormativity is an important component of queer theory in LGBTQ studies and activism.

Variants of Homonormativity Theorist and filmmaker Susan Stryker is often credited with coining the term homonormativity. Stryker’s use of the term is concerned with the way that gays and lesbians became the primary identities represented in the LGBT rights movements of the 1980s and 1990s. The “T” in LGBT was too often an afterthought. In Stryker’s variation, homonormativity drew attention to the ways that queer activism focused almost exclusively on homosexuality. With this focus, transgender was juxtaposed

against norms of homosexuality, which were not the norms that transgender activists needed to be fighting against. For example, organizations like Queer Nation and ACT UP focused on programs and politics that generally benefited gay men. Lisa Duggan, a social and cultural analyst, initially articulated the contemporary idea of homonormativity. Duggan argued that homonormativity is a politic of queer assimilation. Homonormativity is antiqueer in the ways that it reifies heteronormativity, and it is further understood as providing cultural norms for the right way to be gay and lesbian. In this capacity, homonormativity perpetuates gender, sexuality, and racial stereotypes for gays and lesbians. Homonormativity is best understood in relation to heteronormativity, where queer politics and activism arise.

Heteronormativity, Homonormativity, Queer Politics, and Activism Heteronormativity is the culturally constructed assumption that everyone is heterosexual, or straight. Because everyone is presumed straight, the world is designed for straight people. All of our cultural institutions and social structures privilege heterosexual relational configurations. Queer, in the subversive sense, threatens heteronormativity through doing gender, sexuality, and relationships in ways that disrupt what is understood and taken for granted. Although queer is often used as an umbrella term for non-normative genders and sexualities, it is important to note that not all gays and lesbians are queer in the subversive sense of queer theory. As the HIV/AIDS pandemic became clear in the 1980s, queer activism of difference—“We’re here, we’re queer, get used to it”—gave way to a reformed gay movement predicated on normalizing gays and lesbians: “We are your sons and daughters, your brothers and sisters. We are no different from you.” By the 1990s, gay and lesbian activism had fixed on equality in access to marriage and military service. Homonormativity can be understood as gays and lesbians embracing and embodying the norms of heteronormativity. When gays and lesbians mimic straight couples and

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perform the culturally expected gender for their biological bodies, they may avoid punishment and, at times, be socially rewarded. The Human Rights Campaign (HRC), a prominent LGBT civil rights organization, has been criticized as steadfastly homonormative in its activism pursuits. Openly gay, lesbian, and bisexual individuals have been allowed to serve in the military since 2011, and in 2015 the Pentagon announced that it will allow transgender members to serve as of 2016. In June 2015, the U.S. Supreme Court held that states must allow same-sex couples to marry and that they must recognize same-sex marriages from other states. Queer critiques of the HRC have denounced setting normative social goals, such as marriage equality and military inclusion, which do not represent the concerns of all LGBTQ people. Queer activists emphasize the LGBTQ people whose best interests are not served by activism founded in homonormativity such as transgender discrimination; homelessness among LGBTQ youth; job and housing discrimination based on sexuality and gender; bisexual erasure; and inequalities at the intersections of race, gender, sexuality, socioeconomics, and nationalism. Centralizing activism efforts on homonormative political pursuits constructs normative stereotypes of who LGBTQ people are, what they want, and how they behave. These stereotypes are often examined in the context of media representations.

Homonormativity and the Media Early film portrayals of non-normative sexualities were often villainous (e.g., Cruising). There was scarce representation of LGBT identities in popular media until the 1990s, and then it was often as comic relief (e.g., My Best Friend’s Wedding), fodder for tragedy (e.g., Philadelphia), or an oddity (e.g., The Crying Game). In the late 1990s, Will and Grace became a popular, award-winning comedy that featured gay male characters balanced with (straight) female counterparts. Will Truman, the titular character, was unlucky in love and easily desexualized. Will and Grace was quickly criticized for its heteronormativity—a gay television show for straight people to watch.

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In 2000, Showtime’s Queer as Folk presented a group of five friends who were all gay, male, White, sexual beings. The portrayal of gay sexuality was both praised and criticized. In accomplishing what Will and Grace could not, gay sexuality in Queer as Folk could be conceived of as normal and unremarkable—a form of homonormativity. The comedy series Modern Family premiered in 2009 with a gay couple, Cameron and Mitchell, who eventually adopt a child and get married. Their relationship arguably illustrates a second variant of homonormativity in the media: gay people who model their lives after straight people. Beyond the heteronormativity reified through the homonormative gay characters, Cameron and Mitchell present a model of gays for consumption—male, White, successful, and relationally gendered as complementary. This perpetuates heteronormativity through modeling homonormativity. Pervasive homonormativity in popular media proliferates stereotypes of what it means to be gay, how to be gay correctly, and that—in the end—it is quite normal. This disadvantages LGBTQ people who do not—because they are unable or do not want to—conform to homonormative stereotypes.

Homonormativity and LGBTQ Studies Homonormativity offers a useful critical perspective for deconstructing embodied heteronormativity. Variations of what homonormativity means may initially seem disparate. However, each rendering of homonormativity provides a more nuanced space from which to interrogate the heteronormative world in which we live. Scholars have long critiqued queer theory and its ancillaries as too complex and limited. However, the critical theoretical values of the discourse that queer theory has offered, such as heteronormativity and homonormativity, remain beneficial tools for thinking about social constructions of culture and society in LGBTQ studies activism and scholarship. Derek M. Bolen See also Closet, The; Coming out, Disclosure, and Passing; Gender Binaries; Heteronormativity; Queer Politics; Queer Theory; Sexual Norms and Practices; Stealth (Transgender Passing)

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Further Readings Duggan, L. (2002). The new homonormativity: The sexual politics of neoliberalism. In R. Castronovo & D. D. Nelson (Eds.), Materializing democracy: Toward a revitalized cultural politics (pp. 175–194). Durham, NC: Duke University Press. Duggan, L. (2003). The twilight of equality? Neoliberalism, cultural politics, and the attack on democracy. Boston, MA: Beacon Press. Puar, J. K. (2006). Mapping U.S. homonormativities. Gender, Place & Culture, 13(1), 67–88. Stryker, S. (2008). Transgender history, homonormativity, and disciplinarity. Radical History Review, 100(2008), 145–157. doi:10.1215/01636545-2007-026

HOMOPHOBIA Homophobia is a contemporary social scientific term coined in the field of psychology to describe negative attitudes toward nonheterosexuals and nonheterosexuality. It has been characterized in a multitude of ways including aversion, disgust, fear, or hatred of homosexuals (gay men and lesbians) and homosexuality, which may be accompanied by anti-homosexual hostility. The term homophobia provided language for a phenomenon that reversed the dominant approach to homosexuality as psychopathological. Research turned from treating homosexual people in therapy to interrogating homophobia as a construct. Homophobia is understood to operate at multiple levels in society, from individuals to institutions. Although the social and cultural significance of the construct of homophobia is important, recent scholarship has called for a reexamination of the term and construct.

The Pathology of Homosexuality and Naming of Homophobia From the first edition of the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, homosexuality was listed as a diagnosable form of psychopathology (i.e., mental illness). The result, clinically, was that no matter the nature of a

homosexual patient’s issue or problem, homosexuality as psychopathological was the focus of treatment. Issues or problems that homosexual patients brought to the psychoanalytic couches of the 1950s and 1960s were subjugated to homosexuality itself; that is, any issue or problem was regarded as stemming from the person’s being homosexual. Instead of exploring issues or problems that patients perceived to be primary, psychologists were trained to focus on homosexuality as the primary concern and pursued treatment as such. Several years prior to the APA’s historic removal of homosexuality from the DSM in 1974, George Weinberg—a psychotherapist who was trained, practicing, and doing research in the era of homosexuality as pathology—coined the term homophobia. Weinberg, a heterosexual man, conceived of his homophobia construct after reflecting on the way that many other psychotherapists would display intense and personally negative responses to coming into contact with homosexuals outside of their work. He recognized their responses as fear, as a phobia, and began calling them homophobes. The word homophobia is the blending and compounding of “homo,” from homosexual (the term homosexual has its own distinctive morphology), with “phobia,” from the Greek word for fear. In simplified terms, Weinberg’s homophobia of the late 1960s characterized a fear of homosexuals— likely born of religion—that was predicated on social fears that homosexuality would spread and destroy the procreative nuclear family, the bedrock of society, thereby destroying society. In the fields of psychology and sociology, the conception of homophobia helped turn scrutiny away from homosexuals (as mentally ill, abnormal, deviant) and toward homophobia as a social issue, as well as toward those who exhibited homophobic attitudes or behaviors and the effect that homophobia had on the lives of homosexual individuals. Researchers, in turn, began to direct their attention to studying homophobia. As Weinberg continued to articulate and advance his conception of homophobia in the late 1960s and early 1970s at speaking events and in periodicals produced by and for homosexual people, the construct of homophobia offered new ways for gay men and

Homophobia

lesbians to conceive of their social locations in society and provided new language that expanded the discourse for activists of the gay rights movement. Weinberg’s 1972 book, Society and the Healthy Homosexual, was written to be an accessible resource that interrogated homophobia and psychotherapy. Departing from the position of homosexuality as psychopathology, Weinberg endeavored to reframe homosexuality as normal and homophobia and psychotherapy as problematic. Two years later, in 1974, the APA removed homosexuality from the DSM. Many scholars credit this change, in part, to the conceptualization of homophobia. Removing homosexuality from the DSM initiated a change of perspective that affected the health fields (e.g., psychotherapy, medicine) and the social sciences (e.g., psychology, sociology).

Institutionalized Homophobia Institutionalized homophobia refers to instances where homophobic or anti-homosexual ideologies are engrained in the social and cultural institutions of a society. For example, when homosexuality was listed as a pathology in the DSM, homosexuality was positioned as a sickness, abnormal, and bad. It would not have been advantageous to be seen as homosexual or socially supportive of homosexuality. The mental health system, like society in general, viewed homosexual individuals and homosexuality as undesirable and in need of treatment to overcome sickness and abnormality. It follows that when homophobia is institutionalized, large systems that comprise society are encoded with ideologies that subjugate, oppress, and often punish homosexuals and, at times, their allies and advocates. Again, the removal of homosexuality from the DSM is often noted as the deinstitutionalization of homophobia from the field of mental health. That does not mean that the institution of mental health is free of homophobia. Instead, it means that an explicit and radical effort was undertaken that reconfigured the way that the institution of mental health privileged one group of people (heterosexual) while discriminating against another group of people (nonheterosexual).

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Other examples of social and cultural institutions that are regularly critiqued for forwarding homophobic ideologies include religion, government, and education. Because many of our contemporary laws, ethics, and morals are shaped by religious teachings, religion is regularly criticized for institutionalized homophobia. For example, most gay men and lesbians who live in a culture dominated by Christianity are familiar with Leviticus 18:22, “Thou shalt not lie with mankind, as with womankind: it is abomination.” The wording is a bit different depending on which version of the Old Testament it comes from, but the prominent interpretation of this line remains the same in mainstream Christianity and Judaism alike— homosexuality is bad. Thus, a rule from a powerful sociocultural institution can influence not just individual attitudes and beliefs, but whole systems of laws and governance. This is not to say that all religions are homophobic or that all religious people are homophobes. This biblical passage represents an example of homophobic ideology institutionalized in a way that makes it difficult to enact change. It also works to illustrate the way that institutionalized homophobia reaches from one institution to others. Both legal and educational policies have been affected by this instance of what many characterize as institutionalized homophobia. Indeed, homosexuality is often symbolically erased (i.e., not mentioned at all, omitting it from reality) from textbooks in primary and secondary education, and laws may limit the rights of homosexuals so that they are rendered unequal to heterosexuals—both actions serve as examples of institutionalized homophobia. Those who critique religion as a site of institutionalized homophobia may point out that it privileges some relational configurations (heterosexual) at the cost of discriminating against others (homosexual). For instance, religion has slowed the process of realizing marriage equality in the United States.

Social Homophobia While institutionalized homophobia is anti-homosexual ideologies encoded into the social and cultural institutions of society, social homophobia can

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be considered the public or interactional manifestation of institutionalized homophobia. It is the “doing” of homophobia—the action of reifying homophobia. It can be a direct or indirect speech act of name-calling to ostracize or humiliate someone for being nonheterosexual or not heterosexual enough. Social homophobia may also be expressed through avoidance, exclusion, and isolation. If individuals feel targeted, they may feel compelled to affirm their heterosexuality. Whether someone being targeted is nonheterosexual or heterosexual, the message of homophobia is clear: It is bad to be homosexual. Some masculinities scholars have argued that homophobia is the cornerstone to being a real, masculine man. Social homophobia has the potential to incite fear of being perceived as nonheterosexual. Individuals (whether nonheterosexual or heterosexual) who are unable to negotiate social homophobia may face depression and anxiety. Some homosexuals internalize homophobia; this is referred to as internalized homophobia, and it has been linked to a wide range of negative intrapersonal outcomes, including depression and anxiety.

Homophobia, Sexual Stigma, Heterosexism, and Sexual Prejudice Although the term homophobia has played an integral role in much social and cultural change, recent scholarship has identified limitations and questioned its continued use for three reasons. First, the nature of homophobia is not consistent with other phobias. Phobia sufferers generally understand that their fears are irrational, yet they still have a physiological response (e.g., sweat, shivering). Whereas phobias are typified by anxiety, empirical researchers argue that negative emotional reactions to homosexuals and homosexuality tend to be that of anger and disgust, which is in line with similar findings on negative emotional reactions associated with race. It follows that hostility, violence, and brutality toward homosexuals and homosexuality are more consistent with anger than fear. Second, homophobia is an unproductive framework for social change because it tends to conceptually limit anti-homosexual attitudes or

actions to the homophobic individual—it does not encompass the culture and society. Further, homophobia has been extended to describe more phenomena (e.g., institutionalized homophobia, social homophobia, internalized homophobia). Scholars argue that broadening the use of the term is an indicator that we, once again, need new language—just as we once needed homophobia. Third and finally, homophobia has been criticized as outdated because it is conceptually built upon a false binary of heterosexual versus homosexual. Fifty years ago, gay liberationists argued that the binary should be destroyed because there was no true heterosexuality—every heterosexual was repressing his or her homosexuality. In this context, homophobia made sense as one rejecting one’s own homoerotic desires. However, we have moved beyond many of the limitations that rendered the binary sensible, so homophobia no longer works because we know that sexuality is much more complicated than the labels heterosexual or homosexual suggest. To continue understanding the anger, hostility, discrimination, and oppression faced by nonheterosexuals, scholars have taken up three interrelated areas of research: sexual stigma, heterosexism, and sexual prejudice. First, sexual stigma refers to shared knowledge concerning sexuality within a culture or society. No matter what individuals of a culture may personally believe, they are aware of what constitutes good and bad sexually in their culture. Sexual stigmas have permanence. It is through people that sexual stigmas have meaning, and that meaning is widely understood as negative. Individuals with sexual stigmas understand themselves through stigma because it permeates their identity, and what differentiates them from people who are not sexually stigmatized are power and resources. There are exceptions, as sexual stigmas are in constant negotiation. In some ways, sexual stigma expands the space of institutionalized homophobia. Second, heterosexism provides the information and rules that keep sexual stigmas negatively positioned. For instance, the roles and rules of gender performances and expectations are bound in heterosexism. In upholding the rules and expectations that support sexual stigmas, the

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hierarchy is maintained, and power remains with those who are not stigmatized. The way that individuals enact heterosexism is through their sexual prejudices. Third, sexual prejudice refers to persistent negative attitudes that individuals have on the basis of sexual orientation. Although sexual prejudice may occur regarding any sexual orientation, including heterosexual, it is usually directed toward nonheterosexual individuals. Sexual prejudices are attitudes that occur along binaries of good/bad, right/wrong, and they are associated with people as they are grouped. For example, men having sex with men is bad because, categorically, being nonheterosexual is bad. The influential construct of homophobia, which involves thinking about anti-homosexual attitudes and behaviors as individual accomplishments, is limited. Thinking about sexual stigma, heterosexism, and sexual prejudices reveals a more complex framework that allows us to better interrogate hostility based on sexual orientation. Each of these concepts allows for new ways to examine antihomosexual attitudes and behaviors from various locations—from the individual’s actions to the cultural taken-for-granted beliefs. Derek M. Bolen and Dianah McGreehan See also Affirmative Therapy; Biphobia; Bullying, Rates and Effects of; Criminal Legal System and LGBTQ People; Discrimination Against LGBTQ People, Cost of; Employment Non-Discrimination Act (ENDA); Essentialist–Constructionist Debate on the Origins of Sexual Orientation; Heteronormativity; Internalized Homophobia; It Gets Better; Nondiscrimination Protections, State and Local

Further Readings Adam, B. D. (1998). Theorizing homophobia. Sexualities, 1(4), 387–404. Fone, B. (2001). Homophobia: A history. New York, NY: Picador. Haaga, D. A. F. (1991). “Homophobia”? Journal of Social Behavior and Personality, 6(1), 171–174. Herek, G. M. (2004). Beyond “homophobia”: Thinking about sexual prejudice and stigma in the twenty-first century. Sexuality Research & Social Policy, 1(2), 6–24.

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Herek, G. M. (2007). Confronting sexual stigma and prejudice: Theory and practice. Journal of Social Issues, 63(4), 905–925. McCormack, M. (2013). The declining significance of homophobia: How teenage boys are redefining masculinity and heterosexuality. New York, NY: Oxford University Press. Smith, K. T. (1971). Homophobia: A tentative personality profile. Psychological Reports, 29(3), 1091–1094. Weinberg, G. (1972). Society and the healthy homosexual. New York, NY: St. Martin’s Press. Young-Bruehl, E. (1998). The anatomy of prejudices. Cambridge, MA: Harvard University Press.

HOMOPHOBIC LANGUAGE IN THE PEER GROUP This entry focuses on the use of homophobic language among adolescents, with attention to its expression within peer groups and within schools. First, the entry provides an overview of the prevalence of homophobic language use, factors contributing to and explaining this behavior, and how it is connected to other serious behavioral concerns. Next, the entry considers homophobic language use within a broader social context, particularly as it is expressed among peers and within friendship groups. Topics discussed include how peers influence and shape this behavior, how group norms contribute to such socialization processes, and how homophobic language use affects individuals and their interpersonal relationships. Finally, the entry notes the implications of this knowledge for continued research and interventions.

Prevalence and Correlates of Homophobic Language Use Homophobic language can comprise negative, disparaging words or phrases connected to the sexual-minority population (e.g., lesbian, gay, bisexual, queer, or questioning; LGBQQ). This language often is directed toward specific individuals (e.g., calling someone a fag or dyke), or it can be used in a more general manner, though with the same

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underlying intent to express a critical or derogatory judgment (e.g., “that [shirt, activity] is so gay”). Over the past two decades, there have been a number of surveys from researchers and organizations attempting to track the prevalence of homophobic language use and harassment. Whether based on national or local data sources across the United States, an overwhelming majority of sexual-minority youth report hearing or being the direct target of homophobic language, with little evidence of decline during this period. Many heterosexual youth also report being the target of homophobic epithets and harassment, though to a lesser extent than sexual-minority youth. In combination, these findings continue to underscore the widespread nature of this behavior in schools. Use of homophobic language is strongly connected to students’ engagement in various forms of bullying. Students who report more frequent use of homophobic language also engage in more frequent physical (e.g., pushing, hitting, threatening) and relational (e.g., spreading rumors, excluding others) aggression against other peers at school. This association holds for both male and female students, although the connection is stronger for males. Homophobic language often is used as part of bullying to intensify the severity of the aggressive act. Adolescents report that homophobic language is considered especially profane, and they consider bullying that is homophobic in nature to be particularly disturbing. Indeed, emerging studies have shown that students who experience bias-based harassment (e.g., homophobic bullying) report even worse mental and physical health outcomes and poorer academic outcomes than students who experience harassment that is not based in bias (e.g., harassment that students do not perceive to be based on a particular social identity such as ability, gender, race, or sexual orientation). Homophobic language can intensify bullying because it symbolically places the targeted student into a group that is highly stigmatized and marginalized in society, and in the case of sexual-minority youth, it denigrates the entire group of which they are a member. Homophobic language is also used among peers for other interconnected reasons. Students may use

this language to express their negative attitudes toward sexual minorities, to enforce gender-normative behavior, to prove or emphasize their heterosexuality, or to establish and enforce dominance hierarchies among peers. Although some adolescents who use this language at times minimize its seriousness (whereas others emphasize its heightened severity), studies do show that students who report stronger negative attitudes toward sexual minorities also report greater use of this language. Similarly, although some adolescents describe this language as innocuous and harmless banter among friends, findings nevertheless show that this banter is more likely to occur within friendship groups whose members express stronger prejudiced attitudes against sexual minorities and that members of these groups actually report poorer relationship dynamics. Students also use homophobic language to enforce traditional masculine or feminine behavior norms among their peers. Whether an individual identifies as LGBQQ or heterosexual, the person may still be the target of homophobic epithets if he or she behaves in ways that violate rigid expectations for gendered behavior norms. Consequently, many heterosexual male youth report feeling pressured to prove or emphasize their masculinity to peers. Most research has focused on this dynamic among males, given that traditional masculine ideology tends to include a homophobic component that denigrates gay or bisexual men. Still, this same experience is reported by female adolescents, and this should be considered more closely in research. Building on the issue that students feel pressured to prove their masculinity or femininity to peers, students also feel pressured to prove their heterosexuality and to avoid being perceived as a sexual minority for fear of peer stigmatization or rejection. In fact, students who consider their heterosexual identity to be more salient and central to their overall self-identity report more frequent use of homophobic language. In this case, students may use homophobic language as a deliberate means to distance themselves from sexual minorities and to avoid the potential of being perceived or misclassified as a sexual minority. Some heterosexual adolescents may feel especially pressured to

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prove their heterosexuality, given that adolescence is a period during which sexuality and sexual identity become increasingly salient. Finally, students use homophobic language in part to establish and maintain dominance hierarchies over other peers. Again, because sexual minorities are a stigmatized group in society, directing homophobic language toward another student symbolically places that peer in a subordinate position. As such, some students may rely on homophobic language as an antagonistic means to establish a higher position over their peers, and they may continue to use this language to maintain their dominant position over time.

Homophobic Language in a Larger Social Context It is important to consider how homophobic language is expressed within a broader social context. Homophobic language and behavior often are highly visible and widely observed among peers. Particularly when it is tied to aggressive behavior, homophobic language use often occurs as part of a larger group process that involves multiple individuals. Indeed, the general bullying literature has recognized that students are involved in various roles beyond the immediate “bully” or “victim” that include students who reinforce and assist the primary instigator, those who support the student being victimized, and other bystanders who observe this behavior or who are largely uninvolved. Notably, students who reinforce and assist primary instigators of bullying also report frequently using homophobic language. These findings have underscored the need to look at homophobic language use through a broader social lens that acknowledges the role of peer groups and the broader school culture in perpetuating this behavior. Peers become increasingly relevant and influential during adolescence, and peer groups become a central socializing context at this time. Adolescents look to peers as a primary source for support and affirmation, and peer groups provide a context for socializing, learning, and individual development. Through their repeated interactions, peers influence one another across a range of attitudes and

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behaviors. Studies now show that peers influence one another’s use of homophobic language. Studies examining the social networks of adolescents find that peer groups are distinct from one another in the frequency with which homophobic language is expressed among group members. Friends engage in homophobic language use at similar rates. Further, individuals within the same friendship group become more similar to one another in their homophobic language use over time. Students in peer groups using this language may receive a degree of validation and encouragement from their peers for using this language. The desire to receive validation, attention, and status may lead some youth in these groups who initially use this language less than other members to increase their use. Some peer group norms also relate to students’ use of homophobic language. Essentially, individuals’ engagement in this behavior is not simply a reflection of their own attributes or characteristics (e.g., individuals’ own beliefs toward sexual minorities or their own engagement in bullying); rather, the beliefs and behaviors of individuals’ peers also contribute to their use of homophobic language. Homophobic language use is especially heightened among aggressive students who are friends with highly aggressive peers. Similarly, students who are members of peer groups whose members espouse strong traditional masculinity norms are particularly likely to direct homophobic language toward other students. In addition, being called a homophobic epithet is a much stronger predictor of a student also directing homophobic epithets toward others when that student is a member of a more homophobic peer group. Many studies have shown the serious negative effects of homophobic harassment on youth toward whom this behavior is directed. In contrast, there has been less attention to how homophobic language or behavior affects those who use or engage in it. Emerging findings indicate that peer interactions in friendship groups characterized by high levels of sexual prejudice (i.e., groups whose members espoused negative attitudes toward sexual minorities) are more negative than in friendship groups characterized by low

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levels of prejudice. Moreover, these negative interactions increase over time within these groups. Given the significant association between sexual prejudice and homophobic language use, the heightened use of homophobic language and banter within these groups may account for the distinctly negative interactions that occur within them. Along these lines, because homophobic language use is associated with dominance and hierarchy promotion, and because youth in these groups may feel especially pressured to prove their heterosexuality to peers holding negative views of sexual minorities, these dynamics could prompt increasingly negative interactions. These negative effects are important to acknowledge because they highlight complexity and apparent tension in the intents and outcomes of this behavior. In essence, although students may use homophobic language and banter to serve a self-promotional function (in the case of establishing hierarchy and dominance over peers) or to emphasize shared in-group identities and beliefs among peers (e.g., in the case of expressing shared prejudiced beliefs or common heterosexual identities), these behaviors also carry negative implications for the students who engage in them. Thus, these students may experience positive interactions and some connection with their peers that is also accompanied by heightened and increasingly negative interactions. Beyond adolescents’ primary or immediate peer group, it is important to consider the overall network of youth within the broader school ecology and how homophobic language affects youth throughout this network. At this more expansive level, hearing or being the target of homophobic language contributes heavily to negative and hostile school climates. Thus, even though some students who use this language consider it to be nonoffensive in its intent, its use has decidedly negative effects for the youth around them. Even students who are not direct targets of this language or harassing behavior may feel unsafe because they may fear being targeted in the future or may experience secondary trauma from prior victimization experiences. Further, this language and behavior often go uncorrected and unchallenged by other students and adults in schools. As

such, students may perceive that this behavior is passively condoned and acceptable, and that sexual minorities are not welcomed or respected in the school. Building on this issue, attention to bystanders has received growing attention in the general bullying literature, but this attention has been notably absent in extant research on homophobic language use and harassment. Much greater attention is needed to understand what factors prompt other students and adults in schools to be active, rather than passive, bystanders and to intervene specifically during instances of homophobic language use.

Ongoing Research and Intervention to Address Homophobic Behavior As research continues to document the continued prevalence and seriousness of homophobic language use and harassment within schools, ongoing study is vital to aid in the development of more effective interventions to reduce and prevent this behavior. Continuing to identify the range of factors underlying youth’s engagement in this behavior will highlight areas that intervention efforts need to address and challenge. For example, prevention and intervention programs could work with children and adolescents to identify prosocial ways to serve in leadership roles that do not rely on attaining them through antagonistic means such as homophobic language use or bullying. Similarly, the fact that homophobic language use and behavior are socialized by peers underscores the need for interventions to address the groupbased nature of this behavior as opposed to individual-based interventions. Interventions that focus singularly on correcting an individual’s homophobic behavior will likely be ineffective because that individual most likely will be resocialized by his or her peer group to reengage in this behavior. Future research should identify the specific norms and ways in which peers socialize this behavior to help develop interventions to address and counter these specific processes. Finally, emerging research has showcased the value of school and district anti-bullying and anti-discrimination policies that enumerate and extend explicit protection

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to sexual-minority youth in addressing issues of school safety and attenuating health and academic disparities faced by this population. Continued research should identify how these policies and other programs effectively reduce homophobic language use and promote respect for diverse populations. These ongoing efforts have high potential for promoting the health and academic success of both sexual-minority and heterosexual youth. V. Paul Poteat See also Bullying, Rates and Effects of; Gay, Lesbian & Straight Education Network (GLSEN); Gay–Straight Alliances (GSAs); Homophobia; Masculinities; Minority Stress; School Climate; Transphobia; Violence and Victimization of Youth

Further Readings Bigler, R. S., & Liben, L. S. (2006). A developmental intergroup theory of social stereotypes and prejudice. In R. V. Kail (Ed.), Advances in child development and behavior (Vol. 34, pp. 39–89). San Diego, CA: Elsevier. Horn, S. S., Szalacha, L. A., & Drill, K. (2008). Schooling, sexuality, and rights: An investigation of heterosexual students’ social cognition regarding sexual orientation and the rights of gay and lesbian peers in school. Journal of Social Issues, 64, 791–813. Pascoe, C. J. (2007). Dude, you’re a fag: Masculinity and sexuality in high school. Los Angeles: University of California Press. Poteat, V. P. (2007). Peer group socialization of homophobic attitudes and behavior during adolescence. Child Development, 78, 1830–1842. Poteat, V. P., DiGiovanni, C. D., & Scheer, J. R. (2013). Predicting homophobic behavior among heterosexual youth: Domain general and sexual orientation–specific factors at the individual and contextual level. Journal of Youth and Adolescence, 42, 351–362. Rivers, I. (2011). Homophobic bullying: Research and theoretical perspectives. New York, NY: Oxford University Press. Russell, S. T., Kosciw, J., Horn, S., & Saewyc, E. (2010). Safe schools policy for LGBTQ students. Society for Research in Child Development Social Policy Report, 24(4), 3–17.

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Swearer, S. M., Turner, R. K., Givens, J. E., & Pollack, W. S. (2008). “You’re so gay!” Do different forms of bullying matter for adolescent males? School Psychology Review, 37, 160–173.

HOMOSEXUALITY, FEMALE This entry begins with a brief historical review of scientific perspectives on female versus male sexual orientation, and then reviews what is currently known about the ways in which female same-sex sexuality differs from male same-sex sexuality, particularly regarding its development, its nonexclusivity, and its capacity for fluidity. Sexual orientation has historically been conceptualized as a trait-like predisposition to experience sexual attractions for one sex or the other. This predisposition is generally thought to have a biological basis, to operate in a stable fashion, and to channel all markers of erotic interest (sexual attractions, fantasies, behaviors, and romantic affection) in the same direction over the life course. Numerous studies have supported this overall model by documenting a consistent set of early developing behavioral and cognitive markers among individuals with same-sex orientations, such as childhood “feelings of differentness,” gender atypicality, and same-sex attractions and fantasies. Much of the foundational research in support of this model was conducted with predominantly or exclusively male samples, and female and male sexual orientation were generally presumed to be parallel phenomena. In fact, during the first wave of rigorous psychological research on sexual orientation in the 1970s and 1980s, it was common for researchers to discuss “gay men and lesbians” as if they were a single, coherent group, differentiated only by biological sex. The traditional model of sexual orientation that initially emerged from research on men was rigidly categorical, yielding two fundamental types of people: homosexuals and heterosexuals. Yet this model of sexual orientation has proven less successful in describing women’s experiences of same-sex sexuality than

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men’s experiences, and over the years researchers have increasingly documented pervasive differences in the development, expression, and phenomenology of same-sex sexuality in men and women. These differences are reviewed in the sections that follow.

Developmental Trajectories A considerable body of research has focused on developing stage-sequential psychological models of the “coming out” process, through which individuals first become aware of their same-sex attractions; first explore same-sex contact; and eventually adopt a gay, lesbian, or bisexual identity. Most of these models mark the onset of sexual identity development as the individual’s first awareness of same-sex attractions, presumed to occur in late childhood or early adolescence (although sometimes preceded by childhood “feelings of differentness” or gender-atypical behaviors). The next stage involves a period of testing and exploration, during which youths seek information about gay, lesbian, and bisexual individuals and communities and may begin experimenting with same-sex sexual contact. Succeeding stages of identity development entail adopting a sexualminority label, disclosing this sexual identity to others, becoming involved in a same-sex romantic relationship, and celebrating one’s sexual identity within a larger social context (e.g., the political arena). Such models have been strongly criticized over the years for their overly prescriptive nature, their rigid (and often untested) assumptions regarding “healthy” development, their insensitivity to sources of sociocultural variation, and their inapplicability to bisexuals (reflecting the fact that bisexually identified individuals were generally excluded from the research samples on which the models were generally developed and validated). Perhaps more importantly, the very notion of “prototypical” pathways of sexual identity development has become increasingly suspect, as researchers have collected increasingly rigorous data—from increasingly diverse samples—on variation in developmental trajectories. For example,

although it was once thought that all sexual minorities experienced the emergence of their same-sex attractions prior to adolescence, we now know that this is not always the case. Rather, sexual minorities show a wide range of developmental histories, with different ages and contexts for the classic “milestones” of first same-sex attractions, first conscious sexual questioning, first same-sex contact, and first self-identification. Some of the largest and most notable deviations from conventional coming-out models have been documented among women. The most consistent gender differences involve later ages of first awareness, same-sex contact, or identification. Yet, because the magnitude of gender differences in identity milestones varies from study to study, and subgroups of women exhibit patterns that resemble that of their male counterparts in some studies, it is more accurate to conclude that women show greater variability in the timing of sexual identity development than to conclude that they uniformly develop “later.” In addition to variability in timing, women show greater variability in the sequencing of different stages, the length of time between successive stages, and the overall duration of the process, with some women pausing and then revisiting identity questioning multiple times, rather than moving inexorably toward the adoption of a lesbian or bisexual label. Perhaps most striking, however, are the many cases of women who report no adolescent awareness of same-sex attractions at all, and instead begin experiencing these attractions in mid- to late adulthood. Historically, such long delays in awareness were attributed to repression and latency. Yet over the years, studies probing the antecedents and phenomenology of such late-life transitions have suggested that the dormancy model is not always accurate. In some cases, the context for unexpected emergence of same-sex attraction is an intimate emotional relationship with a specific woman, and this has been documented among younger women as well. This is consistent with other research showing that women place greater emphasis than do men on romantic and affectionate feelings in their overall sexual-questioning process, whereas men typically emphasize explicit same-sex arousal

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or attraction. Some women report experiencing emotional attractions to women before ever experiencing physical attractions for women, or describe their sexual feelings as developing out of a singular emotional attachment. Other women emphasize ideological factors and social reference groups as triggering or supporting their identity questioning. In summary, the notion that same-sex sexual orientations express themselves uniformly early in development, in the form of clear-cut same-sex desires, is inaccurate. Although there is variability in both men and women regarding the developmental unfolding of same-sex sexuality, this variability appears to be particularly large among women.

Nonexclusive Sexual Attractions It has long been presumed that sexual orientation has only two forms: exclusive homosexuality and exclusive heterosexuality. Reflecting this view, researchers studying the nature of sexual orientation have historically excluded individuals claiming nonexclusive patterns of attraction, sometimes for the sake of methodological clarity and sometimes because such individuals were simply not considered to be the “prototypical types” of homosexuals. Yet numerous surveys using large, random, representative samples have shown that the opposite is true when it comes to women: The prototypical type of woman with same-sex attractions also experiences other-sex attractions. Largescale representative studies estimate that approximately 5% of men and 12% of women report experiencing both same-sex and other-sex attractions, whereas about 1.5% of men and less than 1% of women report experiencing exclusive same-sex attractions. Hence, directly contrary to the conventional wisdom that lesbians represent the prototypical “types” of sexual minorities and bisexuals are unusual exceptions, the data clearly show that bisexuals are the prototypical type of sexual-minority women, and lesbians represent the exceptions. In every large-scale representative study, the single largest group of women with same-sex attractions reports predominant other-sex attractions (i.e., “mostly but not completely heterosexual”).

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Historically, such individuals have been treated with skepticism by scientists studying sexual orientation, and have often been deleted from research samples on the basis of suspicion that they might not be “authentically” gay. Yet recent research suggests that, although “mostly heterosexual” women show diverse patterns of current and prior attractions and behavior, they nonetheless appear to represent a distinct subtype of nonheterosexual women, with erotic profiles falling midway between bisexuality and exclusive heterosexuality. Without knowing exactly why their sexual profiles develop in this fashion, there is no scientific basis to consider that they are “less authentically gay” than exclusively lesbian women, or to exclude them from research on female sexual orientation. Rather, a growing body of psychophysiological research on female sexual arousal suggests the critical importance of including such women in studies of same-sex and other-sex sexual arousal, as we review below.

Patterns of Sexual Arousal Historically, research on sexual orientation has relied on self-report questionnaire data, which of course has known limitations when it comes to stigmatized topics such as same-sex desire. Perhaps, for example, the appearance of greater numbers of bisexual women than men is due to the fact that men perceive greater stigma attached to bisexuality than do women, and are therefore less likely to report bisexual attractions. The only way to rule out this possibility is to use measures of sexual attraction that do not rely on self-reports. Studies that have adopted this strategy have provided robust evidence that women’s capacity for nonexclusive patterns of attraction is also manifested in nonexclusive patterns of genital arousal. These studies involve continuous measurement of blood flow to the genitals (a well-validated marker of sexual arousal) while participants view erotic film clips of women having sex with women, men having sex with men, and men having sex with women. As one might expect, gay men show the greatest physiological and subjective arousal to male–male sexual contact, whereas heterosexual

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men show the greatest physiological and subjective arousal to female–female sexual contact. Lesbian and heterosexual women, however, show roughly equivalent genital responses to the male–male and the female–female videos, and they also show less correspondence than do men between their genital and subjective responses altogether. Studies using other psychophysiological measures of sexual arousal, such as electroencephalograms, functional magnetic resonance imaging, and viewing time have yielded parallel findings of gender specificity in the sexual arousal of men but not women. Of course, genital or neurobiological measures do not necessarily provide “truer” measures of sexual orientation than do individuals’ own subjective reports, but such findings dovetail with the evidence reviewed above regarding women’s greater capacity for attractions to both sexes.

Change Over Time Historically, researchers have presumed that sexual orientation shows fundamental continuity in its expression over time, but studies have consistently found that a sizeable minority of individuals— more often women than men—report notable shifts in same-sex attractions, behaviors, and identities over time (although changes in identity and behavior tend to be larger and more common than changes in attraction). These findings concur with the evidence for shifts in same-sex and other-sex sexuality among individuals in other cultures, suggesting that some degree of flexibility in sexual desire and behavior may simply represent a general property of human nature. Yet, because studies consistently find larger and more frequent changes in sexuality among women than among men, researchers have argued that women’s sexuality may be intrinsically more “plastic” or “fluid” than men’s, meaning that women’s desires are particularly sensitive to situational or interpersonal factors, making it possible for a woman to develop sexual desires and to enjoy sexual behavior that run counter to her overall orientation. In essence, sexual fluidity suggests that a woman’s orientation provides less of a constraint on her lifetime pattern of desire and behavior than is the case for men.

Female sexual fluidity provides a possible explanation for the fact that women are more likely than men to report that choice, circumstance, and chance have played some role in their sexual orientation and identity. In addition, women have frequently been observed to pursue sexual behavior that would appear to contradict their overall pattern of attraction and identity—that is, women with predominantly heterosexual attractions pursuing sex with women, and women with nearly exclusive same-sex attractions engaging in sex with men. In many such cases, the impetus for these “atypical” encounters is an intense emotional bond, and in fact numerous sexual-minority women have reported that their feelings for women are predominantly emotional, or that their sexual desires are triggered or enhanced by feelings of emotional connection. Other women report that their desires are not so much directed toward women at all, but rather to “the person and not their gender.” The degree to which fluidity is a particularly distinctive feature of female sexuality remains a topic of active debate. After all, the appearance of a distinctively female capacity for fluidity might simply be an artifact of female sexual socialization. For example, the pervasive social and cultural forces that have long controlled and suppressed female sexuality may have left women with blunted awareness of their own sexual feelings and identities, and few opportunities to express and experiment with these feelings. These factors complicate the task of understanding and modeling female sexual orientation, and they must be taken into account as we embark on the next generation of research on these questions.

Toward New Models of Female Sexual Orientation In light of the unique dynamics of female same-sex sexuality reviewed above, how might researchers begin the task of building new models of female sexual orientation? Some have provocatively suggested that women may not even have sexual orientations (to the degree that one defines sexual orientation as a gender-specific pattern of sexual arousal). Yet this notion is not consistent with the

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fact that there is extensive variation among women regarding their specific degree of nonexclusivity or nonspecificity, and some women appear to show tightly “oriented” patterns of exclusive same-sex attraction. Rather, an alternative approach is to imagine that female sexual orientation is composed of two orthogonal dimensions: One represents the degree of “genderedness” of a woman’s desires (i.e., the degree to which a woman’s desires are targeted to one gender over the other), and the other represents the direction of this targeting (same-sex versus other-sex). One of the ways in which this revised model deviates from conventional conceptualizations of sexual orientation is that it no longer takes for granted that sexual desire is always “about” gender. Perhaps, instead, some women’s sexuality might be fundamentally “gender neutral,” in which case a host of other factors (emotional intimacy, sex drive, mood, personality similarity) might determine the partners she finds most arousing. Some women’s same-sex sexuality appears to be strongly influenced by the quality of a single intimate relationship, rather than a uniform, generalized preference for women versus men. Such findings raise the inevitable question of why some women experience their nonexclusive attractions as fundamentally gender-neutral, whereas others do not. In fact, researchers know remarkably little about the gradual “gendering” of children’s erotic impulses more generally. Although this process appears to occur sometime during adolescence, its underlying mechanisms are unknown. Hence, the early factors that might steer some nonheterosexual women toward exclusive lesbianism, others toward bisexuality, and others toward “mostly” heterosexuality remain a topic of active study. An additional complication is that arousal and desire (and for that matter, pleasure and attraction) are not equivalent constructs, despite the fact that they are often used interchangeably in discussions of sexual orientation. This means that when determining the differences between “mostly” heterosexual, bisexual, and lesbian women, we must first decide which aspect of sexual orientation to focus on (sexual desire, sexual arousal, physical attraction, emotional attraction, romantic affection,

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etc.). At the present time, we have little or no basis on which to make this judgment, especially given that there is little research specifying exactly how sexual arousal and subjective desire relate to each other, and how each of them relates to other fundamental components of sexuality, including behavior, fantasy, attraction, and romantic affection. In conclusion, scientists now have an increasingly reliable body of data charting the diverse manifestations and long-term developmental trajectories of same-sex sexuality, in our own culture as well as others, and these data consistently show that female and male sexual orientation appear to represent distinct phenomena. Women’s greater propensity for nonexclusive, fluid patterns of attraction suggests the possibility that the underlying determinants of female same-sex sexuality may be starkly different from those for men, requiring different explanatory models, and the development of such models is a critical next step for research on human sexuality more generally. Lisa Diamond See also Bisexuality, Female; Sexual Attraction, Behavior, and Identity; Sexual Fluidity

Further Readings Bailey, J. M. (2009). What is sexual orientation and do women have one? In D. A. Hope (Ed.), Nebraska Symposium on Motivation: Contemporary perspectives on lesbian, gay, and bisexual identities (Vol. 54, pp. 43–63). Lincoln: University of Nebraska Press. Baumeister, R. F. (2000). Gender differences in erotic plasticity: The female sex drive as socially flexible and responsive. Psychological Bulletin, 126, 247–374. Chandra, A., Mosher, W. D., Copen, C., & Sionean, C. (2011, March 3). Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth. National Health Statistics Reports, 1–36. Chivers, M. L., Seto, M. C., & Blanchard, R. (2007). Gender and sexual orientation differences in sexual response to sexual activities versus gender of actors in sexual films. Journal of Personality and Social Psychology, 93, 1108–1121.

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Diamond, L. M. (1998). Development of sexual orientation among adolescent and young adult women. Developmental Psychology, 34, 1085–1095. Diamond, L. M. (2003). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 173–192.

HOMOSEXUALITY, MALE Male homosexuality has been used as a label to describe a wide array of erotic relations, sexual identities, emotional intimacy, and forms of desire between men. Evidence of male homosexuality has been found in earlier civilizations from around the world, including China, Japan, Europe, South America, and Asia. Research on the etiology (i.e., origins) of male homosexuality has revealed there is no consensus about what causes it, with numerous studies examining the influence of different social, psychological, and biological factors. Historical research highlights the differences in how male homosexuality has been experienced and understood within particular cultures at specific moments in time. That being said, male homosexuality is often deployed narrowly as a term for describing sexual relations between men, which fails to account for the cultural and historical variation in how male homosexuality has been and is currently understood and experienced. This entry outlines some of the principal theories of male homosexuality before discussing examples of how male homosexuality and the figure of the male homosexual have been expressed and treated in earlier civilizations. The entry concludes by noting how histories of male homosexuality are characterized by cultural opposition and resistance to bodies of knowledge that understand male homosexuality as a sin, an abnormality, and a disease.

Theories of Male Homosexuality Theorizing the causes of male homosexuality has attracted much controversy among researchers

who differ on whether male homosexuality and the figure of the male homosexual in Western societies can be explained by psychological, biological, environmental, and social factors. In the sections that follow, some of the most influential theories derived from psychology, biology, and sociology are considered. Psychological Theories

Psychologists have provided some of the most influential explanations for male homosexuality prior to and throughout the 20th century. Early psychological theories have, like biological theories, often emphasized male homosexuality as innate. Such approaches, which are sometimes described as “essentialist,” treat the idea of male homosexuality as a relatively fixed and immutable property of the individual. They also play down, or dismiss altogether, the influence of environmental and social factors in male homosexuality. Sigmund Freud was one of the first to theorize homosexuality in psychological terms. He famously reasoned that homosexual men could be accounted for by how they can become “inverted” or “stuck” in or “regress” to specific stages of psychosexual development throughout childhood—namely, stages that involve the direction of sexual desires toward women at puberty. Freud was notable for his psychoanalytical account of homosexuality, as he was for suggesting that (male) homosexuality was nothing to be ashamed of, explaining it as a result of arrested psychosexual development. Freud did not regard homosexuality as a vice, disease or illness, or as a form of pathology— although these became the dominant frames for understanding homosexuality among later psychologists. Indeed, psychological theories during much of the 20th century tended to pathologize homosexuality as a mental illness, promulgating a view that individuals could not be blamed for their homosexuality. The pathologization of homosexuality within the field of psychology has encouraged many male (and female) homosexuals to seek reparative (or corrective) therapy, the goal of which is to return the individual to a “normal” healthy state of heterosexuality.

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The pathology of homosexuality as a mental illness began to lose academic credibility as a result of influential empirical investigations by psychologists such as Evelyn Hooker in the late 1950s, which failed to return any reliable or concrete evidence to confirm homosexuality as a mental disorder. This wave of research challenged the official classification of homosexuality as a mental disorder and the validity of reparative therapy as an appropriate and ethical treatment, which ushered in a new official consensus within Western psychology that homosexuality is a normal variation of human sexual orientation. This culminated in the American Psychiatric Association’s declassifying homosexuality as a mental disorder in 1973; the American Psychological Association Council of Representatives followed suit in 1975. Today, the American Psychological Association conceptualizes male homosexuality as a natural and healthy variation of human sexuality that cannot and should not be corrected by reparative therapy. Contemporary psychology research exerts a powerful influence on how sexual orientation is understood in general and male homosexuality in particular. For example, psychologists specializing in the psychology of sexualities are committed to developing nonheterosexist and gender-inclusive forms of research, theory, and clinical practice. Some research in this area has problematized essentialist theories of male homosexuality and challenged the stigmatization of male homosexuality, investigating the impact of sexual stigma on the mental health of male homosexuals. Biological Theories

Biological accounts of male homosexuality also endorse an essentialist view that can be traced back as far as ancient Greece. However, it was not until the late 18th and early 19th centuries that the idea of male homosexuality having a biological basis began to gain prominence. One pioneer of this view was Havelock Ellis, a British physician whose research, published in six volumes titled Studies in the Psychology of Sex (1897–1928), suggested that most cases of male homosexuality are innate or “inborn,” and, therefore, not immoral.

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Ellis popularized the view of male homosexuality as a form of sexual inversion, whereby the male homosexual (as a sexual invert) lacked the ability to express “normal” emotional and sexual desires toward the opposite sex. Viewed in this way, male homosexuality is explained as a biological, nonpathological gender anomaly. Contemporary biological perspectives on male homosexuality have come at the topic from a different direction, some of them contending that homosexual men share a “gay gene.” Research seems to be inconclusive on this issue, with social scientists criticizing biological theories for essentializing human sexuality. For proponents of the genetic view, male homosexuality is something that certain men are born with and is not acquired from the social environment. Some neurological research appears to support this claim, by suggesting the brains of gay men are more like those of heterosexual women in terms of structure and function. Scientists interested in the neurological differences between gay men and heterosexual women claim to have found that gay men exhibit more resemblance to heterosexual women on male-typical tests such as those concerning spatial perception and map reading. Nevertheless, many scientists remain confused about the genetic view of male homosexuality, but the increasing number of published studies on the subject have kept afloat the idea that male homosexuality is much more genetically determined than previously believed. Indeed, male homosexuality is regarded by some scientists as another means of contributing to the maintenance of the natural genetic variability of humans. Biological explanations of male and female homosexuality have found favor among some LGBTQ persons who assert that their homosexuality is not a matter of choice but is inborn and, therefore, something over which they have no control. This argument maintains that because male homosexuality may have a biological basis, male homosexuals should be protected from discrimination. However, social scientists have cautioned against using such a view as a platform for advancing LGBTQ equality, not least because some biological theories continue to conceptualize male

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homosexuality as a state of effeminate pathology. As such, scholars of LGBTQ sexualities aver that it is neither possible nor desirable to explain the diverse phenomena behind the term male homosexuality as only the result of DNA or a “gay gene.” Sociological Theories

Sociological accounts of male homosexuality have put forward a view that it is a social construction. In contrast to biological and psychology theories, which articulate an essentialist perspective, sociologists assert that the identities, emotions, desires, and relationships associated with male homosexuality are shaped by society. What this means is that sociological research has focused on the diverse ways in which the organization of, and meanings ascribed to, male homosexuality have been shaped by different norms, values, and beliefs within societies in certain ways at specific moments in time. As such, the terms homosexual and heterosexual are revealed to be relatively new labels for categorizing people sexually. The social construction thesis of homosexuality points out that the term homosexual first appeared in public use in 1869 when German psychologist Károly Maria Benkert used it as a scientific term in a legal argument, to assert that it was a natural and private matter that should be beyond the interference of the law. The idea of the (male) homosexual as a person and a distinct identity gathered momentum from the late 18th century onward, as social constructionists argued that Western cultures are responsible for creating the category of the homosexual (and heterosexual) and ascribing it the cultural disapproval it attracted around that time and still does today. Sociological work on male homosexuality accepts the variability in sexual norms, beliefs, identities, and relationships, placing a great deal of emphasis on the contingency of these variations in how male homosexuality is understood and experienced. As such, sociological theories have served as a counterpoint to pathologizing male homosexuality as a mental “disorder,” which requires the intervention of sex psychologists and psychiatrists.

Sociologist Mary McIntosh is credited as being one of the first to highlight how male homosexuality had become pathologized as a disorder as a result not of scientific fact but of the emergence of a derogatory and widespread European Christian interpretation of same-sex behavior between men. Viewed in this way, male homosexuality is something that society produces in very complex ways. Indeed, sociological theories of male homosexuality tend to embrace the idea that there is no single history of male homosexuality, but rather multiple histories that are intricately linked. This argument has generated a vibrant academic literature on male homosexuality that exposes the multifarious ways in which it has been subject to social control and regulation, but also how male homosexuality has shaped and continues to shape the contemporary landscape of LGBTQ identities, relationships, politics, and activism. Some of these issues are discussed in the following sections.

The Histories of Male Homosexuality McIntosh’s approach has provided, in essence, the basis of most contemporary sociological studies of gay men, lesbians, and same-sex identities and communities. This section discusses the contribution of historical research on homosexuality to identifying how the homosexual emerges as a distinct figure. French philosopher Michel Foucault appears to be credited more than most with examining how power relations have been deployed within Western societies to give rise to specific forms of knowledge about sexuality. In a three-volume study titled The History of Sexuality (1976–1984), Foucault observed how scientific knowledge was used to categorize people as either “homosexual” or “heterosexual,” fueled by a cultural obsession in the West with determining “normal” and “abnormal” sexualities using the dualistic classification heterosexual and homosexual. This argument has provoked debate among social historians about how the existence, nature, and role of male homosexuality was understood and experienced in earlier civilizations.

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Carrying out this type of research sensitively is challenging because historians may be searching for signs of male homosexuality in bygone ages and periods of history where no terms of reference existed for describing these types of relations between men. One risk is that historians can import a contemporary notion of male homosexuality into interpretations of past forms of same-sex intimacies that were not used as a basis for identifying male relationships as “homosexual” or male individuals as “homosexuals.” Some commentators have voiced concerns about how historians have “sexed up” the past by identifying prominent male historical figures as homosexual (e.g., Alexander the Great, Leonardo da Vinci, and Roman emperor Hadrian) and searching for signs of male homosexuality in earlier civilizations based on a Western contemporary understanding of the term that, for example, reduces male homosexuality to a form of sexual intercourse between men. Such endeavors have been criticized for potentially excluding accounts of male homosexuality that may be expressed in other ways. Despite these pitfalls, historians of human sexuality have excavated rich and illuminating evidence on the way male homosexuality has been organized and understood in numerous civilizations separated by wide spans of time. Two examples are provided: ancient Greece and 18th-century England. The ancient Greeks had no word for a male or female homosexual (or heterosexual) person. Some historians have argued that the ancient Greeks believed that individuals were capable of entering into erotic relations with either men or women, as both possess beauty that can provoke erotic responses in a male (or female) onlooker. Homosexuality was prevalent in ancient Greece, particularly within Greek male culture. Although male homosexuality was not stigmatized, how it was organized was of paramount significance. Here, then, the issue was less about the object of desire (i.e., another man), as tends to be the case in contemporary Western societies, and more about how these relations were organized in terms of status. Greek male culture was acutely sensitive to the organization of homosexual relations in terms of which men were active or passive (for example, in

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sexual intercourse between men) given its highly competitive nature and fixation on status distinctions. Idealized sexual relations between men involved an adult lover (between the ages of 20 and 30) and a prepubescent male whose youth ascribed him a low status, the former gaining the latter’s admiration through gift giving and demonstrating exemplary conduct. Sexual relations between men of equal social or political status were frowned upon because a similarity in status was understood as a deprivation of status. So, while the sexual subordination of younger men in ancient Greek culture was culturally acceptable, it was not entirely unproblematic in that men had to engage very carefully with issues of status in order to demonstrate devotion, sacrifice, and honor within these relations. Another example relates to the male homosexual subcultures that developed in the molly houses of 18th-century London. The English molly houses, a name given to the taverns and rooms where men (often dressed as women and taking women’s names) could gather to dance, sing, drink, and meet potential same-sex (sexual) partners, have been understood as a society nestled within a society. In other words, the molly houses have been understood as a concrete manifestation of a gestating male homosexual culture. At this time, uncertainty about what characteristics signaled (un) acceptable male intimacy grew large in the public consciousness. Because the molly houses represented a context in which male homosexuality could be expressed, and therefore recognized as such, they aroused suspicion. Unlike in ancient Greece, the organization and expression of male homosexuality in 18th-century England was subject to severe hostility. The molly houses became targets of organized raids, which led to many of their patrons being prosecuted and some executed, as was the case for three men in 1726. The notorious molly house court trials articulated the cultural anxieties of the time surrounding how to distinguish the bonds between men deemed to be “acceptable” (e.g., platonic forms of male friendship) from those that were to be feared (sexual relations between men). Of note is that writers on this subject have cautioned

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against conflating male homosexuality with practices associated with sodomy. While contemporary definitions of sodomy often refer to acts of sexual copulation between members of the same sex, particularly men, sodomy was understood differently in 18th-century England. Sodomy was not specifically a male or female homosexual crime but rather a capacious concept denoting sexual as well as religious and political crimes and acts of bestiality. All individuals were thought to be susceptible to such vices and, thus, vulnerable to charges of sodomy.

The Emergence of Gay Male Sexualities In concluding this entry, it is imperative to acknowledge research that has exposed numerous homosexual subcultures among men that have resisted moral codes about the nature of homosexuality. As mentioned above, histories of male homosexuality have revealed how individuals have engaged in acts of resistance toward its strict regulation. One important example relates to the adoption of the term gay around the 1970s by the homosexual community as a positive descriptor for referring to male (and female) homosexuality. Today, the term’s most widely held meaning refers to male homosexuality in its coverage of different types of gay sexualities and gay men. Researchers have examined the conditions that have given birth to and the subsequent role played by “gay” male identities and subcultures (e.g., gay skins, radical faeries, bears, clones) within Western societies from the 20th century onward. These subcultures have played a vital role in the development of a vast efflorescence of contemporary gay male identities, sexualities, and relationships that underscore the fluidity in how male homosexuality is currently understood and experienced. Within the social sciences, researchers have addressed wider cultural issues such as what role gay men might play in society. Some commentators point out that gay male sexuality has been understood as a cultural resource that can help heterosexual men, exemplified in Queer Eye for the Straight Guy, a U.S. television show that aired on the Bravo cable television network from 2003 to

2007. The show promulgated the view that gay men are more skilled consumers, are more fashion aware, and understand women better than their heterosexual male counterparts. Marshaled as a resource for heterosexual men who fall short in all these areas, Queer Eye for the Straight Guy brought gay men to the rescue of their heterosexual counterparts in a seemingly innovative depiction of male homosexuality, although critics have argued that the show negatively reinforced the association of gay men with stereotypically feminine activities and qualities. Elsewhere, scholars of adult relationships have seen in gay men the potential for rethinking men’s relationships with other men and women on the basis that gay men have, out of necessity, had to be creative in reforming relationships with other men against a backdrop of homophobia. Gay men might provide perspectives that help heterosexual men (and women) to transcend heteronormative ideals of how human relations ought to be organized, contributing to the ongoing exploration and maintenance of new ways of identifying and relating to others in everyday life as gay. Such analyses bear testimony to the importance of sustaining future avenues of research that aim to undo the grip heteronormativity still holds over how male homosexuality is understood and experienced. Nick Rumens See also Effeminacy; Homosexuality, Female; Hypermasculinity; Masculinity Stereotypes; Men Who Have Sex With Men (MSM)

Further Readings Bech, H. (1997). When men meet: Homosexuality and modernity. Cambridge, England: Polity. Bray, A. (1982). Homosexuality in Renaissance England. London, England: Gay Men’s Press. Foucault, M. (1979). The history of sexuality, volume 1: An introduction. London, England: Allen Lane. Greenberg, D. F. (1988). The construction of homosexuality. Chicago, IL: University of Chicago Press. Halperin, D. M. (2012). How to be gay. Cambridge, MA: Harvard University Press.

Hormones and Surgery During Gender Transition Lewes, K. (2009). Psychoanalysis and male homosexuality: Twentieth-anniversary edition. Lanham, MD: Jason Aronson. Vernon, M. (2000). “What are gay men for?” Theology and Sexuality, 7, 63–76. Weeks, J. (1985). Sexuality and its discontents: Meanings, myths, and modern sexualities. New York, NY: Routledge. Wilson, G., & Rahman, Q. (2005). Born gay: The psychology of sex orientation. London, England: Peter Owen.

HORMONES AND SURGERY DURING GENDER TRANSITION Hormones and surgeries are sometimes used by people who are not content to remain the gender they were assigned at birth (often called trans or nonbinary people) in order to effect a body that is more congruent with their internal sense of self. This entry briefly overviews these interventions and will also consider when it is generally recommended that they be used. People under the broad, umbrella term trans may identify as trans men if they are assigned female at birth and identify as men, or as trans women if they were assigned male at birth and identify as women. People under the broad term trans may also identify as something outside of the gender binary of men or women and so may identify as nonbinary, genderqueer, or one of a number of other terms. Further, those people who do not identify with any gender form may identify as agender, neutrois, or one of a number of other terms. All these groups of people may seek to alter the outward appearance of their body in order to be congruent with their internal gender identity. For example, people may wish to effect the outward appearance of genitalia and secondary sex characteristics (breasts, chest or body hair, etc.) of their identified sex.

Hormones Those people who have a permanent identity as a gender not assigned at birth and are also in a

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position to effect a permanent change in this regard may elect to utilize hormones and/or surgeries in order to change their body to be in line with their identity. Hormonal treatment consists of two main types: 1. Medicines to reduce the production or effect of natal hormones. These either inhibit the action of the gonad to arrest puberty in children, stop the production of endogenous (body-derived) hormones in adults, or reduce the action of natal hormones by preventing them binding to their receptor (antiandrogens). 2. Medicines consisting of various forms of sex steroids—estrogen or testosterone—that are “cross-sex” hormones that replace the endogenous hormones of a trans person with those of their desired sex.

Most often, drugs to stop testosterone, such as gonadotropin-releasing hormone (GnRH) analogues, are used in natal males who have not had their testicles removed, because estrogens alone are usually inadequate to suppress endogenous testosterone—whereas such medicines are usually unnecessary in natal females where exogenous (medicine-derived) testosterone is usually sufficient to suppress endogenous estrogens. GnRH analogues are expensive medicines, and in countries where this cost is an issue, antiandrogens have been used as an alternative. These medicines, however, have more adverse side effects than the GnRH analogues. It is important for trans men and women to have their endogenous hormones suppressed to postsurgical levels prior to surgeries such as removal of the testicles (orchidectomy) or removal of the ovaries (oophorectomy) so that they can experience the postoperative hormonal milieu before permanent removal of the capacity to produce hormones is undertaken. Cross-sex hormones will induce pubertal changes in the person who takes them. For natal males, this will include such things as the development of breasts, softening of the skin, redistribution of body fat to a female contour, finer body hair, loss of erectile function, and loss of fertility. For natal females, changes will include enlargement of the clitoris,

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deepening of the voice, redistribution of body fat to a male contour, male-pattern body hair, baldness in those with a genetic propensity for it, coarser skin, cessation of menses, and loss of fertility. As both natal males and females will lose fertility, gamete storage of sperm or eggs prior to starting cross-sex hormones is an important consideration. Both GnRH analogues and cross-sex hormones may be sourced from the Internet or other retail outlets in countries where this is legal (and indeed, often in countries where it is not), usually by people who wish to forgo the processes associated with engaging with a medical professional for a prescription. This can lead to people taking unwise types and dosages, which can in turn lead to medical complications and may also lead to a poorer outcome in terms of the desired results. As part of a medical or psychological assessment of a social gender role change, it is the usual practice in countries with nationalized health care for the person to have shown psychosocial functioning in their desired gender through proof of having made a formal change to that gender— most usually through a change of identity documentation and having some form of occupation in that gender. The use of hormonal and surgical therapies is usually undertaken in the context of a multidisciplinary team, which may consist of psychologists, endocrinologists, and psychiatrists— and possibly others such as speech therapists, counselors and psychotherapists, primary care physicians with a special interest, specialist nurses, and others.

Surgeries Usually, a period of time longer than 1 year living in the identified gender role and psychological assessment suggesting good psychological functioning in that gender are necessary before genital surgeries may be undertaken (although not all people will wish to have surgeries). Breast surgery, called an augmentation mammoplasty (enlargement for natal males) or bilateral mastectomy and associated chest recontouring (removal for natal females), will often be undertaken after any hormonal manipulation (in order that the best

outcome may be achieved), but often before any genital surgeries. Such surgeries are clustered under a number of names including sex-reassignment surgery (SRS), gender-confirmation surgery (GRS), gender-reconstruction surgery (GRS), and genital-reconstruction surgery (GRS)—with most professionals preferring the latter to refer to genital surgeries as a group, and the specific name of the procedure to refer to each procedure and to each of the chest surgeries. Trans men also sometimes refer to top (chest) and bottom (genital) surgeries. For natal males who wish to have larger breasts, the augmentation mammoplasty is an operative procedure to insert a silicone- or saline-filled breast implant either over or under the pectoral muscle of the trans person such that a larger, female-shaped breast is created. This is usually deferred until breast development is complete, after 18 months to 2 years of hormonal treatment. Augmentation mammoplasty can be required more commonly for natal males, as a fully developed female breast may appear smaller against the proportionally larger and wider natal male chest. The bilateral mastectomy and associated chest recontouring for natal females involves the removal of most of the breast tissue and the surgical creation of the desired (male) chest contour. This can be made more difficult if the person is overweight. If the breasts are small, this can be achieved through an incision around the edge of the areola. If the breasts are large, however, submammary incisions (under the breast) are needed, and repositioning of the nipple may also be required. It can be further complicated if the person has engaged in breast binding to flatten the breast through wearing an elastic undershirt for a protracted period of time, as this causes ptosis (flattening/drooping) of the breast tissue. Genital surgeries consist of the removal of reproductive capacity and possibly the creation of genitalia of the desired gender. For natal males, removal of reproductive capacity will involve removal of the testicles. They may also have the penis removed and the scrotum formed into labia, with the tip of the glans used to create a clitoris and the urethra situated in the usual place for a

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female. This procedure is called a cosmesis or cosmetic vulvoplasty and does not form a vagina. Alternatively, the above may be followed with the skin of the penis, the penis and some of the scrotum, or (very rarely) a piece of sigmoid colon used to create a vagina—a procedure called a vaginoplasty. This vagina must be kept open through regular dilation with a phallus or acyclic dilator for the rest of the person’s life or else contraction of the neovagina will result in a loss of its function. For natal females, removal of reproductive capacity will involve the removal of the ovaries and usually the womb (uterus), too. Removal of the womb can be necessary in those people who have been taking testosterone, as endometrial hyperplasia (thickening of the lining of the uterus) can be an unwanted effect. With regards to the construction of genitals, for those people who wish to have prosthetic testicles, the labia may be fused to create a scrotum, and two standard testicular implants can be added. To create a phallus, some people who have been taking testosterone opt for a metoidioplasty in which the enlarged clitoris is released to sit further forward, often with the additional removal of fat from the mons pubis such that the phallus is yet more prominent. The urethra may be routed through the phallus so that the person may stand to urinate. The phallus is seldom large enough for vaginally or anally penetrative sex and consequently, for those for whom this is important and who have evaluated the increased surgical risk, another option is the phalloplasty. In this procedure, tissue from the forearm, or less commonly the leg or abdomen, is used to create a phallus (the latissimus dorsi muscle may be used also, but this is rare). The phallus thus created must have both blood supply and nerves surgically attached for protective sensation, with erogenous sensation being provided by the clitoris, which is left in place. The urethra is routed through the phallus, allowing the person to stand to urinate, and an implant may be inserted, which allows the penis to become erect. Due to the increased complexity of the phalloplasty, the risks of complications including incontinence and necrosis (tissue death) of the phallus are significantly higher than for the metoidioplasty.

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It should be noted that many trans people opt to have hormones and no surgeries, or neither hormones nor surgeries, and these are entirely acceptable outcomes, as one’s sense of self is not solely determined by one’s body, though having a body congruent with one’s sense of self is important to one’s mental health. Indeed, it appears that for many trans people, there is a biological cause for their gender identity—with the sex of their brain matching their sex of identity rather than that of birth assignation. For this reason, people who have been supported to make well thought out, staged, and real world–tested decisions with regard to hormones and surgeries do far better. Christina Richards and Leighton Seal See also Embodiment; Gender Clinics; Stealth (Transgender Passing); Therapy With Transgender, Transsexual, and Gender-Nonconforming People; Therapy With Transgender Individuals: Mental Health Considerations; Transgender Health Care; Transgender Identities; Transgender People and Binding, Tucking, and Packing; Transgender Youth and Cross-Sex Hormones

Further Readings Barker, M., & Richards, C. (in press). Further genders. In C. Richards & M. Barker (Eds.), The Palgrave handbook of the psychology of sexuality and gender. London, England: Palgrave Macmillan. Gijs, L., & Brewaeys, A. (2007). Surgical treatment of gender dysphoria in adults and adolescents: Recent developments, effectiveness, and challenges. Annual Review of Sex Research, 18, 178–224. Kruijver, F. P. M. (2004). Sex in the brain. Amsterdam: Netherlands Institute of Brain Research. Monstrey, S., Selvaggi, G., Ceulemans, P., Van Landuyt, K., Bowman, C., Blondeel, P., et al. (2008). Chest-wall contouring surgery in female-to-male transsexuals: A new algorithm. Plastic and Reconstructive Surgery, 121, 849–859. Richards, C., & Barker. M. (2013). Sexuality and gender for mental health professionals: A practical guide. London, England: Sage. Richards, C., & Seal, L. (2014). Reproductive issues for trans people. BMJ, Journal of Family Planning and Reproductive Health Care, 40(4), 245–247.

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Seal, L. J., Franklin, S., Richards, C., Shishkareva, A., Sinclaire, C., & Barrett, J. (2012). Predictive markers for breast augmentation and a comparison of side effect profiles in transwomen taking various hormonal regimens. Journal of Clinical Endocrinology and Metabolism, 97(12), 4422–4428.

HOSPITAL VISITATION Hospital visitation is of great concern to the LGBTQ community. Being denied access to a same-sex partner or spouse is one of the community’s greatest fears. This entry provides an overview of the legal issues and general impediments facing LGBTQ individuals and couples when trying to visit each other in a health care setting. Traditional hospital policies have historically limited visitation to immediate family members and were not inclusive of LGBTQ patients and their families. In 2007, Lisa Marie Pond; her life partner, Janice K. Langbehn; and their four children were scheduled to take a cruise out of Miami, Florida. As they were boarding the ship, Lisa collapsed and was taken to Jackson Memorial Hospital Ryder Trauma Center. The admitting clerk refused to provide Janice with access or information regarding Lisa’s condition. A hospital social worker told Janice that she was in an antigay city and state, and Lisa’s power of attorney naming Janice as her agent would not be recognized. Lisa died without her partner of 18 years and their children at her side. Janice Langbehn sued Jackson Memorial Hospital in federal court, but her case was dismissed because the court held that there was no relief available. Although the judge thought the hospital’s actions lacked compassion and did not reflect well on the institution, he agreed that medical personnel must be able to make decisions regarding visitation. The publicity surrounding the Langbehn case caused Jackson Memorial Hospital to make significant changes to its hospital visitation policy as it applied to LGBTQ patients and their families. The case also garnered attention at the federal level and changed the accreditation standards applicable to hospitals.

In April 2010, President Barack Obama issued a Presidential Memorandum on Hospital Visitation that instructed the secretary of Health and Human Services (HHS) to draft a new rule to require all hospitals to honor advance directives. In his memorandum, the president stated the new rule would make sure that patients receive compassionate care and equal treatment while in the hospital. The new rule applies to all hospitals participating in the Medicare or Medicaid programs. The memorandum directed that the new rule must specify that hospitals cannot deny visitation privileges on any basis, including sexual orientation and gender identity. The rule must also guarantee that a patient’s advance directives, including living wills and health care proxies, are respected. Under the new rule, a patient’s designated representative has the right to make informed decisions for the patient. HHS published the final rule in January 2011 in the Code of Federal Regulations Parts 482 and 485. Providers that fail to comply with the rule may be terminated from the Medicare and Medicaid program. The rule requires health care providers to honor a patient’s advance directive that authorizes another person to make medical decisions when the patient is unconscious or unable to make decisions. Advance directives are essential for LGBTQ individuals, couples, and their families because they can grant decision-making authority in the absence of a traditional family relationship. The hospital visitation rule does not include a conscience clause or religious exemption clause that would allow hospital personnel to ignore a rule if they assert the rule violates their religious convictions. Accordingly, a hospital cannot refuse to honor advance directives because the doctor or nurse does not like LGBTQ people. The absence of a conscience or religious exemption clause is significant in light of the 2014 U.S. Supreme Court decision in Burwell v. Hobby Lobby. The Supreme Court decided that closely held for-profit corporations are exempt from a law if its owners have religious objections and there is a less restrictive means of implementing the law. This is the first time the Court has recognized that for-profit companies can have religious beliefs. This decision may

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create problems for LGBTQ patients and their families in the future, especially with providers affiliated with religious institutions. If medical staff in hospitals that are affiliated with a specific religion claim the right to discriminate based on their religious beliefs, many LGBTQ patients may find themselves alone and without support in a medical emergency. Under the hospital visitation rule, a patient may verbally designate an individual as a support person who has the right to visit and make decisions for the patient. Written documentation is only required if the patient is unconscious or incapacitated and has never designated a support person. The documentation that meets the requirement can include evidence of a shared residence, business ownership, financial interdependence, or a legal relationship recognized in another state. The hospital visitation rule does not provide a private cause of action against a hospital, including a critical access hospital, although complaints may be filed with the appropriate state agency. A critical access hospital is certified under Medicare, has 25 or fewer beds, and is designed to provide outpatient care for common conditions. Accordingly, Janice Langbehn’s lawsuit would have likely been dismissed, even after HHS promulgated the new rule. The hospital visitation rule is also no guarantee that hospital staff or a patient’s biological family will honor the patient’s wishes. LGBTQ patients continue to experience discrimination by hospitals and their employees. The Joint Commission on Accreditation of Healthcare Organizations publishes national hospital accreditation standards. Its definition of family extends to the people who play a significant role in the patient’s life, including people who are not legally related to the patient. In 2011, the Joint Commission published a new version of its Hospital Accreditation Program Visitation Rights Rule. The revision includes spouses, same-sex domestic partners, other family members, or a friend as people a patient can authorize to visit. The rule specifically gives the patient the right and authority to name whoever he or she pleases to visit. Health care facilities accredited by the Joint Commission must accept and comply with its rules

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or risk losing accreditation, and without accreditation, the facility cannot operate. A complaint can be filed with the Joint Commission if a hospital violates the rule. Joan M. Burda See also Advance Health Care Planning; Domestic Partnership; Legal Recognition of Nonmarital Same-Sex Relationships; Legal Rights of Nonbiological Parents; Long-Term Same-Sex Couples; Powers of Attorney; Retirement; Second-Parent Adoption; Wills and Trusts

Further Readings Burda, J. M. (2012). Estate planning for same-sex couples (2nd ed.). Chicago, IL: American Bar Association. Joint Commission. (2014). Advancing effective communication, cultural competence, and patient- and family-centered care for the lesbian, gay, bisexual, and transgender (LGBT) community: A field guide. Oak Terrace, IL: Author. Obama, B. (2010, April 15). Presidential memorandum— Hospital visitation. Washington, DC: White House, Office of the Press Secretary. Retrieved November 8, 2015, from http://www.whitehouse.gov/the-pressoffice/presidential-memorandum-hospitalvisitation Squillace, S. E. (2014). Whether to wed. Boston, MA: Squillace & Associates, P.C.

HOUSING, PROTECTION AGAINST DISCRIMINATION IN This entry focuses on housing discrimination against LGBTQ people and their families and efforts to increase access to fair housing in the LGBTQ community. While no federal law explicitly prohibits housing discrimination against LGBTQ people, there are significant federal policies and state and local laws that provide crucial protections for lesbian, gay, bisexual, and transgender (LGBT) people seeking access to fair and affordable housing.

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Overview of Homelessness and Housing Discrimination in the LGBT Community LGBTQ people and families face significant housing discrimination and higher instances of homelessness and housing insecurity than the general population. A 2010 study by the Welfare Warriors Research Collaborative shows that a majority of low-income LGBTQ people have been or are currently homeless, finding that 70% have been homeless in the past year, and 58% are currently homeless. Without explicit federal protections guarding against housing discrimination, LGBTQ people must rely on a patchwork of state and local protections, which are insufficient to adequately protect them. As a result, LGBTQ people are at a much higher risk for adverse housing outcomes, including discrimination, harassment, and eviction based on their sexual orientation or gender identity. In 2013, the U.S. Department of Housing and Urban Development (HUD) conducted a first-ever study examining housing discrimination against same-sex couples at the national level. This study found that same-sex couples were significantly less likely to receive favorable responses to e-mail inquiries about rental housing than heterosexual couples. Different-sex couples were favored over gay male couples in 15.9% of the tests, and favored over lesbian couples in 15.6% of the tests. While this study was groundbreaking and clearly indicates a statistically significant disparity in access to fair housing, it still fails to capture several types of anti-LGBTQ housing discrimination. For example, discrimination faced by single lesbian, gay, bisexual, and queer (LGBQ) people is widespread and could not be measured by this study because the study used same-sex couples. Moreover, the study failed to measure any discrimination faced by transgender and gendernonconforming people. This is particularly troubling because discrimination based on gender identity represents some of the most significant discrimination the LGBTQ community faces. Indeed, research reveals that the transgender community is especially vulnerable to housing discrimination. According to a groundbreaking

survey prepared by the National Center for Transgender Equality and the National Gay and Lesbian Task Force in 2011, transgender people face devastating housing discrimination in a number of different areas. Of the respondents in that survey, 19% reported being refused a home or apartment, and 11% reported being evicted because of their gender identity or expression. Home ownership in the transgender community is only 32%, which is less than half the national rate. Nineteen percent, or nearly 1 in 5 respondents, reported that they had experienced homelessness as a result of discrimination, or mistreatment because of their gender identity or expression. The survey additionally found that discrimination was particularly pronounced for transgender people of color. As this survey confirmed, housing discrimination and a lack of access to housing-related services and programs is extremely pervasive in the LGBTQ community. LGBTQ people of color and low-income LGBTQ people have been especially victimized with respect to housing discrimination. Notably, transgender people of color are particularly vulnerable. In the same transgender study discussed above, 37% of African Americans reported having been evicted because of their gender identity. They were also 3 times as likely to have experienced homelessness. Similar trends are seen for Latinos, Native Americans, and multiracial respondents: All faced significantly higher rates of housing discrimination than their White transgender counterparts. In short, transgender people of color face substantial housing discrimination and are likely to live in low- and very low–income communities. Poverty is also more likely among LGBTQ people and families, particularly female same-sex relationships, same-sex relationships between people of color, and the transgender community. LGBTQ people living in rural communities are also an especially vulnerable demographic. There is a widely held belief that the LGBTQ community is isolated to urban areas of the United States. Contrary to this popular assumption, studies paint a much more accurate picture that includes rural LGBTQ people and families. Research shows that many people in the LGBTQ community live, work,

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and raise families in rural communities across the United States. According to the Williams Institute at the UCLA School of Law, an analysis of the 2010 U.S. Census data revealed that there are approximately 64,000 cohabiting same-sex couples living in rural America. This number represents almost 10% of all cohabiting same-sex couples in the country. Thousands of these samesex couples are raising children in rural areas as well; research by Gary Gates of the Williams Institute shows that same-sex parenting is more common in the South than in any other region. LGBTQ people and families in these areas often face an intersection of identities that subjects them to an even greater degree of marginalization. For instance, these couples are also more likely to be of color, twice as likely to live in poverty, and significantly more likely to receive public assistance. Accordingly, rural LGBTQ communities remain extremely vulnerable to housing instability and discrimination in accessing services. Research by Randy Albelda of the Williams Institute shows that LGBTQ adults who live outside of urban areas are poorer than non-LGBTQ people, and more than twice as likely to live in poverty as LGBTQ people in urban areas. This research also shows that of those LGBTQ people who sought assistance from a government or community agency, about half reported instances of discrimination, with about 40% being denied services. The same research also found that a significant number of LGBTQ people reported instances of violence within social service agencies. Namely, 57% reported that they had been threatened, and 35% reported that they had been physically assaulted. The intersection of poverty and LGBTQ discrimination can lead to greater marginalization of LGBTQ people and families in rural areas. Research shows that lesbian, gay, and bisexual (LGB) people and families living in rural communities are more likely than their nonrural LGB counterparts and their straight rural counterparts to struggle financially. Further, rural LGB people and families are almost twice as likely to receive public assistance as their nonrural LGB counterparts. LGBTQ youth homelessness in the United States is a particularly alarming and often

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overlooked epidemic. The Center for American Progress estimates that there are currently 1.6 million to 2.8 million homeless youth in the United States. LGBTQ youth are disproportionately represented within this population. Although only 5% to 10% percent of the general youth population self-identify as LGBTQ, 20% to 40% percent of homeless youth identify as LGBTQ. This percentage translates, conservatively, to between 320,000 and 400,000 individual homeless LGBTQ youth. The majority of this homelessness is a direct result of discrimination, based solely on LGBTQ identification (whether actual or perceived), from family members, community members, unresponsive school administrators, fellow students, child welfare programs, and other federal programs. LGBTQ youth are highly susceptible to familial discrimination and rejection based on their sexual orientation or gender identity. According to 2010 research by the Center for American Progress, 62% of LGBTQ homeless youth have reported familial conflict as the predominant reason they were homeless. This percentage represents twice the amount reported by their non-LGBTQ peers. Recently, the age when LGBTQ people “come out” to their family has decreased, averaging around 13–15 years, compared to the previous estimate of 18–20 years. Due to this decrease in age, children are being forced out of their homes and ending up on the streets at a younger age, which has created a greater demand for homeless youth services. Without a safety net, LGBTQ homeless youth are resorting to “survival crimes”—crimes necessary in order to meet survival needs such as sex work, drug trade, or theft—as a means to provide food, shelter, money, and clothing.

Federal and State Housing Discrimination Legislation and the LGBT Community Title VIII of the Civil Rights Act of 1968 is the original Fair Housing Act (FHA), which prohibited discrimination based on race, color, religion, or national origin for any sale, rental, or financing of housing. In 1974, amendments to the FHA were enacted to broaden its protections and prohibit housing discrimination based on sex. Congress

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later passed the Fair Housing Act Amendments (FHAA) in 1988, which both again broadened the scope and coverage of the original FHA, and strengthened the remedies and enforcement measures available to private litigants and federal agencies. The FHAA also extended protections to prohibit housing discrimination based on familial status and disability. The FHA, however, has not been amended to contain language explicitly protecting against discrimination directed at LGBTQ people. Recent guidance from HUD on the interpretation of the FHA has provided crucial protections for transgender and gender-nonconforming people. In July 2010, HUD announced that it would interpret the FHA’s prohibition against discrimination “based on sex” to include discrimination based on gender identity and sex stereotyping. As a result, the FHA now prohibits the type of gender identity discrimination most often faced by transgender persons. This announcement opened the door to enforcement actions under the FHA against discrimination directed at transgender and gendernonconforming people based on gender identity and expression. Since this guidance was announced, HUD has pursued at least one case of discrimination based on gender identity and sex stereotyping. In October 2013, the U.S. government filed a lawsuit against a Texas recreational vehicle (RV) park and its management on behalf of Roxanne Joganik, a transgender woman, in the U.S. District Court for the Eastern District of Texas. The complaint alleged that Ms. Joganik and her partner Darlina Anthony had lived in the RV park for over a year when the defendant took over the management of the RV park. According to Ms. Joganik, the defendant prohibited her from wearing female clothes and otherwise expressing her female gender identity in common areas of the RV park. When she refused to comply, the defendant allegedly began eviction proceedings against her and her partner. After an initial investigation, HUD filed a case on Ms. Joganik’s behalf, alleging Ms. Joganik had experienced unlawful sex discrimination based on her gender identity. The case was subsequently settled in the summer of 2014 before going to trial.

Under the terms of the settlement, Ms. Joganik was awarded $4,000 in damages, and the defendant was required to add a prohibition against gender discrimination as a category in the park rules and leases. There have also been efforts to amend the FHA to explicitly include discrimination against LGBT people. The Housing Opportunities Made Equal Act of 2013 (the HOME Act) is the latest iteration that would expand existing prohibitions on housing discrimination to recognize sexual orientation or gender identity as protected classes. The HOME Act inserted the terms “sexual orientation” and “gender identity” after “sex” each time that it appeared in the FHA. Under the HOME Act, “sexual orientation” was defined as “homosexuality, heterosexuality, or bisexuality.” “Gender identity” was defined as follows: “the gender-related identity, appearance, or mannerisms or other gender-related characteristics of an individual, with or without regard to the individual’s designated sex at birth.” In addition to the FHA, states and municipalities also have laws and ordinances that prohibit discrimination in housing. Many states and municipalities have specifically amended their housing laws to prohibit discrimination based on sexual orientation or gender identity. At the time of this writing, 18 states and the District of Columbia currently protect individuals from housing discrimination based on sexual orientation and gender identity. An additional three states protect against housing discrimination on the basis of sexual orientation alone. The Family Equality Council estimates that across the United States, more than 100 towns, cities, counties, and municipalities prohibit housing discrimination based on both sexual orientation and gender identity.

Federal Regulations and Policy Efforts to Target Housing Discrimination in the LGBT Community Without explicit protections at the federal level against housing discrimination, LGBTQ people have historically had to rely on the patchwork of state and local laws that protect against housing

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discrimination. In 2012, HUD promulgated a new regulation known as the LGBT Equal Access Rule that extended critically important protections for LGBTQ people in housing services and programs administered or funded by HUD. This groundbreaking regulatory change provides the first comprehensive protection for LGBTQ individuals against discrimination in housing at the federal level. The LGBT Equal Access Rule prohibits discrimination based on sexual orientation, gender identity, and marital status in public housing programs and services. This rule impacts more than 5.5 million people across the county. HUD-assisted and HUD-insured housing accounts for a large segment of all housing opportunities. The LGBT Equal Access Rule also prohibits all lenders offering FHA-insured mortgages from considering sexual orientation or gender identity in determining a borrower’s eligibility. FHA-insured mortgages represent a very large share—between 40% and 50%—of the mortgage market. The LGBT Equal Access Rule further clarified the definition of “family” to ensure that otherwise eligible participants in any HUD programs will not be excluded based on marital status, sexual orientation, or gender identity. These programs, including crucial public housing programs like the Section 8 Housing Choice Voucher Program, will now be accessible to all LGBT individuals and families. Also, this rule does not provide a religious exemption. It applies equally to all organizations that operate HUD-assisted or HUD-insured housing facilities, including religious organizations. In 2014, the U.S. Department of Agriculture (USDA) followed the lead of HUD and amended its own existing nondiscrimination rule to add “gender identity” as a prohibited basis for discrimination in programs or activities it conducts, including low-income housing and loan programs in rural areas. The USDA nondiscrimination rule had already included prohibitions against discrimination based on sexual orientation and marital status. The rule covers all USDA-conducted programs, which includes crucial loan programs like those designed to help low-income families buy and maintain homes in rural communities.

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The combined effect of the USDA rule and the LGBT Equal Access Rule has been to prohibit discrimination based on sexual orientation, gender identity, and marital status in almost all public housing services and programs in both metropolitan and rural communities. Advocates continue to work on federal protections that explicitly prohibit anti-LGBT housing discrimination because such protections are the only way to ensure that discrimination against LGBTQ individuals and their families is prohibited in all housing situations. The recent changes in federal regulations illustrate that it is sometimes possible to target and address this type of discrimination without legislative action. However, an amendment to the FHA prohibiting discrimination based on sexual orientation and gender identity would have a broader and longer-lasting impact. Maya Rupert See also Nondiscrimination Protections, State and Local; Senior Living Programs and Policies

Further Readings Albelda, R., Badgett, M., Schneebaum, A., & Gates, G. (2009, March). Poverty in the lesbian, gay, and bisexual community. Los Angeles, CA: Williams Institute. Retrieved November 8, 2015, from http:// williamsinstitute.law.ucla.edu/research/census-lgbtdemographics-studies/poverty-in-the-lesbian-gay-andbisexual-community/ Badgett, M., Lau, H., Sears, B., & Ho, D. (2007, June). Bias in the workplace: Consistent evidence of sexual orientation and gender identity discrimination. Los Angeles, CA: Williams Institute. Retrieved November 8, 2015, from http://williamsinstitute.law.ucla.edu/ research/workplace/bias-in-the-workplace-consistentevidence-of-sexual-orientation-and-gender-identitydiscrimination/ Center for American Progress. (2010, June 21). Gay and transgender youth homelessness by the numbers. Retrieved from http://americanprogress.org/issues/lgbt/ news/2010/06/21/7980/gay-and-transgender-youthhomelessness-by-the-numbers/ Friedman, S., Reynolds, A., Scovill, S., Brassier, F., Campbell, R., & Ballou, M. (2013, May). An estimate

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of housing discrimination against same-sex couples. Washington, DC: U.S. Department of Housing and Urban Development, Office of Policy Development and Research. Retrieved November 8, 2015, from http://www.huduser.org/portal/publications/fairhsg/ discrim_samesex.html Gates, G. (2012, Spring). Economic disadvantage in the LGBT community. Management Information Exchange Journal, 26(1). Retrieved from http:// baylegal.org/wp-content/uploads/Providing-FamilyLaw-Services-to-LGBT-clients.pdf Grant, J., Mottet, L., & Tannis, J. (2011, January 1). Injustice at every turn: A report of the National Transgender Discrimination Survey. Retrieved March 4, 2015, from http://endtransdiscrimination.org/PDFs/ NTDS_Report.pdf Quintana, N. (2009). Poverty in the LGBT community. Washington, DC: Center for American Progress. Retrieved November 8, 2015, from http://www .americanprogress.org/issues/lgbt/report/2009/ 07/01/6430/poverty-in-the-lgbt-community/ Welfare Warriors Research Collaborative. (2010). A fabulous attitude: Low-income lgbtgnc people surviving and thriving in love, shelter and knowledge. Retrieved November 8, 2015, from http://www.issuelab.org/resource/fabulous_ attitude_low_income_lgbtgnc_people_surviving_ and_thriving_on_love_shelter_and_knowledge_a

HRC See Human Rights Campaign (HRC)

HUMAN RIGHTS CAMPAIGN (HRC) The Human Rights Campaign (HRC) is the largest civil rights organization working to achieve equality for lesbian, gay, bisexual, and transgender (LGBT) people in the United States. HRC represents more than 1.5 million members and supporters nationwide. The mission of HRC is to create a world where LGBT people are embraced as full members of society at home, at work, and in every community.

HRC was originally founded as the Human Rights Campaign Fund. Today, HRC is home to both a political action arm and the Human Rights Campaign Foundation, which operates as a taxexempt charitable organization. Created in 1980, the Human Rights Campaign Fund was the first political action committee in the United States created specifically to support pro-equality congressional candidates. The Human Rights Campaign Fund raised money for and contributed to the campaigns of candidates who were likely to represent lesbian and gay civil rights in congressional votes and among their colleagues in Congress. It also engaged in education and outreach to voters and to the LGBT community. The organization held its first large fundraising dinner in September 1982 in New York City. The dinner featured former vice president, and presidential hopeful, Walter Mondale. Today, HRC hosts annual fundraising dinners across the United States and in Washington, D.C. In 1985, the Human Rights Campaign Fund merged with the Gay Rights National Lobby. Although outreach regarding political campaigns and candidates had always been a cornerstone of the organization, its outreach efforts expanded in the mid-1980s to include a broader engagement of issues that were of most interest to the LGBT community. The spread of the AIDS epidemic ignited a critical need for research and dissemination of news and information to the broader community. The Human Rights Campaign Fund began distributing a packet of information called a MEDPAC, containing news reports and medical updates regarding HIV/AIDS, including clippings from major newspapers, medical journals, and magazines. MEDPACs laid the groundwork for the future education and outreach efforts of the organization involving health and aging, schools and education, and family formation and protections. In 1995, the Human Rights Campaign Fund underwent significant changes. The name of the organization was officially shortened to the Human Rights Campaign, and the Human Rights Campaign Foundation was officially formed, reflecting then–Executive Director Elizabeth Birch’s sentiment that “we are so much more than a fund.”

Human Rights Campaign (HRC)

In addition to these changes, the modern HRC logo—a yellow equal sign on a blue background— was adopted. In creating the new logo, HRC enlisted Stone Yamashita, a design firm formerly associated with Apple Computers. Of the 10 potential designs for the logo, Elizabeth Birch was drawn to this simple, bold design. The logo was an immediate success. The logo has become an iconic symbol visible at pride celebrations and other LGBT events. The HRC logo can be spotted all over the world. It was also used as a rallying cry around the March 2013 U.S. Supreme Court hearing of arguments in two marriage equality cases. HRC shared a red version of the logo on social media, asking supporters to change their profile pictures in a show of support. The campaign quickly went viral among celebrities and everyday citizens who were searching for a way to show their support for marriage equality. True to its original mission, HRC continues to undertake significant federal advocacy work on issues pertaining to the LGBT community and the federal government. Working with every branch of the government, HRC lobbies to ensure that LGBT issues receive attention from federal officials. In this effort, HRC lobbies for the passage of proequality legislation, monitors the records of judicial nominees on LGBT equality, and advocates for fair-minded regulatory changes. Most recently, HRC worked in coalition to lead the successful lobbying efforts surrounding the passage of the Matthew Shepard and James L. Byrd Hate Crimes Prevention Act and the repeal of the discriminatory military policy known as Don’t Ask, Don’t Tell. In addition to serving as the president of the Matthew Shepard Foundation, Judy Shepard, Matthew’s mother, worked closely with HRC throughout the passage of the Hate Crimes Prevention Act and continues to be an active volunteer and HRC board member. Today, the Human Rights Campaign Foundation provides educational resources and publications addressing issues impacting the daily lives of LGBT people including health care and workplace equality. During the 1999 restructuring, the Human Rights Campaign Foundation also added two significant programs—the Workplace Project and the

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Family Project, now known as the Children, Youth, and Families Program. The Workplace Project advances workplace equality for LGBT employees. It provides not only advocacy but also technical assistance and best practices on LGBT workplace issues. The Workplace Project publishes the Corporate Equality Index (CEI), an annual survey and report benchmarking best practices in LGBT diversity and inclusion among the nation’s largest corporations and law firms. In addition to the CEI, the Workplace Project publishes the HRC Buyer’s Guide, which is the go-to resource for consumers looking to support top-ranked CEI companies. The Buyer’s Guide is distributed at gay pride celebrations and other events nationwide every year. The Children, Youth, and Families Program recognizes the special challenges that LGBT youth and same-sex parents may face. Specifically, the Children, Youth, and Families Program operates the All Children—All Families Project, which trains child welfare professionals to improve agency policies and practices around LGBT foster and adoptive families, as well as LGBT children and youth. This program also operates the Welcoming Schools Project, which offers professional development and curricula for schools to create learning environments that embrace family diversity, avoid gender stereotyping, and end bullying. Within the HRC Foundation, the Health and Aging Program works to ensure that LGBT people receive fair and equal treatment in hospitals, clinics, nursing homes, and assisted living facilities. The program conducts training for current and future care providers, and it serves as a national advocate for LGBT health and aging needs. The Health and Aging Program also includes the Healthcare Equality Index (HEI), an annual report detailing LGBT inclusion and equity in health care facility policies across the country. Robin Maril See also Employment Non-Discrimination Act (ENDA); Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask Don’t Tell; Marriage Equality, Landmark Court Decisions

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Further Readings Chauncey, G. (2004). Why marriage? The history shaping today’s debate over gay equality. New York, NY: Basic Books. Cornell University Library. (2006). 25 years of political influence: The records of the Human Rights Campaign. Retrieved February 28, 2015, from http:// rmc.library.cornell.edu/HRC/ Hirshman, L. (2012). Victory: the triumphant gay revolution. New York, NY: HarperPerennial.

HYPERMASCULINITY Hypermasculinity, a term used to describe the exaggeration of behavior and identity elements stereotypically associated with men, is both celebrated and denigrated throughout Western culture. This entry describes conformity to the more daring and dangerous rules and roles associated with contemporary masculinity. The entry identifies the important qualities of hypermasculinity, discusses some of the factors that influence this particular configuration of gender practice and identity, and addresses some of the associated consequences.

Masculinity as Enactment and Ideology Although many people think of masculinity as biologically determined (as, for instance, arising out of our chromosomal, endocrinological, or brain chemistry), there is actually a great deal more evidence to suggest that masculinity is socially constructed. When scholars say that masculinity is “socially constructed,” they mean that masculinity is a concept that is subject to great variation and that the form, meaning, interpretation, and so forth are better understood as consequences of the structure of the societies in which they emerge than as a natural outcome of the bodies with which they are enacted. Masculinity is best understood as socially constructed in part because of the enormous variation in what different societies and cultures understand as “masculine” in the first place. In some societies, strength, dominance, authority, violence, and the like are understood to be qualities associated with

men. But in others, whether or not men are strong, dominant, authoritarian, or violent is not something people understand as associated with their gender. Masculinity has also varied over time. How people understand and experience masculinity changes over the life course as well. All of this helps illustrate that masculinity is not the stable “thing” that we often suppose it to be. Scholars studying masculinity understand it to be two things at once: a performance and an ideology. To say that masculinity is a performance means that it is enacted; we demonstrate masculinity by “doing” masculinity. This perspective is at odds with a biologically deterministic perspective precisely because masculinity is not here seen as something that men either “are” or “have,” but rather, as something people must demonstrate by “doing” (or failing to do). Beyond this, however, masculinity also operates ideologically. An ideology refers to a set of ideas that are widely shared by members of a society, that shape identities and behaviors, and that become embedded in social institutions. To call masculinity an ideology is to say that it is part of a shared body of gendered ideas and meanings societies collectively construct. This means that masculinity can be understood as simultaneously the product and the producer of an ideology of masculinity. Hypermasculinity refers to an exaggerated conformity to behavior and identity rituals and practices stereotypically associated with contemporary masculinity.

From Masculinity to Masculinities Aside from masculinity being socially constructed, scholars of masculinity also recognize that it is better understood when pluralized—masculinities. Most people conjure up a fairly specific picture in their minds when asked about masculinity. However, it is equally true that most men fail to live up to this image in some way, in part because the qualities that comprise our culturally idealized “masculinity” would be difficult to come across in a single individual: hardworking, playboy, devoted father, professionally successful, incredibly athletic, with a high tolerance for alcohol, and so on. Living up to all of these things at the same time is impossible. Yet, collectively, this constellation of

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practices and traits works in ways that justify and naturalize gender inequality. By virtue of being men, all men have some claim to masculinity, but some are more marginalized or subordinated than others. Hypermasculinity is best understood as a strategy associated with groups of men who easily approximate masculine identities and ideals (e.g., tall, heavily muscled, athletic, wealthy) as well as a compensatory strategy for men who fail to live up to idealized configurations of masculinity. Thus, some hypermasculine displays are best understood as strategies undertaken by men who lack masculine status associated with key facets of their gender identity.

Testosterone as Causal? While testosterone is popularly understood as the “masculine” hormone and blamed for all manner of men’s misbehavior, research on whether testosterone can be understood as causally linked to hypermasculine displays challenges this perspective. For instance, heightened levels of testosterone are often popularly claimed to cause violent behavior. We know that violence and testosterone are correlated with each other (e.g., more violent men also often have higher levels of testosterone). This fact has caused some to claim that certain hypermasculine displays (such as violent behavior) are the result of endocrinology. However, there are really three ways of making sense of the correlation we know exists: (1) It could be that testosterone and aggression are not actually meaningfully related to one another. (2) If they are related, testosterone may play a crucial role in elevated aggression. (3) It is also possible that aggressive behavior might actually elevate levels of testosterone secretion. While there is considerable cultural bias toward number 2 (the notion that testosterone produces aggression), scientific evidence overwhelmingly supports number 3 (aggression produces higher levels of testosterone in the body). This is a significant finding for a variety of reasons, but chief among them is that while hypermasculinity may be manifested physiologically, the best science understands hypermasculinity as a cultural phenomenon with physiological consequences (rather than the other way around). Just

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by way of example, it is also true that playing a central role in the caretaking and nurturing of their children has the effect of lowering levels of testosterone in men (and in women). So this does not mean that men with lower levels of testosterone are more likely to nurture. Rather, the evidence suggests that it is the act of nurturing and caring for others that decreases testosterone secretion. These are significant findings because they support the twin findings on hypermasculinity that it is a cultural phenomenon and that, as such, it is subject to change (i.e., hypermasculinity is not inevitable).

Hypermasculinity as Culturally Normative Rather Than Deviant It is important to understand hypermasculinity as an exaggeration of behavior and identity elements otherwise normatively assigned to boys and men. Hypermasculinity is simultaneously culturally idealized and denigrated. Thus, media portrayals of culturally idealized forms of masculinity often depict men as heavily muscled, violent, physically powerful, and emotionally stoic. However, men are also popularly teased for conforming too closely (or too much) with any of these ideals. Terms like “workaholic,” “meathead,” “hothead,” and the like are testament to the fact that hypermasculinity is best understood as an exaggeration of culturally normative behavior. We expect men to work (but not too much)‚ we expect men to be strong (but not too strong), and we expect men to be capable of violence (but not to be violent too often). It’s these sets of cultural contradictions surrounding masculinity that create difficulty for some boys and men. Hypermasculinity is one attempt to acquire status as “masculine.”

Hypermasculinity Among LGBTQ Populations Hypermasculinity is also often assumed to be a heterosexual configuration of practice. However, these sorts of gendered exaggerations exist among groups of gay men and some rural configurations of lesbian identities as well. Gay identities among men are sometimes culturally situated as at odds with

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normative conceptualizations of masculinity. Thus, it is logical that some gay men will rely on hypermasculinity to acquire a status symbolically denied to gay men as a result of sexual inequality. Indeed, subcultures of gay men sometimes form around hypermasculine stereotypes, such as the emergence of the “gay clone” in the 1970s and 1980s, or, more contemporarily, “bear culture.” Much has been made of the meanings of the hyperconformity to gendered norms associated with these groups. Research has documented that the motivations to participate in hypermasculine displays may be somewhat different for gay men. For instance, hypermasculinity among gay men may be simultaneously a strategy of gender conformity as well as a strategy that might work to ensure individual men’s safety. Thus, hypermasculinity among gay men emerges as a result of a different set of concerns.

Components and Consequences of Hypermasculinity Hypermasculinity has been studied as being composed of three separate components: (1) insensitive sexual attitudes and behavior toward women (and sometimes men), (2) the belief that violence is masculine, and (3) experiencing danger and daring behavior as exciting. These beliefs and behaviors harm both men and women—physically and psychologically. Men are harmed by other men’s hypermasculine displays, as are women. However, hypermasculinity also shapes understandings and expectations of men. So both men and women sometimes seek out protection from men who display hypermasculine traits. In this way, people sometimes favor some hypermasculine traits out of fear of others. According to some researchers, hypermasculinity harms men’s health, shortens men’s lives, causes them to resist emotionally close relationships with others, and more. These behaviors have been shown to be responses to cultural pressures associated with gender ideals. Tristan Bridges See also Bullying, Rates and Effects of; Hate Crimes; Masculinities; Masculinity Stereotypes; Policing Masculinities and Femininities; Sissyboy Experience; Violence and Victimization of Youth

Further Readings Booth, A., Granger, D., Mazur, A., & Kivlighan, K. T. (2006). Testosterone and social behavior. Social Forces, 85, 167–191. Byrnes, J., Miller, D., & Shafer, W. (1999). Gender differences in risk taking: A meta-analysis. Psychological Bulletin, 125, 367–383. Connell, R. (2008). A very straight gay? Masculinity, homosexual experience, and the dynamics of gender. American Sociological Review, 57, 735–751. Courtenay, W. (2000). Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine, 50, 1385–1407. Hennen, P. (2005). Bear bodies, bear masculinity: Recuperation, resistance, or retreat? Gender & Society, 19, 25–43. Kimmel, M. S., & Mahler, M. (2003). Adolescent masculinity, homophobia, and violence: Random school shootings, 1982–2001. American Behavioral Scientist, 46, 1439–1458. Levine, M. (1998). Gay macho: The life and death of the homosexual clone. New York, NY: New York University Press. Messerschmidt, J. W. (2000). Becoming “real men”: Adolescent masculinity challenges and sexual violence. Men and Masculinities, 2, 286–307. Munsch, C. L., & Willer, R. (2012). The role of gender identity threat in perceptions of date rape and sexual coercion. Violence Against Women, 18, 1125–1146. Sabo, D. (2001). Masculinities and men’s health: Moving toward post-Superman era prevention. In M. S. Kimmel & M. A. Messner (Eds.), Men’s lives (5th ed., pp. 285–298). Needham Heights, MA: Allyn & Bacon. Sapolsky, R. M. (1997). Testosterone rules. In M. S. Kimmel & A. Aronson (Eds.), The gendered society reader (3rd ed., pp. 26–31). New York, NY: Oxford University Press. Scheff, T. (2006). Hypermasculinity and violence as a social system. Universitas, 2, 1–10. Schrock, D., & Schwalbe, M. (2009). Men, masculinity, and manhood acts. Annual Review of Sociology, 35, 277–295. Willer, R., Rogalin, C., Conlon, B., & Wofnowicz, M. (2013). Overdoing gender: A test of the masculine overcompensation thesis. American Journal of Sociology, 118, 980–1022.

I a range of disciplines, including sociology, anthropology, ethnic studies, women’s and gender studies, and queer studies, to name a few—interrogates how gender and sexuality, along with race, class, nationality, and geopolitical location, structure processes of international migration and border-crossing. Addressing a range of issues—from immigration rights for binational same-sex couples and LGBTQ refugee claims to transgender migration and queer undocumented youth activism—this field of study rigorously interrogates the social and legal challenges to LGBTQ immigration across national borders. Historical perspectives on LGBTQ migration have established the intersections among sexuality, gender, race, class, and immigration. This scholarship examines how state immigration controls have regulated sexual identities and behaviors from the late 19th century until the present. Such work has demonstrated how the emphasis on family reunification policies in state migration controls has regulated queer expression across a range of national borders. In doing so, research in queer migration studies stresses the importance of a queer-of-color analytical framework for unpacking the complex intersections among sexuality, gender, race, and culture in shaping the mobility of LGBTQ immigrant populations. The more recent repeal of lesbian and gay immigration exclusion policies and the turn toward limited forms of inclusion for queer migrants in a number of countries have facilitated new forms of

IMMIGRATION This entry provides an overview of some of the current issues pertaining to LGBTQ immigration. While the topic of LGBTQ immigration can be defined in a number of ways, this entry focuses on queer migration across national borders. Following a brief historical background on immigration policies concerning LGBTQ individuals, the entry connects the history of LGBTQ immigration to current challenges related to queer immigration, focusing particular attention on two key issues: immigration policies for binational LGBTQ couples and LGBTQ refugee and asylum claims. The entry concludes with additional points about undocumented queer migration and with a call for further research on LGBTQ immigration in the Global South.

LGBTQ Immigration: A Brief History Since its emergence in the 1970s, the field of international migration studies has, for the most part, been driven by the assumption that all immigrants are heterosexual and that all LGBTQ individuals are citizens. However, from the late 1990s onward, a growing body of scholarship on sexuality and immigration has emerged that contests the heteronormative assumptions that underwrite the study of international migration. This interdisciplinary field of research—which encompasses scholarship from 575

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activism pertaining to LGBTQ immigration. Indeed,  contemporary LGBTQ immigrant rights activism has coalesced primarily around immigration rights for binational LGBTQ couples, the repeal of HIV exclusion policies, LGBTQ refugee and asylum claims, and the rights of undocumented queer migrants. However, the majority of scholarship on LGBTQ immigration has focused upon two main issues: immigration rights for binational samesex couples and LGBTQ refugee and asylum claims. The following sections of this entry are devoted to addressing each of these two issues in turn.

Binational LGBTQ Couples and State Immigration Controls Nineteen countries currently allow lesbian, gay, bisexual, and transgender citizens to sponsor their partners for the purposes of immigration. Countries that recognize the immigration rights of same-sex couples are Australia, Belgium, Brazil, Canada, Denmark, Finland, France, Germany, Iceland, Israel, the Netherlands, New Zealand, Norway, Portugal, South Africa, Spain, Sweden, Switzerland, and the United Kingdom. To date, the United States does not have official policies in place that recognize the rights of binational same-sex couples, although the growing recognition of gay marriage in a number of U.S. states and, more recently, the Supreme Court’s legalization of gay marriage in June 2015, will enable more U.S. citizens to sponsor their same-sex partners for the purposes of immigration. Historically, while same-sex marriage had been legalized in 32 U.S. states, including Massachusetts, Vermont, Connecticut, and New York for a number of years, marriages performed within these states failed to have any impact upon federal immigration law, due to the 1996 Defense of Marriage Act (DOMA). DOMA defines marriage for federal purposes as “a legal union between one man and one woman as husband and wife” and permits individual states to disregard same-sex unions performed in other states. As a response to the immigration-related exclusions inherent in DOMA, House Representative Jerrold Nadler (D-NY) and Senator Patrick Leahy (D-VT) introduced the

Permanent Partners Immigration Act to Congress in 2000. The bill was subsequently reintroduced to Congress on July 21, 2005, with a new title, the Uniting American Families Act (UAFA). UAFA does not alter the federal definition of spouse, as codified in the 1996 Defense of Marriage Act, but it does redefine “permanent partner” for the purposes of the Immigration and Nationality Act (INA) as any person 18 years of age or older who is in a committed, intimate relationship with an adult U.S. citizen or legal permanent resident in which both parties intend a “lifelong commitment.” UAFA also stipulates that the non–U.S. citizen in any lesbian or gay binational relationship must be “financially interdependent” with his or her partner, not married or in a permanent partnership with anyone other than that person, and unable to contract with that person a marriage that is recognized under the INA. While UAFA has still not been signed into law, the Supreme Court’s legalization of same-sex marriage in 2015 means that deportation orders against binational samesex couples in the United States have been halted, and petitions for residency are being made on a case-by-case basis. In those countries that do grant immigration rights for binational LGBTQ couples, the queer couples in question are frequently subjected to surveillance on the basis of how well they conform to idealized notions of heterosexual marriage. For example, the Gay and Lesbian Immigrant Task Force in Australia “screens” applicants for their commitment to monogamy and “look-alike” heterosexual relationships. In the United Kingdom, immigration rights for same-sex couples are similarly linked to a class- and race-based economic model of sexual identity governed by neoliberal market principles. Moreover, many of the immigrant rights organizations that advocate on behalf of binational LGBTQ couples still do not offer any legal advice to transgender individuals in binational relationships. The campaigns to include same-sex couples within current family reunification policies disavow queer immigrants who do not conform to neoliberal, homonormative ideals of family and domesticity, yet neoliberal global and economic

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policies arguably make it all but impossible for poor or legally vulnerable queer migrants to assimilate to such norms. The failure of LGBTQ immigration policies to account for individuals who are unable to provide adequate financial support for their foreign partner thus perpetuates existing inequalities along the lines of race, class, gender, and nation. As a result, many LGBTQ immigrants in a relationship with a citizen of another country are forced to remain undocumented. Up until its repeal in 2008, the official ban on admitting HIVpositive immigrants to the United States led to significant challenges for HIV-positive queer migrants who desired to be reunited with their American partners.

LGBTQ Refugee and Asylum Claims Another area in which LGBTQ individuals are eligible for migration is that of refugee and asylum claims. Since the United Nations Refugee Agency published its official guidelines on claims relating to sexual orientation and gender identity in 2008, a number of countries have introduced new training manuals for the adjudication of lesbian, gay, bisexual, transgender, and intersex asylum cases. However, although sexual orientation and gender identity have been recognized as grounds for political asylum since the mid- to late 1990s, not all courts accept sexuality or gender identity as meeting the qualifications of membership in a particular social group. Indeed, a number of challenges to LGBTQ refugee and asylum claims still remain. Like all political asylum applicants, LGBTQ refugees must prove both that they have a “wellfounded fear of persecution” and that they are members of a particular social group. Article 1 of the 1951 Refugee Convention provides the following definition of a refugee: Any person who . . . owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; or who, not having a nationality

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and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwilling to return to it. [emphasis added]

The primary challenge to LGBTQ asylum claims lies in the fact that the 1951 Refugee Convention was designed to protect individuals from racial, religious, and political persecution, and the category “particular social group” included neither women nor individuals persecuted for their sexual orientation or gender identity. Although sexual orientation and gender identity have been included in the category “membership of a particular social group” since the mid- to late 1990s, it is still the case that the closer one’s application conforms to the traditional model of the male activist fleeing an oppressive political regime, the more likely one is to be able to obtain asylum. This tends to benefit those queer refugees (most notably, gay men) whose experiences fit particular gendered and class-based understandings of what it means to be a political refugee, such as being “out” about one’s identity in the public sphere and being targeted by state agents for public displays of that identity. Lesbian and bisexual women’s ways of displaying sexuality and other experiences, including forms of persecution, are often quite different than those of gay men, and frequently fail to conform to immigration officials’ preconceptions and expectations. As a result, women’s and lesbians’ claims for asylum are often dismissed as insufficiently meeting the Refugee Convention requirements. In lesbian asylum cases, courts typically disregard the interrelation of gender and sexual identity in narratives of lesbian persecution. Moreover, courts still have a tendency to equate the lack of documented evidence of human rights abuses against lesbians in country-of-origin reports with an absence of persecution. The result is that it is often difficult for lesbians to produce successful asylum claims when their experiences are perceived by judges to be “too private,” the assumption being that they can return to their countries of origin and be “discreet” about their sexual orientation. While a number of countries (for example, the United Kingdom, the Netherlands, the Czech

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Republic, and Australia) have recently rejected the “discretion” requirement, or the notion that LGBTQ asylum applicants can return to their  country of origin and be “discreet” about their sexual orientation or gender identity, a growing number of lesbian and gay asylum claims are now being refused on the grounds that the applicant’s claimed sexual orientation is disbelieved. This is largely due to the fact that in assessing the credibility of a political asylum applicant’s claim, immigration officials often rely upon stereotypical assumptions and expectations. For example, asylum adjudicators tend to assume that all lesbians and gay men engage in practices of cross-gender identification, that they all form part of a common social group with shared cultural tastes and social spaces, and that they will all come out as gay or lesbian immediately upon arrival in the receiving country. Unlike other refugee claimants who are not compelled to perform a visible identity in the country to which they migrate, lesbian and gay asylum applicants are expected to conform to Western stereotypes about male homosexual behavior grounded in visibility politics, consumption, and an identity in the public sphere in order to be considered worthy candidates for asylum. The kinds of racialized, classed, and gendered stereotypes of male homosexual behavior typically invoked by asylum adjudicators pose significant challenges to lesbian asylum applicants. Although the discretion requirement is no longer explicitly stated in most countries’ asylum policies, it remains implicit in the treatment of lesbian asylum cases and is evident in terms of the increasing burden of proof placed on lesbian asylum applicants to make their sexual orientation visible. The problems of claiming asylum are often compounded for lesbian and bisexual women, who may be asked to “prove” their sexual orientation and who are frequently disbelieved, especially if they have children or have been married. For women who perceive their sexuality as a private and deeply intimate aspect of their lives, proving their sexual orientation in the context of the political asylum process is an incredibly challenging experience. Recent work on LGBTQ asylum claims in Europe and Canada has shown that bisexual and

transgender identities tend to be similarly judged in relation to heteronormative assumptions about gender and sexuality in the political asylum process. While transgender and intersex identities are commonly misunderstood by immigration officials and conflated with sexual orientation, bisexual asylum applicants are frequently deemed to be unworthy of protection because of the heteronormative assumption that it is possible for them to return to their country of origin and assume a heterosexual orientation. There has been a notable lack of attention to transgender refugee claims in the scholarship on political asylum, with the exception of literature focusing on the United States. However, transgender asylum claims are relatively successful in terms of establishing credibility regarding gender identity. This is perhaps due to the privileging of visual markers of difference and gender performance within the political asylum process, as well as to the minority status of transgender applicants. However, while transgender asylum applicants tend to be more successful in establishing credibility than gay and lesbian asylum seekers, the reasoning behind this success is often the result of a misunderstanding on the part of immigration officials about the differences between sexual orientation and gender identity. This frequently results in transgender claims being treated as a “subset” of sexual orientation claims, leading to inappropriate applications of country-of-origin reports in documenting transgender persecution. For this reason, there is a clear need to establish transgender asylum claims as a separate identity category from sexual orientation–based asylum claims within refugee law.

Some Additional Points of Consideration The continuing immigration challenges to family reunification for binational LGBTQ couples, combined with the obstacles to successful LGBTQ asylum claims, means that many queer immigrants choose to remain undocumented. A great deal more work is needed that attends to the subject of undocumented queer immigrant populations. More research is also needed that examines the

Incarceration

challenges to LGBTQ migration in the Global South. As with all refugee populations, the Global South is host to the vast majority of the world’s queer refugees, many of whom do not have the resources needed to seek or be granted political asylum and are compelled to remain undocumented. Many queer refugees in the Global South continue to experience violence as a response to their visibility and do not have the networks that would establish their participation in a “particular social group” that is necessary for producing a credible claim to asylum. Instead of evidence of their public performances of their sexuality, they report the opposite, efforts to conceal their sexuality or gender identity as a matter of safety. This poses serious challenges if and when they choose to seek political asylum. Indeed, the categories are themselves problematic for many asylum seekers whose experiences as sexual and gender minorities do not always match the preconceptions of immigration officials. However, the scholarship on LGBTQ migration has not, for the most part, situated the challenges to LGBTQ immigration in relation to human rights and the challenges of translating global sexualities into political asylum narratives. It is thus essential that future research on LGBTQ immigration continues to connect the study of queer migration to the question of what it means to think of sexuality globally and transnationally. Rachel Lewis See also Binational Same-Sex Couples and Families; Defense of Marriage Act (DOMA); Heteronormativity; Homonormativity; Sexual Minorities and Violence; Transgender Identities

Further Readings Berg, L., & Millbank, J. (2013). Developing a jurisprudence of transgender particular social group. In T. Spijkerboer (Ed.), Fleeing homophobia: Sexual orientation, gender identity, and asylum (pp. 121–153). New York, NY: Routledge. Chavez, K. (2013). Queer migration politics: Activist rhetorics, coalitional possibilities. Urbana: University of Illinois Press.

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Lewis, R. (2013). Deportable subjects: Lesbians and political asylum. Feminist Formations, 25, 174–194. Lewis, R., & Naples, N. (2014). Introduction: Queer migration, asylum, and displacement. Sexualities, 17/(8), 1–9. Luibhéid, E. (2002). Entry denied: Controlling sexuality at the border. Minneapolis: University of Minnesota Press. Luibhéid, E. (2008). Queer/Migration: An unruly body of scholarship. GLQ: A Journal of Lesbian and Gay Studies, 14, 169–190. Luibhéid, E. (2008). Sexuality, migration, and the shifting lines between legal and illegal status. GLQ: A Journal of Lesbian and Gay Studies, 14, 289–315. Miller, A. (2005). Gay enough: Some tensions in seeking the grant of asylum and protecting global sexual diversity. In B. Epps, K. Valens, & B. González (Eds.), Passing lines: Sexuality and immigration (pp. 137–188). Cambridge, MA: Harvard University Press. Peña, S. (2007). “Obvious” gays and the state gaze: Cuban gay visibility and U.S. immigration policy during the 1980 Mariel Boatlift. Journal of the History of Sexuality, 16, 482–513. Rehaag, S. (2009). Patrolling the borders of sexual orientation: Bisexual refugee claims in Canada. McGill Law Journal, 53, 59–102. Simmons, T. (2008). Sexuality and immigration: UK family reunion policy and the regulation of sexual citizens in the European Union. Political Geography, 27, 213–230. White, M. (2013). Ambivalent homonationalisms: Transnational queer intimacies and territorialized belongings. Interventions: International Journal of Postcolonial Studies, 15, 37–54. Yue, A. (2008). Same-sex migration Australia: From interdependency to intimacy. GLQ: A Journal of Lesbian and Gay Studies, 14, 239–262.

INCARCERATION This entry describes the manner in which LGBTQ people are incarcerated in penal facilities in the United States. Penal facilities, which include detention centers, jails, and prisons, are places where every person incarcerated is subjected to the curtailment of his or her liberty, privacy, and agency. By extension, such curtailment of these basic rights

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is associated with feelings of loss of control; loss of familial and personal relationships; and, in some cases, profound sensory deprivation. The manner in which LGBTQ people suffer in penal facilities is both similar to and different from the manner in which heterosexual, cisgender (those who identify as the gender they were assigned at birth) people experience these institutions. This entry identifies the particular ways in which LGBTQ people experience incarceration, exploring the specific hardship they endure and the way in which their sexual or gender nonconformity is punished. The entry also presents a brief overview of LGBTQ communities’ responses to incarceration.

Incarceration in the 21st Century In the 21st century, the United States is the largest incarcerator in the world, with 5% of the world’s population but 25% of the world’s prisoners. As of 2013, there were 2.4 million people in U.S. prisons or jails and 5 million more on probation or parole. A disproportionate number of those incarcerated are people of color, and this includes a disproportionate number of LGBTQ people of color and/or those who are poor. Isolation

All prisoners are forcibly removed from their families and communities, isolating them from human relationships and support. Once removed from their families and community, many prisoners have little or no contact with anyone on the outside. This is particularly true for LGBTQ people, many of whom may already have limited relationships to others, particularly those who have been rejected by their families due to homophobia and transphobia (about 40% of homeless youth identify as LGBTQ, many of whom survive through criminalized economies such as sex work, drug trade, and petty theft). Without any personal or financial means of support, many LGBTQ people are isolated in prison, increasing their vulnerability to violence. Prisoners are required to buy basic necessities from the commissary, including toiletries, footwear,

and food to supplement the inadequate materials provided by the facility. The commissary also sells postage stamps and electronics (radios and televisions) that allow moments of distraction from the reality of prison life, as well as other items to make life more bearable. Without money to buy these items, prisoners are vulnerable to exploitation by those with more resources. As indicated by the Bureau of Justice Statistics, lesbian, gay, and bisexual (LGB) prisoners, and, even more so, transgender prisoners, are vulnerable targets for physical violence or harassment by prison staff and other prisoners. Many prisoner advocacy organizations attribute this reality, in part, to lack of outside contact for LGBTQ prisoners. The assumption is that there will be few or no consequences for harming someone who is not cared for or watched by others, and the manner in which mail is publicly distributed on a daily basis indicates to all exactly who has support on the outside. Lack of support from others on the outside is also an issue for LGBTQ people who are detained in jails, attempting to defend themselves against their criminal charges. Often without money or a stable home address, LGBTQ prisoners are denied bond or cannot afford excessive bond amounts to bail themselves out, compromising their ability to defend themselves and thereby increasing the likelihood they will be convicted or serve a longer sentence. Housing and Solitary Confinement

Prisons are sex-segregated institutions based on the gender binary (the normative assertion that there are only two possible genders), and prisoners are housed in male or female institutions based on their genitalia. Transgender prisoners, therefore, are denied their gender identity by where they are confined, and their mere existence in various institutions can elevate their risk for violence and harassment by prison staff and others. LGBTQ people are also disproportionately placed in solitary confinement, and this is particularly true for transgender women. When imprisoned in solitary confinement units, alternatively called “special housing” or “protective custody,”

Incarceration

prisoners are locked in their cells for 23 hours a day, 7 days a week, and they are denied physical contact or communal activities with other prisoners, including eating, exercising, or religious practice. They are also denied access to educational programs, vocational training, and use of the library. Such conditions can cause severe sensory deprivation, leading to permanent psychological trauma and the exacerbation of symptoms for those who already suffer from a mental illness. For example, in 2011, Juan Mendez, UN Special Rapporteur on Torture (a title given to an individual chosen by the United Nations Human Rights Council working on a specific mandate), found that indefinite and prolonged periods of solitary confinement can amount to torture. Many LGBTQ prisoners report that they have been confined indefinitely in such units for months, years, and even decades. Prison officials claim this is the safest housing option for LGBTQ people, but if given the option, many prisoners would not choose to be detained in these units. Sexual Violence

Overwhelming evidence demonstrates that LGBTQ prisoners are more likely to be subjected to sexual violence than others in the prison population. A popular myth promoted by the mass media tends to suggest such violence is only committed by other inmates; however, a plethora of studies and surveys, including those by the federal Bureau of Justice Statistics, have demonstrated that sexual violence is often perpetrated by prison staff. Such violence includes sexual assault, sexual coercion, dehumanizing strip searches, and sexual harassment. Moreover, prison officials often intentionally house LGBTQ prisoners in dangerous situations, placing them in cells with people who are known to be sexually violent or refusing to remove them after they report having been assaulted. Prison rape has garnered much attention in recent decades and led to the passage of the Prison Rape Elimination Act (PREA) in 2003, as well as regulations issued by the U.S. Department of Justice in 2012 that are ostensibly designed to provide protections for prisoners at risk of sexual

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victimization, especially LGBTQ prisoners. The PREA regulations, however, are not universally celebrated by prisoners or their advocates, who question their efficacy and the further erosion of prisoners’ privacy brought by these reforms. Many object to PREA’s limited definition of sexual violence because it does not include the performance of strip searches, which are degrading to all, and are the means by which scores of LGBTQ prisoners are sexually assaulted and harassed. PREA regulations have also been used by prison officials to further punish consensual sexual activity. The Ban on Sexual Activity

All prisons ban sexual activity between prisoners regardless of whether the sexual activity is consensual. Those who identify as or are perceived to be LGBTQ are subjected to more surveillance and punishment for the violation of these rules, whether or not such violations occur in fact. LGBTQ prisoners are frequently punished and sent to punitive segregation for hand holding or hugging other prisoners or the removal of one’s clothing in hot weather; post-PREA, the frequency and punishment for such violations have increased. Further, LGBTQ prisoners have been denied access to programming where prison officials believe their sexual partners are attending the same services. Though it is well known that prisoners engage in consensual sexual activity, no safer sex materials are made available in the vast majority of prisons. Forbidding items such as condoms places prisoners at risk for sexually transmitted infections (STIs). This is particularly dangerous for HIV-positive prisoners, who are at greater risk of contracting STIs, particularly hepatitis. Denial of Gender Identity and Expression

Transgender and gender-nonconforming prisoners, particularly transgender women, are subjected to additional forms of violence and the denial of their gender identity beyond where they are housed. Transgender prisoners are routinely denied access to hormone therapy and other gender-confirming

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care. Often, access to hormone therapy is dependent on whether prisoners have been diagnosed with gender identity disorder (GID) or gender dysphoria and receiving such treatment prior to their imprisonment. However, there are ongoing battles to get these medications administered consistently in the proper dosages in accordance with the World Professional Association for Transgender Health (WPATH) standards of care. Even those who were taking hormones prior to their incarceration may have such medical care discontinued if they did not  have a legal prescription and a documented diagnosis. Transgender and gender-nonconforming prisoners are also regularly denied access to genderappropriate clothing and grooming items, including undergarments and cosmetics, that cisgender people are allowed to possess. Many are also forced to cut their hair or trim their nails according to traditional gender roles. When transgender prisoners are refused access to gender-affirming care and material needs, they are at a much higher risk for depression, self-injury, and suicide. Medical Neglect

Prisoners all across the country receive substandard medical care, regardless of their gender identity or sexual orientation, but it has particularly damaging effects on prisoners living with HIV/AIDS who are disproportionately incarcerated. (According to the Center for HIV Law and Policy, 1 in 7 people living with HIV will be incarcerated at some point in their lives.) Prisons have a history of isolating HIVpositive prisoners. Prior to 2013, all 50 states failed to have policies that precluded placing prisoners with HIV/AIDS in solitary confinement on the basis of their status. Prisoners with HIV/AIDS continue to be subjected to discrimination, including practices that “out” their HIV/AIDs status, which makes them at risk for harassment, isolation, and violence from other prisoners and staff, and access to medications and proper dosages is interrupted or arbitrarily denied on an ongoing basis. Resistance to Incarceration

As long as LGBTQ people have been subjected to incarceration, there have been grassroots

community efforts responding to the harms caused by imprisonment. In the 1970s, early gay pride marches in New York City rallied outside a jail in Manhattan cheering for prisoners’ release and connecting the struggle for gay liberation with the antiprison movement. Many gay magazines and newspapers, including Boston’s Gay Community News, made subscriptions available to prisoners for free or discounted prices. In the late 1970s through the mid-1990s, support campaigns were organized for gay men who were incarcerated on the basis of trumped-up sex-related charges, often accusing them of pedophilia. In the late 1980s through the early 1990s, the AIDS Coalition to Unleash Power (ACT UP) challenged the U.S. Government’s failure to address the HIV/AIDs epidemic, which included efforts to challenge the criminalization of people with HIV/AIDS (a criminalization tactic that continues in 2015) and support those living with the disease, including those who were incarcerated. By the beginning of 2000, there were multiple organizations throughout the country working to address the needs of LGBTQ people in prison while organizing as part of a larger antiprison movement, including, but not limited to, the Transgender, Gender Variant, and Intersex Justice Project; Black and Pink; Sylvia Rivera Law Project; Hearts on a Wire; and the Transformative Justice Law Project, all of which engage in pen pal  programs and work to build connections with LGBTQ prisoners to meet their needs and stave off isolation and violence. Some mainstream LGBTQ organizations have publicly supported the construction of units designed solely to house transgender prisoners, operating under the belief that such specialized units would be safer for transgender people. Others believe such units will serve to segregate transgender prisoners from other prisoners and make them more vulnerable to abuse and harassment from prison officials in the absence of any other witnesses. Prisoner-specific LGBTQ organizations and many LGBTQ prisoners oppose building new or expanding old prisons to protect LGBTQ prisoners, believing prisons are inherently and inextricably violent and unsafe places. Motivated by such beliefs, many LGBTQ antiprison organizations subscribe to an ideology of

Infertility and Reproductive Loss

prison abolition, in which incarceral institutions and practices (including, but not limited to, police, judges, prisons, surveillance structures, and racialized criminalization) are abolished and replaced with community-based solutions. A growing number of LGBTQ organizations, including Generation Five, Creative Interventions, and the Audre Lorde Project, are exploring transformative ways to hold people accountable for the harm they have caused without resorting to retributive justice and punishment meted out in the criminal legal system and by incarceration.

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depending on local laws) being “reclaimed” by a birth parent. Because of this, concerns that are unique or heightened for LGBTQ families—such as financial concerns relating to assisted reproductive technologies or adoption processes, the experiences of nongestational parents, and homophobia in health care surrounding loss and infertility— have been neglected. This entry presents these aspects of LGBTQ reproductive loss and infertility through a review of the existing literature published by anthropologists, nurse-midwives, social workers, and psychologists.

Jason Lydon and Joey L. Mogul

Deafening Heteronormativity See also Criminal Legal System and LGBTQ People

Further Readings Davis, A. (2003). Are prisons obsolete? New York, NY: Seven Stories Press. Kunzel, R. (2008). Criminal intimacy: Prison and the uneven history of modern American sexuality. Chicago, IL: University of Chicago Press. Mogul, J., Richie, A., & Whitlock, K. (2011). Queer (in) justice: The criminalization of LGBT people in the United States. Boston, MA: Beacon Press. Stanley, E., & Smith, N. (2011). Captive genders: Trans embodiment and the prison industrial complex. Oakland, CA: AK Press.

INFERTILITY

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REPRODUCTIVE LOSS

This entry describes LGBTQ experiences of infertility and reproductive loss, including pregnancy loss (often referred to as miscarriage in early-tomid pregnancy), infant loss following pregnancy, failed adoption, and failed surrogacy arrangements. Although reproductive loss and infertility are common—estimates suggest that nearly 25% of pregnancies end in miscarriage, and infertility is on the rise in many areas of the world—little has been written about LGBTQ people’s experiences with them. Similarly, few studies are available on cases of adoption to LGBTQ families that are not completed, or children that are placed with an adoptive LGBTQ family (often for up to 30 days,

Although much has been written about the homophobia and heteronormativity experienced by LGBTQ parents, few researchers have addressed what Elizabeth Peel and Ruth Cain have referred to as the “deafening heteronormativity” that infuses the experiences of LGBTQ parents who have suffered a loss. It is important to note that the use of the word “parents” in the latter instance is strategic, since most people who have experienced reproductive loss identify themselves as parents of the child(ren) they have lost, whether or not they have other children. Similarly, the experience of infertility among LGBTQ people is often downplayed because of assumptions that a same-sex partner will be willing and able to donate eggs or sperm for subsequent attempts at conception, or, in the case of cis-female partners, carry a pregnancy. Most existing studies of LGBTQ experiences with miscarriage have been based on small samples (6–20 participants) and have focused almost exclusively on White women’s experiences. The first major empirical study addressing queer women’s experiences of pregnancy loss was psychologist Elizabeth Peel’s online survey of 60 lesbian, bisexual, and queer women who had experienced miscarriage. Nurse-midwife Danuta Wojnar has proposed that, unlike some heterosexual mothers, lesbian mothers frequently bonded with their unborn child very early in pregnancy. Regardless of whether a loss occurred early or late in the pregnancy, these studies report that it had a “significant” or “very significant” impact on the lives of lesbian, bisexual, and queer women. Some parents

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report that they grieved not only the loss of their child(ren) but also the loss of their hopes and dreams for the future.

Seeking Support Likewise, little has been written on LGBTQ experiences with infertility. Michelle Walks’s research on infertility in queer families has critiqued the flawed logic of previous studies, which highlighted the “fairly unique advantage” for lesbian women that if one partner was unable to conceive, they could “swap.” She also emphasized the emotional challenges that such an arrangement posed for some queer couples, especially for people who do not embrace a stereotypical “feminine” identity, such as butches, genderqueers, or some transidentified individuals, some of whom reported little interest in pregnancy themselves and were distressed by health care providers’ suggestions that they should pursue pregnancy when their partners experienced infertility. It is also notable that recent studies have suggested particular conditions of infertility are more common or more severe among some queer women and transmen (i.e., polycystic ovary syndrome and endometriosis), which may or may not be acknowledged by health care practitioners. In some cases, LGBTQ individuals have also welcomed a diagnosis of infertility—as a validation of the emotional or physical pain they were feeling during the process and, for those who were trying to conceive, as a reason for no longer having to worry about becoming pregnant themselves. Other studies have shown that many queer women seek support for infertility, infant loss, and miscarriage in online and in-person assisted reproduction support groups, but that homophobia can increase their sense of isolation. Others report avoiding support groups for fear that they would have to justify or explain their (queer) relationship, and were unwilling to do so during such a difficult time in their lives. To date, there is little research on the experiences—homophobic or otherwise— of gay and bisexual men experiencing infertility or loss while pursuing surrogacy or adoption (except

as part of larger studies about gay parenting), or the reproductive experiences of transgender and genderqueer parents. Even for LGBTQ individuals who did not experience overt homophobia in seeking treatment for infertility or during a loss, many report fearing negative responses, and several studies have underscored the importance of educating health professionals about LGBTQ health and families, in particular to emphasize the difficulty of achieving pregnancy. Regarding failed adoptions, some LGBTQ prospective parents feel that because adoption professionals consider them “undesirable” or “hard to place” parents, they are “pushed” to accept “riskier” open adoptions with birth mothers who may not feel ready to commit to adoption. Although there is no statistical data on failed adoptions among LGBTQ families that are forthcoming from adoption agencies (e.g., because they are trying to entice lesbian and gay prospective clients, whom they assume to be wealthier than heterosexual adopters), Abbie E. Goldberg’s work with gay fathers and adoption makes it clear that these experiences are not entirely uncommon. Further, the decision to adopt (rather than pursue surrogacy or conceive children via assisted reproduction) may elicit a considerable sense of loss for parents who had hoped to have a biological connection with their child. Popular sources—including memoirs and blogs—have also begun to address LGBTQ experiences of infertility and loss for broader audiences. For instance, Kristen Henderson and Sarah Kate Ellis’s 2011 memoir, Times Two: Two Women in Love and the Happy Family They Made, chronicles their simultaneous pregnancies, as well as their experience of two losses: Sarah’s miscarriage at 11  weeks, and later her “disappearing twin,” the loss of one child during a twin pregnancy. Even these personal narrative accounts, however, remain relatively sparse.

Partners and “Social” Parents A particularly underresearched area of LGBTQ infertility and loss, as well as LGBTQ parenting, is

Infertility and Reproductive Loss

the experience of what many researchers have come to call “social” mothers in contrast to “biological” or “gestational” mothers, and adoptive parents. Some scholars have gone so far as to describe lesbian motherhood solely in terms of a biological or legally adoptive relationship between a mother and child(ren), negating the experiences of nongestational or “social” mothers who are not legally able to adopt their children. Even when “social” mothers narrate their own accounts, primacy is often placed upon the gestational mother’s experience. In Henderson and Ellis’s memoir mentioned above, for instance, although the authors shift back and forth between their own perspectives throughout the book (identified by their names), the discussion of both losses they experienced together was almost entirely written in the gestational mother’s (Sarah’s) voice, though she notes on several occasions that Kristen was in even worse shape emotionally than she. The existing research on nongestational parents’ experience of infant loss and miscarriage, albeit sparse, shows that some nongestational mothers, trans parents, and gay men who experience miscarriage with a surrogate or during adoption arrangements report having a deep sense of loss after a miscarriage, while others express milder feelings of disappointment (e.g., some feel that they do not experience the level of distress that a gestational parent does). Nongestational parents often report that health care workers, friends, and coworkers—both heterosexual and queer—frequently expressed surprise that they didn’t “get over” the loss faster. Instead, family and friends more consistently inquired about how their partner was doing after their loss. For some nongestational parents, their sense of loss goes structurally far deeper than the emotional loss of their child. For instance, in countries where same-sex second-parent adoption is illegal, infertility that results in a parent shifting from the gestational mother to the nongestational mother means that, in addition to not having a biological relationship to their child, they will also not have legal ties to him or her. The same is true in areas where samesex coadoption is illegal and only one parent is

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able to legally adopt. As Abbie Goldberg’s research demonstrates, negotiations over who will become the “official” adoptive parent in such instances can also cause friction within families by highlighting uncomfortable socioeconomic inequities and power differentials between partners. These legal inequities also leave the potential for further losses in the future, in the event that a relationship ends and the parent who was unable to adopt legally retains no legal relationship to the children. Regarding child loss, Ellen Lewin’s study of gay fatherhood notes that when an adoption does not go through for gay men, or a birth mother “reclaims” the child after a gay (or lesbian) couple has brought the child into their home, such losses are experienced similarly to the way the death of an already existing child might be felt. Researchers have also shown that, whereas gestational mothers felt they could grieve openly, social mothers often kept their sadness more hidden with the intent of “being strong” for their partners. Such losses are compounded for expectant nongestational parents who have not come out at work or to their family. It is also important to note that the experiences of infertility and reproductive loss among LGBTQ people are inevitably mediated by intersecting axes of privilege and marginalization based on ethnicity, social and economic capital, (dis)ability, and so on. No current research exists that is extensive enough to attend to these differences. There is also a great deal of variation regarding the legal status of LGBTQ relationships and parents throughout the world, and within countries like the United States, where legal rights vary by state. These diverse legal statuses undoubtedly affect the experiences of reproductive loss for nongestational parents, particularly regarding whether they are able to make health care decisions for their partner or the autopsy or funeral arrangements after a stillbirth.

Infertility, Loss, and Financial Concerns Financial concerns are often an unspoken anxiety that LGBTQ individuals and families have during the already emotional experience of infant loss or

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prolonged infertility. Financial concerns may be especially heightened among those who have invested substantially in assisted reproductive technologies, surrogacy arrangements, or adoption proceedings. Talking openly about the expenses associated with a baby they had lost, however, may be avoided by the parents, as it may seem to taint the emotional experience of loss. Ultimately, the resources invested in achieving pregnancy (emotional, interpersonal, financial, and physical) shape, and often intensify, the experience of reproductive loss and infertility for LGBTQ families. It is significant that financial concerns for LGBTQ families vary widely across countries and jurisdictions, based on whether access to assisted reproductive technologies is open to LGBTQ parents and which technologies are available for free, or paid for by the individual or family. For many LGBTQ parents, experiencing prolonged infertility or loss increases the urgency to try to become pregnant or adopt again. Some report taking out second mortgages, maxing out credit cards, or borrowing money from relatives to try to conceive or adopt again. In addition, there are many LGBTQ people who would like to try in vitro fertilization or to adopt, but are unable because of restricted financial resources. Financial concerns in LGBTQ reproduction remain a significant issue that has yet to be discussed in most academic and popular literature.

experience of having an adopted child who was ultimately “reclaimed” by a birth parent. Others have “marked” their experience with commemorative tattoos—some individual and others as matching artwork shared by parents. These memorials help parents to mourn their loss within their communities immediately following their experience, and permanent memorials like tattoos can be part of their long-term healing process and their connection to wider communities of support.

Conclusion Although research on infertility and reproductive loss in LGBTQ communities is relatively nascent, studies are emerging across a variety of academic disciplines and health professions. Since there is growing evidence that pregnancies and adoptions for LGBTQ people are more likely to have involved lengthy planning and resources, professionals should be particularly attentive to how their reproductive histories may contribute to and amplify experiences of loss. Similarly, experiences of infertility for LGBTQ individuals and families are likely to be amplified by inequitable laws, as well as homophobic or heterosexist responses by professionals, family, colleagues, and friends. Better understanding of these experiences is central to broader health care efforts aimed at improving the health—both physical and emotional—of LGBTQ populations.

Memorializing Loss LGBTQ communities have a long history of memorializing loss, such as with the NAMES Project or AIDS memorial quilt, the Transgender Day of Remembrance, and art and fiction memorializing the Stonewall riots. The experience of reproductive loss (and, to a lesser extent, infertility) is emerging as another powerful space for memorialization that can challenge heteronormative assumptions about loss and grief, as well as expectations of belonging, community, and family formation. For instance, LGBTQ families of various faiths have worked with religious practitioners to create new ceremonies and physical memorials to mark the death of children, the experience of miscarriage, and the

Christa Craven See also Adoption and Foster Care Discrimination; Coparenting; Deciding Whether to Parent; Dying, Death, and Bereavement; Families of Choice; Health Care Providers, Disclosure of Sexual Identity to; Health Disparities; Legal Rights of Nonbiological Parents; Second-Parent Adoption

Further Readings Cacciatore, J., & Raffo, Z. (2011). An exploration of lesbian maternal bereavement. Social Work, 56(2), 169–177. Craven, C., & Peel, E. (2014). Stories of grief and hope: Queer experiences of pregnancy loss. In M. Gibson (Ed.),

Intellectual Disabilities Queering motherhood: Narrative and theoretical perspectives (pp. 97–110). Bradford, Ontario, Canada: Demeter Press. Goldberg, A. E. (2012). Gay dads: Transitions to adoptive fatherhood. New York, NY: New York University Press. Miscarriage Association. (2014). Partners too. Retrieved November 10, 2015, from http://www .miscarriageassociation.org.uk/wp/wp-content/ uploads/2011/04/Partners-Too.pdf Peel, E. (2010). Pregnancy loss in lesbian and bisexual women: An online survey of experiences. Human Reproduction, 25(3), 721–727. doi:10.1093/humrep/ dep441 Peel, E., & Cain, R. (2012). “Silent” miscarriage and deafening heteronormativity: A British experiential and critical feminist account. In S. Earle, C. Komaromy, & L. Layne (Eds.), Understanding reproductive loss (pp. 79–92). Farnham, England: Ashgate. Walks, M. (2007). Breaking the silence: Infertility, motherhood, and queer culture. Journal of the Association for Research on Mothering. Special Issue: Mothering, Race, Ethnicity, Culture, and Class, 9(2), 130–143. Wojnar, D. (2007). Miscarriage experiences of lesbian couples. Journal of Midwifery & Women’s Health, 52(5), 479–485. doi:10.1016/j.jmwh.2007.03.015 Wojnar, D., & Swanson, K. M. (2006). Why shouldn’t lesbian women who miscarry receive special consideration? Journal of GLBT Family Studies, 2(1), 1–12. doi:10.1300/J461v02n01_01

INTELLECTUAL DISABILITIES This entry addresses the nuanced concerns of a sexual minority within a sexual minority. People with intellectual disabilities (ID) are frequently thought to be sexually innocent, but many have the ability to understand and act on sexual orientation and gender identity. While it is recognized that sexuality traverses intellectual boundaries, there is little support for its encouragement. This entry also addresses topics that help us to better understand how sexual orientation and gender identity are expressed among people with ID and includes the topics of consent, protection from abuse, demographics, and education.

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Background People with intellectual disabilities have been integrated into society in significant ways, but there is still a pre-Stonewall mentality, a lack of full acknowledgment and acceptance, when considering their needs and desires for sexual expression. Still emerging is the recognition that people with an intellectual disability share the same human need for sexual expression as those without disabilities. National organizations supporting people with ID, such as the American Association of Intellectual and Developmental Disabilities and The Arc, acknowledge that an ID does not preclude someone from being able to explore and enjoy his or her sexuality, but there is little evidence that sexuality is supported and encouraged. These difficulties result in a stark contrast between the overarching policies guiding professionals who support people with IDs and their implementation with the very people the policies are designed to impact. People with ID have many obstacles to overcome in order to have opportunities for sexual expression. There is a well-documented history of how people with ID have been denied opportunities for sexual expression. Moments of intimacy and the ability to develop close personal relationships are frequently restricted for people with ID, due to paternalistic attitudes that regard them as sexually innocent and requiring protection from adult experiences. Many people with ID, especially those who receive support through state-sponsored services and their network of private nonprofit providers for residential and vocational services, rely on support staff to facilitate the daily routines of life. Developing a relationship that has the potential to lead to intimacy with another person often requires access to financial resources, transportation, wardrobe, and privacy, among many other considerations. Maneuvering within a relationship is further complicated for people with ID, since they can be dependent on support staff for access to various resources (e.g., transportation, since many people with ID do not drive). The ability of a person with ID to explore sexual expression engages a process that frequently requires staff

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who are comfortable with providing that support. When sexual expression topics are filtered through staff and become incorporated into practices, people with ID can experience varying outcomes as reflected along a continuum from low to high staff support. These outcomes are often connected to the comfort level of the support person when facilitating sexual expression opportunities for their clients with ID. People with ID often require additional assistance to develop an understanding of sexuality. They require a comprehensive approach to sexuality that goes beyond the traditional sex education programs to one that involves a person-centered support team with individualized assessment of needs. The primary barrier to sexual expression by people with ID has been an insufficient effort by caregivers and provider agencies to adequately address sexuality. It was believed that by deliberately keeping people with ID uninformed about issues involving sexuality, they could be protected from experiencing a sexual awakening. However, the resulting ignorance manifests in higher rates of sexual abuse, unsafe sexual practices, unintended pregnancies, inappropriate social behavior, and ultimately a diminished quality of life. Even though many of the agencies that support people with ID recognize there is an inherent sexual right for people with ID, persistent conservative societal attitudes restrict their right to sexual expression. Many parents, service providers of people with ID, and even people with ID hold more conservative views toward all but the most benign expressions of sexuality. Conservative and negative attitudes result in the identification of people with ID as innocent dependents requiring protection from adult experiences. Sexuality is an underaddressed area in the support of people with ID. Specifically, there is limited acknowledgment that people with ID can understand many topics relating to sexuality and sexual expression including gender identity, safe-sex practices, and contraceptives. People with ID are frequently reliant on support staff, yet there is a lack of information revealing how caregiver practices impact the ability of people with ID to experience sexual expression.

What is needed in the profession is guidance reflecting how caregivers can support people with ID when those opportunities emerge.

Demographics Recognizing the demographic considerations of a cultural group allows for a more in-depth presentation of its diversity. As a marginalized group, people with ID have often been presented as monolithic and sexually obscure. Therefore, the consideration of demographics of people with ID provides a path for recognizing sexual diversity within the population. A diagnosis of intellectual disability requires the presentation of three criteria. These include (1) a subaverage general intellectual functioning with an IQ below 70, (2) limitations in adaptive behaviors, and (3) a manifestation before the age of 18. It is generally accepted that up to 3% of the U.S. population experiences an intellectual disability, and among these 9 million people, most experience only a mild intellectual disability. This means that most people with ID have the capacity to understand safe sexual practices. Many studies have been conducted to identify the population of LGBTQ people. These studies usually rely on self-disclosure of sexual identity, and while the community is difficult to quantify, the Williams Institute’s 2011 study reported that 3.5% of the population identifies as lesbian, gay, or bisexual (LGB), and another 0.3% identifies as transgender. Since sexual orientation and gender identity traverse multiple boundaries, including intellectual boundaries, a best estimate would be that there are approximately 350,000 LGBTQ people with ID in the United States.

On Becoming a Sexual Person Developing sexual knowledge for anyone usually happens over time. Sexual knowledge is obtained by engaging in personal exploration, formal sex education, peer interactions, and media consumption, among many other ways that a person discovers what he or she likes and dislikes. For people

Intellectual Disabilities

with ID, the process can be arduous as they must frequently navigate major obstacles due to a lack of formal education, low expectations from family and society, support staff indifference, and limited opportunities for social interactions. Too often, in order for a person with ID to be able to have sexual opportunities, the individual must be able to articulate or demonstrate his or her desires and intentions and then have a network of support to ensure that those opportunities occur. There are several considerations that can assist people with ID to express their sexuality including understanding what it means to give consent, participating in educational opportunities, learning about legal issues and social norms, and maintaining good working relationships with support staff.

On Being LGBTQ With an Intellectual Disability People with ID and people who are LGBTQ are aware that there is bias and discrimination directed at these communities. Just as people with ID are part of a marginalized community, they also encounter an additional burden when they identify as LGBTQ. Despite several initiatives that have dealt with the discrimination and bullying that people with ID frequently endure, such as the R-word campaign to eliminate the use of the word retarded in social vernacular and popular culture, change is difficult to enact. Similarly, people with ID can be conflicted about openly identifying as a sexual-minority person and being part of another stigmatized community. Since most people with ID rely on others to assist them with their daily life, whether or not they are able to have opportunities for sexual expression is determined by how comfortable their support staff and family members are with them engaging in these activities. Support staff working within the disability community may have conservative rules and values, thereby presenting additional challenges when a person seeks to engage in any sexual activity. It can be difficult for people with ID to find a peer group where they can find a partner. So

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limited are the opportunities that often the only way for an LGBTQ person with ID to engage his or her sexuality is in a support group where there is only conversation and few opportunities for sexual activities. Some people with ID have said that they find greater societal acceptance of their sexuality as an LGBTQ person than as a person with ID. A topic for research would be to consider how people with ID navigate their connection between these two marginalized communities.

Consent Agencies within the ID profession (e.g., American Association of Intellectual and Developmental Disabilities [AAIDD] and The Arc) presume that people with ID are able to make important personal decisions that allow them to lead self-determined lives. However, because of the disability, a person with ID many not have the capacity to give valid consent to engage in sexual activities. When a person is unable to give valid consent, legal intervention may be required to designate a guardian. Different sexual activities may be impacted by the ability of the individual to give consent. People with ID are generally able to participate in benign activities, such as demonstrations of affection or learning about sexual health, but more intimate physical activities, especially those that involve same-gender sexual behaviors, require professional scrutiny to determine whether the individual can be safe and is able to give consent to the activity. Valid consent means that it must be voluntarily given and without coercion. Assisting people with ID to have better access to sexual expression requires support staff to understand that the ability to give consent is but one resource and does not automatically restrict an individual from having more involved opportunities.

Protection From Abuse It is widely noted that people with ID experience a very high rate of sexual abuse. Victimization includes both sexually inappropriate and nonconsensual actions. Support staff often receive training

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about how to recognize, prevent, and report instances of abuse. In part because of this dynamic, support staff can interpret any displays of sexuality to be a risk for sexual abuse. Even though the LGBTQ community has made tremendous social advancements such as the decriminalization of same-sex activities and the freedom to legally marry, many individuals and support staff can be conflicted about what is legally and morally permissible for people with ID to experience.

Education A desire for relationships and sexual expression is a fundamental component of the human experience. It is important to recognize that romantic relationships and sexual activity are also important issues for people with ID. Friendships and interactions with support staff, volunteers, and family members cannot substitute for personal friends and intimate companions. Sex education must be tailored not only for people with ID, but also for those who must provide individualized support and advocacy for their clients.

Conclusion Many enduring assumptions have been made about the sexual expression of people with ID. Among the most damaging has been that they are asexual or childlike and deserve protection from such adult experiences. Others have similarly believed that by keeping those with ID uninformed or by deliberately withholding sexual education, they could maintain a sexual innocence. However, there is a growing awareness that having a good quality of life involves being able to possess sexual knowledge, have access to sexual pleasure, and form friendships that can develop into romantic relationships. The ability to participate in life as a sexual person with a basic knowledge of biological and emotional sexual functioning and to know how to be safe when engaging in sexual activities is a fundamental right of all people. Acknowledging and practicing this right engages a process that begins with self-awareness and leads to self-determination and greater independent living. In order for people

with ID to have greater acceptance in society, the need for genuine opportunities for sexual expression is a frontier that will have to be acknowledged not only by people with ID, but also by family members and the professional network of support. John D. Allen See also Age of Consent; Ally Experience; Bullying, Rates and Effects of; Physical Disabilities; Support Groups and Resources

Further Readings Allen, J. D. (2003). Gay, lesbian, bisexual, and transgender people with developmental disabilities and mental retardation: Stories of the Rainbow Support Group. Binghamton, NY: Haworth. Gardner, J. F., & Chapman, M. S. (1993). Developing staff competencies for supporting people with developmental disabilities: An orientation handbook (2nd ed.). Baltimore, MD: Brookes. Monat-Haller, R. K. (1992). Understanding and expressing sexuality: Responsible choices for individuals with developmental disabilities. Baltimore, MD: Brookes. Schwier, K. M., & Hingsburger, D. (2000). Sexuality: Your sons and daughters with intellectual disabilities. Baltimore, MD: Brookes. Stavis, P. F., & Walker-Hirsch, L. W. (1999). Consent to sexual activity. In R. D. Dinerstein, S. S. Herr, & J. L. O’Sullivan (Eds.), A guide to consent (pp. 57–67). Washington, DC: American Association on Mental Retardation. Walker-Hirsch, L. (Ed.). (2007). The facts of life . . . and more: Sexuality and intimacy for people with intellectual disabilities. Baltimore, MD: Brookes. Wolfensberger, W. (1972). The principle of normalization in human services. Toronto, Ontario, Canada: National Institute on Mental Retardation.

INTENTIONS TO PARENT

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MOTIVATIONS

Around the world and across cultures, most people eventually become parents. Unwanted pregnancies do occur, but most unplanned pregnancies are merely mistimed; most childless people are motivated to

Intentions and Motivations to Parent

become parents and plan to become parents at some time. Descriptions of intentions and motivations for parenthood have appeared in literature as old as the Hebrew Bible, and they persist cross-culturally today. Even the phenomena of nonheterosexual and transgender parenthood are not new: Historically, people in Western societies who experienced same-sex desires and intimacies often married different-sex partners and became parents, a practice that has become less common among sexual-minority adults, but still occurs today. Most LGBTQ people today, however, face unique barriers to parenthood. Family formation outside of heterosexual marriage has historically been stigmatized in Western societies, and there are legal, social, financial, and biological barriers to parenthood that can render intentions and motivations for parenthood among LGBTQ people more complex than among cisgender, heterosexual people. This entry will describe research findings about LGBTQ people’s intentions and motivations for parenthood. Further, it will discuss research with lesbian, gay, bisexual, transgender, and queer people with attention to the ways that experiences within this group may vary, given that there is a great deal of diversity within LGBTQ communities. This is particularly true in discussions of intentions for parenthood. Cisgender lesbian, bisexual, and queer women and some transgender people can become pregnant, while others who intend to become biological parents without cisgender female partners must pursue surrogacy, which is much more financially costly than donor insemination. Some members of LGBTQ communities are likely to face greater social and legal barriers to parenthood than others, depending on local legal and social climates as well as their own identity, gender expression, and other demographic characteristics.

Intentions for Parenthood “Now I’ll never have grandchildren,” was once a common parental refrain when their adolescent child came out as lesbian, gay, or transgender. To many lesbian, gay, transgender, or queer (LGTQ) individuals and their parents, coming out as lesbian, gay, or transgender before having children

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often implied forgoing parenthood. This conflation of parenthood and heterosexuality has become less and less common in recent decades. Today, many LGBTQ people are becoming parents outside of heterosexual relationships. The increasing visibility of openly LGBTQ parents in media and daily life has helped childless LGBTQ people to recognize that this is possible. Many routes to parenthood outside of heterosexual sex are now available, such as adoption, foster care, donor insemination, surrogacy, and coparenting. Femalebodied people (such as cisgender women and some transgender people) can become biological parents through donor insemination, in which a layperson or a medical professional inseminates a woman with fresh or previously frozen donor sperm. Male-bodied people (such as cisgender men and some transgender people) can become biological parents through surrogacy, in which a woman carries and gives birth to a child for someone else. Coparenting is a variation on these methods, in which two or more people agree to conceive and raise a child together outside of a romantic relationship. For example, a gay male couple might decide to coparent with a single female friend. In other words, intentions to engage in heterosexual sex are no longer necessary to become a parent. Intentions consist of what someone plans to do. Notably, this is distinct from desires, which are what someone wants to do, and motivations, which are the reasons that someone wants or plans to do something. Sometimes, there is a gap between parenting desires and intentions, which a person might express by saying, “I want to become a parent, but I don’t think it will happen.” For example, a single gay man in his 40s who wants to become a father might not intend to do so if he feels that he is too old, it is too difficult to overcome legal barriers to adoption as a single father, or being a single parent is too emotionally difficult.

Transgender People’s Intentions for Parenthood Unfortunately, no research has focused on intentions for parenthood among bisexual people, and little research has addressed this topic specifically among

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transgender people. Decision-making about biological parenthood, in particular, presents challenges for childless transgender adults who have undergone or are considering undergoing hormonal therapy or sex reassignment surgery. This transition may interfere with the potential for biological parenthood. Existing research suggests that many childless transgender adults want and intend to become parents. Some transgender adults freeze their genetic material (i.e., sperm, eggs) prior to undergoing biological transitions. This can allow them to fulfill intentions for parenthood, or, if they are already parents, to have additional children after transitioning. Some childless transgender men regret that they did not do this. In some cases, the technology wasn’t available at the time they transitioned, and in other cases, the transgender men were unaware that the technology was available. These findings have implications for mental and physical health care. Providers might help transgender people make informed decisions about reproduction by discussing possible intentions for parenthood with those who are considering hormone therapy or sex reassignment surgery.

Lesbian and Gay People’s Intentions for Parenthood Many childless lesbian and gay adults (some of whom may be transgender) in the United States, Italy, and Israel (the nations studied) report that they do want to become parents at some time. Most childless lesbian and gay adults who report that they want to become parents also intend to become parents; in other words, they plan to fulfill their desire for parenthood. However, gay men seem to be more likely than heterosexual peers to harbor desires but not intentions for parenthood. Notably, this research has mental health implications. Gay men who want to become parents but don’t intend to do so are more likely to experience symptoms of depression and otherwise lower sense of well-being. Mental health providers might note that this finding is consistent with literature on heterosexual prospective parents experiencing infertility; that is, infertile heterosexual couples often experience depressive symptoms as well. Thus, unfulfilled desires for parenthood may lead

to negative mental health outcomes regardless of whether someone is actively pursuing parenthood. Because gay men (and potentially lesbian women) are more likely than heterosexual peers to experience desires for parenthood without intentions for parenthood, unfulfilled parenting desires may contribute to higher rates of depressive symptoms among lesbian and gay adults than among their heterosexual counterparts. A small but growing body of research suggests that plans for parenthood also relate to aspects of lesbian, gay, and bisexual (LGB) adults’ social climates. For example, among those who live in U.S. states with policies that affirm LGB-parent families, gay and bisexual men who care more about becoming fathers in the future report greater wellbeing than gay and bisexual men who don’t care as much about becoming fathers. In contrast, gay and bisexual men who care more about becoming fathers in the future report worse well-being than those who don’t care as much about becoming fathers when they live in states with policies that disallow full legal recognition of LGB-parent families. These findings may reflect differences in legal and social experiences in these distinct communities, and they highlight the importance of legal and social context in intentions for parenthood.

Motivations for Parenthood A life free of children holds a certain appeal for many people, regardless of their sexual orientation or gender identity. After all, research suggests that the transition to parenthood leads to a decline in relationship satisfaction for most couples (LGBTQ and otherwise). Further, raising a child to adulthood today costs a great deal of money, and adults without children have more freedom to travel and pursue hobbies. There are additional reasons why LGBTQ people might choose not to become parents. Many LGBTQ people face additional financial costs for becoming parents, whether through adoption, assisted reproductive technology, or other means. Some routes to parenthood also require prospective parents to overcome social barriers, such as social workers who disapprove of LGBTQ parents, or legal barriers, such as laws that prevent two women

Intentions and Motivations to Parent

from becoming legal parents to the same child. Perhaps because of these barriers, LGBTQ people are less likely than heterosexual people to experience social pressure to become parents. So what is it that is motivating more and more LGBTQ people to pursue parenthood? Little to no research has addressed this topic among transgender people, but there is a body of research on LGB people’s motivations for parenthood. When asked, LGB parents and prospective parents describe some of the same motivations as their heterosexual peers. They also, however, describe some motivations related to their experiences as LGB people. Motivations Unrelated to LGB Identity

Heterosexual and LGB people describe many similar motivations for parenthood. For example, LGB and heterosexual parents and prospective parents alike tend to name personal fulfillment as a motivating factor. Personal fulfillment includes giving love, enjoying time with children, and passing on family traditions. Gay men who are pursuing adoption, in particular, have described altruistic motivations shared by heterosexual prospective adoptive parents. In particular, they report that they are motivated to emotionally and financially support children who might have otherwise lacked that support. Other motivations to parent are less altruistic, but are also shared by many LGB and heterosexual parents and prospective parents. For example, some heterosexual and LGB parents and prospective parents note that one of their motivations for parenthood is to have children to care for them in their elder years. Many LGB and heterosexual parents also note that they are motivated to take on a parenting role in part because it is such a common part of life for many adults. Motivations Related to LGB Identity

While many heterosexual parents and prospective parents report that motivation to share their values with a child contributed to their plans for parenthood, one study suggests that LGB parents and prospective parents are particularly motivated

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by the desire to teach a specific value: tolerance. The authors of this study have suggested that experiences with bias and discrimination may be one reason that LGB parents and prospective parents are more likely to focus on this value. Notably, some motivations for parenthood seem more common among heterosexual than among LGB prospective parents. For example, the desire to continue the family line is less commonly cited by LGB parents and prospective parents, perhaps because LGB parents and prospective parents are less likely to pursue biological parenthood.

Conclusion LGBTQ people can face unique challenges as they pursue parenthood, but notably, there are unique strengths as well. Because cisgender, heterosexual people face more pressure to become parents, LGBTQ people may be less likely than their peers to take parenthood for granted, pursuing it as a default rather than due to strong desire. Some researchers have suggested that this may be why lesbian mothers have reported stronger motivations to become parents compared to their heterosexual counterparts. Counselors and therapists would do well to recognize that many LGBTQ people intend to become parents, while many others do not. Those LGBTQ people who do intend to become parents may experience similar or distinct motivations, compared with their cisgender, heterosexual peers. Rachel G. Riskind See also Adoption, Choices About; Assisted Reproductive Technologies (ARTs); Deciding Whether to Parent; Infertility and Reproductive Loss; Surrogacy

Further Readings D’Augelli, A., Grossman, A., Sinclair, K., & Rendina, J. (2007). Lesbian and gay youths’ aspirations for marriage and raising children. Journal of LGBT Issues in Counseling, 1, 77–98. Goldberg, A. E., Downing, J. B., & Moyer, A. M. (2012). Why parenthood, and why now? Gay men’s motivations for pursuing parenthood. Family Relations, 61, 157–174.

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Rabun, C., & Oswald, R. F. (2009). Upholding and expanding the normal family: Future fatherhood through the eyes of gay male emerging adults. Fathering: A Journal of Theory, Research, and Practice About Men as Fathers, 7, 269–285. Riskind, R. G., & Patterson, C. J. (2010). Parenting intentions and desires among childless lesbian, gay, and heterosexual individuals. Journal of Family Psychology, 24, 78–81. Shenkman, G. (2012). The gap between fatherhood and couplehood desires among Israeli gay men and estimations of their likelihood. Journal of Family Psychology, 26(5), 828–832. Wierckx, K., Van Caenegem, E., Pennings, G., Elaut, E., Dedecker, D., Van de Peer, F., et al. (2012). Reproductive wish in transsexual men. Human Reproduction, 27, 483–487.

INTERNALIZED HOMOPHOBIA Internalized homophobia is a term used by social scientists to describe the phenomena by which lesbian, gay, bisexual, and queer (LGBQ) persons direct negative societal attitudes regarding homosexuality toward themselves. Internalized homophobia is generally assumed to have deleterious effects on the health and well-being of LGBQ persons by diminishing self-regard, inhibiting protective factors associated with positive identity development, and fostering identification with the oppressor. The use of the term developed with the advent of gay-affirmative therapeutic interventions during the late 20th century. Detractors have argued that using the stem phobia emphasizes the fear-based aspects of prejudice and further stigmatizes the individual to whom prejudice is directed, whereas homonegativity and heterosexism locate prejudice within its sources in society and social structures rather than within the individual.

Stigma, Minority Stress, and Internalized Homophobia The concept of internalized homophobia is rooted in theories of stigma and the stigmatization of individuals and groups. The work of Gordon Allport

and Erving Goffman maintained that societal attitudes discredit individuals or groups with stigmatized attributes, lower their status within the society based on these attributes, and label such individuals deviant from accepted societal norms. Reactions to such stigma among stigmatized individuals may be externally expressed through rebellion against the stigma or internally expressed through self-denigration and identification with the oppressor. When a gay, lesbian, or bisexual individual exhibits internalized homophobia, the negative societal attitudes and stigma have been directed to and internalized within the self rather than externally attributed. Internalized homophobia is often considered a dimension of minority stress, a broad psychosocial framework that conceptualizes stress processes that occur within individuals as a result of the stigmatization of minority groups. Ilan Meyer has described dimensions of minority stress along a continuum ranging from the distal (associated with the external environment) to the proximal (associated with the self). Externally located forms of minority stress include perceiving and anticipating stigmatizing attitudes in the general population and experiencing discrimination in social settings. Internal stress processes associated with minority stress include efforts to conceal one’s stigmatized attribute(s), as well as internalized homophobia. From a minority stress perspective, internalized homophobia (via the adoption of stigmatizing attitudes within the self) constitutes the most internal or proximal stress process.

Links With Identity Development The roots of internalized homophobia may begin early in a person’s life, given that societal attitudes toward homosexuality are often transmitted to children prior to their awareness of same-sex attractions. Development of sexual orientation and sexual identity often begin during early adolescence but may extend into young adulthood and beyond, during which time the processing of diverse societal attitudes by the individual may bolster or diminish the internalization of homophobia or heterosexism. Some research findings suggest that early socialization experiences may

Internalized Homophobia

contribute to negative self-regard during the development of a same-sex identity, even if subsequent socialization experiences may support positive identity development. Internalized homophobia has been conceptualized as a “failure” of the coming-out process for gay men and lesbians, and its inverse relationship to positive identity development is an area of interest for developmental psychologists and behavioral health researchers. Stigma management strategies and resources, such as seeking social support, becoming aware of positive LGBQ role models, and fostering LGBQ community affiliation, have been suggested as ways in which stigmatized persons create positive personal identities, and evidence exists that individuals who use these strategies have lower levels of internalized homophobia.

Associations With Health Risks Internalized homophobia has been identified as a pathogenic process associated with increased risk for mental distress, mental health disorders, substance use, domestic violence, and sexual risk behavior across numerous studies of gay and bisexual males and other men who have sex with men. In lesbian and bisexual women, internalized homophobia has been associated with mental distress, substance use, and domestic violence. The specific mechanisms that may lead to adverse health outcomes often vary by the health behaviors being examined, and because the majority of research on internalized homophobia has been correlational in nature, direct causal mechanisms have not been definitively identified. The largest body of evidence for internalized homophobia’s effect on the health of LGBQ persons has focused on its associations with depression, anxiety, and suicidal ideation. Theoretically, the concept of internalized homophobia suggests that internalizing negative attitudes toward the self should produce lower levels of self-regard, selfworth, and self-esteem. Consistent with this view, a meta-analysis of selected studies of mental health in gay men and lesbians has shown that internalized homophobia correlates more strongly with depression than it does with anxiety. Researchers focusing on lesbian and bisexual women’s relationships have

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found links between internalized homophobia and domestic or intimate partner violence, with internalized homophobia associated with both perpetration and victimization in lesbians. Researchers have argued that women who exhibit higher levels of internalized homophobia may be more likely to believe they deserve to be treated abusively; conversely, internalized homophobia may predispose some women to abuse or denigrate their female partners. Substance use has been conceptualized as a strategy by which some LGBQ individuals cope with internalized homophobia. Specifically, some LGBQ people may use substances to reduce the negative affect stemming from the stress and conflict that comes from living with a stigmatized identity and internalizing stigmatized attitudes. Similarly, sexual risk behavior among gay and bisexual men has been theorized as a possible form of maladaptive coping among men with elevated levels of internalized homophobia. Sexual risk taking behavior may serve as an alternative to deeper emotional connections of love and intimacy among groups of men who struggle with internalization of stigmatizing attitudes toward their identities, traits, and behaviors. Notably, some work suggests that substance use may mediate the link between internalized homophobia and sexual risk behavior among gay and bisexual men, such that men with high levels of internalized homophobia may be more likely to use substances and consequently more likely to engage in risky sexual behavior.

Research Limitations The measurement of internalized homophobia has been inconsistent across studies. The earliest and most widely used scale to measure the construct was developed in the late 1970s (the Nungesser Homosexual Attitudes Instrument, or NHAI). Subsequent measures include the Internalized Homophobia Scale, Internalized Homonegativity Inventory, and Lesbian Internalized Homophobia Scale. Validity concerns emerge when examining individual items associated with some of these measures. For example, several items in the NHAI appear to align with psychosocial constructs other than internalized homophobia per se, such as

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generalized discomfort with sexuality. Revisions and adaptations to existing internalized homophobia measures are ongoing, and more robust psychometric analyses of measures are needed. Several researchers have noted that the inconsistent measurement of internalized homophobia is especially problematic in light of advances in LGBQ civil rights over the past few decades and increases in the visibility and acceptance of LGBQ individuals in many communities. With a decrease in stigmatization of homosexuality in such communities, it may be assumed that there would be a concurrent decrease in internalized homophobia among LGBQ persons in those communities, but comparisons across studies and across different historical periods have been difficult to conduct due to variability in measurement. Systematic studies investigating how internalized homophobia varies geographically, as well as its potential relationship to institutionalized discrimination against LGBQ persons, have not been conducted. There is also insufficient data on experiences of internalized homophobia among culturally and ethnically diverse samples of LGBQ persons, as the majority of research on internalized homophobia has been conducted with samples predominantly composed of White men. Measures of internalized homophobia that were developed with such samples may not be applicable to other ethnic groups, and at the current time there are no measures that have been validated for use with diverse populations. The degree to which internalized homophobia may operate differently within communities of LGBQ persons of color and how it may interact or intersect with experiences of racism and internalized racial stigma are not well known. Lastly, more research is needed on internalized homophobia among lesbians and bisexual persons. In most previous studies of internalized homophobia, bisexual individuals have been combined with gay and lesbian individuals, and there is little rigorous research on the specific ways in which internalized homophobia may operate differently in bisexual persons. Douglas Bruce See also Depression; Heterosexism; Minority Stress

Further Readings DiPlacidio, J. (1995). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation (pp. 138–159). Thousand Oaks, CA: Sage. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems. Clinical Psychology Review, 30, 1019–1029. Shidlo, A. (1994). Internalized homophobia: Conceptual and empirical issues in measurement. In B. Greene & G. M. Herek (Eds.), Lesbian and gay psychology: Theory, research, and clinical applications (pp. 176–205). Thousand Oaks, CA: Sage. Williamson, I. R. (2000). Internalized homophobia and health issues affecting lesbians and gay men. Health Education Research, 15(1), 97–107.

INTERNATIONAL SURROGACY/ REPRODUCTIVE OUTSOURCING International surrogacy is a method of reproductive outsourcing in which an infertile individual or couple employs the service of a surrogate mother who resides outside the individual’s or couple’s country of origin. These individuals or couples, known as intended parents, often desire a genetic connection to their child but are medically, socially, or otherwise unwilling or unable to conceive or carry the child to term. Intended parents often seek surrogate mothers internationally due to financial or legal barriers at home. Employing a surrogate, for example, may cost up to 3 times as much in their own country as it would abroad. Moreover, many intended parents who identify as LGBTQ may encounter legal or social complications with surrogacy due to prohibitive laws related to

International Surrogacy/Reproductive Outsourcing

same-sex coupling. This entry discusses general trends in international reproductive outsourcing and the significance of international surrogacy for sexual-minority families. Since the early 2000s, the prevalence of intended parents participating in international reproductive outsourcing has become increasingly widespread. In fact, due to its rising popularity and exclusivity, this phenomenon has come to be known as reproductive tourism, or fertility tourism, a practice that falls under the broader umbrella of medical tourism. Whether attempting to create a “designer embryo” that will produce a child with particular physical, emotional, or mental characteristics, or looking to acquire a gestational surrogate mother who has proven fertile in the past, many intended parents opt to outsource reproduction to foreign countries where such reproductive practices are less regulated. Less regulation for intended parents often signifies reduced legal barriers as well as a less prohibitive price tag. Statistics pertaining to frequency, participants, and locations of surrogacy employment are generally unavailable due to the private, potentially stigmatizing, and possibly illegal nature of surrogacy. However, because of the wide availability of skilled medical professionals and suitable facilities, as well as an abundance of willing surrogate mothers, it is well known that India has become the premier locale for commercial surrogacy, which has become a booming multibillion-dollar business. India alone projects its share of the reproductive outsourcing market to exceed $2 billion by 2020. In fact, surrogacy practices in India are purposefully unregulated in order to drive down the costs of reproductive outsourcing and thereby attract international clients. Brokers create contracts for their international clients that cost up to 3 times less than surrogacy would in their native country. A traditional surrogacy arrangement in the United States, for example, may cost upwards of $100,000; however, an Indian broker may charge an intended parent couple approximately $35,000, which includes the broker fees; medical bills; and stipend for the surrogate herself, usually ranging between $5,000 and $8,000. Other countries with relatively well-developed and less

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regulated surrogacy programs include Ukraine, Guatemala, and Thailand. However, countries such as Australia, Canada, the United States, and Belgium—where surrogacy is regulated—are also places in which surrogate mothers are utilized by intended parents residing elsewhere. For instance, some Japanese intended parents have employed White American surrogates to conceive a child. Moreover, it is true that those destination countries—countries where surrogates may be sought—are also locations of departure; that is, individuals from these countries may go elsewhere to pursue surrogacy. The United States, for example, is a country where procreation is protected under the constitutional right to privacy. However, individual states choose to regulate surrogacy in different ways—some allowing for surrogate compensation (e.g., Arkansas, California, Florida, and Illinois) and others allowing surrogacy only in altruistic or unpaid cases (e.g., Michigan, Nebraska, New Jersey, and Virginia). Further, in countries like Canada, Australia, and the United Kingdom, surrogacy is only legally permitted when it is altruistic. Thus, intended parents who cannot find an altruistic surrogate or who live in a highly regulated state/country may seek surrogacy through international means. In addition to restrictive surrogacy laws at home, intended parents may also find laws related to adoption and other means of becoming parents too limiting. Adoption, for example, may be too costly, may require years of waiting, or the couple may not qualify to adopt. LGBTQ intended parents may encounter such issues as adoption ineligibility if their coupling status is not legally recognized in their home country. Although it may be the preferred option for some intended parents, international surrogacy comes with its own set of legal perils. Maternity in most countries, for example, is awarded to the surrogate as the birth mother, and therefore legal arrangements are required to ensure parental rights are transferred to the intended parent(s). Legality can grow more complicated in cases where the surrogate grows attached to the child and refuses to relinquish her maternal rights. These difficulties may heighten for LGBTQ intended parents who

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are seeking dual maternity or paternity, depending upon the legal restrictions in the country in which the child was born. For many intended parents in general, there are additional issues with passports, citizenship documentation, and proving the maternity or paternity of the child when attempting to return to the country in which they reside. International surrogacy has met its share of stark criticism. The majority of commercial surrogacy is conducted between intended parents from predominantly affluent White backgrounds, and poor, usually brown-skinned, surrogate mothers. In turn, human rights advocates condemn surrogacy as outright exploitation. Activists claim that surrogacy is globally dehumanizing, as surrogate women are valued only for their reproductive organs, are not provided with adequate care or compensation, and are forced into surrogacy by their impoverished conditions. Additional ethical concerns include the rights of the child, the parental competency of intended parents, and the separation of the child from his or her surrogate and/or biological mother. Dana Berkowitz and Crystal Paul See also Assisted Reproductive Technologies (ARTs); Surrogacy; Surrogacy, Legal Considerations of

Further Readings Chang, M. (2009). Womb for rent: India’s commercial surrogacy. Harvard International Review, 31(1), 11–12. Deonandan, R., Green, S., & Van Beinum, A. (2012). Ethical concerns for maternal surrogacy and reproductive tourism. Journal of Medical Ethics, 38(12), 742–745. Inhorn, M. C., & Patrizio, P. (2012). The global landscape of cross-border reproductive care: Twenty key findings for the new millennium. Current Opinion in Obstetrics and Gynecology, 24(3), 158–163.

INTERRACIAL RELATIONSHIPS The term interracial refers to couples in which one partner is of a different race than the other. Interracial couples have long captured the attention of social scientists who believe these relationships

offer insights into broader race relations. Most research on this topic focuses upon heterosexual couples, but a growing number of studies examine same-sex interracial intimacy, especially between Blacks and Whites. This entry explores the patterns, history, and contemporary challenges of same-sex interracial relationships.

Patterns National data on same-sex relationships has only recently become available. Beginning in 2000, the United States Census began collecting data on “unmarried partner households,” including lesbian couple households, gay male couple households, and heterosexual unmarried couple households. Ten years later, the U.S. Census allowed same-sex partners to identify as “spouses.” In 2010, an estimated 0.6% of all U.S. households belonged to same-sex partners. Focusing on these same-sex couple households shows that female and male interracial relationships are uncommon. Only about 14% of gay male couples and 11% of lesbian couples are interracial. While those percentages are relatively small, same-sex partners are more likely than their heterosexual counterparts to be in a relationship with someone from another race. (Only 4% of straight married couples and 9% of straight unmarried partners are interracial.) Most male and female interracial couples live in the West, especially Hawai’i, California, Oklahoma, and Alaska. Census data also reveal differences in the prevalence of particular types of mixed relationships. Interethnic gay and lesbian pairs are 3 times as common as interracial pairs. Compared to interethnic relationships between Hispanics and nonHispanics, which accounted for 10% of all same-sex couples, only 2% of same-sex couples were White/Asian pairs, and 3% of all same-sex households were Black/White interracial partners. Another way to consider this pattern is to examine how likely sexual minorities from different racial groups are to form mixed same-sex relationships. Whites and Blacks are the least likely to form interracial or interethnic same-sex relationships (12% of White and 23% of Black same-sex partners

Interracial Relationships

enter these unions). In contrast, among same-sex partners, 45% of non-Hispanic Asians, 62% of non-Hispanic Native Hawai’ian/Pacific Islanders, and 70% of non-Hispanic Alaskan Indians and Native Americans are in interracial or interethnic relationships.

History Even as their numbers are relatively small, interracial relationships have long held symbolic meaning to those interested in understanding U.S. race relations. Heterosexual interraciality has received a vast amount of attention in scholarly and popular writings, in part because prohibiting heterosexual interracial sexuality and marriage was long considered crucial to upholding White supremacy. The social significance of same-sex interracial relationships, on the other hand, is best understood in the context of LGBTQ communities. Examining the history of same-sex interraciality necessarily involves exploring the ways in which the color line between same-sex partners has looked similar to and different from the heterosexual color line. One commonality lies in the ways in which White supremacy in the 19th century rendered interracial sex and intimacy highly volatile and dangerous. An overt system of racial stratification made it highly unlikely for Whites, African Americans (enslaved or free), Asian migrant workers, or Native Americans to interact as equals. Clandestine sexual same-sex encounters may have occurred, but sustained relationships were highly unlikely. It is important to note that the category of “homosexual” did not emerge until the 1880s. Before then, same-sex sexual behaviors were practices in which some people took part, but engaging in a same-sex sexual act did not necessitate a specific label or render one a specific kind of person. It was only in the late 19th century that expanding sexual subcultures and medical experts’ articulations interacted to construct the notion of a sexual identity around which same-sex desires and behaviors durably cohere. Some of the earliest historical evidence of samesex interraciality comes from social reformers and medical experts at the turn of the 20th century, who

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found same-sex socializing and carousing particularly abhorrent. For example, in 1893 a prominent doctor referred to “drag dances” attended by Black and White male “inverts,” as they were called, as an “orgy of lascivious debauchery.” Such sexual relations caused much consternation. A medical expert on sexual disorders called men who engaged in interracial sex with other men “homosexual complexion perverts,” because they were thought to suffer from a particular syndrome in which color or racial difference substituted for the gender difference found in heterosexual relationships. Though shaped in large part by the same system of racial oppression that found heterosexual Black–White intimacy to be immoral or unnatural, these historical characterizations reveal that same-sex interraciality occupied an especially strange position. Same-sex interraciality combined race-mixing with a troubling perversion—homosexuality. In the early 20th century, urban centers like New York and Chicago were sites where homosexuals could find venues for dancing, socializing, or illicit sexual encounters. By the 1920s, Black sexual minorities had built an extensive homosexual world in their own Harlem neighborhoods, a world that celebrated musicians, artists, writers, and entertainers. Flouting Prohibition laws, Harlem also contained numerous speakeasies, which commonly catered to multiple “vices”—including drinking and prostitution, in addition to homosexual socializing. There is irony in the fact that the separate world cultivated by African Americans in response to overt and often violent exclusion ultimately became a point of fascination for Whites. But that is exactly what happened. Among affluent and middle-class Whites, “slumming” in Harlem became a popular diversion, and White urbanites ventured into Black neighborhoods for leisure and sexual amusement. Neighborhoods like Harlem were seen by Whites as at once forbidding and lurid. Observing early same-sex interraciality against the backdrop of a northern metropolis like New York is instructive because it illustrates the eroticization of race that has sometimes characterized Whites’ desire for Blackness. African Americans’ desire for Whiteness may have also been fueled by

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a sense of danger and intrigue, but objectifying Whiteness would not have been enough to recast the power disparities between White and Black. It may seem incongruous that interracial socializing quietly prospered in Harlem speakeasies at the same time as harsh Jim Crow segregation enveloped much of the United States, but these trends reflect a similar underlying truth: Both Whites’ eroticization and denigration of African Americans stemmed from a sense that Blacks were fundamentally different from Whites. By the 1970s and 1980s, same-sex interraciality had become the focus of political tensions, especially in Black gay and lesbian communities. Leaders such as Amiri Baraka of the Black arts movement had unequivocally argued that a gay identity was contradictory to an “authentic” political Black identity. A critique of this notion was taken up over the next several decades by Black sexual minorities who contended that embracing a gay or lesbian identity in no way precluded a celebration of Black pride. Black gay and lesbian texts devoted much attention to the notion of “the Black community” and reimagined a racial authenticity that included samesex loving. In the words of filmmaker Marlon Riggs in Tongues Untied, “Black men loving Black men is the revolutionary act!” Against this backdrop, interracial intimacy was positioned as a site of alienation or racial unmooring. Black–White couples were viewed by some with suspicion, as Black men who desired White men were thought to have political, social, and cultural allegiances to White gay politics and White cultural forms. Indeed, the heavy symbolic weight of interracial intimacy is evident in the canon of Black gay and lesbian writing. Some of the most important texts feature interracial themes, including James Baldwin’s Giovanni’s Room (1956), Audre Lorde’s Zami: A New Spelling of My Name (1982), and Darieck Scott’s Traitor to the Race (1995). Interracial desire was a symbol through which these writers explored questions of race, authenticity, and belonging. Another dimension of the political nature of interracial intimacy was in social activism. In the early 1980s, about two dozen men in San Francisco formed a group called Black and White Men Together (BWMT). The purpose of the group was

to engage in consciousness-raising activities, to socialize, and to support men in interracial relationships. Over time, other local chapters of BWMT formed in cities like Philadelphia; Washington, D.C.; Los Angeles; Detroit; Atlanta; and Milwaukee. These groups recognized the latent and sometimes overt tensions within gay communities over interracial intimacy. The District of Columbia branch’s Statement of Purpose explains, BMWT is a gay, interracial organization committed to supportive environments where racial and cultural barriers can be overcome and the goals of human equality realized. To these ends, we engage in educational, political, cultural, and social activities as a means of dealing with the racism, sexism, and homophobia, and other inequalities in our communities and in our lives. (G. Kantak, Letter of May 14, 1992, p. 1. Rainbow History Project digital archive. http:// www.rainbowhistory.omeka.net)

As the group expanded, it was later renamed Men of All Colors Together, and in some places, People of All Colors Together, which included women.

Contemporary Challenges In the United States, same-sex interracial couples still live at the complex juncture of racial and sexual inequalities. Like other LGBTQ couples, they enjoy growing access to same-sex marriage but remain vulnerable to discrimination in other areas of life, including employment, housing, adoption, and education. Like heterosexual interracial couples, they live in a society in which overt forms of hostility against interracial couples—such as cross burnings or outright exclusion from institutions or associations—have become unusual. Yet the experience of same-sex interracial couples is more complex than the sum of its constituent parts. As with previous eras, exploring the lives of same-sex interracial couples in the early decades of the 21st century requires attention to intersections of race, sexuality, and gender. Unlike most heterosexual interracial couples, same-sex interracial couples often feel that their intimacy goes unseen in public. The same racial

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difference that may immediately draw strangers’ attention to heterosexual pairs can render same-sex couples invisible. For couples walking on the streets of a metropolitan area or patronizing a movie theater, restaurant, or shopping center, racial difference is most legible when it is embodied by heterosexual partners. Lesbian and gay partners’ perceptions of invisibility emerge from interactions with strangers in these settings. Some same-sex couples pay little attention to these moments, but for many they are troubling. The cumulative effect of these everyday slights is significant. Social devaluation can affect relationship experiences, including contributing to lower levels of commitment and a greater likelihood of breakups. Maintaining intimate relationships across racial inequalities is a challenge for same-sex couples, as it is for their heterosexual counterparts. This is especially evident in Black–White relationships. Occupying different positions in relationship to discrimination and privilege, African Americans and Whites grow up with disparate racial orientations. In a society with deep racial inequalities, Black children learn to anticipate how others will perceive them. Not only do they see the world through their own eyes, but they also see themselves through the world’s eyes. W. E. B. Du Bois called this “double consciousness.” Whites, on the other hand, who are raised almost exclusively among other Whites, as many are, grow up without racial self-awareness. White racial homogeneity is seen as normal, neutral, and nonracial. For same-sex interracial couples, race-based differences in perspectives emerge in the most ordinary of settings, and navigating these differences requires emotional labor. This labor includes adjusting behaviors, concealing emotions, translating racial perspectives, deciding whether and how to discuss racial matters, using humor, and avoidance. Same-sex interracial relationships offer a unique lens into how intimacy is shaped by broader social forces. More research is needed to explore how Asian Americans and Native Americans experience interracial relationships and what interracial intimacy looks like between people of color. Amy C. Steinbugler

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See also African American Sexualities; Asian American/ Pacific Islander Sexualities; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ People of Color

Further Readings Dunning, S. K. (2009). Queer in Black and White: Interraciality, same sex desire, and contemporary African American culture. Bloomington: Indiana University Press. Mumford, K. (1997). Interzones: Black/White sex districts in Chicago and New York in the early twentieth century. New York, NY: Columbia University Press. Pearlman, S. F. (1996). Loving across race and class divides: Relational challenges and the interracial lesbian couple. Women & Therapy, 19(3), 25–35. Rostosky, S. S., Riggle, E. D. B., Savage, T. A., Roberts, S. D., & Singletary, D. (2008). Interracial same-sex couples’ perceptions of stress and coping: An exploratory study. Journal of GLBT Family Studies, 4(3), 277–299. Scott, D. (1994). Jungle fever? Black gay identity politics, White dick, and the utopian bedroom. GLQ: A Journal of Lesbian and Gay Studies, 1, 299–321. Steinbugler, A. C. (2012). Beyond loving: Intimate racework in lesbian, gay, and straight interracial relationships. New York, NY: Oxford University Press.

INTERSECTIONS BETWEEN SEX, GENDER, AND SEXUAL IDENTITY People are commonly viewed as having discrete identities. These identity categories are often seen as or used in isolation from other categories. Therefore, identity comparisons are often made in dichotomous ways. For instance, a construct such as life expectancy may be distinguished along gender lines (i.e., between males and females). In some instances, the description of such constructs may take into consideration another identity marker. Therefore, academics and policy makers may consider the difference in life expectancy among Black men and women compared with White men  and women, thereby creating a 2x2

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matrix (gender along one axis and race along the other). Rarer still are the instances where yet another identity marker is added to the mix—for example, considering how social class relates to life expectancy of Black and White men and women. Intersectionality represents an approach to theorizing multiple identity statuses, which helps in problematizing these individual categories by questioning who is represented, who is left out, what are the similarities and differences between and within categories, who is privileged and who is disadvantaged because of their position within a specific constellation of identities, and what power differentials are enacted in interactions between people. Therefore, intersectionality is not about demonstrating who is most subjugated by adding one minority status to another, but how when these minority statuses collide, they offer a unique position for the person inhabiting that space. Historically, the distinction between sex and sexual identity has not always been clearly made, with both terms conflated with the term sexuality. As a result, some researchers, health care professionals, and activists have assumed that each of these concepts can be understood without necessarily attending to the others. This has produced unintended negative consequences: Groups have been marginalized, health care interventions and social care initiatives have been mistargeted, and the unique experiences of certain individuals and subgroups have been made invisible. More recent writing and practice has learned from the perils of focusing on single identity agendas, and has begun to appreciate the complexity of people’s multiple identities and how they are interlinked. These recent efforts fall under the umbrella term of intersectionality. This entry continues with a discussion of the concept of intersectionality and how it illuminates the intersections between sex, gender, and sexual identity. Other factors, such as culture (typified here in terms of racial and ethnic identity), and their influence on definitions of sex and gender will then be considered. The challenges and opportunities of considering gender, sex, and sexuality within an intersectional framework will be

explored. Finally, this entry concludes with some of the challenges faced by the concept of intersectionality itself.

Intersectionality Intersectionality has been conceptualized as an organizing framework, a theory, a heuristic, or even as a reading strategy. Kimberlé Crenshaw is credited with coining the term intersectionality in 1989, to demonstrate how multiple systems of oppression and discrimination intersect with each other. Initially studied from a gender and race perspective within the field of law and legal studies, it is now used to explore the lived experiences of many other individuals with “minority” categories and identities, and has found its place in disciplines such as sociology, social policy, and psychology. The word minority is used here not to describe a group that is smaller in numbers than a majority group, but one that, because of its social position in society, has been disempowered and subjugated by those who are more powerful. Therefore, minority groups could include those who do not identify as heterosexual (such as LGBTQ groups), those with physical or mental disabilities, those who are poor, and so on. However, it is worth noting that even within each of these minority groups, there are subgroups of people who face varying levels of disenfranchisement as a function of other minority statuses. For instance, some lesbians experience discrimination because of their gender or sexuality, but also their minority ethnic or religious status. This discrimination could be from a sexual majority (e.g., heterosexual) group or from other lesbians, thereby creating a variety of in-groups and out-groups within the minority group itself. This kind of fractioning of identities has historical precedent, perhaps most prominently in the feminist and civil rights movements of the late 1960s and early 1970s in the United States. In this context, women of color challenged the notion of a shared history and destiny with their White sisters, arguing that gender was not the only organizing principle of their disadvantage and that race played a significant role in structuring the different forms of

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disadvantage they experienced in their daily lives. Therefore, the underlying concept of intersectionality is not new, and in fact goes back to other African American women’s movements over the past century. What is new since Crenshaw’s work is the explicit articulation of these concepts within an overarching framework. Although intersectionality has been championed as more progressive and effective than “single identity” approaches to civil rights, it is not universally embraced as a force for progress; in fact, some groups have experienced it as a threat to unity. Within groups that have been fighting on a single-identity agenda (e.g., based only on gender or race or sexuality), an emphasis on within-group differences is perceived to break the single voice, thereby reducing the strength of the voice and diluting the effect of the cause. However, the emphasis on a single voice makes the erroneous assumption that all voices within the group are in fact equal, and has the unintended consequence of silencing the minority within the minority (or the “meta-minority”). Intersectionality, therefore, draws attention to these silences and the erasures of mixed (or “hyphenated”) identities and their effects on individuals and communities. Intersectionality also focuses attention on what lies beyond the obvious or the prototypical depiction of any one social group or identity, helping to provide nuance and depth to our understanding of how complex social hierarchies are perceived and maintained. For example, if we set aside social class differences, we may conclude that White men are perceived as holding a more dominant position in contemporary Western society than Asian men. But what about an unemployed White man versus a wealthy Japanese banker? By taking into consideration factors such as finance, education, and social class, these perceived hierarchies can be dismantled. Similarly, intersectionality allows us to observe and understand how individuals within oppressed groups can use other identity categories to marginalize and oppress one another (e.g., Black heterosexual women discriminating against Black lesbians). Intersectionality has mainly been used to highlight and critique discrimination and prejudice, but

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increasingly it is also used to document how the disadvantaged negotiate their intersectional positions within their environments to allow themselves not to be subjugated. Therefore, people may identify situations or encounters where they can use their minority status as a strength in order to disrupt dominant structures or systems. They may be able to achieve this aim by way of articulating a previously unarticulated or hidden identity in a way that would assert their own power within an interaction. For instance, a woman who is erroneously assumed to be heterosexual may assert her bisexual identity among a group of other heterosexuals. This disclosure may immediately change her relative power within the group. In a conversation about sexuality or gender, her disclosure may enable her to speak authoritatively from lived experience rather than vicariously. Intersectionality theory also demonstrates that another way of negotiating minority identities is to make certain aspects of the self “invisible” to those who cannot read these identity markers. For instance, an Asian lesbian may not explicitly articulate her sexual orientation or identity among her ethnic groups or family members, but may still be able to enjoy physical contact and closeness with her same-sex companions because the society she inhabits expects women to be segregated from men. This, to some activists, may be seen as a retrogressive act of concealment, but to others it can be interpreted as an authentic (and perhaps the only) strategy for preserving same-sex relationships in one’s daily life without risking one’s own safety. According to this view, people who use such strategies should not be seen as “closeted,” as this judgment wrongly presumes that everyone has the same opportunities (or indeed, desires) to be “out and proud” LGBTQ people in all the different walks of their lives, when clearly this is not the case. Therefore, intersectionality demonstrates how visibility, hypervisibility, and invisibility can each be alienating as well as liberating for different individuals in different circumstances. It also facilitates an appreciation of the plurality of an individual’s identities, and forces critical engagement with problematic concepts such as the “true” or “authentic” or “primary” identity and self.

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The Perils of Focusing Only on Single-Identity Issues Single-identity agendas tend to create hierarchies of importance, with some identities being seen as more important than others. This allows for the dominance of one identity over others and can serve to disadvantage those who do not fit the presumed ideal (or “average”) of that identity. This may explain the prejudice and marginalization that some individuals experience. Lesbian-only groups, for example, may perpetuate transphobia by recognizing only cisgendered women (i.e., those born with biologically female bodies) as lesbians. By excluding those who do not fit the group’s own definition of “woman,” the group uses a sexualbased identity (lesbian) to maintain guardianship of a gender-based identity (woman). There are other instances where one identity is considered more important than others. For example, if an individual considers religion to be the most significant identity, then all other identities (e.g., sexuality) may assume a subsidiary role to the primary identity. This, for some individuals, can cause conflicts that may lead to the subsidiary identity being denied, rejected, conflicted, or compromised. Such conflicts may be not only internal (i.e., within the person) but also external (i.e., from the wider social groups). Other group members may force individuals to make their allegiance clear: for instance, “You are first a Christian, then a lesbian” (i.e., religion is more significant than your sexuality). Research on people’s lived experiences shows that identities are constantly in a state of flux. Some identities that were initially considered primary may move to the background as other identities take precedence. But even within this flux, some identities may continue to remain a core component of an individual’s sense of self. This is another reason why intersectional approaches to understanding the self in society are crucial.

Interconnections Between Sex, Sexuality, and Gender It is important to demarcate sex from sexual identity, although these terms are sometimes

conflated. This conflation may result from the fact that sexuality is used as an umbrella term to encompass sex, gender, reproduction, sexual orientation, and so on. One such wide definition of sexuality has been proposed and popularized by the World Health Organization, particularly in health-related research and initiatives. However, “sexuality” as a colloquial term usually refers to sexual orientation, and it is in this vein that the term is used here. Multiple constellations of sexuality, sexual practice, and gender identity exist. People may selfidentify as men (based on gender), as gay men (based on sexual identity), and as “bottoms” who prefer the receptive role in penetrative sex (based on sexual practice). However, identities such as bottom (or “bot”) may not always be constrained to sexual practices. For some, these identities may also be relevant for their nonsexual interactions and relationship patterns. These patterns or ways of relating to each other may consciously mimic or parody what is seen as traditional heterosexual ways of relating (based on gender-role stereotypes enacted by heterosexuals). Therefore, these categories are more than simple words or labels: Rather, we must understand the interconnectedness of sex, sexuality, and gender underlying these categories to understand their relevance in the context of health, politics, legislation, subcultures, and social structures. Asexuality presents another case in which it is important to distinguish sexual practices from sexual behaviors and identity concerns. The term asexuality often presents problems for researchers and policy makers because in some cases it is used solely as a descriptor of sexual activity (or the lack thereof), independent of one’s sexual orientation identity (such that an asexual gay man is a gay man who is not currently sexually active), whereas in other cases it is used as an independent sexual identity (such that asexual individuals are distinguished from heterosexuals, bisexuals, and gays/ lesbians by their overall lack of sexual attractions and not simply their lack of sexual behavior). This again highlights the significance of language and the importance of using an intersectional perspective to disentangle the multiple meanings of sex, sexuality, and gender that are often conflated.

Intersections Between Sex, Gender, and Sexual Identity

In relation to health, for example, research has found that rates of HIV infection are greater among men than women, greater among gay men than heterosexual men, and greater among bottoms (those taking the receptive role in penetration) than tops (those taking the insertive role in penetration). Therefore, sexual health initiatives need to examine the nuances of both sexual practices and identities in order to develop effective interventions. This is often best achieved through understanding the terms of self-reference for particular individuals and groups, which is particularly pertinent in populations that do not necessarily use terms or notions related to Western ideas of gender and sexuality. For example, sociologists and anthropologists working in the Global South have documented numerous terms and identities representing distinct sexual identities, sexual practices, and gender identities, and although some of these terms may find a parallel with dominant sexual identities such as “gay,” “lesbian,” and so on, others have no such direct translation, and must be understood and interpreted within their own cultural context. Since the 1990s, health care researchers have attempted to elide the complexities of sexual identities by categorizing people mainly on the basis of their gender and sexual behaviors, which was also felt to reduce the stigma associated with specific sexual identity labels (e.g., “gay”). Thus, terms such as “men who have sex with men” (MSM) and (the more recently coined and less frequently used) “women who have sex with women” (WSW) have been in use among researchers and policy makers. These terms are problematic, however, as they reduce individuals to a single aspect of their sexuality: their sexual behaviors. Furthermore, there is evidence to suggest that these behavior-based descriptors can themselves become identity labels for some people, often then incurring stigma within the LGBTQ community because they are perceived to be less “authentic” identities. These groups may then be seen as unwilling to “commit” to a sexual identity and to be living “double lives.” There is also concern that because terms such as “men who have sex with men” necessarily incorporate the

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gendered terms “men” or “women,” these terms neglect the sexual behaviors and identities of those with liminal gender identities as well as younger individuals who may see themselves as “boys” or “girls” rather than “men” or “women.” More complex cultural understandings of gender are also poorly represented by these behaviorally based terms. For instance, men in some Indian contexts may see themselves as kothi or panthi, based on the gender roles that they enact in relationships with others. In a Northern Indian and Bangladeshi context, kothis perform a feminized gender performance and desire to be the “female” (sometimes penetrated) partner in a same-sex sexual interaction, often with a panthi. Panthis perform a typically masculine gender performance and desire to be the “male” partner in a same-sex sexual interaction with a kothi. These are viewed as indigenous sexual identities, but they incorporate more than just sexuality, since they involve one’s relational sense of gender. Hence, these identities cannot be considered akin to the Western “trans” identities or “gay” or “bi” identities, and must be understood within their local cultures and histories. “Culture” in this context refers not only to nation-states or geographical regions but also to the cultures that are negotiated within certain strata in society. For example, Indian men from more urban, English-speaking communities may be more comfortable with terms such as gay, whereas those with different social locations may prefer the more precise descriptors such as kothi, which offer a sense of community with other kothi-identified individuals. Therefore, an intersectional perspective highlights how the constructs of gender, age, social class, race/ethnicity, and sexuality coalesce to create a variety of unique experiences for different individuals or groups that cannot be generalized with global terms such as MSM or WSW. Such generalizations are fraught with omissions and gaps that limit our knowledge of the lived experiences of different individuals and groups. Just as some “indigenous” sexualities can conflate issues of gender and sexuality, similar conflations are made regarding gay and lesbian sexualities.

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These conflations hinder our understanding of distinct performative identities within gay and lesbian culture, such as “camp” and “butch” among gay men and “femme” and “butch” among lesbians. Historically, the butch/femme dynamic in lesbian relationships was seen as a reproduction of traditional heterosexual ways of relating, with the butch person performing the stereotypical masculine role and the femme person performing the stereotypical feminine role. Yet this interpretation fails to appreciate how this dynamic serves to subvert and parody heteronormative ways of relating by making evident the performative nature of all gendered relationship behavior. In gay men, identities such as camp and butch relate to the overall performance of a gay or bisexual identity, whereas identities such as top and bottom are more specific identities of their own, relating mainly (but not exclusively) to sexual practices. Therefore, even sexual identities such as gay and lesbian may be further subdivided according to some aspect of gender, in some cases only reflecting one’s role within sexual encounters but in other cases reflecting one’s dominant way of relating to one’s self and others. With any type of grouping, characteristics that are seen as emblematic of the most visible members of the group are exaggerated and caricatured to create a stereotype of this group. Therefore, gay men are often portrayed as uniformly flamboyant, camp, and effeminate. However, even within LGBTQ communities, there are stereotypes of different sexual identities and ways of presenting. Camp men, for instance, may be assumed to be bottoms, whereas muscled men may be seen as dominant and assumed to be tops. These are gendered stereotypes. Although distinctly gendered expressions of sexuality can help individuals and groups to express their unique identities and make them visible and heard, the use of conventional gender stereotyping within the LGBTQ community as well as mainstream society can foster prejudice and disenfranchisement toward such individuals. Camp or effeminate men, for instance, are more likely to experience homophobia because they “stand out,” are seen as prototypically “gay,” and are seen as violating gendered norms of

masculinity. Similarly, butch lesbians tend to be targets of homophobia because of their visibility and perceived nonconformity to the norms of womanhood and femininity. Another further intersection between gender and sexuality relates to bisexual identity and experience. This is a further stigmatized identity, which receives censure from both heterosexual groups (with the “no one is safe” [from their sexual advances] discourse) and homosexual groups (with the “can’t make up their mind,” “just experimenting,” or “in denial” [of being gay] discourses). Here, the perceived sexual identity is often obfuscated by the gender of the bisexual person’s partner(s). Bisexual individuals with same-sex partners are misread as gay/lesbian, and those with other-sex partners are misread as straight/heterosexual. Therefore, bisexuals may only be visibly perceived as bisexual if they are seen to be with both men and women at the same time. This way of thinking perpetuates the stereotype of bisexuals being “unfaithful” or incapable of monogamy. Furthermore, this stereotype denigrates and misinterprets the choices that some bisexuals make to pursue polyamory (i.e., multiple sexual or romantic attachments, with the agreement and consent of all involved). The stereotype of bisexuals as promiscuous may be more pernicious for women, given that sexual permissiveness in women has long been considered a cause for censure and shaming. The same stereotype of promiscuity in men might be seen as a triumph of their masculinity and sexual prowess, further highlighting the gendered nature of prejudice.

Race, Ethnicity, Gender, and Sexuality Race and ethnicity intersect critically with gender and sexuality, specifically defining these identities by creating a language and practices that shape these identities. The term race refers to groupings of people based on biological traits that are visible to society and that are treated as significant distinguishing features between groups (e.g., skin color). The term ethnicity refers to groupings of people based on shared cultural practices that distinguish

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them from others (e.g., language or religion). It is important to treat race and ethnicity as separate, but often interlinked social constructs, because the way in which they interact with gender and sexuality may vary. This section examines how race and ethnicity influence the way in which gender and sexuality intersect. While there are certain gendered constructs that appear to carry across cultures, such as women being seen as “mothers,” other gendered constructs may be more culture-specific, such as “paid paternity leave.” This is significant because while there may be some “globalized” stereotypes of gender and sexuality, many others are limited to certain cultures and certain points in history. For instance, there may be a shared experience of homophobia among Black African men, both in Africa and abroad. However, gay/bi Black African men in a White-majority state or country have a unique experience of receiving both homophobia and racism from both White and Black communities. Not all societies and people specifically label their sexual identity. In some instances, even what is thought of as “sex” by most people in the West may not be coded as sexual activity. Here, “sex” (the activity) is not determined solely by behavior, but by the individuals and the circumstances in which such activity takes place. For example, people detained in prisons may engage in same-sex sexual behaviors, but not all of them will identify as lesbian, gay, or bisexual (LGB), or even mark their same-sex activity as being linked to a sense of who they are (i.e., their identity). Similarly, in certain cultures where men and women do not or cannot openly mingle, the ensuing homosocial environments may offer possibilities to experiment or “have fun,” without attributing a sexuality label to these activities. This, therefore, marks a distinction between doing (activity) and being (identity). The norms of sexuality are also culture-bound, and because of this, gestures and performances such as same-sex public hand-holding may in the West be coded as “gay,” whereas such an activity may be considered camaraderie without any sexual/ sexuality connotations attached to it in some other cultures.

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Added to the mix of activity and identity are the people involved (the “actors”). In some societies, it is only the feminine (or receptive partner in anal intercourse) male partner who is marked with a sexuality identity or label, while the masculine (or insertive) partner is not so marked. Sometimes, however, both partners may take on unique sexuality identities based on the predominant sexual role in their relationship (e.g., kothi and panthi, described earlier). A gendering effect on sexual identity is also found when race is added to the mix. Research has shown that gay men of certain races are perceived as being more masculine or feminine simply because of their race. For instance, Asian lesbians have reported that their physical attributes (such as long hair) are read as symbols of their ethnicity or religious affiliation, but are also read as being femme. Similarly, East Asian gay men are seen as feminine (i.e., bottoms), whereas Black men are seen as masculine (i.e., tops). Thus, the sexuality of these individuals is prejudged based on their racial features. Racial identity codes not only the person who inhabits that identity but, in some gay communities, the sexuality of the partner as well. Culinary argots such as “rice queen” refer to a White man (usually older) who prefers (younger) East Asian men. Similar terms suggest such racialized desires (e.g., “potato queen” [Asian man desiring a White man], “curry queen” [White man desiring South Asian man], “sticky rice” [Asian men desiring other Asian men]). These terms are not neutral descriptors of sexual orientation or relationship preference of others, but are value-laden terms portraying the “queen” not as a connoisseur having developed an exotic taste in men, but as someone who has failed to acquire the ideal gay partner(s). Intersectionality, as seen through this race– gender–sexuality matrix, allows for exploration of these complexities, and enables the problematization and critique of taken-for-granted dominant discourses about these identities and their meaning. Intersectional analyses highlight points of difference and dissonance for people whose lives are lived at the crossroads of multiple identity statuses.

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Intersectional Identities: Challenges and Opportunities Everyone has intersectional, or hyphenated, identities (e.g., White-Jewish-Mother), but for those whose identities are marginalized by the dominant society, there are unique challenges that must be negotiated on a daily basis. Combatting racism, sexism, homophobia, and so on can take its toll on an individual’s health and well-being. Often, this is mitigated by social support from one’s communities. However, for those with intersectional identities, the very notion of “community” is complex. Black and minority ethnic people in the West, who typically rely on their own ethnic community as a primary source of support and a haven from racism within the wider society, may suddenly find such support revoked if they are exposed to be nonheterosexual. Minority ethnic people who identify as LGBTQ may find solace within the LGBTQ community, but these communities may harbor racism, or may be insensitive to the unique challenges of individuals whose LGBTQ status intersects with their ethnicity. These factors are even more of a concern for individuals who may be more vulnerable than others because of their age (e.g., teenagers or older adults), gender (women), ability (e.g., those with mental or physical disabilities), parenting status (e.g., single mothers), social class (e.g., the poor). Such individuals may be even less likely to have access to adequate support to deal with the challenges of marginalization. Thinking intersectionally has challenged the notion that there is a monolithic gay identity and a unitary LGBTQ community. It has also challenged ideologies related to the benefits or necessity of coming out (i.e., disclosing one’s LGBTQ status openly) as a prerequisite for a healthy, fulfilled life. Decisions related to coming out and expressions of sexuality can be complex for people who find themselves in vulnerable positions in society, and a careful evaluation of the risks and benefits of coming out need to be undertaken. For some, this process may be a challenge that requires careful identity negotiation across different social spaces, and hence individuals may benefit from

supportive services (e.g., psychological services, social services, women’s groups). Most important, however, this is not a “one-off” process that has a clear ending point, but requires constant vigilance and skill as individuals move through different social situations and contexts that require new decisions about disclosure and new forms of identity negotiation. The holding of multiple identity positions presents opportunities as well as challenges. Belonging to multiple identity groups may open up multiple avenues of support, allowing people to selectively seek the support they need for a particular purpose. There may also be instances whereby those who have learned to deal with one form of oppression are able to transfer this learning to deal with another form of oppression. Furthermore, at the group level, we can imagine transformative possibilities in which different identity groups might grow and thrive by learning from one another’s unique ideas and experiences. The development of LGBTQ churches and the establishment of different women’s groups devoted to fighting for LGBTQ causes provide examples of such beneficial linkages.

Conclusion: Challenges Facing Intersectionality In the final analysis, sex, sexuality, and gender cannot be fully appreciated unless they are viewed from an intersectional perspective. Despite this fact, institutions and social systems have not always embraced the notion of intersectionality, and for most, intersectionality remains a buzzword. Part of the problem with incorporating intersectionality into more research and policy is that it is not always clear how it can be put into practice. First, the term itself is rather difficult and can be seen as academic and exclusionary. To become more widely adopted, the concept needs to be used in nonacademic discourse. There have been some inroads made on this front, but not nearly enough. Another problem concerns the definition and scope of the term. Intersectionality has been variously described as a theory, framework, methodology, and organizing principle that describes a

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matrix, crossroads, junction, and so forth. Some scholars have argued that these multiple conceptualizations aim to show what intersectionality can be, rather than what it “is,” and that this flexibility in definition enables people to use the term in various ways to cover personal, interpersonal, group, process, and institutional and systems levels. It is vital to retain this broad scope for intersectionality because concepts such as sex and gender are inherently broad, and only a holistic approach can enable us to fully understand them.

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talk: Conceptualising multiple oppressions in critical sexuality studies. In A. Kuntsman & E. Miyake (Eds.), Out of place: Interrogating silences in queerness/ raciality (pp. 265–292). York, England: Raw Nerve. Fisher, D. (2003). Immigrant closets: Tactical-micropractices-in-the-hyphen. Journal of Homosexuality, 45(2/3/4), 171–192. McCall, L. (2005). The complexity of intersectionality. Signs, 30, 1771–1800. Shields, S. A. (2008). Gender: An intersectionality perspective. Sex Roles, 59(5–6), 301–311.

Roshan das Nair See also African American Sexualities; East Asian Sexualities; Homonormativity; Native American/First Nations Sexualities; Psychological Approaches to Studying LGBTQ People; Sexual-Identity Labels

Further Readings Butler, C., das Nair, R., & Thomas, S. (2010). The colour of queer. In L. Moon (Ed.), Counselling ideologies: Queer challenges to heteronormativity (pp. 105–122). Surrey, England: Ashgate. Choo, H.-Y., & Ferree, M. M. (2010). Practicing intersectionality in sociological research: A critical analysis of inclusions, interactions, and institutions in the study of inequalities. Sociological Theory, 28(2), 129–149. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299. das Nair, R. (2013). If singularity is the problem, could intersectionality be the solution? Exploring the mediation of sexuality on masculinity. In R. Dasgupta & M. Gokulsing (Eds.), Masculinity and its challenges in India: Essays on changing perceptions. Jefferson, NC: McFarland. das Nair, R., & Butler, C. (2012). Intersectionality, sexuality, and psychological therapies: Exploring lesbian, gay, and bisexual diversity. London, England: Wiley Blackwell. Davies, K. (2008). Intersectionality as buzzword: A sociology of science perspective on what makes a feminist theory successful. Feminist Theory, 9(1), 67–85. Erel, U., Haritaworn, J., Rodriguez, E. G., & Klesse, C. (2008). On the depoliticisation of intersectionality

INTERSEX SOCIETY NORTH AMERICA

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From 1993 to 2008, the Intersex Society of North America (ISNA) was at the forefront of the effort to destigmatize intersex and reform the medical treatments regularly practiced by doctors treating intersex conditions. As a result of this activism, this medical approach was propelled into crisis and reform and remains in a state of flux today. The timing of the intersex patients’ rights movement in the mid-1990s followed on the heels of the considerably larger lesbian, gay, bisexual, and transgender movements. This entry defines intersex; examines the medical treatment model in question; and discusses the development, impact, and dissolution of the Intersex Society of North America.

Background The term intersex is synonymous with the word hermaphrodite and refers to anatomical and physiological attributes such as genitalia and gonads, chromosomes, hormones, and secondary sex characteristics that are difficult to categorize as clearly female or male. For example, in the case of a newborn with ambiguous genitalia, it might be unclear whether the child has a small penis or an enlarged clitoris. In a culture that privileges heterosexuality and sex/gender/sexual normalcy, intersex variations of sex development create social upheaval. Intersex variations are generally not physiologically harmful and occur in newborns as well as in

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early childhood or during puberty when secondary sex characteristics develop. For example, a young woman who has female sexual anatomy may not menstruate or develop pubic or underarm hair despite developing female-typical breasts and hips. Upon further examination, it might be discovered that this young woman has XY (male-typical) chromosomes; no uterus, ovaries, or fallopian tubes and undescended testes. This type of intersex is known as complete androgen insensitivity syndrome (CAIS). Other common intersex conditions include congenital adrenal hyperplasia, Klinefelter syndrome, Turner syndrome, and hypospadias, to name just a few. Intersex variations are often characterized as extremely rare, but that is not actually the case. Frequency estimates put the occurrence of intersex at 1 or 2 out of every 2,000 births. These estimates are consistent with the prevalence of both Down syndrome and cystic fibrosis. Medicalization of Intersex: A Rather Recent Development

The treatment protocol to make an intersexed child appear unambiguously female or male was created in the United States in the mid-1950s at Johns Hopkins University. This model is most closely associated with the late psychologist John Money and typically involves early surgical and hormonal intervention to decrease or remove sexual ambiguity. The rationale for this treatment is to help intersex children form “normal” gender and sexual identities and to prevent them from experiencing stigma. This treatment model encourages parents to keep the child’s ambiguous anatomy a secret, even from the child. The rationale behind this deception is that a child’s gender and sexual identity may develop problematically if he or she were to learn that the child once had intersex features that were medically “corrected.” By intervening early and erasing visible sexually ambiguous features, the parents and intersex child will presumably be able to develop a healthy bond, and the child will form normative gender and sexual identities.

This treatment model was made famous by its application to a child born as Bruce Reimer. Bruce was a non-intersexed identical twin whose penis was burned off in 1966 during a circumcision accident. He was 8 months old at the time. The Reimer family worked with Dr. Money to attempt to bring about optimal gender identity development through a surgical castration and social reassignment of Bruce as female when he was 22 months old. At that time, they changed his name from Bruce to Brenda. This case was widely reported as a success and as evidence that socialization holds more sway than biology with regard to gender identity development, given that baby Brenda had reportedly grown up to be a feminine girl, while her identical twin brother, Brian, had grown up to be a masculine-identified boy. Medical intervention on intersexed children relied on the apparent success of this model until Brenda Reimer spoke out in 1997. Brenda had rejected the female gender that he had been assigned and had been living as a boy named David since the age of 14. David reported that the treatments that were intended to bring about a feminine gender identity were, in fact, a cause of great shame and stigma. He spoke out after learning that other children were being subjected to the same treatments he received and that his case had been lauded as evidence of the success of sex reassignment in early childhood. Notably, David/ Brenda eventually committed suicide in 2004 at the age of 38. The First Wave of Intersex Activism

In the 1990s, a patients’ rights model emerged as the first generation of intersex adults who had undergone childhood sex reassignment began to mobilize and speak out. While the objective of these medical treatments is to decrease social stigma and optimize the formation of clear gender and sexual identities, adults who underwent these procedures in early childhood conveyed that they experienced feelings of isolation, stigma, and shame—the very feelings that such procedures attempt to alleviate.

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Many clinicians initially dismissed these critiques as representative of only an unhappy vocal minority. As the criticism grew to include a second and third generation of adults who experienced such treatments as harmful, this treatment came under greater scrutiny.

Founding of the Intersex Society of North America The most vocal and visible intersex activist of the 1990s and 2000s was Cheryl Chase. Chase founded the Intersex Society of North America (ISNA) in 1993 (using the pseudonym Cheryl Chase). Chase was born in 1956, just 1 year after the initial publication by John Money and colleagues that put intersex medicalization on the map. ISNA’s mission was to destigmatize intersex and put an end to cosmetic genital surgery on intersexed infants and children. The group’s critique of the medical “normalization” of intersex infants and children centered on the following points: (1) Most cases of intersex do not cause physiological harm, (2) sexual and psychological satisfaction and function are often impaired by medical normalization procedures, and (3) the secrecy surrounding their intersex traits results in feelings of shame and isolation. ISNA was the most active and visible intersex support and advocacy organization from its inception in 1993 to its dissolution in 2008. Its website remains operational as a historical artifact. People often falsely attribute the beginning of the intersex movement to the founding of ISNA in 1993 and even equate the intersex movement with ISNA itself. In actuality, there were three intersex parent support groups already in existence several years before Chase founded ISNA, and the movement extends far beyond the life of this now-defunct organization. ISNA and Chase had acquired so much media attention by 1998 that Chase was voted one of the 100 “most interesting and influential gay men and lesbians in America” in Out magazine’s top 100 people of the year. In 1999, Chase’s own amicus brief was paramount in the Supreme Court of Colombia’s decision to establish human rights

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protections for people born intersex. In 2004, Chase was successful in getting the San Francisco Human Rights Commission to investigate the medical treatment of intersex children. They ruled that these medical interventions were violations of patients’ human rights. In 2005, Chase had a seat at the table with 49 other professionals at an international and controversial “consensus meeting,” which resulted in the 2006 publication of “The Consensus Statement on the Management of Intersex Disorders” and a change in nomenclature from “intersex” to “disorders of sex development” (DSDs) in medical and some activist communities. This change in nomenclature spawned the death of ISNA and the birth of a new organization, Accord Alliance, also formed by Cheryl Chase, using her legal name: Bo Laurent. While Accord Alliance embraces the DSD terminology, many activists, scholars, and some clinicians do not, and this is currently a very heated issue. Accord Alliance continues to work alongside medical professionals to help educate and build alliances between parents with intersex children and the clinicians who treat them. There are now many other intersex support and advocacy groups around the world, aided significantly by the growth of the Internet and various social media outlets. How ISNA Got Its Start

Chase initially founded ISNA by publishing a letter to the editor in the July–August 1993 issue of the New York Academy of Sciences’ journal The Sciences. This letter was a response to biologist Anne Fausto-Sterling’s article, “The Five Sexes: Why Male and Female Are Not Enough.” In her letter, Chase critiqued intersex medical sex assignment as destructive, raising concerns about the ethics and effectiveness of surgical procedures that impair sexual and psychological function. In the last line of her letter, Chase announced the formation of a support group called the Intersex Society of North America. In actuality, the organization was formed by Chase’s letter to the editor. In her signature line, Chase listed a mailing address for ISNA at a San Francisco P.O. box, and she soon

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began receiving mail from people with intersex anatomy around the world. Hermaphrodites With Attitude

ISNA published the first issue of its newsletter Hermaphrodites with Attitude in the winter of 1994. By that time, ISNA had established a mailing list that included recipients in 14 states within the United States and five countries. The political content of the publication and the organization itself worked to transform intersex and the word hermaphrodite from being sources of shame into sources of pride and empowerment. The newsletter consisted primarily of personal stories, essays, poetry, and humor, providing formerly isolated individuals with the means to connect with others who had similar experiences. Hermaphrodites with Attitude was published on a fairly regular basis from 1994 to 1999. Political Activism and Social Support

In addition to its newsletter, ISNA also provided support groups, a popular website, and annual retreats. Early on, ISNA’s mission was divided between providing peer support to its members and its objective of medical reform. While other intersex organizations chose to address the mission of support, ISNA ultimately decided to pursue social change. The group’s political action alienated them from some other activists and groups. ISNA made deliberate appeals to queer activists, press outlets, and medical organizations, framing intersex as an issue of gender and sexuality. LGBTQ organizations both in and outside medicine could easily relate to intersex grievances of stigma, shame, and alienation. At the same time, aligning intersex issues with sexual or gender minorities compromised intersex activists’ ability to establish credibility with the non-LGBTQ medical mainstream, who viewed heterosexual normalcy as one of the primary objectives of intersex medical sex assignment. In September 1996, U.S. Representative Patricia Schroeder’s (D-CO) anti–female genital mutilation (FGM) bill became law. This law banned genital cutting on girls under the age of 18 years old except in

cases where “health” demands its necessity, thus allowing for intersex “emergencies” to be exempt from the law. Press coverage of this law included a front-page article in the New York Times. Chase and other members of ISNA were outraged by the law’s complicit endorsement of intersex genital surgeries. They began to stage protests to draw attention not only to this law’s loophole, but to “intersex genital mutilation” (IGN) as well. In addition to lobbying members of Congress to extend the anti-FGM bill to include IGM, ISNA staged protests at medical conferences. ISNA’s first major protest was at the 1996 American Academy of Pediatrics meeting in Boston. Members of ISNA and activist Riki Anne Wilchins’s group Transsexual Menace joined together for this event—calling themselves “Hermaphrodites with Attitude”  (HWA)—to picket after intersex activists were denied floor time to address the doctors in attendance. ISNA representatives used the name HWA frequently during the 1990s when they were engaging in protests. ISNA’s protest propelled the American Academy of Pediatrics to create a position statement on infant and childhood genital surgery.

Early Medical Response to ISNA’s Activism By 1997, the broader medical community began engaging in a debate about best practices for intersex infants and children, largely in response to the first reports of David Reimer’s unsuccessful sex/ gender reassignment, which served to discredit the validity of the medical model as the best standard of care. Early debates were quite polarized and framed the issue as immediate versus delayed treatment (rather than whether and not when to intervene), and many physicians felt that they were being put on the defensive. In more recent years, some physicians have begun to advocate watchful waiting rather than emergent intervention in an appeal for additional and more systematic research on intersex children and adults. Calls for Additional Research and Collaboration

This debate came to a head in 2000 and was described as a crisis in medicine by physicians who had formerly considered this treatment to be in the

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best interest of intersex children and their families. The North American Task Force on Intersex was formed that year with the intention of open and interdisciplinary conversations and collaboration. This group was charged with coming to some consensus on best practices and included key members of the American Academy of Pediatrics and ISNA, as well as scholars and clinicians in many related fields. While the task force was not long-lived, some of the conversations were and ultimately led to the National Institutes of Health (NIH) issuing a program announcement in 2001 for funding dedicated to new and continued research on intersex. More than a decade later, the NIH continues to dedicate resources to and requests for research on culturally competent care for intersex patients and their families.

Depoliticization of ISNA As ISNA sought credibility in medical circles by shedding its former confrontational Hermaphrodites with Attitude activism, it retooled itself to put forth a more professional image. This included the publication of its new newsletter, ISNA News, in 2001. In addition to the newsletter’s change in title, ISNA News moved away from the personal stories and humor that were commonplace in its predecessor, Hermaphrodites with Attitude, to professional and organizational concerns such as financial reports, profiles of board members, and the continued coverage of medical conferences and research. This shift mirrors an overarching change within the intersex movement at the beginning of the 21st century, when intersex activists and doctors began working alongside one another for change rather than against each other as political adversaries. A mere 4 years after picketing outside of such events, Cheryl Chase began to be featured as an invited keynote speaker at prominent medical conventions. ISNA distancing itself from a narrative of personal medical trauma was furthered when Chase stepped down as the executive director and a non-intersexed medical sociologist, Monica Casper, took the helm for 1 year, from 2003 to 2004. Chase stepped back in to serve as ISNA’s executive director in 2004 until ISNA closed down in 2008. During her time at ISNA, Casper helped connect the intersex movement’s concerns to other movements and

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communities including women’s health, disability rights, children’s rights, sexual rights, and reproductive rights. She also helped grow ISNA’s Medical Advisory Board and distribute the recently developed handbooks for clinicians and parents. Other intersex organizations formed or expanded to fill the void created by ISNA’s transition from support and activism to professionalism. Examples of these organizations include Bodies Like Ours, Intersex Initiative, Organisation Intersex International, Inter/Act Youth, the Androgen Insensitivity Syndrome–Disorders of Sex Development Support Group, Advocates for Informed Choice, and the Interface Project. The Interface Project has created a website featuring brief videos of people with intersex traits discussing their experiences and the belief, as stated in a widely publicized banner, that “No Body Is Shameful,” reminiscent of the “It Gets Better” video campaign. Sharon E. Preves See also Coming Out, Disclosure, and Passing; Embodiment; Intersexuality; It Gets Better; Nonbinary Genders; Resilience and Protective Factors, Youth

Further Readings Accord Alliance. http://www.accordalliance.org/ Advocates for Informed Choice. http://aiclegal.org/ Androgen Insensitivity Syndrome-Disorders of Sex Development Support Group. http://aisdsd.org/ Chase, C. (1993, July/August). Letter to the editor. The Sciences, p. 3. Dreger, A. D., Chase, C., Sousa, A., Gruppuso, P. A., & Frader, J. (2005). Changing the nomenclature/ taxonomy for intersex: A scientific and clinical rationale. Journal of Pediatric Endocrinology & Metabolism, 18(8), 729–733. Fausto-Sterling, A. (1993, March/April). The five sexes: Why male and female are not enough. The Sciences, 33(2), 20–25. Inter/Act Youth. http://interactyouth.org/ Interface Project. http://www.interfaceproject.org/ Intersex Society of North America. http://www.isna.org/ Lee, P. A., Houk, C. P., Ahmed, S. F., & Hughes, I. A. (2006). Consensus statement on management of intersex disorders. International Consensus Conference on Intersex. Pediatrics, 118(2), e488–e500.

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Money, J., Hampson, J. G., & Hampson, J. (1955). An examination of some basic sexual concepts: The evidence of human hermaphroditism. Bulletin. Johns Hopkins Hospital, 97(4), 301–319. Organisation Intersex International. http://oiiinternational .com/ Preves, S. E. (2004). Out of the O.R. and into the streets: Exploring the impact of intersex media activism. Research in Political Sociology, 13, 179–223.

INTERSEXUALITY This entry provides a historical overview that situates debates and alliances over/between the largely European American call for human rights protections for intersex persons, and contemporary LGBTQ human rights movements in the West. The alliances that formed in the 1990s as each movement grew alongside the others have been the subject of debates with political and clinical import arising in the mid-2000s and continuing since. The sections that follow make clear the central importance of LGBTQ support to the formation of intersex rights movements’ challenges to heteronormativity.

History and Definitions The term intersex has a clinical history almost 100 years old; medical historian Lizzie Reis traced its first use to geneticist Richard Goldschmidt who, in 1917, described humans with apparently ambiguous biological or anatomical sex characteristics first noticed in infancy or early childhood. It was not, however, until Brown University geneticist and professor of biomedicine Anne Fausto-Sterling published an article intended for more popular readership in 1993 that the term intersex entered popular awareness. The article proposed that the medical management of intersex states imposed a social expectation of two distinct and opposite sexes onto a biological reality in which anatomical and genetic sex characteristics develop along a spectrum. Further, Fausto-Sterling proposed that we could easily see that a large percentage of the population would have sex characteristics that resided

somewhere in the middle of the spectrum, with the extreme poles of male and female representing merely those whose bodies most closely met the dichotomized and idealized requirements of maleness and femaleness. For the sake of convenience, Fausto-Sterling argued that we might think of five sexes—males, merms, herms, ferms, and females— as a bare minimum for capturing this human diversity—but, most importantly, she argued against using surgical or other medical methods to try to force intersexed persons to meet social expectations about appearance. Fausto-Sterling did not mean that there were literally five sexes; rather, her argument drew attention to the injustice of altering the bodies and biochemistry of children using a model based on heterosexist assumptions about what a proper adult sexuality should be. In other words, the expectation of heterosexual marriage as the goal of successful treatment, and the definition of such marriage resting on the idea of “opposite” sexes, meant that an estimated 1% of the population was being forced to have their genital appearance reshaped, and for many, also to have certain internal organs removed or “rebuilt” in an effort to produce a “normal” body. By the early 1990s, when Fausto-Sterling felt compelled to write her article, it was becoming quite clear that the young adults who had been treated using these protocols, largely dependent on models developed by John Money at Johns Hopkins hospital in the 1950s and 1960s, were struggling with both organic dysfunctions caused by the surgeries and feelings of shame about the differences in their bodies that they had been forced to ignore, to conceal, and not to discuss even in the face of obvious scars, multiple hospital stays, and so forth.

Intersex Society of North America Is Born of Five Sexes Fausto-Sterling’s 1993 article prompted an immediate response from a reader who identified herself as Cheryl Chase, director of the Intersex Society of North America (ISNA). Chase, who has since come out publicly as Bo Laurent, was a student at the time in San Francisco, and also the owner of a

Intersexuality

technology and communications company based in the Bay Area. Because of her professional interests, Laurent decided to work for a number of years under the Cheryl Chase pseudonym, and published a number of editorial letters and articles under that name. In an almost parallel timeframe, Suzanne Kessler, a professor of psychology at the State University of New York, Purchase, was publishing findings from her ethnographic work in hospitals with families. Kessler’s work on intersex first appeared in a lengthy article in the journal Signs in 1990. Kessler’s research was remarkable because it showed unequivocally that parents had to be taught how to see their children as problems in the same way that clinicians and surgeons did. In the majority of cases, Kessler realized that parents had to be taught, for example, to understand that where they saw an ordinary baby boy, the clinicians had identified a biological female—by which they meant that the infant had internal ovaries and a uterus, and might one day get married and have babies. If such children were to be left as they were, medical experts opined, they would surely “fail” as males in adulthood because they might not mature to have an average-sized penis, and they would not be able to father children. In other cases, where parents perceived their infants as ordinary girls, parents had to be taught that these children were genetic males with internal testes that would require removal in early infancy or childhood. Other surgeries, such as vaginoplasty, were often recommended for these infants and children as well, intended as they were to produce heterosexually viable female adults. In sum, the parental perception of their children as healthy babies had to be corrected to match the clinical view of the children as intersex, and successful management of parents was measured by obtaining consent to surgeries meant to produce adults who would be socially, and, optimally, reproductively heterosexual. Chase’s response to Fausto-Sterling marked the active start of peer-based intersex activism in North America, and quickly drew attention and support from gay and lesbian associations in academic and medical circles. For example, the gay and lesbian division of the American Psychological

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Association (APA) and members of the Gay and Lesbian Medical Association (GLMA) were early supporters. Indeed, during the mid-1990s, both organizations welcomed members from the rapidly growing ISNA to present critical work and make requests for recognition of intersex rights as human rights concerns. However, not all professional organizations were equally enthusiastic about this critical work taking place in dialogue with their larger professional bodies, and so it was highly important that intersex activists received support from openly gay and lesbian practitioners and scholars. William Byne at Mount Sinai Hospital in Manhattan, for example, along with Suzanne Kessler, helped ISNA to present a panel at a medical conference on plastic surgery in April of 1996. The Mount Sinai presentation was covered at length by Anne D’Adesky in an Out magazine feature article that highlighted the drive of surgeons to produce adults who would effectively “pass” as females in heterosexual relationships.

Alliance With Transgender and Queer Activists and Scholars In October of 1996, ISNA had gained the support of activist Rikki Wilchins and the Transsexual Menace, who brought along members for moral support when ISNA members Max Beck (d. 2008) and Morgan Holmes sought to confront surgeons at the American Association of Pediatrics meeting held in Boston that year. Although surgeons at that meeting, who were advocating aggressive surgical intervention for intersex infants, did not welcome any dialogue with the group of protesters, the day (October 26) is now observed annually around the world as Intersex Awareness Day. This tradition was started by Betsy Driver, founder of the intersex support group Bodies Like Ours. In cooperation with activist member and former ISNA intern Emi Koyama, Driver was able to secure the support of Edward Stein at Yeshiva University’s Cardozo School of Law to hold a 2-day conference that gathered together the growing population of critical scholars working on intersex issues. These scholars included Sharon Preves, Julie Greenberg, Emi Koyama, and Morgan Holmes, and resulted in

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a dedicated issue of the Cardozo Journal of Gender and Law that appeared in 2005. Until 2005, then, the collaborative relationship of intersex activism and activists with various lesbian and gay organizations and individual scholars was strong. The relationship stemmed in part from the concentration of intersex activists who also identified as “queer” in some way or another, or who experienced social gender transition (i.e., nonmedical/nonsurgical) as part of their aging process—as happened in Max Beck’s case. While medical practitioners had long noted the common outcome for some populations of intersexualized patients to grow up to identify as lesbian or gay, practitioners had approached these people as problematic examples. Indeed, some practitioners worried that the relatively common tendency for girls with congenital adrenal hyperplasia (CAH) to develop into adults who identified as lesbian was evidence of so-called androgenic hormones having “masculinized” their brains, and mused on different ways such outcomes might be prevented in future.

The Creation of “DSD” Language for Clinical Use By around 2005, the association of intersex activism with LGBTQ supporters and cross-population pollination of ideas, as well as social and financial support, had hit the mainstream, and in 2006, the Lawson Wilkins Pediatric Endocrinology Society (LWPES), meeting with a small number of intersex representatives, determined to change the nomenclature of intersex to “disorders of sex development” (DSD) in an effort to depoliticize and unqueer the movement. On the heels of the change, medical historian and bioethics professor Alice Dreger explained that parents were typically put off by the association of intersex with perceived “radical” gay, lesbian, and trans groups. The use of DSD, it was thought, would help direct attention away from sexual identity politics and toward reducing the frequency and aggressiveness of early intervention. Eight years after the DSD language was decided on at the LWPES meetings, indications from clinical practice and publication suggest that treatment remains as aggressive as it was in earlier

decades, and that the time frame to try to alter intersex bodies may even have been pushed back to the prenatal stage. In particular, suggestions abound regarding the off-label use of dexamethasone (a very powerful steroid usually administered as an immunosuppressant) to prevent fetal masculinization of CAH fetuses who are biologically female, as do suggestions to terminate pregnancies in which complete androgen insensitivity is diagnosed in a chromosomal XY fetus. Those scholars who do critical intersex studies—in particular Iain Morland, Lena Eckert, Margriet van Heesch, and Adrienne Asch— have argued that these prenatal efforts to remove intersex traits or to terminate fetuses in which intersex is genetic and unalterable are based on fears that such persons simply cannot grow up to be “normal,” that is, heterosexually reproductive adults.

Global Activist Responses to “DSD” Conceptual and political tensions persist between those who argue in favor of using DSD language to mark a treatable set of disorders, and those who advocate for the recognition of intersex as a legitimate identity based on bodily differences present from birth. For example, the development of DSD language in North America led to the more vocally queer international advocacy group, Organisation Intersex International (OII). Many activists from OII around the globe have been welcomed by the International Lesbian and Gay Association (ILGA), a larger international lobbying and advocacy body that recognizes the need to contest the heterosexist clinical view of intersex, to protect intersexualized infants and children from heteronormative expectations, and to secure human rights recognitions for intersex persons. ILGA has also welcomed individuals not affiliated with OII, and sees the need for an international secretariat (elected for the first time in 2014) for intersex issues. In general, LGBTQ support and recognition of intersex does not deny that many intersex persons mature to identify as heterosexual, but recognizes that even those adults have their rights to bodily integrity threatened by the continued heteronormative social demands and expectations. In terms of

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activism, it is largely parents who feel their concerns are best represented by the shift to DSD language, and it is largely adults who have come to understand their differences as part and parcel of the ways their bodies and relationships challenge heterosexism who have embraced intersex as an identity that should be valued and protected. M. Morgan Holmes See also Heteronormativity; Heterosexism; Intersex Society of North America; Queer

Further Readings Beck, M. (2001). My life as an intersexual. PBS Broadcasting. Retrieved November 12, 2015, from http://www.pbs.org/wgbh/nova/body/intersexual-life.html Chase, C. (1996). Affronting reason. In D. Atkins (Ed.), Looking queer (pp. 205–219). Binghamton, NY: Haworth Press. D’Adesky, A. (1996, September). The third sex. Out, p. 104f. Dreger, A., Chase, C., Aaron, S., & Gruppuso, P. (2005). Changing the nomenclature/taxonomy for intersex: A scientific and clinical rationale. Journal of Pediatric Endocrinology and Metabolism, 18(8), 729–733. Fausto-Sterling, A. (1993). The five sexes: Why male and female are not enough. The Sciences , 33(2), 20–25. Holmes, M. M. (2008). Intersex: A perilous difference. Selinsgrove, PA: Susquehanna University Press. Kessler, S. (1990). The medical construction of gender: Case management of intersexual infants. Signs: Journal of Women in Culture and Society, 16(1), 3–26. Preves, S. (2003). Intersex and identity: The contested self. New Brunswick, NJ: Rutgers University Press. Reis, E. (2009). Bodies in doubt: An American history of intersex. Baltimore, MD: Johns Hopkins University Press.

INTIMATE PARTNER VIOLENCE, FEMALE This entry describes intimate partner violence (IPV) victimization of females, with a particular focus on lesbian and bisexual women. It provides a definition of IPV, describes dynamics of IPV relationships, presents estimates of the prevalence of

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IPV among female victims, describes suspected causal factors in IPV perpetration, lists consequences of IPV victimization, and briefly describes barriers to helping resources.

Definition of Intimate Partner Violence Intimate partner violence is the use of physical, psychological, or sexual violence against current or former intimate partners. A couple need not have been sexually intimate, nor to cohabitate, for abusive behaviors to be categorized as IPV. Intimate partner violence may vary in frequency and severity, ranging from chronic, severe battering to as little as one hit with no victim impact. Historically, IPV has also been called spousal abuse, marital violence, domestic violence, partner violence, intimate partner abuse, and partner aggression.

Subtypes of Intimate Partner Violence One problem in the field of IPV prevention is that professionals from different sectors (e.g., law enforcement, medicine, child protection, advocacy) do not always define IPV in the same way, or share viewpoints on why it occurs. Conflicting definitions have contributed to debate about whether women perpetrate IPV at rates equivalent to men. In an attempt to refine our understanding, researcher Michael Johnson proposed that IPV is an umbrella concept that includes four subtypes of couple abuse: situational violence, self-defensive partner violence, mutually abusive partner violence, and intimate terrorism. The form of IPV upon which domestic violence shelter workers typically focus is intimate terrorism. Intimate terrorism involves one partner maintaining power and control over the other using a range of coercive tactics. The other forms of IPV (i.e., situational violence, self-defensive violence, and mutual abuse) are more likely to involve bidirectional violence—that is, abuse perpetrated by both members of a couple.

The Prevalence of Intimate Partner Violence Among Females The U.S. National Intimate Partner and Sexual Violence Survey (NISVS) found that more than 4 in

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10 lesbian women (44%), more than 6 in 10 bisexual women (61%), and more than 1 in 3 (35%) heterosexual women reported rape, physical violence, and/or stalking by an intimate partner during their lifetimes. Translating those percentages into numbers of women affected means that presently there are approximately 714,000 lesbian women, 2,000,000 bisexual women, and 38,300,000 heterosexual women over the age of 17 years old in the United States who are survivors of IPV. According to the NISVS data, bisexual women have a statistically significantly increased risk of lifetime IPV victimization as compared to either lesbian or heterosexual women, but the difference in prevalence rates between lesbians and heterosexual women (44% and 35%, respectively) is not statistically significant. In other words, according to this source, lesbians are not at increased risk for victimization as compared to heterosexual women. Importantly, the NISVS reveals that lesbian and bisexual women who report ever having been raped, assaulted, or stalked by an intimate partner are not always reporting violence inflicted by a female perpetrator. In fact, 90% of bisexual women and 33% of lesbian women who report lifetime IPV victimization indicate that it was perpetrated by a male. While it seems counterintuitive that lesbians could report IPV victimization perpetrated by male partners, the most likely explanation is that a substantial proportion of lesbians who report having experienced IPV in their lifetimes are recalling experiences from a time in their lives when they had dated, been married to, or been having sex with a male partner. The prevalence of IPV victimization among lesbian and bisexual youth is also high. A nationally representative study of adolescents in the United States, conducted by Carolyn Halpern and her colleagues, found that among female youth who reported only having same-sex sexual partners, 29% had ever experienced physical or emotional IPV victimization, and 13% had ever experienced physical IPV victimization. This study did not establish whether the perpetrators of these incidents were male or female, however. Estimates of IPV victimization among lesbian and bisexual women in nations other than the

United States are rare, but Andrew Frankland and Jac Brown in Australia found that the past-year prevalence rates of IPV victimization among lesbians and gay men (who were grouped together) was 36% for physical IPV and 26% for sexual coercion. A study of Italian lesbian and bisexual women conducted by Concetta Pellulo and colleagues found that 41% had ever experienced physical or sexual violence by a partner, and 17% did in the year prior to the survey. Data on IPV victimization among transgender people is also scant, although one Massachusetts-based study found that 14% of gay men and lesbians, 18% of bisexual people, and 34% of transgender people reported that they had ever been threatened with physical violence by an intimate partner.

Causes and Consequences of Intimate Partner Violence Victims of IPV may experience a range of adverse consequences. These include depression, anxiety, posttraumatic stress symptoms, disordered eating, unhealthy substance use, poor academic performance, sexually transmitted infections (STIs), injury, and death. There are a number of different theories about why IPV occurs. Although no single explanation is applicable to all IPV cases, there are several factors that appear to elevate risk for perpetration. These include experiencing parental abuse or neglect; witnessing interparental partner violence; having antisocial personality characteristics; perpetrating violence toward nonintimates; associating with aggressive peers; sustaining a frontal lobe head injury; using alcohol or drugs; experiencing deprivation (i.e., low employment, poverty); having an attachment disorder, trait hostility, or stress; living in a neighborhood characterized by disorder or low collective efficacy; and living in a community with social norms supportive of using violence to resolve conflict. Importantly, violence may become more severe during or immediately after a breakup. It should also be noted that some research finds that the use of violence and abuse by one member of a couple appears to increase the likelihood that the other partner will also use violence,

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either aggressively or in self-defense. There are also a few factors that appear to prevent IPV perpetration. These include having strong social support, better friendship quality, high verbal IQ, and experiencing close supervision and support from parents or guardians as a child. Historically, the grassroots advocacy perspective on IPV has been rooted in feminist theory, which contends that men who abuse their female partners capitalize on male societal, political, and economic privilege to do so, and that the gender roles promoted by male-dominated societies create conditions in which women may more easily be oppressed in intimate relationships. That explanation for IPV has been problematic for LGBTQ advocates, because it fails to adequately explain the victimization of gay males or perpetration by females. Today, the majority of IPV prevention efforts are guided by a more nuanced perspective on how traditional gender norms can influence relationship behavior, even in same-sex couples. This perspective holds that the pressure to conform with traditional gender roles can exacerbate risk for IPV perpetration for all people, and that the same values that privilege males also encourage homophobia, which intensifies the difficulties that gay and lesbian IPV victims face when they are being abused or seeking help. An important caveat is that research on gender identity and IPV perpetration suggests that there is no higher likelihood of IPV being perpetrated by a “butch” (or masculine-identified) lesbian than a “femme” (or feminine-identified) one.

Dynamics of Intimate Partner Violence for Females in Same-Sex Relationships Women in abusive same-sex relationships may experience all of the same aggressive behaviors that victims in opposite-sex relationships do. Verbal and emotional abuse (e.g., threats, insults, name-calling, making a partner feel emotionally unstable, isolating a partner from friends or family members) is the most common form of IPV. Other forms can include physical violence (e.g., hitting, slapping, punching, kicking, biting, choking); sexual assault or coercion (e.g., rape, using threats to

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obtain sex, convincing a partner to participate in sexual acts that he or she does not want to do, humiliating or shaming someone about sex without consent); reproductive or sexual health coercion (e.g., tampering with birth control, refusing to wear a condom, failing to disclose sexually transmitted infection status); stalking (e.g., constant texting, showing up uninvited, spying, reading partner’s e-mail or text messages, using the Internet to track a partner’s activities, placing a GPS device in a partner’s vehicle to monitor his or her whereabouts); or economic abuse (e.g., withholding money, forcing a partner to do things for money that he or she does not want to do). In addition, there are potentially lethal or severe IPV behaviors such as threatening suicide or to harm a pet, child, or other loved one; threatening to kill one’s partner; displaying or using a weapon such as a gun or knife; using an object like a bat or cell phone as a weapon; or inflicting injuries that require medical attention. Women and men in same-sex relationships are vulnerable to additional abusive tactics. Abusive partners may threaten to “out” or expose their partner’s sexual orientation without consent, may attempt to convince their partner that IPV does not occur in same-sex relationships, may monopolize helping resources such as domestic violence agencies or friends by claiming to be the “real” IPV victim, or may claim that the abusive behavior is a normal part of non-normative gender behavior (e.g., acting powerful or controlling is an attractive quality). LGBTQ and heterosexual people who engage in bondage, dominance, sadism, or masochism (BDSM) can also be vulnerable to additional forms of partner abuse; IPV perpetrators may claim that abusive behaviors are part of a BDSM scene or relationship dynamic.

Helping Resources for Lesbian and Bisexual Victims of Intimate Partner Violence Many female survivors of same-sex IPV feel hesitant about seeking help. Lesbians and bisexual women can face discriminatory responses from the criminal justice system, and may be met with heteronormative and homophobic responses from

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social service and health care providers. The discriminatory response of law enforcement has been empirically established. For example, one study found that police were less likely to make an arrest in domestic violence cases where both parties were female than in cases involving an opposite-sex couple. The lower arrest rate for same-sex female couples may reflect cultural assumptions that women are not as violent or dangerous as men. These types of assumptions, and heterosexism embedded in many social service practices, create a need for LGBTQ-specific IPV helping resources. Emily Rothman and Nkiru Nnawulezi See also Dating, Sexual-Minority Men; Dating, SexualMinority Women; Relationships with Former Spouses; Sexual Minorities and Violence; Violence and Victimization of Youth; Youth and Dating

Further Readings Balsam, K. F., & Szymanski, D. M. (2005). Relationship quality and domestic violence in women’s same-sex relationships: The role of minority stress. Psychology of Women Quarterly, 29, 258–269. Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating violence experiences of lesbian, gay, bisexual, and transgender youth. Journal of Youth Adolescence, 43, 846–857. Frankland, A., & Brown, J. (2014). Coercive control in same-sex intimate partner violence. Journal of Family Violence, 29, 15–22. Halpern, C. T., Young, M. L., Waller, M. W., Martin, S. L., & Kupper, L. L. (2004). Prevalence of partner violence in same-sex romantic and sexual relationships in a national sample of adolescents. Journal of Adolescent Health, 35(2), 124–131. Johnson, M. P. (1995). Patriarchal terrorism and common couple violence: Two forms of violence against women. Journal of Marriage and the Family, 57(2), 283–294. Messinger, A. M. (2011). Invisible victims: Same-sex IPV in the National Violence Against Women Survey. Journal of Interpersonal Violence, 26(11), 2228–2243. Pattavina, A., Hirschel, D., Buzawa, E., Faggiani, D., & Bentley, H. (2007). A comparison of the police response to heterosexual versus same-sex intimate

partner violence. Violence Against Women, 13(4), 374–394. Walters, M. A., Chen, J., & Breiding, M. J. (2013). The National Intimate Partner and Sexual Violence Survey: 2010 findings on victimization by sexual orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

INTIMATE PARTNER VIOLENCE, MALE This entry describes intimate partner violence (IPV) victimization of males, with particular focus on the experiences of men who are gay and bisexual, and men who have sex with men (MSM). It provides a definition of IPV; describes dynamics of IPV relationships; presents estimates of the prevalence of IPV among male victims; describes suspected causal factors in IPV perpetration; lists consequences of IPV victimization; and briefly describes barriers to helping resources that gay, bisexual, and transgender men have experienced.

Definition of Intimate Partner Violence Intimate partner violence is the use of physical, psychological, and/or sexual violence against a current or former intimate partner. A couple need not have been sexually intimate, nor to cohabitate, for abusive behaviors to be categorized as IPV. Intimate partner violence may vary in frequency and severity, meaning that as little as one hit with no victim impact may constitute IPV, as does chronic, severe battering. Historically, IPV has also been called spousal abuse, marital violence, domestic violence, partner violence, intimate partner abuse, and partner aggression.

Subtypes of Intimate Partner Violence Researcher Michael Johnson proposed that IPV is an umbrella concept that includes four subtypes of couple abuse including situational violence, self-defensive partner violence, mutually abusive partner violence, and intimate terrorism. The form

Intimate Partner Violence, Male

of IPV upon which domestic violence shelter workers typically focus is intimate terrorism, which involves one partner maintaining power and control over the other using a range of coercive tactics. The other forms of IPV (i.e., situational, self-defensive, and mutually abusive partner violence) are more likely to involve bidirectional violence—that is, abuse perpetrated by both members of a couple.

The Prevalence of Intimate Partner Violence Among Males Using data from the U.S. National Intimate Partner and Sexual Violence Survey (NISVS), Mikel Walters and colleagues found that more than 1 in 4 gay men (26%), more than 1 in 3 bisexual men (37%), and more than 1 in 4 (29%) heterosexual men reported rape, physical violence, and/or stalking by an intimate partner during their lifetimes. Translating those percentages into numbers of men affected means that presently there are approximately 708,000 gay men, 711,000 bisexual men, and 30,250,000 heterosexual men over the age of 17 years in the United States who are survivors of IPV. The lifetime IPV victimization rate among heterosexual women in the United States is 35%, which is approximately equivalent to the risk for bisexual men (37%), but greater than the risk for gay men (26%) and heterosexual men (29%). The differences in IPV victimization for gay, bisexual, and heterosexual men participating in the NISVS was not statistically significant, meaning that according to this data source, gay and bisexual men are no more or less likely than heterosexual men to experience IPV. The finding that gay men are at equivalent, but not increased, risk for lifetime IPV victimization as compared to heterosexual women and heterosexual men was also reported by researchers who used the nationally representative Behavioral Risk Factor Surveillance System (BRFSS) to estimate rates. Importantly, the NISVS reveals that gay and bisexual men who report ever having been raped, assaulted, or stalked by an intimate partner are not always reporting about a same-sex perpetrator. More than 90% of gay men who have experienced

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IPV report that it was perpetrated by a male partner. However, 79% of bisexual male IPV survivors reported that it was perpetrated by a female. The nationally representative estimates of IPV for gay and bisexual men found by the NISVS parallel rates from state-level studies. For example, a study of a representative sample of Californians conducted by Naomi Goldberg and colleagues found that the lifetime IPV victimization rate was 27% for gay men, 20% for bisexual men, and 17% for men who have sex with men (MSM). Ana Buller and her colleagues reviewed the results of 18 research studies on IPV against gay men and found lifetime prevalence rates of IPV victimization for gay men that ranged from 32% to 82%. The wide range is attributable to varying definitions of sexual orientation and of IPV that were used across the studies. The prevalence of IPV victimization among gay, lesbian, and bisexual youth is also high. A nationally representative study of adolescents found that 9% of gay male and 13% of lesbian adolescents reported physical IPV victimization during the 18 months preceding the survey. Another study conducted by Meredith Dank and colleagues grouped lesbian, gay, and bisexual youth together and found that 43% experienced physical IPV by the time they were in Grade 12, as compared to only 29% of heterosexual youth; this difference was statistically significant. A 2009 report from the Massachusetts Department of Public Health found that 35% of transgender people and 14% of non-transgender people were threatened with physical violence by an intimate partner in the preceding year, indicating increased risk for transgender people (with maleto-female and female-to-male transgender people grouped together).

Dynamics of Intimate Partner Violence for Males in Same-Sex Relationships Males in same-sex relationships may experience all of the same forms of partner aggression that women and men in opposite-sex relationships do (with the exception of abuse related to contraception and

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pregnancy). Specifically, they may experience verbal and emotional abuse (e.g., threatening, insulting, isolating from friends and family); physical abuse (e.g., hitting, punching, kicking, choking); sexual abuse (e.g., being forced or coerced into sexual activity, being humiliated because of sexual desires); stalking (e.g., electronic or in-person monitoring of a partner’s whereabouts or activities); and economic abuse (e.g., withholding money). In addition, men in same-sex relationships are vulnerable to additional abusive tactics. Abusive partners may threaten to “out” or expose their partner’s sexual orientation without consent, may attempt to convince their partner that IPV does not occur in same-sex relationships, may monopolize helping resources such as domestic violence agencies or friends by claiming to be the “real” IPV victim, or may claim that the abusive behavior is a normal part of non-normative gender behavior (e.g., acting powerful or controlling is an attractive quality). Abusive partners may also call the other’s sexual orientation into question in an attempt to control the person, or they may minimize and deny abuse perpetration. People who engage in bondage, dominance, sadism, or masochism (BDSM) can also be vulnerable to additional forms of partner abuse; IPV perpetrators may claim that abusive behaviors are part of a BDSM scene or relationship dynamic.

Risk Factors for Intimate Partner Violence Perpetration There is no singular personality profile of a domestic violence offender. Numerous risk factors for IPV perpetration have been identified. These include experiencing parental abuse or neglect; witnessing interparental partner violence; having antisocial personality characteristics; perpetrating violence towards nonintimates; associating with aggressive peers; sustaining a frontal lobe head injury; using alcohol or drugs; experiencing deprivation (e.g., low employment, poverty); having an attachment disorder, trait hostility, or stress; living in a neighborhood characterized by disorder or low collective efficacy; and living in a community with social norms supportive of using violence to

resolve conflict. Importantly, violence may become more severe and potentially lethal during or immediately after a breakup. It is possible for a person to perpetrate IPV even if none of the above-listed factors is present. It should also be noted that some research finds that the use of violence and abuse by one member of a couple appears to increase the likelihood that the other partner will also use violence, either aggressively or in self-defense. There are also a few factors that appear to prevent IPV perpetration. These include having strong social support, better friendship quality, high verbal IQ, and experiencing close supervision and support from parents or guardians as a child.

Consequences of Intimate Partner Violence Victimization Male victims of IPV may experience all of the same adverse consequences as female victims, which can include depression, anxiety, posttraumatic stress symptoms, disordered eating, unhealthy substance use, poor academic performance, sexually transmitted infections (STIs), injury, and death. Research suggests that male victims of female-perpetrated IPV are significantly less likely to sustain an injury than female victims of male-perpetrated IPV. Male victims of female-perpetrated IPV are also less likely to be sexually abused or stalked by their partner than female IPV victims.

Helping Resources for Male Survivors of Intimate Partner Violence Regardless of their sexual orientation, men who attempt to report IPV victimization to law enforcement are sometimes not believed or are denigrated because of societal beliefs that women are rarely violent and that men who are physically or sexually assaulted are weak and deserving of the abuse. Men who are in same-sex relationships are sometimes discriminated against by the criminal justice system. Not all states grant civil orders of protection (i.e., restraining orders) to gay and lesbian people. Advocates have also documented cases where courts consider both members of a same-sex couple equally

It Gets Better

at fault, without reviewing the facts. Helping services and social service providers have also discriminated against male and transgender victims of IPV, including denying them access to domestic violence shelters and other community- and state-supported resources. When granted access to mainstream helping services, some male and transgender IPV victims face inappropriate behavior from other victims who are also receiving services—for example, being insulted by a member of a support group or bullied by a fellow shelter resident. In some cases, the potential consequences of having to reveal a gay or bisexual sexual orientation to local law enforcement or service providers prevent IPV victims from seeking help altogether. The insular nature of LGBTQ social networks in some locales may also inhibit help-seeking, because gay and bisexual victims fear they will be disbelieved and subsequently socially isolated from their community. Despite these barriers to help-seeking and receiving services, some men do call mainstream or gay-specific domestic violence hotlines for assistance. Some seek and receive emergency shelter, obtain restraining orders, are granted victim recovery funds, or join support groups with success. There are numerous LGBTQ-specific domestic violence service providers around the world, and increasingly, mainstream service providers are participating in cultural competency trainings in order to improve their capacity to help LGBTQ and heterosexual male survivors of IPV. Emily Rothman and Nkiru Nnawulezi See also Dating, Sexual-Minority Men; Dating, SexualMinority Women; Intimate Partner Violence, Female; Relationships With Former Spouses; Sexual Minorities and Violence; Violence and Victimization of Youth; Youth and Dating

Further Readings Buller, A. M., Devries, K. M., Howard, L. M., & Baccus, L. J. (2014). Associations between intimate partner violence and health among men who have sex with men: A systematic review and meta-analysis. PLOS Medicine, 11(3), 1–12.

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Dank, M., Lachman, P., Zweig, J. M., & Yahner, J. (2014). Dating violence experiences of lesbian, gay, bisexual, and transgender youth. Journal of Youth Adolescence, 43, 846–857. Finneran, C., & Stephenson, R. (2014). Antecedents of intimate partner violence among gay and bisexual men. Violence and Victims, 29(3), 422–435. Frankland, A., & Brown, J. (2014). Coercive control in same-sex intimate partner violence. Journal of Family Violence, 29, 15–22. Goldberg, N. G., & Meyer, I. H. (2013). Sexual orientation disparities in history of intimate partner violence: Results from the California Health Interview Survey. Journal of Interpersonal Violence, 28(5), 1109–1118. Johnson, M. P. (1995). Patriarchal terrorism and common couple violence: Two forms of violence against women. Journal of Marriage and the Family, 57(2), 283–294. Messinger, A. M. (2011). Invisible victims: Same-sex IPV in the National Violence Against Women Survey. Journal of Interpersonal Violence, 26(11), 2228–2243. Walters, M. L., Chen, J., & Breiding, M. J. (2013). The National Intimate Partner and Sexual Violence Survey: 2010 Findings on victimization by sexual orientation. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.

IT GETS BETTER It Gets Better (IGB) is a video project that was initiated by writer Dan Savage in September 2010 as a way to speak directly to lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) youth who are coping with the challenges of coming of age. Savage, best known for his nationally syndicated sex advice column, was inspired to start IGB in response to a series of suicides by youth who identified as, or were perceived to be, gay. The video that launched the project features Savage and his husband Terry Miller talking to the camera about their difficult experiences as gay teenagers and how happy and fulfilling their lives are now as adults. In the video, Savage and Miller assure LGBTQQ youth viewers that their lives will get better and insist that suicide is never the answer to the challenges they are facing in adolescence.

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IGB rapidly went viral, with hundreds of people uploading their homemade videos within the first 2 weeks of its inception. Since then, over 50,000 unique IGB videos have been made and uploaded to YouTube. Among the most prominent of IGB video makers are U.S. President Barack Obama, former U.S. Senator and Secretary of State Hillary Clinton, actor Neil Patrick Harris, comedian Ellen DeGeneres, pop star and American Idol winner Adam Lambert, and pop star Ke$ha. As of September 2014, IGB videos have been viewed over 50 million times. According to its Facebook profile, IGB seeks to show LGBTQ youth the levels of happiness, potential, and positivity their lives will reach. IGB has been hailed by some as a remarkable grassroots social justice project that helped ensure that the related issues of bullying and queer youth suicides are part of conversations on sexuality and mental health. The popularity of IGB is further evidenced by the establishment of multiple IGB-related platforms, including a foundation, which manages a YouTube channel of IGB videos; as well as a book; speaking engagements; an hour-long MTV episode devoted to IGB; and an MTV television series in which Savage dispenses sex advice to college students, called Savage U. In addition, the Academy of Television Arts & Sciences announced that IGB was the recipient of its prestigious Governors Award of 2012. The explicit message of IGB centers on imploring queer youth not to kill themselves while assuring them that their lives will improve once they finish high school and can escape their hostile environment. While not all video makers are themselves LGBTQ-identified, the videos produced by those who are include testimony about their own challenging experiences with growing up and how rewarding their lives are now. Videos made by LGBTQ-identified employees of prominent companies such as Facebook and Google are good examples of this format. Regardless of the sexual and gender identities of the video makers, all assert that it will eventually get better once LGBTQQ youth transition from adolescence to adulthood.

IGB has met with a significant amount of criticism. First, critics contend that the IGB approach does not go far enough in helping LGBTQQ youth to cope with bullying and related forms of social ostracism and harassment in their present circumstances. Missing from the messages communicated through IGB are clear and practical strategies for young people to manage their day-to-day realities and to challenge the anti-LGBTQ practices that produce hostile environments in the first place. Second, concerns have been raised about the extent to which IGB treats LGBTQQ experiences as homogenous and centers the experiences of White, middleclass, gay-identified cisgender male teenagers. This focus arguably obscures the lived experiences of economically disadvantaged queer youth; queer youth of color; gender-nonconforming and transgender youth; and sexually nonconforming girls who also experience bullying and harassment that is compounded by racism, sexism, classism, cissexism, and/or transphobia. Third, IGB has been criticized for ignoring the persistence of racial, gender, and economic discrimination within the LGBTQ community. By positioning urban, predominantly White gay male enclaves as enlightened and inclusive safe havens compared with more geographically isolated, less cosmopolitan areas, IGB tells a story about unconditional acceptance in queer communities that many critics argue is simply not accurate. In addition to these criticisms, attention has also been paid to the ways in which “it gets better” within the IGB framework are predicated on socioeconomic success, including college-level educational attainment, and coupling with a long-term domestic partner, which amounts to a prescription for how to live and ignores the ways in which social mobility is relatively limited in the United States. In response to criticisms of IGB, other groups formed to try to address its perceived limitations. One example is Make It Better, a project initiated by the Gay–Straight Alliance Network that focuses on improving conditions for LGBTQQ youth in their schools and communities. Groups such as Make It Better, however, lack the resources and celebrity-related notoriety of IGB and have not enjoyed as much attention and support. While it is

It Gets Better

clear that IGB has made an important contribution to a U.S.-specific national conversation about the social problem of bullying and its relationship to queer youth suicide, and sought to reach LGBTQQ youth who are socially isolated, it is hard to measure the impact of IGB on the schools and communities that produce the conditions that necessitate a project like IGB. Emily S. Mann See also Bullying; Gay–Straight Alliances (GSAs); Suicide, Risk Factors for and Prevention of; Transgender Youth and Well-Being; Violence and Victimization of Youth

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Further Readings Goltz, D. B. (2013). It Gets Better: Queer futures, critical frustrations, and radical potentials. Critical Studies in Media Communication, 30, 135–151. Grzanka, P. R., & Mann, E. S. (2014). Queer youth suicide and the psychopolitics of “It Gets Better.” Sexualities, 17, 369–393. Puar, J. K. (2012). The cost of getting better: Suicide, sensation, switchpoints. GLQ: A Journal of Lesbian and Gay Studies, 18, 149–158. Savage, D., & Miller, T. (Eds.). (2011). It gets better: Coming out, overcoming bullying, and creating a life worth living. New York, NY: Penguin.

J among the four major movements within Judaism: Orthodox, Conservative, Reform, and Reconstructionist. Jewish identity is more than belonging to one of the four major movements, though—it is an ethnicity, a culture steeped in tradition. A central component of Jewish culture is the family. The key holy texts of Judaism are the Torah, which consists of the first five books of the Hebrew Bible (in Christianity, the Old Testament), and the Talmud (a collection of Rabbinic commentaries on Jewish law). The Torah and the Talmud regard the family as sacred and deserving of respect and loyalty. Guidelines for the nurturance of family life include marriage and the social expectations of an appropriate relationship. For example, intermarriage (a Jew marrying a nonJew) may be viewed as threatening Jewish survival and solidarity and therefore may be met with hostility and rejection. Further, marriage bears the responsibility of childbearing. Children are important for the continuance of Jewish identity, and parents are expected to cultivate a strong sense of family cohesion and family obligation. Jewish identity encompasses more than religious-based ideals of family life. Jews are bound by a shared sense of oppression, stigma, and resiliency. A long history of anti-Semitism has motivated Jews to retain close ties with their families and religious communities in order to combat the fear of annihilation arising from centuries of persecution (e.g., the Holocaust, in which one third of the world’s Jews were killed; and blood libels—a

JEWISH LGBTQ PEOPLE This entry provides a brief introduction to Jewish LGBTQ people, exploring the interconnection of religious and cultural identity with sexuality in an effort to understand the context of living as a religious minority with a sexual-minority status. The LGBTQ community celebrates a diverse membership, and this entry, which is focused on the experience of Jewish Americans, is significant in highlighting a different aspect of sexuality against the background of a richly cultural, historical, and traditional religious group. Beginning with an overview of Jewish values and traditions, the entry continues with a discussion of modern views of Judaism and LGBTQ people. The task of managing multiple minority statuses (e.g., religious and sexual orientation) is also examined, and the entry concludes with information about dating, relationships, and family formation.

Jewish Identity and Jewish Faith According to the 2010 U.S. Census, 2.1% of the  U.S. population is Jewish. Eighty percent of American Jewry identify as Ashkenazi, which means that they have ancestral ties to Eastern Europe and Russia (in comparison to the 20% that are Sephardi Jews who recognize a Spanish and Portuguese heritage). The diversity of Jewish identity and religious belief systems is represented 627

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centuries-old allegation that Jews murdered Christian children in order to use their blood for rituals). Family and community rituals evolved as a way to strengthen these ties while protecting Judaism from unknown peoples.

Judaism and Homosexuality Until the late 20th century, the majority of Jews perceived homosexuality as a sin and an abomination. The emergence of the Reform movement and the changing sociopolitical landscape of the United States helped shift popular Jewish opinion. Today, Judaism retains a more nuanced view of homosexuality, which will be discussed along denominational lines associated with the four major movements. The Orthodox community remains the most traditional faction of Judaism and believes in a literal reading of the Hebrew Bible. The Orthodox believe Jewish law (Halakkah) is divine, unchanging, and free from personal interpretation. Orthodox Jewry is the least LGBTQ-affirming, commonly citing Leviticus 18:22 and 20:13 to condemn homosexuality. The most fundamental followers (living in strict adherence to Halakkah) support conversion therapy as an instrument for steering LGBTQ Jews back to the natural state of heterosexuality. There is, however, a movement toward LGBTQ acceptance and integration within Orthodoxy. A number of LGBTQ Orthodox groups have emerged in the United States and Israel (e.g., Eshel, Keshet, Havruta), and the 2001 documentary Trembling before G-d became the first film to showcase the expanding Orthodox LGBTQ community. Yet, because of Halakkah, and the importance of the family in childbearing, many Orthodox Jews do not support LGBTQ relationships or same-sex marriage. The Conservative branch of Judaism views Halakkah as subject to human intervention, and is less literal in their interpretations of Scripture than the Orthodox community. As such, the Committee on Jewish Law and Standards (CJLS)—the governing body of the Conservative movement—allows LGBTQ Jews to engage in religious activities, gain admittance into religious schools and the clergy, and participate in same-sex marriage ceremonies.

The CJLS recommends each individual rabbi and congregation determine the extent to which they enact these opportunities in their own communities. The Reform movement is the largest branch of U.S. Judaism, with the longest history of supporting LGBTQ Jews while embracing a flexible interpretation of Halakkah. The guiding principles of the Reform movement rely on Tikkun Olam—a dedication to bringing about change in the world through acts of social justice, such as by advancing the rights of women or advocating on behalf of LGBTQ families. In 1972, Congregation Beth Chayim Chadashim opened its doors in Los Angeles as the first LGBTQ Reform synagogue, and in 1990, the Reform movement’s rabbinical school (Hebrew Union College) voted to end sexual orientation discrimination. Moreover, the Hebrew Union College admitted its first openly transgender student in 2003, and the Reform movement has initiated programs focused on transgender inclusion. Reconstructionist Judaism is the most recent branch to emerge, and it was founded in the United States when it split from Conservative Judaism in the 1960s. Reconstructionists view Halakkah as an important cultural touchstone, but not as religious law. The movement sees Judaism as an evolving religious civilization and observes the state of Israel as important to building this ideal. Indeed, a strong emphasis on community and communal decision-making is one of the differences between the Reform and Reconstructionist movements. LGBTQ people enjoy a long history of acceptance within this movement. Similar to the Reform movement, Reconstructionists have instituted programs focused on transgender inclusion, including welcoming transgender rabbis into the movement. All LGBTQ members are allowed full participation in Reconstructionism as community members and leaders.

Managing Multiple Minority Identities Jewish and LGBTQ identities are both minority statuses. In the United States, Christianity is practiced by the majority of the population, and heterosexuality is the predominant sexual orientation

Jewish LGBTQ People

identifier. Thus, a Jewish LGBTQ person must be prepared to manage confrontations with antiSemitism, homophobia, and possibly transphobia. A Jewish LGBTQ woman may encounter gender discrimination and sexism as well, and a Jewish LGBTQ person of color may confront acts of racism. Yet, unlike gender and race, which are easier for others to assess, religion and sexuality status may be more difficult to determine on the basis of visual cues. Jewish LGBTQ people may strive to keep those aspects of the self invisible. However, given the potential confrontations described above, this means Jewish LGBTQ people must exercise caution when deciding whom to come out to about their Jewishness, their LGBTQ status, or both. Jewish transgender individuals may face a particularly challenging path when it comes to revealing their statuses. Some Jewish rituals, such as the Mikveh, expose the human body as part of the ceremony. A Mikveh is a purifying bath performed in front of a member of the rabbinate and select attendants during a conversion-to-Judaism ceremony. It is common in Conservative and Orthodox traditions. In addition, the Jewish burial ritual of Tahara requires proper preparation of deceased bodies, and the sex of the preparers must match the sex of the deceased. If a Jewish transgender person has chosen not to disclose his or her identity, certain rituals may prove difficult for participation. The Jewish community, too, may be faced with rethinking certain rituals and ideals about sex, gender, and bodies. For some Jewish LGBTQ people, it can be difficult to integrate their sexual identity with a religious identity that disapproves of homosexuality. Further complications include family closeness, and since family is central to Jewish culture, receiving acceptance and support from family members is important for a healthy blending of identities. Jewish LGBTQ people who attend and participate in LGBTQ-affirming synagogues experience less difficulty negotiating their identities. Engaging in activism efforts, such as working in synagogues to increase awareness of Jewish LGBTQ identities and Jewish LGBTQ families, or working as volunteers, educators, or clergy people, not only assists with the blending of identities,

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but can also act as paths to new friendships and romantic relationships.

Romantic Relationships and Family Formation Securing romantic relationships and building a family is important for LGBTQ Jews. Even if a Jewish LGBTQ individual disconnects for a period of time from the religious and cultural practices of Judaism (e.g., during young adulthood), entering into a romantic relationship may assist the person in easing back into Jewish (religious) life. For example, family members may extend invitations for the couple to attend a Passover Seder meal (a traditional Jewish event commemorating the release of the Israelites from slavery in ancient Egypt), allowing for the blending of family, religion, and a newfound romantic relationship. Jewish holidays and cultural events are significant to cultivating family cohesion, and denote a time when the entire family (including extended kin) comes together; thus, the welcoming of the LGBTQ couple into these events strengthens perceptions of social acceptance and relationship legitimacy. Moreover, the decision to parent a child together may further bolster family support and serve as a means to introduce, or reinforce, Judaism in the couple relationship. As with many Jews and nonJews alike, the decision to parent is filled with many questions, one of which involves whether to raise the child with a specific religious and/or cultural identity. When both individuals in the relationship identify as Jewish, the decision to raise a child Jewish is met with less resistance than if only one person in the couple identifies as Jewish. For Jewish LGBTQ people, the merging of family identity and religious–cultural identity comes into sharper focus, as they maneuver discussions of whether to raise their child in the Jewish faith. Ultimately, raising a child as Jewish includes various religious–cultural celebrations surrounding developmental events throughout one’s life. For example, when the child is born, a Bris (male circumcision ritual) or naming ceremony can welcome the child into the family and into the faith. Around 12 years later, a Bar (boys) or Bat (girls) Mitzvah recognizes the child as an adult of the

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synagogue. Confirmation and wedding ceremonies are additional rituals celebrating developmental milestones. Family (including parents, grandparents, siblings, and extended kin) and friends unite and acknowledge the child—and by extension, the LGBTQ family—in the spirit of Jewish tradition. Family relationships may be further strengthened with the arrival of a grandchild, niece/nephew, or cousin. Familial and social acceptance that can arise in light of parenthood may work to buffer perceived barriers based on religious–cultural, sexual, gender, or racial identity. For example, celebrating significant life events surrounded by supportive individuals with a common background and shared experience can encourage a deeper appreciation for the varying identities that a Jewish LGBTQ person might be attempting to reconcile. In addition, through the formation of romantic relationships and intentional parenting, Jewish LGBTQ people are challenging Jewish ideals of family and sexuality. Their very existence is igniting conversations within all factions of Judaism, and broadening a deeper societal understanding of what it truly means to be Jewish, LGBTQ, and a family. Katie M. Barrow See also Families of Origin, Relationships With; Minority Stress; Religion/Spirituality and LGBTQ People; Religious Identity and Sexuality, Reconciliation of

Further Readings Barrow, K. M., & Kuvalanka, K. A. (2011). To be Jewish and lesbian: An exploration of religion, sexual identity, and familial relationships. Journal of GLBT Family Studies, 7, 470–492. doi:10.1080/1550428X.2011 .623980 Davis, D. S. (2008). Religion, genetics, and sexual orientation: The Jewish tradition. Kennedy Institute of Ethics Journal, 18, 125–148. doi:10.1353/ken.0.0008 Glassgold, J. M. (2008). Bridging the divide: Integrating lesbian identity and Orthodox Judaism. Women & Therapy, 31, 59–72. doi:10.1300/02703140802145227 Lustenberger, S. (2014). Questions of belonging: Same-sex parenthood and Judaism in transformation. Sexualities, 17, 529–545. doi:10.1177/1363460714526117

Schnoor, R. F. (2006). Being gay and Jewish: Negotiating intersecting identities. Sociology of Religion, 67, 43–60. doi:10.1093/socrel/67.1.43 Shneer, D., & Aviv, C. (Eds.). (2002). Queer Jews. New York, NY: Routledge.

JOINT ADOPTION Adoption is a formal process by which a person may become a fully recognized legal parent. If two people (generally a couple) adopt a child together, this is a joint adoption. Once a joint adoption has been properly completed, each member of the couple is a full legal parent of the child. The rights of the adopting individuals are equal, and the parental status of each individual does not depend on the continuing relationship between the adults. Thus, if the adults separate, each remains a legal parent of the child. Disputes about child-rearing at that point may lead to custody litigation. Thus, there are significant consequences to completing a joint adoption. At the same time, joint adoption is not always available to same-sex couples. This entry discusses both the consequences and the availability of joint adoption. Status as a legal parent is of critical importance. In general, legal parents have the right to make significant decisions for their minor (or otherwise incompetent) children, including decisions about medical care, education, religion, and with whom a child will spend time. Legal parents are presumed to act in the best interest of their children and to have a right to spend time with them. In addition, legal parents are subject to obligations. The primary obligation is that they care for and support their child. An adoptive parent is subject to this obligation, the same as any biological parent. A legal parent has greater rights with regard to a child than anyone else, save for another legal parent. Legal parents are also granted substantial (though not unlimited) protection from state interference with their children. While parental rights can be terminated or restricted, this cannot be accomplished without formal legal proceedings and generally requires proof of parental unfitness.

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If a couple plans to adopt and raise a child together, it is generally best if both members of the couple have status as legal parents. The simplest way to achieve this result is to complete a joint adoption. This secures each person’s relationship with the child. In the event that one parent dies, the other parent’s relationship with the child continues. In the event that the parents separate, they will be obliged to continue the coparenting relationship. While legal relationships between adults can be dissolved, legal relationships with children generally cannot be. A couple pursuing joint adoption must understand that each member of the couple is undertaking a permanent relationship to the child and, therefore, very likely to each other. Each member of a couple pursuing a joint adoption is subject to the same evaluative processes as an individual seeking to adopt. These processes may differ from state to state, but in general, the parental fitness of each member of the couple is assessed. This will require extensive disclosure of personal information and some form of home study. The stability of the relationship may also be subject to inquiry. While all states permit single people to adopt, many states have laws that restrict the circumstances under which a joint adoption can be completed. The most common restriction is a requirement that the couple seeking to complete a joint adoption must be married. (Note that some states do permit unmarried couples to jointly adopt. A local lawyer should be consulted to determine whether the law in any given state permits unmarried couples to adopt.) Historically, restricting access to joint adoption to married couples has been a serious impediment to same-sex couples. Same-sex couples were not permitted to marry or were not recognized as married and so could not qualify for joint adoptions. While the right of same-sex couples to marry is now the law nationwide, it does not necessarily follow that same-sex couples will have ready access to joint adoption processes in all states. In particular, states that are hostile to same-sex couples may attempt to continue restrictions on access to joint adoption to different-sex married couples

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only. The legal validity of such restrictions is as yet untested. States may argue that whatever the right to marry, the right to adopt is historically controlled by state law and that there is no fundamental or constitutional right to be allowed to adopt a child. States may also attempt to justify differential treatment of same-sex and different-sex married couples by insisting that ideally a child should have a mother and a father in order to thrive. While this position is at best debatable, hostile courts and legislatures may attempt to rely on what research there is to justify preferential treatment for different-sex couples. Whether courts will permit this remains to be seen. It is possible that in some states, recognition of a same-sex couple’s marriage will not necessarily entail the right to joint adoption for that couple. If joint adoption is not available, a same-sex couple could consider having one person complete an initial individual adoption and then have the other person complete a second-parent adoption in a jurisdiction where second-parent adoptions are permitted. While more cumbersome, this process could result in each member of the couple having full recognition as a legal parent. The limited availability of second-parent adoptions (discussed in a separate entry in this volume) may limit the practical feasibility of this course of action. Once an individual or a couple has properly completed an adoption in any state, all other states must recognize the legal status gained through that adoption. Thus, if a couple adopts in state A, where joint adoption is permitted, and later moves to state B, where joint adoption is not available, state B must nonetheless recognize both members of the couple as legal parents. This outcome is mandated by the Full Faith and Credit Clause of the United States Constitution, which requires state courts to give effect to court orders from other states. Thus, a couple might consider moving to a favorable state in order to complete a joint adoption. If this strategy is pursued, it is essential that the law of the state completing the adoption be followed carefully. Consultation with a competent local lawyer is essential. Julie Shapiro

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See also Adoption, Choices About; Adoption, Legal Considerations in; Adoption and Foster Care Discrimination; Custody and Litigation, LGBQ Parents; Parent–Child Relationships; Second-Parent Adoption

Further Readings Joslin, C. G., Minter, S. P., & Sakimura, C. (2014). Lesbian, gay, bisexual and transgender family law. Eagen, MN: Thomson Reuters.

JUVENILE JUSTICE SYSTEM LGBTQ youth are disproportionately represented in the juvenile justice system (JJS), as well as in the child welfare system, and among homeless youth populations. Research points toward complex pathways into and out of the JJS for LGBTQ youth, mediated by factors such as child welfare involvement, the spectrum of family acceptance and rejection, experiences within schools, community-based experiences, and experiences within the JJS itself. Understanding LGBTQ youth’s complex pathways into and out of the JJS should look at this constellation of factors holistically across the lifespan to illuminate the ways in which pipelines or “revolving doors” are created at the intersection of systems. This entry provides an overview of the experiences of LGBTQ youth in the JJS, including rates of incarceration, pathways into the JJS, and experiences within it. Factors contributing to LGBTQ youth’s overrepresentation within the JJS, including hostile school climates, community-level profiling, and family rejection, will also be explored.

LGBTQ Youth Homelessness LGBTQ youth are severely overrepresented among homeless youth populations and experience unique vulnerabilities as a result of interpersonal and institutional homophobia and transphobia. For example, LGBTQ youth have less access to safe shelters and housing; are at increased risk for sexual assault and other forms of physical

violence; and are more likely to engage in exchange of sex for food, shelter, or money than their heterosexual and cisgender (i.e., non-transgender) counterparts. Homeless LGBTQ youth also have a higher likelihood of having attempted suicide, having been enrolled in a substance abuse program, and having been in the child welfare system. They are also significantly more likely to have been tested for HIV and hepatitis C than heterosexual and cisgender youth. Research regarding LGBTQ youth homelessness has also demonstrated that LGBTQ youth move frequently between their families of origin, child welfare placements, the street, residential treatment programs, shelters, and other informal living arrangements as they seek out a support system and living situation among frequently hostile social service systems.

LGBTQ Youth and the Child Welfare System LGBTQ youth are overrepresented within the public child welfare system and sometimes face unique ports of entry into the foster care system due to family rejection or conflict related to youth sexual orientation or gender identity. For example, the Los Angeles Foster Youth Survey (LAFYS) recently found that LGBTQ youth represent 19% of youth in care in the child welfare system in Los Angeles County. Although some states have anti-discrimination policies to protect the interests of LGBTQ youth, they commonly experience discrimination, harassment, and violence within the child welfare system, which is overutilized; underresourced; and suffers from a chronic shortage of competent staff, caregivers, and service providers to care for the more than 500,000 young people in the United States who are residing outside of the homes of their birth families. LGBTQ youth are vulnerable to repeated movement and unstable placements and are more likely to be placed in congregate care facilities, or group homes, rather than with foster families. They are also more likely to be hospitalized for emotional reasons. This has led some jurisdictions to begin the proactive recruitment of affirming foster

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parents, although such efforts remain the exception rather than standard policy. Researchers associate LGBTQ youth’s increased risk for multiple child welfare placements with nonaffirming placements that either passively encourage LGBTQ youth to leave their placements by neglecting their needs or actively discriminate against them, resulting in premature ejection or departure. Social work scholar Gerald Mallon and his colleagues attribute the frequent moves for LGBTQ youth to four factors: (1) staff members not accepting or not affirming youth’s sexual orientation, (2) youth feeling unsafe because of their sexual orientation, (3) youth’s sexual orientation being seen as a “management problem,” and (4) youth not being accepted by peers because of their sexual orientation.

LGBTQ Youth and the Juvenile Justice System Strong parallels between the child welfare system and the JJS indicate that many of the stereotypes, biases, discriminatory practices, and structural barriers that shape the lives and experiences of LGBTQ youth are shared across both systems, likely explaining LGBTQ youth overrepresentation in both. Most states and jurisdictions do not collect data related to youth’s sexual orientation and gender identity, making it difficult to assess the exact degree to which LGBTQ youth are overrepresented. In one study, LGBTQ youth represented between 13% and 15% of youth in the JJS. Given the dual realities of overrepresentation of both LGBTQ youth and youth of color within the JJS, it follows that the majority of LGBTQ youth in the system are also youth of color. The Equity Project, an initiative to ensure that LGBTQ youth in juvenile delinquency courts are treated with dignity, respect, and fairness, has also found disparities that disadvantage LGBTQ youth in various stages of juvenile justice involvement, including arrest, trial, sentencing, and incarceration. For example, LGBTQ youth are more likely to be detained prior to sentencing and pathologized based on their sexual orientation or gender identity, at times resulting in inappropriate “sex

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offense” (e.g., lewd conduct) charges. These charges then impact not only hearings and sentencing but also eventual disproportionate placement of LGBTQ youth in the JJS. LGBTQ youth tend to be overcharged with sex offenses related to age-ofconsent laws when compared to their heterosexual and cisgender counterparts, an occurrence that paves the way for further potential systemic abuses, including unnecessary sex offender treatment. Consequences sometimes include courtordered reparative or conversion therapy, which aims to change a person’s same-sex attraction based on the premise that it is a mental disorder, a practice that has been condemned by every major U.S. health and mental health organization. In addition, findings from multiple studies indicate large-scale profiling of LGBTQ youth, particularly youth of color, who are disproportionately targeted and apprehended for “quality of life” offenses (e.g., loitering, littering, public drunkenness) when compared with their heterosexual and cisgender counterparts. Institutional mistreatment and abuse within the system including by police in the community and by guards, or correctional officers, within detention facilities have additionally been widely documented. This mistreatment takes the form of physical assault; verbal harassment; and increased use of solitary confinement, which is often justified as being a safety measure used to protect LGBTQ youth, but is known to have injurious consequences for physical and mental health, as well as prospects for release. Finally, the Prison Rape Elimination Act (PREA), passed in 2003, recognized the unique vulnerability of LGBTQ inmates to sexual assault while incarcerated.

Gender, Gender Identity, and School-Based Harassment and Discipline Within the already sparse body of research on LGBTQ youth’s experiences in the JJS, the lives and experiences of queer or same-sex–practicing women and transgender youth occupy a particularly marginalized place. A small number of studies have begun to explore the relationship between juvenile justice involvement, court processes,

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same-sex attraction, gender nonconformity, and gender identity among young people who are placed in facilities designated as being “for girls.” For example, recent scholarly attention has been given to the overrepresentation of lesbian and bisexual girls within the JJS. Data from the National Longitudinal Study of Adolescent Health, a nationally representative, population-based sample, has been used to demonstrate that nonheterosexual adolescents, particularly girls, are disproportionately sanctioned by schools and criminal justice authorities, despite the fact that they are not engaging in more lawbreaking or transgressive behavior than their heterosexual peers. Recent research has begun to explore the relationship between school-based victimization and life outcomes and pathways, paying unprecedented attention to the mediating roles of gender and gender identity and their intersection with race. In a study conducted by sociological researcher Angela Irvine, sampling youth from the JJS in six jurisdictions around the nation, 27% of self-identified girls surveyed reported that they were LGBTQ, compared to only 8% of self-identified boys, suggesting that lesbian, bisexual, questioning, and gender-nonconforming girls remain more invisible in these systems than gay, bisexual, questioning, and gender-nonconforming boys. Irvine additionally confirms that these youth are more likely than heterosexual or gender-normative peers to have entered the JJS because they ran away from home or because of status offenses such as school truancy. Finally, she notes that youth’s fear of reprisal from corrections staff, peers, and judges was one of many reasons why they may not disclose their sexual orientation or gender identity.

Transgender and Gender-Nonconforming Youth and the Juvenile Justice System As with many school settings and the child welfare system, the JJS sites involve particular hostility toward and vulnerability for transgender and gender-nonconforming youth. Legal scholar Jody Marksamer has highlighted the criminalizing and abusive pathways for transgender youth who come to the attention of the law, noting that their reasons for involvement in the JJS frequently have to

do with petty crimes related to efforts to live out their felt gender (e.g., shoplifting women’s clothing, engaging in survival sex in order to afford street hormones) or are a result of the discrimination and abuse that they experience within their families, schools, foster care facilities, homeless shelters, and places of employment. Once involved in the JJS, transgender and gender-nonconforming youth are commonly housed in sex-segregated facilities where their gender identity is policed or placed in isolation. Placement of these youth in sex-segregated facilities based on birth-assigned gender can subject transgender youth to harassment, sexual assault, and other forms of violence. Moreover, transgender youth often do not receive adequate legal representation and advocacy because of attorney bias and lack of understanding of gender and sexuality. The lack of trans-affirming social services and treatment programs also results in the exclusion of transgender youth from “rehabilitative” alternatives to incarceration that may be available to other youth. The combination of these factors, in conjunction with a frequent lack of support from family members, results in disproportionately poor outcomes for transgender youth involved in the JJS. Such poor outcomes include vulnerability to assault, lack of socialization and programming, loss of connection with community and family, and an increased likelihood of becoming further ensnared in the juvenile justice and adult criminal justice systems. Thus, for LGBTQ youth in general, and gendernonconforming youth in particular, profound discrepancies exist between the stated “rehabilitative” promise of the JJS and the “healthful” family environments of the child welfare system, on the one hand, and the reality of institutional responses that are at least highly stressful and in extreme cases potentially lethal, on the other hand. This portrait of large-scale systemic and institutional bias illustrates a system of revolving doors, where LGBTQ youth are all too commonly in constant flux, denied access to opportunity structures, experiencing a deprivation of opportunities, and exposed to violence and other conditions that contribute to health disparities and shortened lifespans. In their book Queer (In)Justice, activist legal scholars Joey Mogul, Andrea Ritchie, and Kay

Juvenile Justice System

Whitlock argue that criminalizing tropes about queer and transgender people have become solidified within legal discourses, where they are repeatedly used to classify queer and trans individuals within criminal cases. These tropes of criminality and deviance undergird the JJS, policing, courtbased processes, and social service provision, and have been tacked on to the bodies and lived experiences of LGBTQ young people. These grand narratives are also racialized, classed, gendered, nationalized, and embedded in historical narratives about the place and worth of lives within the colonial project that, according to many critics, has been the basis of U.S. nation-building pursuits and a continually unfolding national identity. Unfortunately, they remain the lens through which policy is shaped and articulated, social service systems are structured and funded, legal processes are carried out, and prison expansion is justified. The persistent conflation of queerness and gender nonconformity with deviance is a contributing factor to the criminalization of LGBTQ youth, as is school bullying, family rejection, lack of social services, the hostility of the child welfare system, and LGBTQ youth’s disproportionate representation and increased vulnerability among homeless youth populations. All of these challenges land LGBTQ youth in public spaces where they are likely to be targeted by police and ensnared in a JJS whose structural and explicit homophobia and transphobia subject LGBTQ youth to further violence and victimization while mitigating access to opportunity and creating pathways with poor outcomes. Sarah Mountz See also Foster Care; Homelessness; School-to-Prison Pipeline; Transgender and Gender-Nonconforming Youth and the Legal System; Transgender and GenderNonconforming Youth of Color; Transgender Inmates; Transgender Youth and Well-Being

Further Readings Himmelstein, K. E. W., & Bruckner, H. (2011). Criminaljustice and school sanctions against nonheterosexual youth: A national longitudinal study. Pediatrics 127(1), 49–57.

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Irvine, A. (2011). “We’ve had three of them”: Addressing the invisibility of lesbian, gay, bisexual, and gender non-conforming youths in the juvenile justice system. Columbia Journal of Gender and Law, 19(3), 675–701. Majd, K., Marksamer, J., & Reyes, C. (2009). Hidden injustice: Lesbian, gay, bisexual, and transgender youth in juvenile courts. Equity Project. Retrieved November 14, 2015, from http://www. equityproject.org/pdfs/ hidden_injustice.pdf Mallon, G., Aledort, N., & Ferrera, M. (2002). There’s no place like home: Achieving safety, permanency, and well-being for lesbian and gay adolescents in out-of-home care settings. Child Welfare, 81(2), 407–439. Marksamer, J. (2008). “And by the way, do you know he thinks he’s a girl?” The failures of law, policy, and legal representation for transgender youth in juvenile delinquency courts. Sexuality Research & Social Policy, 5(1), 73–92. Mogul, J. L., Ritchie, A. J., & Whitlock, K. (2011). Queer (in)justice. Boston, MA: Beacon Press. Mountz, S. (2011). Revolving doors: LGBTQ youth at the interface of the child welfare and juvenile justice systems. LGBTQ Policy Journal at the Harvard Kennedy School, 1, 29–45. Ryan, C. (2010). Engaging families to support lesbian, gay, bisexual, and transgender youth: The Family Acceptance Project. Prevention Researcher, 17(4), 11–13. Van Leeuwen, J. M., Boyle, S., Salomonsen-Sautel, S., Baker, D. N., Garcia, J. T., Hoffman, A., et al. (2006). Lesbian, gay, and bisexual homeless youth: An eightcity public health perspective. Child Welfare, 85(2), 151–170. Whitbeck, L. B., Chen, X., Hoyt, D. R., Tyler, K. A., & Johnson, K. D. (2004). Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. Journal of Sex Research, 41(4), 329–342. Wilson, B. D. M., Cooper, K., Kastanis, A., & Nezhad, S. (2014). Sexual and gender minority youth in foster care: Assessing disproportionality and disparities in Los Angeles. Los Angeles, CA: Williams Institute. Retrieved November 14, 2015, from http://williamsinstitute.law.ucla.edu/ wp-content/uploads/LAFYS_report_final-aug2014.pdf

K “deviant, sick, dangerous, bad, queer” sex has been questioned from various perspectives, for instance, by the sex-positive movement. Yet social norms remain effective and leave an imprint on individuals socialized in a certain culture. Shame may, for instance, be considered an individual emotional response to possessing or acting on non-normative sexual desires. The fact that social and moral values are emotionally charged may be one of the reasons why some people experience the transgression of such cultural norms and taboos, as well as their individual boundaries, to be erotic. Anything that is not considered “normal” to either society at large or the individual in question may therefore be considered as a kinky sexual activity, not in the sense of an aberration, but as a part of sexual variation. If kink is therefore defined by a concept of transgression, it becomes relative to the context. For instance, anal sex on the receiving end could be considered more transgressive for a heterosexual man than for a gay man, being urinated upon may be experienced as even more humiliating or transgressive (and therefore erotically stimulating) in front of witnesses than in private, and so on. This highly subjective element in the experience of kink creates a broad field of potentially erotic and sexual practices. Therefore, only a few common examples of different kinds of kink can be mentioned in the following. The inserting of a whole hand into the vagina or  anus (“fisting”) can be considered an intense

KINK The term kink is sometimes used as a synonym for BDSM but is generally used for an even broader array of sexual practices and preferences that transgress social norms in some way, either objectively or as subjectively experienced by the individual. Whether or not an activity is considered as “kinky” is therefore relative to a particular definition of “normal” and the figuration of one’s personal limits. Sexual norms still tend to privilege vaginal intercourse as the gold standard. Even though mutual masturbation and oral sex for same-sex interactions and anal sex for gay men are increasingly considered as appropriate expressions of sexual desire and loving relationships, other sexual practices remain marginalized or pathologized. Among them are sexual interactions not focusing on genital stimulation or including intense (“extreme” in the eyes of the norm) kinds of physical and psychological stimulation, those involving technical artifacts, and those with more than two participants or outside the private sphere. Often, the fact that an activity is less common in the statistical sense has been considered sufficient reason to regard it as deviant, sick, or morally wrong by society at large, as well as by science, rather than just as a value-neutral minority practice. This taken-for-granted distinction between “normal, healthy, safe, good, respectable” and 637

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stimulation of body (and mind) and is one of those sexual practices that requires specific skills and training. Role-playing in general, but particularly with cultural taboos, can be considered kink. For instance, so-called “age play,” especially enacting “incest” scenarios (by actual unrelated adults), is utilizing the transgression of a great taboo and therefore can lead to intense psychological experiences. Infantilism is one variant of playing with age, in which a grown-up person takes up the part of a baby, wearing diapers and being cared for by a responsible adult figure. To some, humiliation is erotically charged, and being forced to wear diapers or chastity devices, being urinated or defecated upon, or being forced to consume urine or feces (“water sports”/“scat”) may provide them with this kind of erotic humiliation. For others, in contrast, the same practices may be experienced as kinky and taboo-breaking, but not humiliating. Practices like spanking the buttocks may also be experienced as humiliating if given as punishment, while simply providing a sensual experience for others or in a different setting. Sex is commonly still regarded as occurring “naturally.” Therefore, those practices utilizing technical artifacts (“sex toys”) such as penetration devices (dildos), other tools that stimulate the body (for instance, vibrators), or clothing and adornments that are erotically charged and worshipped (fetishes) are considered as “unnatural,” “artificial,” and possibly as kinky in a positive sense to those engaging in them. Fetishists are people for whom specific fabrics, aesthetics, objects, or body parts are imbued with erotic value. Common fetishes are leather, rubber, silk, stretch fabrics, neoprene, boots, feet, various uniforms (for instance military, police, nurse), as well as stereotypical clothing of another gender (as in cross-dressing or playing with gender). For fetishists, wearing certain clothing and seeing and

feeling it on their partners is a means of arousal and enhances their sexual experience. But the traditional psychoanalytical idea that the fetish is a substitute for the genitals does not seem to hold, as many fetishists tend to also enjoy and incorporate genital sex into their fetish life. Another group of sexual practices is considered as kinky because it violates the idea that sex should only take place between two people in a (loving) monogamous relationship in a private setting. This includes activities with more than two participants such as swinging, group sex, and orgies; sexuality in the presence of others, such as at a sex party, in a sex club, or in a public park or restroom; and finally, the phenomena of voyeurism (getting aroused by watching others have sex) and exhibitionism (getting sexual pleasure out of being watched). Robin Bauer See also Bondage, Dominance/Submission, Sadism/ Masochism (BDSM); Monogamy and Non-Monogamy; Sex Positive Movement; Sexual Norms and Practices

Further Readings Bienvenu, R. V. (1998). The development of sadomasochism as a cultural style in the twentiethcentury United States. Dissertation Abstracts International, 59(02A), 0620. (UMI No. 9825507) Brame, G., Brame, W. D., & Jacobs, J. (1993). Different loving: An exploration of the world of sexual dominance and submission. New York, NY: Villard Books. Califia, P., & Sweeney, R. (Eds.). (1996). The second coming: A leatherdyke reader. Los Angeles, CA: Alyson. Thompson, M. (Ed.). (2004). Leatherfolk: Radical sex, people, politics, and practice. Los Angeles, CA: Daedalus.

L successfully fight restrictions the university had imposed on the group’s ability to hold social functions on campus, such as dances. The New Hampshire Lambda argued that the restrictions impermissibly infringed on the group’s freedom of association as guaranteed under the First Amendment. In 1983, Lambda Legal won the nation’s first HIV/AIDS discrimination case, People v. West 12 Tenants Corp. The case helped establish that disability anti-discrimination laws apply to people living with HIV. Lambda Legal also got insurance companies to cover HIV testing and treatments and to pay benefits to those disabled by the disease, and helped establish privacy rights including the right to keep test records confidential. In the 1990s, Lambda Legal won a historic legal precedent holding schools responsible for harassment and violence against LGBTQ students in Nabozny v. Podlesny. Lambda Legal also successfully defended the right of Gay–Straight Alliances to exist in public schools in Colin v. Orange Unified School District. In 1992, Lambda Legal collaborated with the American Civil Liberties Union and the Colorado Legal Initiatives Project to help invalidate Colorado’s Amendment 2, which had been approved by the voters in a ballot referendum. The statewide initiative would have stripped lesbians, gay men, and bisexuals of civil rights protections, nullifying existing bans on antigay discrimination and preventing others from being enacted. In 1996, the

LAMBDA LEGAL Lambda Legal was founded in 1973 as the first legal organization in the United States dedicated to achieving full equality for lesbian and gay people. Its mission is to achieve full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people, and people living with HIV through impact litigation, education, and public policy work. Lambda Legal grew from a group of volunteers working out of a spare room in New York City to an expert staff of more than 100 in five offices around the country—New York, Los Angeles, Chicago, Atlanta, and Dallas. In 1972, Lambda Legal became its own first client when the state of New York denied its application to incorporate the Lambda Legal Defense and Education Fund as a nonprofit corporation. A panel of New York judges held that the organization’s mission was “neither benevolent nor charitable” and, therefore, did not satisfy the statutory requirement for nonprofit corporations. Lambda Legal appealed to New York’s highest court, which finally approved the grant of articles of incorporation. Throughout the 1970s, Lambda Legal fought and won some of the nation’s first cases on behalf of lesbian and gay parents and same-sex couples. In one of its first cases, Gay Student Organization v. Bonner, Lambda Legal helped a gay student group at the University of New Hampshire 639

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U.S. Supreme Court held that Amendment 2 violated the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution in Romer v. Evans. The decision made it clear that lesbians, gay men, and bisexuals have the same right to seek government protection against discrimination as any other group of people. In 2000, Lambda Legal successfully argued that a sheriff was legally culpable for his failure to protect Brandon Teena, after he had filed charges against two men who had brutally raped Teena when they discovered that he was transgender. The sheriff refused to arrest the men, citing lack of evidence, and they later killed Teena and two of his friends in revenge. In Brandon v. Richardson County, the Nebraska Supreme Court held the sheriff responsible for his failure to protect a witness who was cooperating with the police and awarded Teena’s mother damages. This case brought unprecedented visibility to the transgender community and was the subject of the film Boys Don’t Cry. Prior to the landmark 2003 U.S. Supreme Court decision Lawrence v. Texas, Lambda Legal helped convince state courts to strike down sodomy laws in New York, Kentucky, Tennessee, Montana, and Georgia. In Lawrence v. Texas, Lambda Legal successfully argued that state sodomy laws violated the Due Process Clause of the Fourteenth Amendment. The Supreme Court decision invalidated all remaining state sodomy laws. In addition to ending the criminalization of sexual intimacy between consenting same-sex adults, Lawrence established the legal foundation upon which subsequent marriage equality and other victories have been based. The contemporary movement for the freedom to marry for same-sex couples began to take shape in Hawai’i in the early 1990s with the case of Lewin v. Baehr, which was later renamed Lewin v. Miike. Lambda Legal filed an amicus brief in 1993, when the case was pending before the highest court in Hawai’i, and later joined as counsel when the case was remanded to the trial court. The Hawai’i Supreme Court was the first state supreme court to rule that excluding same-sex couples from marriage constituted impermissible discrimination. Before the ruling could take effect, Hawai’i voters approved a state constitutional amendment that

authorized the state legislature to define marriage, effectively mooting the favorable court decisions. In 1997, the Hawai’i legislature passed a landmark “Reciprocal Beneficiaries” law that extended some of the protections same-sex couples could not access because of their exclusion from marriage—a huge step forward at the time. After Hawai’i, Lambda Legal continued to work for marriage equality across the country and secured a major victory with partner organizations in California in 2008. In 2009, Lambda Legal obtained a historic unanimous pro-marriage decision from the Iowa Supreme Court, in Varnum v. Brien, making Iowa the first state in the Midwest to uphold marriage equality. Lambda Legal also led litigation and legislative efforts to win the freedom for same-sex couples to marry in New Jersey, Illinois, Indiana, Virginia, Nevada, West Virginia, and Arizona. In addition to tackling the issue of marriage equality, Lambda Legal continues to address discrimination in many aspects of the lives of LGBTQ people and people living with HIV. Using legal and community education strategies, Lambda Legal fought for a lesbian who had been denied access to her dying partner in a Florida hospital—leading to the adoption of federal rules that require fair visitation practices for same-sex couples in all hospitals receiving federal funding. Lambda Legal won a unanimous decision in 2011 from the U.S. Court of Appeals for the Eleventh Circuit, in Glenn v. Brumby, upholding a lower court ruling that the Georgia General Assembly had discriminated against a transgender woman who was fired from her state job after she told her supervisor that she planned to transition from male to female. In Rhoades v. Iowa, the Iowa Supreme Court set aside the conviction of an HIV-positive Iowan who was initially sentenced to 25 years in prison after having a one-time sexual encounter with another man during which they used a condom. The 2014 decision recognized that HIV-positive individuals who have a reduced viral load as a result of effective treatment pose little risk of transmitting HIV. Leslie J. Gabel-Brett See also Bullying, Legal Protections Against; Discrimination on the Basis of HIV/AIDS in Health

Latina/o Sexualities Care; Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Gender Transition at Work; Hospital Visitation; Legal Recognition of Nonmarital Same-Sex Relationships; Marriage Equality, Landmark Court Decisions

Further Readings Eskridge, W. N., Jr., & Hunter, N. J. (1997). Sexuality, gender, and the law (3rd ed.). St. Paul, MN: Foundation Press. Lambda Legal. http://www.lambdalegal.org Rubenstein, W. B., Ball, C., Schachter, J., & NeJaime, D. (2014). Cases and materials on sexual orientation and the law (5th ed.). St. Paul, MN: West.

LATINA/O SEXUALITIES Latina/o sexualities is a relatively young area of research, but it is one that has expanded considerably in recent years, adding valuable insight to LGBTQ studies. Three of the most well-developed areas of study include research on (1) the sexual practices and health risks of Latino men who have sex with men, (2) Latinas and their sexualities, and (3) the intersections of sexualities and migration studies. This entry provides a brief overview of these three areas.

Latina/o Sexualities: A Note on Terminology Latina/o, an adjective referring to a person of Latin American descent, combines both the masculine and feminine forms of the word in an effort to more inclusively describe individuals irrespective of gender. When not combined, the adjective Latina typically refers to a woman and Latino typically refers to a man of Latin American descent. The term Latina/o sexualities is not without its limitations. The term can imply that Latinas’ and Latinos’ sexualities exist separate and apart from that of Whites in the United States. On the other hand, the panethnic category Latina/o coupled with sexualities can promote the idea that issues of sexuality do not vary across Latina/o groups, or that findings on one group will somehow apply to another. This is particularly problematic

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because, while the panethnic category Latina/o encompasses many different nationalities, research in the area of Latina/o sexualities has predominately focused on people of Mexican, Puerto Rican, and Cuban descent. Latina/os of other nationalities are sorely understudied. This limitation should not be overlooked. Latina/o sexualities scholarship explores issues of sexuality among some (but certainly not all) Latina/o groups. Latina/o sexualities research is limited in its ability to offer a nuanced analysis of diverse experiences across Latina/o groups. Still, despite its limitations, the area of Latina/o sexualities has much to offer LGBTQ scholarship. Research in this area contributes an analysis of how Latina/o cultures, immigration narratives, and economic disadvantage impact lived sexual experiences.

Sexual Practices and Health Risks A great deal of research on Latina/o sexualities has placed an emphasis on male same-sex sexual behaviors. Scholarship generated along these lines has focused predominantly on Latino gay men and men who have sex with men (MSM). In the early 1990s, sociologist Tomás Almaguer was among the first to explore this theme, advancing the understanding that sex among Chicano (Mexican American) men can be framed from within an activo–pasivo paradigm. Activo–pasivo is a system for organizing sexual relations between men whereby one partner takes on the active or penetrative sexual role, and the other takes on the passive or penetrated role. Under this sexual system, a gay identity is reserved for a man who takes on the pasivo role during sexual intimacies, and a man taking on the activo role during these encounters is not automatically stigmatized with the gay identity label. Since its inception, the activo–pasivo paradigm has been refined and complicated by many Latina/o sexualities scholars who criticized the rigid and static ways this paradigm is often taken up in the larger scholarship. In part due to the paucity of available research, the activo–pasivo paradigm is often interpreted by researchers in essentialist and culturally reductive ways. Furthermore, this paradigm is used to reify the difference between Mexican men (and to some degree Latino

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men more broadly) and White gay men in the United States. The activo/pasivo paradigm should be understood as one of a variety of different ways of organizing sexual cultures among Mexican American MSM. It is a point of departure for organizing sexual intimacy among some men, but like all cultures, it is always in flux and can evolve for couples within a relationship or from one sexual encounter to another. Other research on Latino men’s sexual behaviors with other men has focused on health disparities and HIV and sexually transmitted infection (STI) risk. This work explores sexual behaviors with an emphasis on risk reduction. Social inequality such as poverty, racism, homophobia, and antiimmigrant sentiment have left Latino MSM at increased risk for HIV and other STI transmission. Despite these inequities, it is important that Latino men who have sex with men are not solely portrayed as passive victims who are paralyzed by their oppression. Latino MSM are also sexual agents who, while negotiating their marginalities, mobilize their family and community resources for social support. While understanding sexual behaviors is important for a larger assessment of risk, this emphasis in research has stifled a larger dialogue about these men’s sexual lives, their pleasures, desires, and needs.

Latinas and Their Sexualities Research on Latina adolescent sexualities has focused on the negotiation of first sexual encounters among teenagers as well as the sexual messages young Latinas receive regarding their bodies and proper sexual comportment. The tensions between mothers and daughters, particularly around the preservation of female virginity and sexual purity, have been a popular theme for this work. Much of the tension between Latina mothers and daughters emerges from intergenerational differences in sexual socialization. Mothers and daughters have differing ideas regarding when and how to approach sex, with mothers promoting abstinence and daughters wanting sexual autonomy. When it comes to sexual communication,

Latina/o families at times promote sexual silencing in the home. The absence of clear dialogue within Latina/o families regarding sex can lead young Latinas to struggle with advocating for their own sexual needs in relationships and ultimately contribute to their disempowerment. Familial tensions regarding sexual behavior and virginity are governed by gendered sexual double standards that romanticize virginity for young Latinas and result in restrictions of their sexual freedom. Parents promote the idea that virginity is a status marker for Latina girls and preserving virginity helps to secure a young Latina’s prospects for familial stability in adulthood. Like the research on Latino MSM, much of the research on adolescent Latina/o sexualities has used a disease model for understanding sexual behavior. Emphasis has been narrowly placed on safe sex at the expense of analyses of young Latinas’ agency or the ways in which they negotiate the familial, peer group, and individual constraints placed on their sexualities. Sociologist Lorena Garcia’s work elucidates how within their peer groups, adolescent Puerto Rican and Mexican American girls experience sexual double standards and constraints on their sexualities based on peer group labeling, slut shaming, and overall policing of their sexual desires. Garcia finds that while Latinas in heterosexual relationships are savvy in their efforts to negotiate safe sex practices, there is a relative lack of discussion regarding sexual pleasure among them. In contrast, Garcia finds that adolescent Latinas in same-sex relationships are more comfortable negotiating pleasure and exploring their sexual needs but less so discussing safe sex practices. Research on Latinas in relationships with other women has been particularly understudied. As is the case with adolescent Latinas in relationships with men, many familial tensions arise for sexually nonconforming Latinas, particularly around parents’ shame and concern for the potential stigmas their daughters may face in life. This fear is mitigated for sexually nonconforming Latinas who are willing and able to mitigate the visibility of their sexualities in public spaces. Religion can also play

Latina/o Sexualities

a major role in how sexually nonconforming Latinas and their families negotiate sexualities. Sexually nonconforming Latinas must themselves try to reconcile the contradiction between their love for other women and their religious convictions. In this effort, sexually nonconforming Latinas share similarities with heterosexual Latinas who must also reconcile their sexualities with their religious beliefs. Sociologist Gloria González-López finds that Mexican American women redefine the purpose of Catholicism in their lives, separating their religiosity from their sexuality and challenging the Church’s ability to weigh in on issues of procreation and contraception in their daily lives.

Sexualities and Immigration Given that migratory experiences are central to the lives of many Latina/o groups, it is no surprise that some researchers have focused on the ways immigrant identities intersect with sexual identities to shape experience for Latinas and Latinos. This work complicates our understanding of what motivates migration and has contributed to advancing the understanding that Latina/o migrants’ decisions to leave their countries of origin are motivated not only by economic need but also the desire for sexual freedom and familial anonymity. Research at the intersections of immigration and sexualities scholarship offers an analysis of the ways in which sexual identity fuels individual migrants’ decisions to leave their home countries. These decisions are at times motivated by a desire to lead a more authentic gay existence or by a desire not to bring shame onto their families. As the late sociologist Lionel Cantú noted, even for those who name economic opportunity as their primary motivator for migration, sexual and gender identities impact migrants’ decisions. LGBTQ Latina/os describe a need to overcome the economic hindrances imposed by limited opportunities and homophobia, such as being shut out of economic opportunities on account of their sexual or gender nonconformity. The new economic opportunities available to Latina/o migrants in the United States can shape

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their sexualities in unexpected ways. GonzálezLópez notes that for heterosexual Mexican women, living in the United States and gaining opportunities to earn their own wages allow them to negotiate more sexual autonomy within their homes. Furthermore, in separate studies, Cantú and American Studies scholar Carlos Decena both find that for Mexican and Dominican men, respectively, economic autonomy buys bargaining power with families of origin—making them less likely to experience rejection or judgment from families of origin because of their financial contributions. Scholarship at the intersections of sexualities and migration studies has also considered how immigration policies impact sexual-minority subjects. Changes made to asylum policies in the United States have opened up the opportunity for sexual minorities to immigrate to the United States if they are being politically persecuted on account of their sexual or gender nonconformity in their countries of origin. While this change marks an effort to improve upon homophobic biases in immigration policy, it is not without its limitations. While these policy changes have created a path to citizenship for many persecuted LGBTQ individuals, it also promotes an idea that sexual identities are immutable and static, and places the burden on individual asylum seekers to prove their active persecution in the form of violence from family, community members, and/or government. Such a burden constructs the successful asylum seeker as an individual whose sexual and gender marginalities are visible and public even within communities where such expressions are otherwise frowned upon. Thus, without additional immigration reform, the changes to asylum policies continue to create inequities for LGBTQ Latina/o migrants.

Conclusion Consistently missing from Latina/o sexualities scholarship is an analysis of sexual desire or pleasure in Latinas’ and Latinos’ lives. This limitation is particularly detrimental because it reinforces the misconception that Latinas and Latinos are not in control of their sexualities or are uninterested in

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Laws Banning Homosexuality and Sodomy

sexual pleasure. Because a great deal of the work on Latina/o sexualities has been framed around public health concerns, scholarship on the love relationships of Latinas and Latinos of varying sexual orientations has been slower to emerge. This is especially the case for research on bisexual, queer, transgender or other non–gender binary–identifying individuals, which is scant and where available is confined primarily to a health risk analysis. Crucial future directions for Latina/o sexualities research should include more empirical studies on Latina/o groups from underrepresented nationalities. More scholarship is also needed on aging Latina/o populations. More research on the intersections of race and sexuality is also missing. Most scholars have relied on an analysis of cultural differences and have oversimplified the vast racial heterogeneity among Latina/os and the ways in which this difference shapes experience. Given the recent growth and expansion Latina/o sexualities have experienced, some of these gaps may soon cease to exist. Katie L. Acosta See also Adolescent Pregnancy; African American Sexualities; HIV/AIDS and Racial/Ethnic Disparities; Immigration; LGBTQ People of Color

Further Readings Acosta, K. L. (2013). Amigas y amantes: Sexually nonconforming Latinas negotiate family. New Brunswick, NJ: Rutgers University Press. Almaguer, T. (1993). Chicano men: A cartography of homosexual identity and behavior. Differences: A Journal of Feminist Cultural Studies, 3(2), 75–100. Alonso, A. M., & Koreck, M. T. (1993). Silences: “Hispanics,” AIDS, and sexual practices. In H. Abelove, M. Barale, & D. Halperin (Eds.), The lesbian and gay studies reader (pp. 110–126). New York, NY: Routledge. Asencio, M. (Ed.). (2010). Latina/o sexualities: Probing powers, passions, practices, and policies. New Brunswick, NJ: Rutgers University Press. Cantú, L., Jr. (2009). The sexuality of migration: Border crossings and Mexican immigrant men. New York, NY: New York University Press.

Garcia, L. (2012). Respect yourself, protect yourself: Latina girls and sexual identity. New York, NY: New York University Press. González-López, G. (2005). Erotic journeys: Mexican immigrants and their sex lives. Berkeley: University of California Press. Zavella, P. (2003). Talkin’ sex: Chicanas and Mexicanas theorize about silences and sexual pleasures. In G. F. Arredondo, A. Hurtado, N. Klahn, O. Nájera-Ramírez, & P. Zavella (Eds.), A critical reader: Chicana feminisms (pp. 228–253). Durham, NC: Duke University Press.

LAWS BANNING HOMOSEXUALITY AND SODOMY While it has never technically been illegal to be an LGBTQ person in the United States, government actors enacted and enforced many laws that were used to functionally criminalize homosexuality, starting in the late 19th century. Governmental oppression of lesbian, gay, bisexual, and trans (LGBT) people accelerated through the 1950s, but began to lose steam thereafter. Eventually, most laws and policies designed to functionally criminalize LGBT people were dismantled, although problem areas remain. This entry describes these laws and their evolution in the United States. Although laws prohibiting sodomy (most commonly defined as anal sex) have existed since colonial days, sodomy was not considered to be a serious social problem prior to the late 19th century; prosecutions were extremely rare. However, in the late 19th century, sexologists and psychologists began to reclassify homosexuality as an identity rather than an act. A rapid consensus emerged that inverts (as LGBTQ people were then called) were a danger to society, prompting massive efforts to criminalize and contain them. The expansion of sodomy laws was central to these efforts. States without sodomy laws quickly enacted them, and three-quarters of U.S. states expanded the meaning of sodomy to include fellatio (oral sex performed on a man); a few states

Laws Banning Homosexuality and Sodomy

also added prohibitions on cunnilingus (oral sex performed on a woman). Some states even expanded their sodomy laws to include mutual masturbation. Although these laws nominally applied to heterosexual acts as well, enforcement against those who were not lesbian, gay, or bisexual (LGB) was exceedingly rare except in cases of prostitution and sexual assault. In contrast, enforcement of such laws against inverts (primarily gay men) skyrocketed. The functional criminalization of homosexuality extended far beyond sodomy laws. Police used existing laws against solicitation, cross-dressing, loitering, vagrancy, and disorderly conduct to harass LGBTQ people, particularly in larger cities where homosexuality was more visible. LGBTQ people were also caught up in the rise of the eugenics movement. In the first few decades of the 20th century, over 30 states passed laws providing for compulsory sterilization of individuals deemed unfit to reproduce. So-called sexual degenerates, sexual perverts, and sex offenders were often included in these laws. The years between the 1930s and the early 1960s were particularly difficult for LGBTQ people. During this time, over half the states passed legislation requiring that individuals convicted of sodomy and other sexual offenses be evaluated by psychiatrists for possible commitment to mental hospitals; in some states, mere suspicion of homosexuality was enough to trigger mandatory psychiatric examinations. In 1949, the U.S. Department of Defense issued formal rules barring LGB people from military service. In 1950, the U.S. Senate held hearings designed to ferret out LGB people working for the federal government. President Eisenhower followed up with a 1953 Executive Order barring LGB people from all federal jobs and also requiring that all businesses with federal contracts dismiss their LGB employees. The Immigration and Nationality Act of 1952 treated homosexuality as evidence of a “psychopathic personality” and made it grounds for deportation. The FBI and Post Office both developed surveillance programs to expose LGB people. In addition, many states had regulations prohibiting bars and restaurants from

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serving LGB people; bars suspected of having LGB clientele were regularly raided and the patrons arrested. Police even raided private parties suspected of having LGB people in attendance. Criminalization of homosexuality began to ease by the late 1960s. A major reason for this was the American Law Institute’s promulgation of a Model Penal Code (MPC), designed to standardize criminal codes across state lines. The MPC decriminalized all sex acts performed in private by consenting adults. By 1983, a total of 22 states had adopted the MPC in full—although 7 other states removed penalties for non-LGB people while continuing to criminalize sodomy when performed by same-sex couples. A second reason was the removal of homosexuality from the American Psychiatric Association’s list of mental disorders in 1973, thereby undercutting a major rationale for penalizing homosexuality. A third reason was the emergence of the modern LGBTQ rights movement in the years after the 1969 Stonewall rebellion; the movement focused heavily on the eradication of laws and policies targeting LGBTQ people. While LGBTQ people made several gains in the 1970s and early 1980s (for example, the federal government lifted its ban on LGB employees in 1975), the 1986 Supreme Court decision in Bowers v. Hardwick placed a major roadblock in the path of LGBTQ rights. The Court held that Georgia’s sodomy law was constitutional, dismissing the claim that LGB people had a fundamental right to have consensual same-sex sex as “at best, facetious.” This ruling, along with panic over the AIDS epidemic, strengthened opposition to LGBTQ rights. Another roadblock was the 1992 passage of Amendment 2 in Colorado that repealed all existing LGBTQ rights laws in the state and prohibited the enactment of any future laws. Yet the tide was clearly shifting. Over the next decade, 10 more states decriminalized sodomy, and many states and localities instituted laws prohibiting discrimination on the basis of sexual orientation and sometimes gender identity. Congress enacted the Don’t Ask, Don’t Tell (DADT) law, which permitted LGB (but not T) people to serve in the military so long as they did not reveal their

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sexuality—a small but real improvement over the previous policy. In 1996, the Supreme Court held in Romer v. Evans that Colorado’s amendment was unconstitutional. In 2003, the Court overturned Bowers with its decision in Lawrence v. Texas, holding that sodomy laws were unconstitutional; this removed the major remaining rationale for discrimination against LGBTQ people. But the most telling indicator of this shifting tide was the astonishingly rapid evolution of marriage law. In 2004, Massachusetts became the first state in the nation to permit same-sex couples to marry. Over the next 11 years, the edifice of constitutional and statutory laws excluding same-sex couples from access to marriage collapsed completely. In 2015, the Supreme Court ruled that same-sex couples had a fundamental right to marry (Obergefell v. Hodges). Problem areas remain, however. While LGB people have been able to serve openly in the military since 2011, when DADT was dismantled, the military still retains the right to dismiss transgender service members, although it is currently reviewing its stance on that matter. Police harassment still occurs, especially with respect to gender-nonconforming people, who are also disproportionately subject to hate crimes. Congress has consistently refused to pass a law protecting LGBT people from discrimination in employment and public accommodations. Yet, by any measure, the legal position of LGBT people has improved dramatically in recent decades. Ellen Ann Andersen See also Discrimination Against LGBTQ People by Law Enforcement; Discrimination Against LGBTQ People in the Public Sector; Military and LGBTQ People; No Promo Homo Policies; Sexology

Further Readings Chauncey, G. (2004). “What gay studies taught the court”: The historians’ amicus brief in Lawrence v. Texas. GLQ: A Journal of Lesbian and Gay Studies, 10(3), 509–538. D’Emilio, J., & Freedman, E. B. (1988). Intimate matters: A history of sexuality in America. Chicago, IL: University of Chicago Press.

Eskridge, W. N. (2008). Dishonorable passions: Sodomy laws in America, 1861–2003. New York, NY: Viking Press.

LEADERSHIP Although there is a great deal of scholarship on the general topic of leadership, the study of LGBTQ leadership is in its infancy. This entry summarizes what is known at present about leadership as enacted by LGBTQ individuals, bringing to bear pertinent scholarship in several related areas: stigma and marginalization of LGBTQ people, leadership in particular status groups (e.g., women, college students), and LGBTQ career and workplace issues. Much of this discussion is based on the only (known) model of LGBTQ leadership articulated in the research literature, developed by psychologists Ruth Fassinger, Sandra Shullman, and Michael Stevenson in 2010. The entry begins with a brief foundational introduction, followed by consideration of the context of stigma and marginalization in which the LGBTQ leadership process occurs. Then, three important dimensions or aspects of LGBTQ leadership are presented: sexual orientation, gender, and group composition. The entry concludes with a glimpse at the future of scholarship in LGBTQ leadership.

Foundations Leadership is an interpersonal influence process in which an individual (the leader) uses power (the ability to influence) to move others (followers) in a particular direction to bring about change. The influence process can affect many aspects of the followers’ psychological and psychosocial worlds— attitudes, values, beliefs, goals, motivations, skills, perceptions, desires, judgments, behaviors, and the like—and the leader may use a variety of strategies to exert influence (e.g., rewards, praise, encouragement, education, inspiration, feedback, and punishment). There are several bases of power upon which leaders’ capacities to influence others rest, and they depend upon different human

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motivations. Coercive power, for example, is based on followers’ fear of the leader, whereas expert power relies on followers’ respect for the knowledge and skills the leader brings to the leadership role; legitimate power emanates from the formal position the leader occupies relative to followers, and referent power derives from personal traits (e.g., charisma) of the leader that motivate followers to embrace the leader’s vision and direction. Until the middle of the 20th century, most discussion of leadership focused solely on the leader (e.g., personality traits, skills and competencies, power bases, and behavioral styles) to understand why some leaders were more successful than others. However, the radical social upheaval of the second half of the century ushered in new attention to the contexts in which leadership is enacted and what followers thought, felt, and did when leaders attempted to lead them. Models of leadership that focused on the interactions between leaders and followers appeared, and the study of leadership became more embedded in group and social processes. Most contemporary theories acknowledge that leadership is a complex process in which leaders and followers interact; followers interact with each other; leaders interact with other leaders; outsiders exert influence on the interactions; and all of this intense interpersonal activity takes place in a particular social milieu, culture, and time that constrains it in unique ways. This complexity is extremely important in understanding the challenges of LGBTQ leadership. There are numerous historical and contemporary examples of formal leadership roles taken by LGBTQ people (e.g., San Francisco Supervisor Harvey Milk in the 1970s; current Wisconsin Senator Tammy Baldwin), as well as leadership that is informal or even accidental—for example, the coming out of an important public figure (e.g., entertainer Ellen DeGeneres in 1997, Apple CEO Tim Cook in 2014, and star NBA athlete Jason Collins in 2013) may place that person in a position of considerable influence in becoming an inspiration and role model for others. Regardless of whether the leadership role is formal or informal, long-term or short-term, pursued or conferred, one’s status as a sexual-minority individual—that

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is, one who transgresses societal expectations regarding gender and sexuality and thus faces stigma and marginalization—complicates leadership enactment for all involved.

Context of LGBTQ Leadership: Stigma and Marginalization Because sexual stigma—defined by psychologist Gregory Herek as the inferior status, negative regard, and relative powerlessness society accords anyone associated with nonheterosexual behaviors, identity, relationships, or communities—is so formative in the lives of LGBTQ people, even in the relatively liberal United States at this point in history, it is critical to understand the context in which LGBTQ leadership occurs. Sexual stigma occurs at both a cultural level, embedded as heterosexism in social institutions (e.g., education, law, religion, the military) and at an individual level (e.g., enacted as exclusion, discrimination, hostility, and violence). Sexual stigma is well documented in both its ongoing presence in contemporary life and its negative effects on LGBTQ individuals’ mental and physical health, interpersonal relationships, education and work, and in LGBTQ communities. Research shows, for example, that even a very mild derogatory remark (“He’s so gay”) can cue negative perceptions of a gay leader by others, regardless of the leader’s exemplary performance, and the permitted expression of such overt prejudice can lead to unsupportive, discouraging, and even hostile education and work environments for sexual minorities. Negative environments, in turn, heighten feelings of stigmatization and foster minority stress in LGBTQ people, in which anxiety, fear, and the constant exercise of self-protective strategies (e.g., identity concealment) become their daily reality. In addition, stereotype threat also proliferates in such environments, where awareness of the negative stereotypes of one’s stigmatized group constantly are evoked, leading to actual performance impairment over and above individuals’ internal feelings of anxiety and marginality. Societal and individual expressions of stigmatization affect LGBTQ core self-evaluations as well,

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in the form of internalized heterosexism and stigma, or self-stigma, in which one consciously or unconsciously accepts the legitimacy of marginalization and incorporates self-hatred, identity denial, and disempowerment into one’s sense of self. In this experience of compromised self-evaluation, even the most benign forms of environmental and interpersonal heterosexism serve as constant reinforcers of stigmatized status, thus maintaining the disempowerment of LGBTQ individuals and groups. This is why affirming education and work environments are so important, because the deleterious impact of negative environments not only is not confined to overt manifestations of bias and prejudice, but also fosters the internalization of stigmatizing experiences into negative core evaluations of the self. Core self-evaluations, in turn, are strongly linked to life success and happiness. Research shows that positive core self-evaluations confer many advantages in the workplace; they are associated with career success, high job performance, high job and life satisfaction, low levels of stress and conflict, high coping ability, and capacity to capitalize on opportunities and advantages—all important factors in leadership development. For LGBTQ leaders, the effects of sexual stigma likely function at all stages of leadership development. For example, sexual-minority individuals may be prevented in some occupational environments (e.g., religious or military institutions) from assuming or even considering leadership roles, or they may be reluctant to take on leadership roles for fear of being more publicly scrutinized, particularly if they are concealing their sexual-minority status from others. If they do assume leadership positions, they may find their effectiveness and success compromised by sexual prejudice and stigma, often based on mere suspicion that they might be LGBTQ. Finally, even when their record suggests clear accomplishment, they may be perceived or formally evaluated as unsuccessful. To the extent that the leader is struggling with internalized heterosexism and selfstigma—a predictable aspect of sexual-minority identity for most LGBTQ individuals in a stigmatizing culture—the ability to cope effectively or address some of these challenges to leadership

development will be compromised, and leadership trajectories truncated or altogether derailed. Increasingly, however, scholarship is documenting the more positive possibilities of having a marginalized identity. LGBTQ leaders may benefit from their own developmental experiences of learning to cope with opposition and negative feedback, finding and building strong support systems, advocating for themselves and others within systems of power and privilege, deeply exploring their own identities and life goals, and creating their own norms and ways of living outside the constraints of heterosexual expectations. Indeed, research on diverse women leaders (also marginalized in dominant culture) suggests similarities in their leadership experiences in such areas as inclusion of diverse others, open communication, sharing of power, collaboration, and values-based problem solving; they also are more likely than men to manifest transformational approaches to leadership, which emphasize follower empowerment and collaborative movement toward mutually determined goals. These findings make sense, given that marginalization provides an outsider perspective that may free an individual from unthinking adherence to traditional notions of authority and power, and open the possibility that a minority sexual identity, too, offers something unique to the leadership process.

Sexual Orientation in LGBTQ Leadership Sexual orientation pertains to the organization of one’s identity around particular intimate partner choices—that is, identifying as lesbian, gay, bisexual, or similar self-label. The limited research on sexual orientation and leadership begins, in terms of the life course, with studies of college students. Research has found the development of sexualminority identity and leader identity as mutually reinforcing for many LGBTQ students, particularly those who lead LGBTQ identity–based organizations (e.g., outness catalyzes being tapped to lead LGBTQ organizations, and leading such organizations increases outness). Personal identity also appears to affect leadership approach in that students who identify as “queer” may espouse more

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radical goals (identity affirmation, social change) than those who identify as lesbian, gay, bisexual, or transgender (LGBT), who appear more focused on securing acceptance, inclusion, and equitable treatment in existing systems. As compared to heterosexual socially responsible student leaders, LGBTQ student leaders self-report more civil management of controversy, more recognition of interconnectedness among community members, and greater belief in the possibility of change when people work together. Self-efficacy or self-confidence in performing leadership roles successfully appears to be affected by self-esteem, and confidence seems to be similar for sexual-minority and -majority students across types of organizations. Research on adult LGBTQ leaders indicates that they recognize how pervasive societal heterosexism and sexual stigma can set limits on their advancement trajectories, and they cite achieving and demonstrating high competence as a defense against possible or actual discrimination. Studies show that LGBTQ leaders view many of their most effective leadership practices as grounded in and emanating from their sexual-minority identities. These include leadership behaviors and qualities such as challenging the status quo of the organizational culture; fostering inclusion, nurturance, and affirmation; empowering others (particularly marginalized organization members); inspiring shared vision; modeling integrity and honesty; tolerating ambiguity and being flexible; showing inner strength and willingness to take reasonable risks; being willing to listen and learn; modeling personal authenticity and humility; understanding oppression and valuing diversity; fostering collaboration; exhibiting creative problem solving; and being willing to take reasonable risks. That these kinds of leadership behaviors are linked to positive workplace outcomes for LGBTQ leaders is suggested by research findings that gay male executives’ ability to adapt, to solve problems creatively, and to communicate intuitively and sensitively was related positively to the engagement, job satisfaction, and workplace morale of their employees. One of the problems with the existing studies in LGBTQ leadership is that self-disclosure of one’s

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sexual-minority status is assumed or controlled for in the sampling for the study—that is, the leaders studied are known by themselves and others to be LGBTQ, and their identities thus are assumed to exert influence in overtly recognized ways. However, many LGBTQ leaders are not publicly out (some not even to themselves), or are out only selectively to a few trusted others. The fact that sexualminority status is largely invisible to others means that most LGBTQ individuals—including leaders— engage in a constant internal decision-making process about the revelation of their identity to every new person and group with whom they come into contact. For leaders, this renders each small coming-out event a test of their perceived legitimacy and acceptance as a leader by others, necessitating different kinds of conversations/disclosures to different audiences and for different reasons. Research has not addressed this aspect of LGBTQ leadership, and it is a unique issue that has no counterpart in any other kind of leadership process or group in the scholarly literature. Similarly, researchers have not explored the unique question of how a hidden minority status affects both leaders and their followers. Research on disclosure suggests that LGBTQ individuals are less likely to disclose their minority identities in educational or workplace environments viewed as unsupportive or unsafe (for very understandable reasons). However, when an individual moves into a leadership role, it may be more difficult (and even undesirable) to continue to try to protect a concealed identity. Research generally supports coming out in the workplace, and finds many LGBTQ individuals to be out, at least selectively. Studies not only indicate that identity avoidance or concealment takes a substantial psychological and performance toll on LGBTQ individuals themselves, but the concealment of a suspected or assumed sexualminority identity also leads to negative judgments by others. In addition, research shows that identity disclosure in the workplace generally is associated with positive outcomes such as greater organizational commitment and job satisfaction, higher performance, less stress, more effective coping, better relationships with coworkers, and greater career success.

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However, the positive effects of coming out in education and at work are attenuated by the degree of discrimination and stigma present in one’s immediate environment, necessitating careful identity management and disclosure decisions for many LGBTQ leaders in unsupportive environments. Moreover, there are widely publicized cautionary stories of the tragic effects of antigay prejudice on LGBTQ leaders in contemporary life—the 2006 suicide of Denise Denton, an “out” lesbian and then-chancellor of the University of California Santa Cruz, is a case in point. The Denton case also implicates sexism as a contributing factor, suggesting the critical importance of considering intersectionality in identities—that is, the ways in which other marginalized statuses based on gender, race, ethnicity, disability, and the like intersect with sexual-minority status. For LGBTQ leaders, the most salient of these intersectional identities is gender.

Gender in LGBTQ Leadership Gender consideration refers not only to biological gender, but also to chosen and expressed gender— the attitudes, roles, behavior, and presentation of oneself in relation to the social category of gender. It is important to LGBTQ leadership because the frequent and erroneous confounding of gender and sexual orientation that occurs in society (i.e., the assumption that same-sex desire indicates wanting to be the other sex, or the belief that gender-nonconforming behavior signals homosexuality) renders sexual orientation profoundly gendered, and gender expression profoundly sexualized. Thus, LGBTQ leaders cannot be discussed without reference to their gender and gender presentation, and the effect of gender is intensified by the fact that this status indicator is the only one related to sexual-minority status actually seen by others (compared to the invisibility of sexual desire and intimate partner preferences)—so inferences about sexual orientation will be made on this basis alone. Fortunately, there is a substantial scholarly literature on gender and leadership that offers direction for considering gender in LGBTQ leadership

enactment. It is a well-known fact that women remain severely underrepresented in management and leadership roles in contemporary workplaces, and are subject to a wide range of discriminatory forces in hiring, evaluation, compensation, and advancement. Research consistently implicates gender roles and gender expectations in the seemingly intractable glass ceiling, as they exert significant and negative influence on every phase of women’s leadership development: from getting recruited or hired in the first place, to obtaining the kinds of on-the-job experiences and opportunities that allow the building of important skills, to being mentored and integrated into professional networks, to receiving fair salaries and performance evaluations, to being considered for and offered advancement opportunities, to receiving support in leadership roles by one’s colleagues and superiors. Gender role expectations are the reason that both women and men are seen as more effective when they function in leadership situations viewed as congruent or congenial for their gender (e.g., a woman leading an educational organization consisting mostly of women or a male leading a business group composed primarily of men). However, the acceptable ranges of leadership situations and behaviors are far more tightly circumscribed for women than men, and women’s success depends upon their ability to navigate a very narrow band of behaviors—not so masculine as to challenge their credibility as women, but not so feminine as to compromise their credibility as leaders. An angry professional woman, for example, is viewed by others more negatively than an angry professional man, and her emotions are presumed to be due to internal factors, whereas a man’s emotions are attributed to external factors. Evaluations of leadership in managerial situations generally result in lower ratings of key leadership skills for women than men, even when women’s actual performance exceeds men’s, and in self-ratings, men tend to rate themselves as higher in effectiveness than women rate themselves. Given the oft-conflated notions of gender and sexual orientation, it might be expected that gender role expectations and gender stereotypes figure

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importantly in LGBTQ lives—and in fact, they do. In a stigmatizing culture, sexual minorities’ acceptance by others depends heavily on the extent to which they camouflage (i.e., don’t “flaunt”) their transgression of societal norms. Those who seem more similar (in looks and behavior) to their heterosexual peers are likely to garner less negative attention than those who deviate more obviously from proscribed roles, such as in one study in which gay men behaving in ways perceived as feminine and lesbians behaving in masculine ways elicited more negative judgments from others than did more gender-conforming gay and lesbian individuals. For LGBTQ leaders, such stereotypes profoundly complicate the ways in which they are perceived by others based on their own status and self-presentation. Because gender stereotypes render the default image of a “leader” as male, a woman who leads is viewed as a “woman leader,” with her gender clearly signified. Applying these gender stereotypes to sexual-minority leadership, the default image of “leader” also presumably is heterosexual and living in the gender to which he was born, while a sexual-minority leader might be a “gay leader,” “lesbian leader,” or “transgender leader,” with aspects of the person’s gender and sexual transgression also signified clearly. For a gay male leader who is not out, he is likely to be assumed heterosexual, and his leadership probably will be judged with all of the benefits accorded him by his male status. However, if he is out, then his status as a gay leader will highlight his sexual orientation (with all of the attendant heterosexist and antigay attitudes of others), and judgment of his leadership is likely to be confounded further by his gender presentation—is he masculine enough to be a credible male and therefore a credible leader, or will the epithet “He’s so gay” be in the minds of others and compromise perceptions of his maleness, and therefore his leadership? For a lesbian leader, whether out or not, the disadvantages of default assumptions come into play immediately based on her gender, and if she is out, the double bind she faces is obvious—as a lesbian, she is not viewed as a “real” woman (and

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thus might transcend some of the leadership disadvantages of her female status), but as a woman, she is not a “real” leader (and thus subject to all of the prejudices against women in leadership positions). Her gender presentation further complicates the situation: If she displays a traditionally feminine appearance and behaviors, she highlights her marginalized status as a woman, but if she is more masculine (or even gender-neutral) in appearance and behaviors, she emphasizes her gender transgression and marginalized sexual-minority status (and others may assume she is a lesbian even if she is not out). In any of these instances, her leadership is potentially compromised, and it becomes extraordinarily difficult to sort out and address sources of bias and marginalization based on the intersections of her identities. When other intersectionalities of identity due to race, ethnicity, disability status, and the like are integrated, one can easily see how sexual-minority leadership complexity becomes exponential. For transgender leaders who choose a binarygendered identity as clearly male or female, the default assumptions regarding gender and leadership likely will prevail, captured dramatically in the experience of Stanford biologist Ben Barres, whose scientific work rose in prestige after he transitioned from female to male in the 1990s. However, if transgender leaders choose selfidentifications/presentations that are less traditionally demarcated by gender and more ambiguous to others, their gender-minority status is highlighted— opening themselves to some of (arguably) the most virulent prejudice operating in contemporary society. Moreover, it is impossible to overcome or discount years of socialization into a particular gender, so regardless of the current self-identifications of transgender leaders, their styles and behaviors likely are marked by the gender that constituted their formative years, rendering their leadership highly unpredictable to followers. If they grew up male, for instance, with all of the attendant male privilege, but identify currently as female, their deeply unconscious presumption of their own power and privilege likely will assert itself at some point in their leadership, often to the shock of

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those around them. Moreover, given societal beliefs in the immutability of gender, followers’ awareness of the leader’s transgender status likely will result in vigilant anticipation of the leader’s “real” gender asserting itself, regardless of what the leader actually says or does—thus highlighting the importance of others’ expectations in the enactment of leadership.

Group Composition in LGBTQ Leadership As the foregoing discussion suggests, LGBTQ leadership cannot be understood without reference to others involved in the process—not just because researchers have found the situation to be a significant aspect of the leadership process more generally, but also because of issues that LGBTQ leaders face uniquely: stigma and marginalization in the environment and internalized into the self, pervasive stereotypes about sexual orientation and gender, and the need for constant negotiation of identity disclosure. Leaders and followers each bring to the leadership process their own personal core identities, ideas and beliefs, worldviews, values and goals, prior experiences, skills and capacities, needs and desires, and even assumptions about what “good” leadership looks like. No two followers will be having the same experience of a leader at any given time, and no leader will have exactly the same experience with two or more followers. There are myriad aspects of situational influences on leadership enactment studied by researchers, but one that is particularly relevant to LGBTQ leaders is that of group composition, or more specifically, whether a group is—or is not—an identity-focused group and whether it consists primarily of LGBTQ members. Research suggests that many LGBTQ leaders have early experiences leading LGBTQ advocacy groups or other similar political and social identity–focused organizations. They probably experience a fair amount of congruence with followers in goals, values, approaches, respect for identity authenticity and transparency, and the experience of shared stigma. As leadership research indicates that followers’ willingness to follow a leader is based largely on the extent to

which the leader reflects their identities and values, the congruence or congeniality of the fit between leader and followers in homogeneous groups (i.e., mostly LGBTQ members) probably facilitates the leadership process significantly. On the other hand, in heterogeneous, or mixedmember groups (largely or mostly heterosexual members), the situation for LGBTQ leaders may be less predictable. The expectations of the leader by members may be strongly influenced by conscious or unconscious sexual prejudice, which research has shown to be linked to maleness, conservative religious views, authoritarian or dogmatic attitudes, lack of contact with (known) LGBTQ people, and belief that sexual-minority status is a chosen attribute. In addition, because sexual orientation is a concealable stigma (and anyone could be LGBTQ), some people may feel especially threatened, asserting and exaggerating their heterosexuality publicly to prove their belonging to the dominant group. Whether the LGBTQ leader is out or not, the heterosexism and sexual prejudice of others likely will exert influence, forcing adherence to a careful line of identity management, with different kinds of groups evoking different kinds of identity responses. For example, a sexual-minority leader in a military or paramilitary (e.g., police) group may conceal identity initially for fear of being forced out, but as leadership success and reputation grow and confidence rises, that same leader may begin to selfdisclose identity in the safest sectors of the organization, gradually extending self-disclosure as positive (or at least nonnegative) reactions ensue. A sexual-minority leader who has learned leadership in congenial group situations may be unprepared for the challenges of leading more heterogeneous groups. Moreover, leadership in identity-focused groups may include expectations regarding personal identity openness that are irrelevant at best, or unwelcome at worst, in organizations that are not identity-based. For example, in a business organization with no overt focus on social justice strategies or ideologies, followers may find proclamations of sexual-minority status by the leader unnecessary and annoying, unless delivered

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in the context of a relevant organizational event (e.g., bringing one’s partner to the company picnic). In addition, even if an LGBTQ leader has been hired specifically to work to broaden the diversity goals of an organization, it is wise to ascertain exactly what meanings, expectations, and readiness the members of the organization attach to that task before implementing change—particularly regarding the use of one’s own identity in the change process. In sum, the process of leading by LGBTQ individuals is likely to be influenced strongly by a context of pervasive societal heterosexism and stigma that filter down into education and work environments; by the leader’s own sexual orientation and gender identity—and the presentation and disclosure of those identities; and characteristics of the followers and the groups being led. How these factors intersect is merely speculative at present, because little scholarship has tackled the complexities of LGBTQ leadership to date, and clearly such study is much needed.

The Future of LGBTQ Leadership LGBTQ leadership is ripe for study. Among the many research questions that future scholarship can and should explore are the following: 1. Under what circumstances does the sexualminority status of an LGBTQ leader matter? What conditions support or detract from a leader’s self-identification as LGBTQ? 2. How do marginalization and stigma affect LGBTQ leadership? How does LGBTQ leaders’ handling of their identities affect leadership outcomes? 3. Does good LGBTQ leadership differ from poor LGBTQ leadership, and is it related to the leader’s identity? 4. What does LGBTQ leadership have to contribute to the larger scholarship about leadership and followership? Is there something unique that LGBTQ people bring to leadership? 5. How can LGBTQ leaders learn and be mentored, especially in circumstances of concealed identities?

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6. How can supportive, affirmative environments be built for LGBTQ individuals to develop their leadership capacities, move into positions of leadership, and lead successfully across all kinds of groups?

Ruth E. Fassinger See also Career Development and Trajectories; Education; Employment Non-Discrimination Act (ENDA); Work Environments; Workplace Discrimination; Workplace Policies

Further Readings Badgett, M. V. L., Lau, H., Sears, B., & Ho, D. (2007). Bias in the workplace: Consistent evidence of sexual orientation and gender identity discrimination. Los Angeles, CA: Williams Institute. Bieschke, K. J., Hardy, J. A., Fassinger, R. E., & Croteau, J. M. (2008). Intersecting identities of gendertransgressive sexual minorities. In W. B. Walsh (Ed.), Biennial review of counseling psychology (Vol. 1, pp. 177–207). New York, NY: Routledge/Taylor & Francis. Brewster, M. E., Velez, B. L., Mennicke, A., & Tebbe, E. (2014). Voices from beyond: A thematic content analysis of transgender employees’ workplace experiences. Psychology of Sexual Orientation and Gender Diversity, 1(2), 159–169. Browne, J. (2014). The glass closet: Why coming out is good for business. New York, NY: HarperCollins. Chin, J. L., Lott, B., Rice, J. K., & Sanchez-Hucles, J. (Eds.). (2007). Women and leadership: Transforming visions and diverse voices. Oxford, England: Blackwell. Davies, P. G., Spencer, S. J., & Steele, C. M. (2005). Clearing the air: Identity safety moderates the effects of stereotype threat on women’s leadership aspirations. Journal of Personality and Social Psychology, 88(2), 276–287. Eagly, A. H., & Carli, L. L. (2007). Through the labyrinth: The truth about how women become leaders. Boston, MA: Harvard Business School Press. Fassinger, R. E. (2008). Workplace diversity and public policy. American Psychologist, 63(4), 252–268. Fassinger, R. E., & Arseneau, J. R. (2007). “I’d rather get wet than be under that umbrella”: Differentiating among lesbian, gay, bisexual, and transgender people. In K. J. Bieschke, R. M. Perez, & K. DeBord (Eds.), Handbook of counseling and psychotherapy with

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lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 19–50). Washington, DC: American Psychological Association. Fassinger, R. E., Shullman, S. L., & Stevenson, M. R. (2010). Toward an affirmative lesbian, gay, bisexual, and transgender leadership paradigm. American Psychologist, 65(3), 201–215. Herek, G. M., Gillis, R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56(1), 32–43. Judge, T. A. (2009). Core self-evaluations and work success. Current Directions in Psychological Science, 18(1), 58–62. Madera, J. M., King, E. B., & Hebl, M. R. (2012). Bringing social identity to work: The influence of manifestation and suppression on perceived discrimination, job satisfaction, and turnover intentions. Cultural Diversity and Ethnic Minority Psychology, 18(2), 165–170. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. Mohr, J. J., & Fassinger, R. E. (2013). Work, career, and sexual orientation. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 151–164). New York, NY: Oxford University Press. Ragins, B. R., Singh, R., & Cornwell, J. M. (2007). Making the invisible visible: Fear and disclosure of sexual orientation at work. Journal of Applied Psychology, 92, 1103–1118. Renn, K. A. (2008). LGBT student leaders and queer activists: Identities of lesbian, gay, bisexual, transgender, and queer identified college student leaders and activists. Journal of College Student Development, 48(3), 311–330. Velez, B. L., Moradi, B., & Brewster, M. E. (2013). Testing the tenets of minority stress theory in workplace contexts. Journal of Counseling Psychology, 60, 532–542.

LEATHER CULTURE The leathermen community is a group of men within greater gay culture who display a hypermasculine gender expression and engage in scripted

sexual roles and practices. Their presence within the sexual-minority communities has played an important role in expanding the images of gay masculinity and sexuality. In addition, their capacity to create and maintain a community of the 1960s to the present day demonstrates the powerful effects of social organizing and visibility. This entry provides a brief history of the leathermen community; an understanding of how leathermen define their identity, gender and sexuality, and a consideration of women and others who have adopted leather culture; and an overview of controversies that have arisen through its history.

A Brief History of the Leathermen The gay community is often reduced to a homogeneous group defined by their same-sex sexual orientation; however, within this community there are multiple movements, cultures, subcultures, and identities. The leathermen movement was initiated by a group of gay men who aimed to challenge mainstream representations of gay men in the early to mid-1950s. Gay men had been stereotyped in popular media as effeminate and weak, treated as the subject of humor, and were subjected to heterosexist hostility. In response, a new gay masculinity was shaped through donning leather attire and adopting a hypermasculine gender expression with scripted sexual roles and practices. By implementing techniques from the 1980s civil rights and 1990s human potential movements, the leathermen structured and organized a community, creating a culture of their own. Leathermen were, and continue to be, identified by their leather apparel and sadomasochistic (S/M) sexual practices. Their distinct form of dress gained the group visibility within the gay community, featuring boots, t-shirts, biker jackets, heavy belts, and Harley caps. Their aesthetic was formed against the backdrop of proliferating heterosexual biker clubs. These establishments were frequented by heterosexual military and working-class men. Given the context, the leathermen, who also originated from a working-class background, began to tap into these empowering constructions of masculinity.

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Leather bars at the time opened in major cities like New York, Los Angeles, Chicago, and San Francisco. By 1962, Folsom Street in San Francisco had opened multiple leather bars creating what could be considered “leather square,” or as it was nicknamed at the time, the “Miracle Mile.” As the sixties came to a close, those interested in S/M practices began creating their own S/M spaces at home (i.e., dungeons). They bought gear and equipment that had become readily available by this time through mail-order catalogues. During the 1970s, recognition of the leather community began to increase following the development of interstate and international organizations. Unfortunately, in the same decade, the gay community suffered great stigmatization from psychiatrists within the American Psychiatric Association, who pointed to leathermen’s sexual practices as justification for labeling homosexuality as pathological and degenerative. Fortunately, countermovements from within psychiatry were able to oppose these ideas and in 1973, homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM). As the 1970s progressed, so did the S/M and leathermen movement. The Eulenspiegel Society and Society of Janus are two examples of mainly heterosexual organizations that developed a political agenda to move the community forward by creating more S/M spaces. Even though these were mainly composed of heterosexual men and women, the organizations accepted gay members as well. In 1974, the European Confederation of Motorcycle Clubs (ECMC) was established to bring together the different motorcycle, leather, uniform, and fetish communities that were emerging throughout Europe. In the United States, the era saw the birth of special invitation–only parties, such as the Chicago Hellfire Club, which hosted a special annual party called the Inferno; the Mineshaft in New York City, in 1976, year-round nights of these private gatherings; and the Catacombs (1975–1981), in San Francisco, which was primarily a leather gay male club that was also invitation only. Later on, the Catacombs held a separate night for women, and had mixed-sex and -sexual orientation parties. In 1978, Samois, the

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first lesbian S/M organization, was created, but it was disbanded in 1982. By the 1980s, the leather community was fully integrated into mainstream gay culture. Open and sponsorship-free S/M groups for gays and lesbians were created, such as Gay Male S/M Activists (GMSMA) and the Lesbian Sex Mafia. The organizations formed a space of communication and education via bimonthly meetings for the leather community in New York City. A year later, GMSMA helped further unify the leather community by creating the Leather Pride Night Committee, a coalition of New York City leather organizations. Moreover, seats were reserved in the steering committee of the 1987 March on Washington for Gay and Lesbian Rights for both male and female representatives of the leather community, which signified their influence within the greater gay community. By 1991, leathermen and leatherwomen were included in gay pride marches around the country, furthering their visibility. Today, leathermen continue to have a strong presence in gay pride parades both in the United States and abroad. Folsom Street in San Francisco remains the mecca of the S/M movement, and continues to host the Folsom Street Fair, a major yearly event for the S/M community. The fair was originally created in 1984 with the aims of fundraising, political activism, and general entertainment for S/M aficionados. Currently, the Folsom Street Fair continues to offer workshops and demonstrations with the purpose of educating those interested in S/M. In 1997, the Folsom Street Fair propelled GMSMA to create an East Coast equivalent, the Folsom Street East—the largest S/M block party on the East Coast. The year after, across the Atlantic, the “Berlin Leder and Fetisch e.V.” (Berlin Leather and Fetish) was established as a nonprofit organization to give a space, build a community, and promote events focused on S/M practices in Germany. Now called the BLF, the organization holds a yearly event in the month of March or April called Easter Berlin, which brings people interested in S/M from all over Europe. In 2003, Folsom Street Europe was also created in Berlin with the goal to increase education about

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S/M practices and fund-raise for the European S/M community. Currently, Europe continues to have a flourishing leather community, with ECMC uniting over 35 fetish groups across the continent, and through the Leather History Foundation, which tracks, archives, and promotes knowledge about contemporary and past history of the leather movement throughout Europe. Unfortunately, in the United States, GMSMA ceased its operations in 2009 due to decreases in membership and lack of leadership. The organization transitioned into a nonprofit foundation with the role of providing support to Folsom Street East and commenced an annual Leather Pride Night and auction fund-raiser with the goal to protect the rights of consenting adults who want to practice S/M.

Identity, Sexuality, and Gender Expression of Leathermen Leathermen utilize leather gear and engage in S/M practices, also termed leathersex, to accentuate their hypermasculine identity and style. However, the usage of leather is not primarily for bondage and pain, as with those who practice S/M, but rather to mark their masculinity. The leather community counters stereotypes of a less masculine, genteel, mainstream gay community by positioning itself as not only more masculine than gay male stereotypes but also surpassing heterosexual norms around masculinity. Leathermen value tough and severe appearances, utilizing vests, chaps, and cuffs made of leather to accentuate muscular physiques. Leather garb and equipment communicate belonging to the leather community as well. The leather community provides these men with a sense of connection and camaraderie, resulting in greater self-acceptance and positive self-concept. The leathermen have criticized the gay community for holding superficial and classist values in contrast to their own working-class values that emphasize loyalty, egalitarianism, nondiscrimination, and acceptance. Therefore, the social and psychological perspective of the leathermen may be considered one of pride in connection to their gender, sexual

orientation, and class. Their community can be seen as an organized bolstering of resilience in the face of multiple social stigmas. The leather community is symbolically represented by flags that are composed of black, blue, and white stripes with a heart in the upper-left quadrant. These flags are used to mark leather spaces, and in gay pride events they are used to announce the presence of leathermen. Another form of symbolic communication developed within the leather community is the “hanky code.” Leathermen place handkerchiefs or bandanas in their back pockets to signal preferred sexual roles; pocket placements signify top, bottom, or versatile positions, and specific colors indicate desired sexual practices. The sexual practices of leathermen can be viewed as intriguingly complex and highly structured. For instance, different sexual rites imbue leather garb with emotional significance, and these sexual rituals further mark the identity formation of leathermen. Within their sexual lexicon, leathermen sometimes use the terms Leather Daddy and Leather Boy as ways to mark power differentials in relationships, a categorization style that is similar to Master and Slave within the S/M community. Age and physical appearance also play an important role for leathermen; individuals who are more sexually experienced, older, and physically larger tend to take on more dominant roles within sexual relationships. It is important to note, however, that submission in leathersex is not considered a lesser position, and dominance is not viewed as a more desirable position. Instead, submission is constructed as a sign of strength and commitment, while dominance is viewed as dependency on the submissive partner’s willingness. In addition, care and nurturance are attributes associated with the dominant partner; however, the relationship style of leathermen is one marked by a mutual exchange of nurturance. Key to their sexuality is trusting and transparent communication about sexual desires, decisions, and consensus about participation in S/M. This communication style results in a deeper attunement between sexual partners.

Leather Culture

Ultimately, the leathermen, through their sexual and social rites, have come to reinterpret submission, vulnerability, and nurturance, values traditionally seen as unmasculine, and have integrated them into a hypermasculinity identity.

Controversies Related to Leathermen Many different interpretations have been put forward to understand the role of masculinity in the leather community. The leathermen’s form of masculinity has been viewed as a self-protective reaction to the feminized gay man, as an internalization of sexism that drives heterosexism, and as a challenge to heterosexual masculinity. However, within the leathermen community some members have critiqued their contemporary S/M practices, suggesting that leathersex has departed from its emphasis on power differentials based upon the original Old Guard codes—viewed by some as the emasculation of S/M. These codes established rules around the treatment of the slave by the master. Whereas originally it was expected for a slave to provide pleasure to his master, today the master is seen as responsible for the pleasure of his slave. This trend was partly propelled by trends of the human potential movement of the 1990s that viewed S/M as a self-realization practice. These changes also reduced psychiatric stigma and attempted to address feminist critiques regarding the problematic nature of power differentials. In addition, radical feminists criticized the S/M culture, and by association leathermen, claiming that internalized patriarchal forces are present throughout all practices of domination and submission. Feminists held that S/M perpetuated patriarchy by endorsing the economic, psychological, and sexual abuse of women. They charged that the abuse present in lesbian S/M practice was evidence of patriarchy internalized from a misogynist society that derived pleasure from objectifying and harming women. The critique was extended to gay leathermen who, due to internalized patriarchy and heterosexism, derived pleasure from the pain imposed on submissive men.

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Conclusion The leathermen movement was formed in sharp contrast to mainstream gay culture. Members developed a complex understanding of masculinity, along with elaborate relational, social, and sexual practices that established a sense of sensuality, community, and pride for gay men who endorsed historically working-class values and gender presentations. The practices of leathermen have not only expanded the boundaries of gay aesthetics but also furthered our understanding of gay masculinities. The leathermen movement has demonstrated the powerful effect of social organizing in increasing the visibility of marginalized identities and in creating a sense of camaraderie and belonging across differences within the gay community. Francisco I. Surace and Heidi M. Levitt See also Bondage, Dominance/Submission, Sadism/ Masochism (BDSM); Hypermasculinity; Kink; Masculinities; Sexual Attraction, Behavior, and Identity; Social Class; Social Class and Sexuality, Intersections Between

Further Readings Deckha, M. (2011). Pain as culture: A postcolonial feminist approach to S/M and women’s agency. Sexualities, 14, 129–150. Harris, D. (1997). Metamorphosis of the modern dungeon. Harvard Gay & Lesbian Review, 4, 29. Hopkins, P. D. (1994). Rethinking sadomasochism: Feminism, interpretation, and simulation. Hypatia, 9(1), 116–141. Mosher, C. M., Levitt, H. M., & Manley, E. (2006). Layers of leather: The identity formation of leathermen as a process of transforming meanings of masculinity. Journal of Homosexuality, 51, 93–123. Rubin, G. (2004). The Catacombs: A temple of the butthole. In M. Thompson (Ed.), Leatherfolk: Radical sex, people, politics, and practice (pp. 119–140). Los Angeles, CA: Daedalus. Smith, T., & Bale, C. (2012). Guide for the modern bear. Port Townsend, WA: Pixelita Press.

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Legal Consciousness

LEGAL CONSCIOUSNESS Legal consciousness is a term used in sociolegal studies to consider the role that law plays in everyday life. It is different from legal awareness, which refers to individuals thinking about the place of law in their lives. Legal consciousness, by contrast, often involves individuals engaging with law in the everyday without necessarily reflecting upon law. Legal consciousness scholars are interested not only in how law shapes people’s lives, but also how people interact with law, how they engage with law, and how the social world shapes law as much as law shapes the social world. They are also interested in who is privileged, and who is marginalized by law. Legal consciousness scholars describe three ways in which individuals engage with law: before the law, with the law, and against the law. In before the law, individuals face a detached, expertdriven system of rights, rules, and processes. In standing before the law, individuals may hope for justice, but it is out of their control, with power lying not in their own hands but in the hands of law itself. By contrast, with the law involves seeing law as a game, something to be played, manipulated, and strategically deployed, as in courtroom tactics, for example. In against the law, rather than being seen as something to be engaged with, law is seen as something to be resisted, something risky, something that is beyond the reach of certain marginalized groups or individuals and that is to be avoided/subverted. These three types of engagement are not mutually exclusive and can overlap in individuals’ understanding and mobilization of law in their lives. Legal consciousness has been applied to such areas as employment contexts, workplace rights, and sexual harassment in the workplace; transcultural comparison in everyday constructions of law; street harassment; prison dynamics; citizenship participation, including illegal citizens; and marginalized family formations and recognition. It has only been applied in a limited way so far to LGBTQ issues, in relation to lesbian and gay families, partnership and parenthood recognition, and U.S. civil rights.

Rosie Harding, writing in the UK, has suggested that lesbians and gay men engage with all three forms of legal consciousness in relation to debates about recognition. They mobilize “before the law” discourse in relation to notions of equality, human rights, and citizenship to articulate how their relationships should be recognized in law. They also recognize the inequalities and injustices of uneven recognition in law, compared with heterosexual individuals, mobilizing “with the law” legal consciousness in discourse about tactics and strategies to change law. The most dominant form of legal consciousness discourse found by Harding related to resistance in relation to lesbian and gay sexualities being regarded as lesser or deviant, different methods of relationship recognition for lesbians and gay men and heterosexual individuals, and unequal treatment in law of lesbians and gay men as individuals. Harding proposed that this activist, equality-seeking resistance constituted a form of legal consciousness insufficiently encompassed by the three standard categories. She argued that lesbian and gay activism involved resistance that was not, as would usually be the case, “against the law” (i.e., defying law) nor even “with the law” (i.e., cynically playing the “game” of law). Lesbian and gay activism, Harding proposed, is positioned “before the law,” in that it appeals for inclusive citizenship on the basis of entitlement within existing legal structures, such as human rights, equality, parity with heterosexual individuals, and so on. Nancy Knauer, writing in the United States, has observed the many ways in which LGBTQ individuals are marginalized in law. Lesbians and gay men face challenges in relationship and parenting recognition, adoption rights, access to health and social care, estate management, housing, and immigration status. They experience discrimination in education, employment, housing, and health and social care provision (especially in older age). Knauer has also highlighted the differences in state and federal recognition in the United States. Historically, samegender couples recognized as married in one state could become legal strangers when in others. A nonbiological parent of a child in a same-gender

Legal Recognition of Nonmarital Same-Sex Relationships

couple, recognized as a parent in one state, is not necessarily recognized as that child’s parent in another. Transgender individuals also face discrimination in education, employment, housing, and health and social care provision. All LGBTQ individuals are at risk of physical and mental health problems associated with minority stress. Transgender individuals are at heightened risk of major depression, selfharm, and attempts to end their lives. Transsexual individuals—that is, those who are transitioning/ have transitioned to a gender not assigned at birth—have variable access to treatment and support and also experience variable legal recognition of their revised gender status, again differentiated at state and federal levels in the United States. These variable recognitions complicate the practicalities of everyday living in legal contexts, and also how they are approached and engaged with by transgender individuals. Legal consciousness has been criticized in four main ways: by those who question the relevance or appropriateness of studying law in everyday life; by those who interrogate the use of the term consciousness because often unconscious or semiconscious processes are involved; by those who object to the way it individualizes issues that belong in collective, sociopolitical structural arenas; and lastly, by those who argue that it is overly descriptive, rather than explanatory. Other scholars have defended the approach, arguing that it can offer a nuanced analysis of how law plays out in individuals’ lives, at the intersection of social divisions. They also assert that legal consciousness studies highlight how law is differently experienced by individuals—especially marginalized individuals—according to context and social location, and how law is implicated in both power and resistance. Given their ongoing social exclusion and marginalization, in both formal and informal law, further research using a legal consciousness approach could offer illuminating insights into how this is understood, experienced, and engaged with by LGBTQ individuals. Sue Westwood

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See also Discrimination Against LGBTQ Elders; Discrimination Against LGBTQ People by Law Enforcement; Discrimination Against LGBTQ People in the Public Sector; Heteronormativity; Heterosexism; Laws Banning Homosexuality and Sodomy; Policing Masculinities and Femininities; Psychological Approaches to Studying LGBTQ People

Further Readings Ewick, P., & Silbey, S. (1998). The common place of law: Stories from everyday life. Chicago, IL: University of Chicago Press. Harding, R. (2011). Regulating sexuality: Legal consciousness in lesbian and gay lives. Abingdon, England: Routledge. Knauer, N. J. (2012). Legal consciousness and LGBT research: The role of the law in the everyday lives of LGBT individuals. Journal of Homosexuality, 59(5), 748–756. Richman, K. D. (2006). LGBT family rights, legal consciousness, and the dilemma of difference. In B. Fleury-Steiner & L. B. Nielsen (Eds.), The new civil rights research: A constitutive approach (pp. 77–99). Aldershot, England: Ashgate.

LEGAL RECOGNITION OF NONMARITAL SAME-SEX RELATIONSHIPS The demand for legal recognition of same-sex relationships in the United States began as a natural extension of the broader goals of equality and individual freedom espoused by the LGBTQ rights movement. Starting in the late 1970s, the earliest efforts to secure recognition focused primarily on employee benefits, specifically employer-provided health insurance. Framing the issue as a question of “equal pay for equal work,” employees lobbied their employers to extend spousal benefits to their same-sex partners in the form of “domestic partner” benefits. The first wave of the HIV/AIDS epidemic in the mid1980s highlighted the importance of legal recognition. Same-sex partners were refused hospital

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visitation rights, disregarded in medical decision making, evicted from apartments, and denied the property rights typically extended to surviving spouses or family members. Under the law, samesex partners were considered legal strangers, regardless of the length or quality of their relationship. Since the 1980s, the law has developed a number of mechanisms on both the state and local levels that address these inequities and provide various levels of recognition, ranging from the limited grant of domestic partner employee benefits to laws that extend all the rights and obligations of marriage. These forms of nonmmarital recognition have been called by different names, including domestic partnerships, reciprocal beneficiaries, and civil unions. With the advent of marriage equality, nonmarital legal recognition has declined in importance, and many jurisdictions discontinued nonmarital recognition when they adopted marriage equality. This practice reflects the widely held view that nonmarital recognition was only a temporary measure until same-sex couples could legally marry. However, marriage is not a universally shared goal within the LGBTQ community, and some same-sex couples may prefer a legally recognized nonmarital relationship over marriage. This entry discusses the way that the law privileges family members in terms of property rights and decision making and how this preferential treatment led to the demand for legal recognition of same-sex relationships. It then outlines the various ways that the law has recognized nonmarital same-sex relationships and concludes with a discussion of the future of nonmarital recognition in light of marriage equality.

The Law and Family Relationships Despite many advances, the law continues to privilege relationships defined by blood, marriage, and adoption. Without relationship recognition, a same-sex partner is considered a legal stranger who stands behind children, parents, siblings, grandparents, aunts and uncles, cousins, and even

the state in terms of priority and legal standing. The absence of a legally recognized relationship can have significant bearing in cases of relationship dissolution, employee benefits, parenting decisions, second-parent adoption, inheritance, and health care decision making. When same-sex couples are considered legal strangers, they must rely on private contracts; beneficiary designations; dependent classifications; and, at times, the goodwill of family members to secure recognition for their relationship. Historically (i.e., prior to marriage equality in 2015), surviving same-sex partners in jurisdictions that did not recognize same-sex marriage have been especially vulnerable because they were denied the property rights and decision-making authority that inure automatically to the benefit of a surviving spouse or next of kin, including the right to inherit under the rules of intestate succession or standing to file a wrongful death action. In these jurisdictions, courts generally upheld an otherwise valid will that primarily benefited a samesex partner, but the relatives of the deceased partner had standing to challenge the will. Moreover, estate planning documents have historically often been insufficient to grant a same-sex partner all the rights that automatically attach to family members, such as the authority to make funeral and burial arrangements.

Lack of Uniformity in Nonmarital Relationship Recognition States and municipalities have been experimenting with a variety of nonmarital forms of relationship recognition since the early 1980s. These forms of recognition have successfully secured important rights for same-sex couples on the state and local level, but they have also been the source of confusion and additional stress for same-sex couples. The degree and nature of the recognition have tended to vary by jurisdiction. Depending on where the couple lived and worked, they could be considered legal strangers, spouses, or something in between. In addition, nonmarital recognition was rarely portable, meaning that same-sex

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couples could lose their status if they ventured out of the jurisdiction. In 2004, both the American Psychiatric Association and the American Psychological Association came out in support of equal marriage rights and specifically recognized the stress caused by the lack of uniform relationship recognition.

Local Domestic Partnership Ordinances The legal recognition of same-sex relationships first began on the local or municipal level with the adoption of domestic partnership ordinances. Although these ordinances were a significant step forward in the recognition of same-sex relationships, they were often largely symbolic and granted few substantive rights because they could only extend to same-sex couples the rights that were within the power of the city municipality to grant. The first ordinances focused on employee benefits and offered domestic partner benefits to city employees. They were later followed by more comprehensive ordinances that established domestic partnership registries; extended full spousal rights to domestic partners; and, in some instances, required city contractors to provide domestic partner benefits. The term domestic partnership was coined in 1979 by gay rights activist Tom Brougham. At the time, Brougham worked for the City of Berkeley, California, which had just passed an ordinance that outlawed discrimination based on sexual orientation. Brougham asked the city to extend spousal employee benefits to his same-sex partner, whom he referred to as his “domestic partner.” Although Berkeley did not approve the request, Brougham’s idea gained momentum, especially given the importance of employer-provided health insurance. The first ordinance to recognize samesex domestic partners was introduced in San Francisco in 1982. Private employers also began to offer domestic partner benefits at approximately the same time. Berkeley eventually became the first municipality in the United States to extend domestic partner benefits to its city employees in 1984. Its domestic partner ordinance was gender-neutral

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and applied to any unmarried partners who satisfied the eligibility criteria. In addition to extending domestic partner benefits, municipalities created official domestic partnership registries that provided couples an opportunity to solemnize and record their relationships. The City of West Hollywood, California, became the first municipality to create a domestic partner registry in 1985. Some cities later expanded their recognition of domestic partnerships by enacting broader ordinances that granted domestic partners all of the rights and obligations that were available to spouses within the municipality. These rights were limited in scope, but could include the right to visit a same-sex partner incarcerated at a county prison; municipal spousal tax benefits; and the ability to transfer certain municipal licenses, such as a liquor license, to a same-sex partner. In 1996, San Francisco became the first municipality to pass an equal benefits ordinance that expanded the domestic partner mandate by requiring all city contractors to extend spousal employee benefits to the domestic partners of their employees. In order to determine who qualified as a domestic partner, employers and municipalities developed a multipart inquiry that attempts to identify and disaggregate the features of a committed spousal-type relationship. Standard eligibility requirements include a statement of commitment and proof of financial interdependence. In addition, domestic partners may be required to satisfy minimum age requirements, pledge exclusivity, and certify that they are not closely related to each other. The definition of a domestic partner has also influenced court decisions where same-sex couples have asked for recognition on the grounds that the couple was financially interdependent and functioned as a family.

Statewide Recognition: Limited Rights In advance of marriage equality, a number of states adopted laws that extended limited rights to samesex couples. The statutory schemes varied considerably in terms of scope and went by different names, including reciprocal beneficiaries, domestic

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partnerships, and civil unions. Some of the statutory schemes were restricted to same-sex couples, whereas others were also open to different-sex couples. Some of the statutes were based on the municipal domestic partnership ordinances that had created an alternative status to marriage, whereas other statutes emphasized individual beneficiary designations. All of the states that extended limited recognition to same-sex couples later adopted full marriage equality. Only a handful of states and the District of Columbia continue to extend nonmarital recognition. In 1997, Hawai’i became the first state to provide nonmarital relationship recognition for samesex couples when its legislature enacted the Reciprocal Beneficiaries Act in response to ongoing marriage litigation that had begun years earlier. In 1993, the Hawai’i Supreme Court ruled in Baehr v. Lewin that prohibiting same-sex couples from marrying constituted gender discrimination and violated the Equal Rights Amendment to the state constitution. The case was remanded to the trial court to determine whether the prohibition against same-sex marriage was justified by a compelling state interest. While the litigation was pending, the state legislature created the status of reciprocal beneficiary, which extended approximately 60 rights and responsibilities commonly associated with marriage to individuals who registered as “reciprocal beneficiaries.” These rights included wrongful death rights, the right to inherit through intestate succession, and the right to make certain health care decisions. The status of reciprocal beneficiary was not limited to same-sex couples. Any two single adults who were otherwise prohibited from marrying were eligible to register, including a brother and sister. Although the Reciprocal Beneficiaries Act was not repealed when Hawai’i adopted marriage equality in 2012, samesex couples are no longer eligible to register as reciprocal beneficiaries unless they are also disqualified from marriage, which would only happen if they were closely related to each other. In 2009, Colorado enacted similar legislation known as the Designated Beneficiary Agreement Act that grants limited rights to “designated beneficiaries.” Although the Colorado status also

focuses on beneficiary designations, it is more flexible than the “reciprocal beneficiary” status offered in Hawai’i. The Colorado designation does not have to be reciprocal, nor do the parties have to be prohibited from marrying. Even though Colorado adopted civil unions and later marriage equality, it has not repealed the Designated Beneficiary Agreement Act, which continues as a form of nonmarital legal recognition. California was the first state to recognize samesex domestic partners in 1999. The California legislature later expanded the scope of the recognition to extend a number of rights traditionally reserved for spouses to “registered domestic partners,” including inheritance rights, certain health care decision-making authority, and standing to sue for wrongful death. Although other states followed suit, the scope of the statewide recognition varied widely. In 2004, Maine adopted a statewide domestic partnership registry, but only extended certain health care decision-making authority and inheritance rights to domestic partners. Rhode Island passed domestic partnership legislation in 2009, but it only included the right to make funeral arrangements. That same year, the Wisconsin legislature passed domestic partner legislation that granted same-sex couples 43 rights and protections, including inheritance rights and health care decision-making authority. All of these states now have marriage equality. Only California and Maine continue to offer domestic partnership recognition.

Statewide Recognition: Marriage Equivalents A number of states created a statutory status designed to grant same-sex couples all of the rights and obligations of marriage, but without the designation of marriage. These states created the parallel status in order to extend equal rights to same-sex couples, while maintaining marriage as a special status reserved for different-sex couples. Some of these states, such as Vermont and New Jersey, created the parallel status in response to a decision of their state supreme court. All of the states offering an equivalent status to marriage

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eventually adopted full marriage equality in advance of nationwide marriage equality as mandated by the 2015 U.S. Supreme Court case Obergefell v. Hodges. The question remains as to what status the couples should have who entered into the now-defunct relationships. In 1999, the Vermont Supreme Court ruled in Baker v. Vermont that same-sex couples were entitled to the same rights and privileges afforded to married couples under the Vermont state constitution. The decision specifically suspended the issuance of marriage licenses to same-sex couples until the state legislature could attempt to remedy the situation. A year later, the legislature enacted the parallel status of civil unions, which granted same-sex couples all of the rights of marriage and effectively avoided the recognition of same-sex marriage in Vermont. Unlike what happened in Hawai’i after the decision in Baehr v. Lewin, the Vermont voters were not able to overturn the court decision by amending the state constitution because Vermont does not have a statewide referendum process. In 2006, the Supreme Court of New Jersey held in Lewis v. Harris that limiting access to the protections and benefits of civil marriage to differentsex couples violated the state constitution, but it did not require the state to permit same-sex couples to marry. In response to the decision, the New Jersey state legislature passed the Civil Union Act, which created a parallel status extending all of the rights and responsibilities of marriage to same-sex couples. New Jersey had earlier extended limited rights to same-sex partners and different-sex partners over 62 years of age who registered as “domestic partners.” The creation of a wholly equivalent parallel status to marriage led to arguments that the dual status, especially when restricted to same-sex couples, violated the Equal Protection Clause of the Fourteenth Amendment because it created a status that was “separate, not equal.” In 2008, the Connecticut Supreme Court ruled in Kerrigan & Mock v. Dept. of Public Health that excluding same-sex couples from marriage violated the Connecticut state constitution and ordered the state to issue marriage licenses to same-sex couples.

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Case-by-Case Recognition The courts have also recognized same-sex relationships in the absence of authorizing legislation in certain specific instances, such as protection from eviction under municipal rent control guidelines, and standing to sue for wrongful death. These decisions are based on the notion of a “functional” family or equitable principles, not a declaration of equality for same-sex couples. Although taken together, they represent a trend toward greater legal recognition for same-sex relationships, they have been decided on a case-by-case basis and rest on a variety of theories. For example, New York City rent control guidelines allowed a member of a decedent’s immediate family who shared the household to stay in a rentcontrolled apartment, even where the surviving family member was not a named party to the lease. The groundbreaking 1989 case of Brashi v. Stahl Associates Co., extended this protection to a surviving same-sex partner through the adoption of a functional definition of family, with an emphasis on mutual interdependence. Some courts have used equitable principles to recognize same-sex partners. In the 2001 case of Vasquez v. Hawthorne, the Washington State Supreme Court upheld a claim by a surviving same-sex partner against his partner’s estate, even though they had not formalized their relationship and the partner had not left a valid will. Other courts have interpreted anti-discrimination laws to compel employers to provide domestic partner benefits and private business to offer spousal rates to same-sex couples. For example, the California Supreme Court ruled in the 2005 case of Koebke v. Bernardo Heights Country Club that registered domestic partners were equivalent to married couples for purposes of discrimination laws applying to private businesses.

Marriage Equality and the Future of Nonmarital Recognition The advent of marriage equality has placed the future of nonmarital forms of relationship recognition into question. The prominence of the marriage

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Legal Rights of Nonbiological Parents

equality movement has established marriage as the desired benchmark, and anything short of marriage may be perceived as an example of inequality based on sexual orientation. As a result, many of the jurisdictions that had offered nonmarital recognition for same-sex relationships discontinued their recognition of nonmarital status upon the adoption of marriage equality. A similar trend has been observed in the private sector where employers have been discontinuing domestic partnership benefits after same-sex marriage is recognized in their jurisdiction. This phase-out of nonmarital recognition assumes that it was designed as a temporary measure, rather than an alternative to marriage. Accordingly, the jurisdictions where the nonmarital status was also available to different-sex partners as an alternative to marriage have been more likely to continue the nonmarital status after marriage equality. For example, the District of Columbia has maintained its domestic partnership status for both same-sex and different-sex couples, even though it began recognizing samesex marriage in 2009. For jurisdictions that had nonmarital recognition, marriage equality also raises the question of how to treat the couples who had entered into those legally recognized nonmarital relationships. For example, Vermont discontinued its civil union status when it adopted marriage equality, but couples who have entered into a civil union will remain in that relationship unless they dissolve it by court order or choose to get married. Illinois, on the other hand, kept its civil union status for both same-sex and different-sex couples, but provided a streamlined process by which same-sex couples in civil unions could convert their relationship to a marriage. Connecticut took yet another approach. When it discontinued its civil union status, which had been restricted to same-sex couples, Connecticut automatically converted all civil unions to marriages. Nancy J. Knauer See also Defense of Marriage Act (DOMA); Domestic Partnership; Marriage, Reasons for and Against; Marriage Equality, Landmark Court Decisions

Further Readings Baehr v. Lewin, 852 P.2d 44, 53 (Haw. 1993). Baehr v. Miike, No. 91–1394, 1996 WL 694235, at *21 (Haw. Cir. Ct. 1996), aff’d 950 P.2d 1234 (Haw. 1997). Baker v. Vermont, 744 A.2d 864 (Vt. 1999). Brashi v. Stahl Associates Co., 74 N.Y.2d 201 (1989). Chauncey, G. (2004). Why marriage? The history shaping today’s debate over gay equality. New York, NY: Basic Books. Defense of Marriage Act, Pub. L. No. 104-199, 110 Stat. 2419 (1996). Kerrigan & Mock v. Dept. of Public Health, 289 Conn. 135 (2008). Knauer, N. (1998). Domestic partnership and same-sex relationships: A marketplace innovation and a less than perfect institutional choice. Temple Political & Civil Rights Law Review, 7, 337–349. Knauer, N. (2006). The recognition of same-sex relationships: Comparative institutional analysis, contested social goals, and strategic institutional choice. University of Hawai’i Law Review, 28, 23–83. Knauer, N. (2014). LGBT elders in a post-Windsor Windsor world: The promise and limits of marriage equality. Texas Journal of Women and the Law, 24(1). Available at http://ssrn.com/abstract=2557402 Koebke v. Bernardo Heights Country Club, 31 Cal. Rptr. 3d 565 (2005). Koppelman, A. (2002). The gay rights question in contemporary American law. Chicago, IL: University of Chicago Press. Lewis v. Harris, 188 N.J. 415 (2006). Obergefell v. Hodges, 135 S. Ct. 2584 (2015). Polikoff, N. (2008). Beyond gay (and straight) marriage: Valuing all families under the law. Boston, MA: Beacon Press. Vasquez v. Hawthorne, 33 P.3d 735 (Wash. 2001).

LEGAL RIGHTS PARENTS

OF

NONBIOLOGICAL

The term nonbiological parent can be a confusing one. It is not a term with a fixed legal meaning but rather a generally descriptive term that is commonly used in specific circumstances. This entry first considers the usage of the term and then discusses its potential legal importance.

Legal Rights of Nonbiological Parents

Taken literally, nonbiological parents could describe a wide range of parents. Adoptive parents, for instance, are nonbiological parents in that they do not have a biological relationship with the children they raise. Similarly, stepparents may fall within the category of nonbiological parents. In practice, however, the term nonbiological parent is usually used much more narrowly. It is most commonly used in the context of lesbian couples who create families using donor sperm and assisted insemination. The woman who does not give birth to the child is often referred to as a nonbiological parent or, more commonly, a nonbiological mother. By contrast, the woman who gives birth to the child is described as a biological parent or biological mother. In some unusual circumstances, this terminology may be difficult to apply. Some lesbian couples conceive children through in vitro fertilization. One lesbian partner contributes an egg, which is fertilized in vitro and then transferred to the uterus of the other partner. This means that one woman is genetically related to the child and hence may be called a “genetic mother,” while the other woman, who gives birth to the child, may be called the “birth mother.” Whether the genetic mother falls within the category “biological mother” is unclear, as some people use “biological mother” as a synonym for “birth mother.” Generally, these fine distinctions are irrelevant. In vitro fertilization is expensive and invasive, and it is far more common for lesbian couples to use simple insemination, which means that one member of the lesbian couple will be both the birth mother and the genetic mother and therefore clearly the biological mother. In this context, the term is important because the nonbiological mother may not be recognized as a legal parent, or her legal parental rights may be subject to challenge. Historically, these challenges have most often been raised by the biological mother after an acrimonious separation. The superior legal rights of the biological mother will often give her an insurmountable advantage over the nonbiological mother in any postseparation litigation over the child. Generally, a woman who gives birth to a child is recognized as a legal parent (a legal mother) of the

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child. (Some states do have special legal treatment for surrogate mothers.) Thus, the legal parental rights of biological mothers—including lesbian biological mothers—are generally secure and wellrecognized. Legal parents have significant rights (as well as obligations) with regard to their children. These include the right to make important decisions, such as decisions about with whom a child spends time. Legal parents can curtail contact between nonparents and their children. Thus, the legal status of a nonbiological mother is an important concern. Unless the nonbiological mother has a claim to legal parentage, her access to the child may be in jeopardy. There are three main avenues by which a nonbiological mother can claim legal status as a parent. First, she can adopt the child to whom her partner gave birth. This form of adoption is often called a second-parent adoption and is discussed elsewhere in this encyclopedia. Second-parent adoptions are not available in all states, and in some states they may only be available in certain counties. However, once a second-parent adoption is completed, it must be recognized by all other states. The precise procedures required to complete a second-parent adoption vary. A local lawyer must be consulted. For those lesbian couples who are married, a nonbiological mother may attempt to invoke the marital presumption. Historically, when a married woman gave birth, her husband was presumed to be a legal parent. While the presumption has changed over time and now varies widely from state to state, it is still often true that if a husband wishes to assert his parental rights over a child born to his wife, he will be able to do so. Some states permit the wife to defeat his claim with evidence that he is not genetically related to the child, but others do not and will afford the husband parental rights, even if he cannot demonstrate a genetic connection to the child. Before 2004, this presumption could not benefit nonbiological lesbian mothers, because the presumption is founded on marriage, and only marriages between a man and a woman were granted legal recognition. The legal landscape has changed dramatically with regard to marriage, but in many states the parental status of married nonbiological

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legal mothers remains uncertain. In particular, it is possible that states that are hostile to same-sex relationships and recognize marriage only because they are required to do so by court order will refuse to extend the marital presumption to samesex couples. Even in states where a nonbiological mother is permitted to invoke the marital presumption, a court might permit the biological mother to rebut the presumption with evidence that the nonbiological mother is not genetically related to the child—and this evidence will generally be available. There are, of course, a number of states that will recognize parental status of the nonbiological mother by virtue of the marital presumption. However, while this might mean her status is secure as long as all parties remain in the hospitable state, other more hostile states may not be obliged to recognize her status. Thus, a nonbiological mother could lose parental recognition if the family relocated to a hostile state. A final avenue by which a nonbiological mother may gain legal recognition is through some version of de facto parenthood. In some states, a person who acts as a parent for a sufficient period of time may gain legal recognition of her or his relationship with the child. The circumstances under which recognition will be granted vary from state to state as does the extent of recognition. Some states will recognize a de facto parent as a full legal parent, while others will only recognize more limited rights. Because local law varies greatly, a lawyer should be consulted as to the relevant details in any given place. Also, as with the marital presumption, this recognition may not be respected by other states. Thus, adoption remains the most certain way of securing the rights of a nonbiological parent. Julie Shapiro See also Custody and Litigation, LGBQ Parents; Parent–Child Relationships; Second-Parent Adoption

LEISURE Leisure for lesbian, gay, bisexual, and transgender (LGBT) people can be understood in terms of gay commercial spaces. These spaces have long offered respite from heterosexual worlds, and for some they still do. However, studies of leisure are increasingly recognizing that we need to take into account mundane/boring leisure activities that LGBT people partake in, and also recognize that not all heterosexual space is hostile. Leisure is a broad subject area and has many different definitions. For the purposes of this entry, leisure is defined as activities and spaces outside of paid employment. This is problematic when we think about gay people’s leisure, because for some, being paid to work in gay/queer/LGBT spaces might also be leisure. Nonetheless, it enables an examination of key leisure sites and changes in leisure practices and scholarly analyses. Leisure for LGBT people has been a key topic for academic debate and discussion for over 40 years. This is because in the late 20th century, leisure spaces were seen as sites of safety, community, political power, and identity formation. It was in (mainly gay) leisure spaces that many gay men and lesbians created opportunities to socialize and create their sexual and gender identities. This occurred because these spaces and the practices that made them were, and are, sheltered from the hostile, heterosexual, and unaccepting “outside” world. This entry begins by exploring these spaces and their exclusions. It then examines the space of the home, before examining how the normalization of heterosexuality and the dangers of straight space played a part in forming gay leisure spaces and how these sites can also be reworked. The final section examines the ways that studies of leisure activities and contexts where there are increasing rights for LGBT people have changed the ways scholars approach LGBT leisure.

Further Readings Joslin, C. G., Minter, S. P., & Sakimura, C. (2014). Lesbian, gay, bisexual and transgender family law. Eagen, MN: Thomson Reuters.

Gay Leisure Spaces Gay territories are places that are usually visibly recognizable as gay. They can also be called gay

Leisure

ghettos. These sites of economic and political power in places like San Francisco and New York were seen as exemplary of tolerant and then cosmopolitan “queer” urbanities, because of their large gay scenes. Reading gay scenes as, in part, sites of leisure means that a significant proportion of the literature on these spaces is focused on leisure for LGBT people, although this term is rarely used. Yet leisure is core to understanding LGBT lives and the development of gay politics. The term gay is used here deliberately, as these politics and spaces are focused predominantly on gay men. Because of the place of leisure in the construction of contemporary postindustrial identities and landscapes, the growing visibility of lesbian and gay lives and landscapes has been celebrated in relation to the economic benefits of the “creative classes” (e.g., artists/actors). The “pink pound,” as it is called in the UK, or the “gay dollar” (that is, the presumption that gay men have more disposable income than other groups), and other financial myths/assumptions that advocate the wealth and disposable incomes that are read as creating gay lifestyles, draw on and reiterate the assumption that gay men (and to an extent, lesbians) define their identities through consumption or leisure and lifestyle. Scholars have discussed the heterosexualization of gay social spaces. That is, these spaces can be read as trendy, edgy, and popular with certain heterosexual groups. This can be about having an exotic or risky experience, for example, when celebrating the end of your single life at a stag and hen (bachelor/bachelorette) night out. For some, this is an invasion of gay space and “degays” the space, diluting the possibilities for politics and visibility. Moreover, it can also be seen as making gay spaces unsafe, especially for those who are not out at work or school or in certain social circles. The arrival of a large group of straight people who might talk about the “freak show” that they have seen can be threatening and alienating in spaces that are supposed to be by and for gay (and at times lesbian, bisexual, and trans) people. The use of the term gay rather than LGBT when discussing gay ghettos, villages, and commercial spaces, as noted earlier, has been deliberate. Gay

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refers specifically to gay men. Lesbians have been shown to occupy and use territories differently. In terms of leisure, lesbians do create commercial spaces, as well as use mixed “gay” spaces. However, lesbians and lesbian leisure spaces are less visible and often are temporally created, having, for example, 1 night a month, rather than a permanent space 7 days a week. Gay women are likely to have less economic power to support public sites of leisure and are also more likely to have caring responsibilities that result in less time and resources for leisure activities. It is clear, then, that engagement with and enjoyment of such spaces is not homogeneous, and there are power relations between individuals and groups who are part of LGBT collectives. Homonormative (referring to when gay identities are offered inclusion and privilege because they conform to dominant social norms in terms of monogamy, class, race, and/or gender) gay (and lesbian) lives are often associated with leisure spaces, and particularly commercial ones. Equating leisure and the commercial means that there are only some who can buy into safe spaces where they may feel more able to enact same-sex desires and practices. Social differences such as ethnicity, social class, age, and ability/disability are important in terms of who is welcomed and valued in gay spaces and who is disparaged. It has also been noted that L, G, B, and T people have different experiences of gay spaces. For example, Black and minority ethic people can be excluded from predominantly White gay spaces in places such as the United Kingdom and the United States. However, other scholars have noted that gay spaces can be used by people of color to create alternative events and leisure sites. In contrast to gay commercial scenes, some queer leisure spaces offer open, fluid, transgressive spaces for both play and resistance. People can use these spaces to question and expose homonormative structures that exist within more commercial spaces, and these places can also offer alternatives to commercialization, monosexual lifestyles, and other forms of normalizing imperatives. However, queer leisure spaces have also been accused of excluding people for not having the education to understand the politics of these spaces.

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Home The home can be exclusionary, marginalizing, and dangerous for LGBT people, in that parents, spouses, children, or other kin may reject them because of their sexual or gender identity. However, the home, a space that is often presumed to be heteronormative (referring to a combination of heterosexuality and normative gender, class, ethnic, and other dominant and privileged identities), can also be an important site for LGBT social networks, for expressing identities, and for socializing. It can be an important social space that exists outside of gay commercial scenes and places that are read as “straight” such as bars, restaurants, and the cinemas. Historically, the home and private spaces have been primary sites for LGBT leisure. Parties and other events in the home can create opportunities to explore sexual desires and gender identities outside of the public gaze. While most LGBT people will have some experiences of socializing in the home, scholars have also shown that the home can be a primary site of leisure for gay men and for lesbians, including African American lesbians. Research has shown that the use of the home for socializing is dependent on the existence of friendship groups and relationships, which not all will have. Social networks are central in engaging the home as a leisure space, and how and where they form/are dissolved is key to understanding isolation and other forms of vulnerability for LGBT people. Nonetheless, in thinking about leisure and LGBT people, the home is an important site to consider.

Straight Exclusions In contrast to commercial gay scenes as spaces of acceptance for some, heterosexual spaces are understood as intolerant and dangerous for LGBT people. These spaces include leisure spaces that are often seen as “normal” or “asexual,” but actually are straight. Because the enactment of heterosexual identities passes unnoticed, heterosexualized performances (holding hands, kissing, touching, and so on), symbols, and representations are seen as natural and also pass unnoticed.

Heterosexual spaces such as work and institutional spaces like school also serve as a counterpoint to gay/lesbian/LGBT and queer leisure spaces. These spaces are seen as unfriendly, intolerant, potentially violent, and dangerous. However, the presumed heterosexuality of public spaces of the street have been challenged by events such as gay pride, which can be seen as showing how normally heterosexual streets can be queered through the enactment of non-normative sexualities and gender expressions. During pride events, those in parades and at times lining the routes can question that these spaces are necessarily heterosexual, and instead show how who is in these spaces and what they are doing at that particular time (holding hands, kissing, camping it up, etc.) matter. For 1 day a year, the streets are different; for the duration of the pride parade, the space is not heteronormative. Similarly, sports activities that are pursued as leisure can be both homo-/bi-/transphobic in ways that reiterate heterosexual norms (such as homophobic chanting in football stadiums), and also welcoming. For example, women’s football (soccer) in the UK (especially during the late 20th century) and women’s softball in the United States are understood as “lesbian” sports. While this can result in vilification, these sporting practices can also create time-spaces where same-sex relationships, lesbian identities, and same-sex attraction can be normalized and welcomed, or at least considered to be “part of” the sport. Leisure spaces such as public parks can also be subverted through cruising, mainly by gay men, but car parks and remote locations can also serve those interested in dogging (engaging in public sex) and heterosexual sexual practices. Although these spaces, particularly through the daylight hours, might be read as normatively heterosexual, in darkness and at certain times, the normative heterosexuality of these leisure spaces can be subverted.

Beyond Gay Commercial Socializing It is important to be wary of both seeing gay/LGBT spaces as necessarily inclusive and welcoming and,

Leisure

conversely, viewing straight leisure spaces as those where violence is perpetrated and as necessarily exclusionary. In discussing the ways that straight social space can be appropriated, it has been suggested that at times there can be a gaying of straight space. In other words, that gay men, and LGBT people, can use supposedly heterosexual spaces in ways that challenge the supposed norms of these spaces. Therefore, it is important to look at the different ways that LGBT people socialize, and not only look at “gay” or “LGBT” spaces. This is because LGBT people use a broad range of spaces to socialize in; they don’t just go to gay bars and clubs. Indeed, LGBT socializing (and to a larger extent, leisure activities) may not occur only (or even predominantly) in commercial gay leisure spaces. There is also a need to look at generic commercial leisure spaces such as cinemas, restaurants, and other places that are often considered heteronormative. Contemporary leisure activities, and particularly socializing, are directly affected by legislative and cultural shifts over the past 10 to 15 years. In certain parts of the world, legislation and cultures have changed to offer a different context for LGBT (or at least gay and lesbian) lives, relationships, and identities. Equalities and cultural shifts have meant that some “acceptable gay” identities are increasingly recognized in mainstream arenas and sexual and gender identities can be protected in workplaces, the provision of goods and services, and so on. This is important for considering LGBT leisure practices. Whereas formerly, rejection and prosecution might have been the result of same-sex enactments in “straight” spaces in places like South Africa, Canada, and the United Kingdom, this is now illegal. This is not to say that LGBT people are no longer harassed, abused, and violently attacked. Instead, it is to suggest that expectations of certain places have changed the way LGBT people are socializing. This has resulted in some claiming the end of the “gay village,” as this is understood as no longer being necessary for protection, safety, and politics. As sexual and gender identities (apparently) have become more fluid, the division of gay/straight can be seen as outdated.

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Leisure activities such as socializing and cruising can, for some, take place anywhere. Thus, in summary, LGBT leisure is diverse and varied. While historically, scholars have often focused on gay scenes, gay spaces, and gay tourism to discuss leisure, these have more recently been shown to be potentially exclusionary to the broad diversities of LGBT people. Taking an account of leisure through socializing practices that are not confined to narrowly defined gay (safe) or straight (dangerous) spaces has shown that LGBT socializing may not be focused on sexual/gender identities, sex, or providing formal support. Kath Browne See also Gayborhoods; Heteronormativity; Homonormativity; Rural and Urban Communities; Visual Arts

Further Readings Bassi, C. (2006). Riding the dialectical waves of gay political economy: A story from Birmingham’s commercial gay scene. Antipode: A Radical Journal of Geography, 38(2), 213–235. Browne, K., & Bakshi, L. (2011). We are here to party? Lesbian, gay, bisexual and trans leisurescapes beyond commercial gay scenes. Leisure Studies, 30(2), 179–196. Caudwell, J. (2007). Queering the field? The complexities of sexuality within a lesbian-identified football team in England. Gender, Place & Culture, 14(2), 183–196. doi:10.1080/09663690701213750 Caudwell, J., & Browne, K. (2013). Sexualities, spaces and leisure studies. London, England: Routledge. Gorman-Murray, A. (2007). Reconfiguring domestic values: Meanings of home for gay men and lesbians. Housing, Theory and Society, 24(3), 229–246. Gorman-Murray, A. (2008). Queering the family home: Narratives from gay, lesbian and bisexual youth coming out in supportive family homes in Australia. Gender, Place & Culture, 15(1), 31–44. doi:10.1080/09663690701817501 Johnston, L. (2005). Queering tourism: Paradoxical performances at gay pride parades. London, England: Routledge. Moore, M. (2012). Invisible families: Gay identities, relationships, and motherhood among Black women. Berkeley: University of California Press.

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Lesbian “Bed Death”

Visser, G. (2013). Challenging the gay ghetto in South Africa: Time to move on? Geoforum. doi:http://dx.doi .org/10.1016/j.geoforum.2012.12.013

LESBIAN “BED DEATH” Lesbian “bed death” is the idea, whether real or simply feared, that for same-sex coupled women, their sexual desire and sexual activity begin to wane and even cease to exist over time. This topic is controversial among researchers, therapists, and the popular press, with some arguing that it is a real problem that lesbians face, and others arguing that the concept of lesbian bed death is inaccurate and should be put to rest. Despite the controversy surrounding the topic of lesbian bed death, it continues to be discussed and joked about in popular literature and television shows (e.g., The L Word) geared toward sexual-minority individuals. The topic of lesbian bed death began to be popularized following a landmark study in the early 1980s by Philip Blumstein and Pepper Schwartz that addressed four types of American couples: lesbians, gay men, cohabiting heterosexuals, and married heterosexuals. This study found that lesbians reported the lowest frequency of sexual activity compared to gay men and both types of heterosexual couples. Other scholars, in the early 2000s, compared lesbian women with heterosexual women, and found that lesbians were less frequently sexually active compared to their heterosexual counterparts. There is much debate as to why these findings might exist. One argument in support of lesbian bed death is that women are not socialized to initiate sexual activity, and they have a lower libido and sex drive. A second argument, suggested by many feminist therapists studying this issue, is that women in a sexual relationship begin to merge and develop an overly close connection that can resemble incest; as this happens, the desire for genital sexual relations diminishes. Additional arguments as to why there may be findings of lower sexual behavior among lesbian couples have taken into account the fact that this

issue is far more complex than simply viewing lesbians as less sexual than others. That is, there are many definitions and types of sexual behavior that also include nongenital sexual behaviors such as kissing, cuddling, and touching. These sexual behaviors may be just as important, if not more, to women’s sexual experience and pleasure. Thus, according to this perspective, even though sexual frequency has been found to be lower for lesbian couples, the amount of time spent per sexual encounter tends to be greater than for heterosexual couples. These arguments have led some researchers and lesbian activists to call for an end to studies promoting the concept of lesbian bed death. Still, the concept continues to attract the attention of researchers, therapists, activists, and the popular press. As such, lesbian bed death continues to be examined and debated. Research on lesbian bed death has benefited from increasing social acceptance of same-sex couples. Namely, new directions in lesbian bed death research have broadened the definitions of and questions about sexual behaviors and expanded the range of participants to include all women who are in same-sex relationships, regardless of their sexual orientation identity. One of the key findings from this body of research is that there is only a small difference in the sexual frequency or satisfaction among women who are in the early phase of a same-sex relationship compared with women in long-term same-sex relationships. This research takes into account the general waning of sexual behavior in any relationship over time. Studies that have examined lesbian sexual desire have noted the connection between emotional intimacy and sexual behavior. Although it is still generally accepted that women, more so than men, desire committed relationships when engaging in sexual activity, the lower levels among some lesbians in long-term relationships, but not among lesbians who are in dating relationships, may reveal more about the passage of time than about the nature of sexual behavior between two women. Overall, the reduction or lack of genital sexual behaviors, then, appears not to be due to a lack of intimacy but may be more reflective of the way that any long-term relationship unfolds.

LGB Parenting Styles and Values

To critically evaluate and understand the concept of lesbian bed death, then, clearly requires broader definitions of sex and sexual encounters. Women and particularly lesbian women may define sexual activity and connection differently. They may engage in a range of physical contact, including genital sexual contact, that others do not define as sexual encounters. It is important, then, to measure the quality of sexual behavior rather than simply the frequency. Just like heterosexual relationships, lesbian couples have an ebb and flow of sexual behaviors and desires. Examining the complexity of how gender and sexual orientation work together to influence sexual behavior has led to a new understanding of sexuality in general and lesbian sexual relationships in particular. Erin S. Lavender-Stott and Katherine R. Allen See also Aging, Sex, and Sexuality; Couples Therapy; Dating, Sexual-Minority Women; Homosexuality, Female; Intersections Between Sex, Gender, and Sexual Identity; Long-Term Same-Sex Couples; Sexual Desire and Relationship Quality; Sexual Norms and Practices

Further Readings Blumstein, P., & Schwartz, P. (1983). American couples: Money, work, sex. New York, NY: William Morrow. Cohen, J. N., & Byers, E. S. (2014). Beyond lesbian bed death: Enhancing our understanding of the sexuality of sexual-minority women in relationships. Journal of Sex Research, 51, 893–903. doi:10.1080/00224499.20 13.795924 Diamond, L. M. (2008). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press. Nichols, M. (2004). Lesbian sexuality/female sexuality: Rethinking “lesbian bed death.” Sexual and Relationship Therapy, 19, 363–371. doi:10.1080/14681990412331 298036 Peplau, L. A. (2003). Human sexuality: How do men and women differ? Current Directions in Psychological Science, 12, 37–40. doi:10.1111/1467-8721.01221 Rose, S., & Zand, D. (2000). Lesbian dating and courtship from young adulthood to midlife. Journal of Lesbian Studies, 6, 85–109. doi:10.1300/ J041v11n02_04

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LGB PARENTING STYLES AND VALUES In spite of concerns that lesbian, gay, and bisexual (LGB) parents’ sexual orientation will negatively affect their children, studies have shown that sexuality is irrelevant with respect to one’s ability to parent. This entry describes parenting styles and values among lesbian and gay parents. It explains how they divide household labor and child care, and identifies values that lesbian and gay (LG) parents instill in their children, as well as gender and discipline practices. Much of the research in this area has compared LG-parent households to heterosexual-parent households, focusing most intensely on lesbian-parent households and almost entirely neglecting bisexual-parent families.

Division of Labor Within heteronormative society, there is a great deal of pressure for LGB couples to fall into traditional gender roles. Many couples struggle to resist these traditional roles, particularly in the division of household and child care labor. Most of the research in this area has concentrated on lesbianparent couples, comparing them to heterosexual parents, although there is a growing body of research on gay-parent couples in comparison to heterosexual parents. Housework

There are differences in division of household labor in gay-, lesbian-, and heterosexual-parent families. For instance, egalitarianism seems to be more important to lesbian mothers than to gay fathers. In lesbian-parented families, the role of income earner is more flexible, with both partners alternating breadwinning roles or both reducing or switching their working hours to be more involved at home. Lesbian parents tend to have more equal distributions of unpaid family labor than heterosexual parents. However, lesbian mothers spend less time on taking care of the house when compared to heterosexual mothers.

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LGB Parenting Styles and Values

When there are differences in labor in lesbianparented households, they tend to occur along the lines of biology. That is, in lesbian-parent families formed through donor insemination, biological mothers do more of the housework than nonbiological mothers. As a result, they tend to have more power over making decisions related to the household. Child Care

Division of child care occurs differently between lesbian-, gay-, and heterosexual-parent families. For instance, in comparison to heterosexual couples, same-sex couples tend to share child care labor more equally and report greater satisfaction with the division of labor and their relationship than heterosexual parents. Lesbian mothers also tend to be more emotionally involved in childrearing than heterosexual mothers, and in lesbianparent families formed through donor insemination, nonbiological mothers tend to be more involved in parenting than fathers in heterosexual-parented families. Within lesbian-parent households formed through donor insemination, although couples may share household tasks and decision making, biological mothers tend to be more involved in child care, while nonbiological mothers work more in paid employment. This division is often due to early demands of parenthood, such as breastfeeding, since only the biological mother can fulfill that role. Biological mothers tend to have greater access to parental leave than nonbiological mothers, making the biological mother the more likely choice for which parent will take care of the child. However, mothers who share child care more evenly tend to be more satisfied and to have children who are more well-adjusted than those families where the division of child care labor is not equal. For LG parents who adopt, there is a greater likelihood of egalitarianism, since even the process of adoption itself requires both parents to be fully engaged in the process. Both partners tend to be highly motivated to parent, having invested extensive time and resources into an often drawn-out

adoption process. In addition, since neither parent experiences pregnancy nor breastfeeding, child care can be more equally distributed starting at infancy.

Parenting Values Just as with child care and housework, LG parenting styles tend to emphasize equality, with a focus on preparing children for the challenges they will likely face outside the family. Parental concerns around discrimination and stigmatization shape the values they bring to parenting. LG parents prepare their children for discrimination; they raise their children with strong values, particularly around gender roles; and they are careful to discipline their children in a way that reflects flexibility in parenting roles. Preparing Children for Discrimination

LG parents are aware of the implications that their family structure might have for their children. LG parents must decide how and when to divulge their family identity and to prepare their children for reactions from people outside the family. They report that they prepare their children for the outside world in ways that heterosexual parents do not, knowing that their children might face challenges and discrimination from peers, friends, family, and others. Children of LG parents will likely have concerns about how their family is different from others. Studies on lesbian-parent families have shown that these mothers communicate to their children that people have different beliefs, and that these beliefs might support or not support their family. Lesbian parents want their children to be critical thinkers regarding outsider messages about family. Lesbian mothers also emphasize how families are diverse, and that diversity is good. LG parents teach their children to be confident in the family they have. Teaching Children Values and Traditions

Some research on lesbian-parent households has revealed the kinds of values these mothers work to

LGB Parenting Styles and Values

instill in their children. For example, lesbianparent households teach their children to show respect to others, through being sympathetic toward the needs and feelings of other people. These mothers strive to raise their children to be sensitive and considerate of others. Many LG-parent families report working to instill religious values and traditions in their children. However, in the domain of religious observance, LG parental roles may shift away from traditional heterosexual parental role expectations. For instance, in traditional Jewish households, the male head of the house is the one who says the prayers, and the woman lights the candles. In LGparent households, couples may shift roles between each other when practicing religion, even while maintaining traditional values. Teaching Children About Gender

Children who grow up in same-sex–parent households typically lack a different-sex live-in parent, and this has raised attention to whether or not these children demonstrate gender-typed play, behaviors, and attitudes that differ from those of children with different-sex parents. Social learning theory, for instance, would suggest that parents influence the gender development of their children. As a result, much research has been done on whether or not the absence or presence of samesex parents in LG-parent households might impact gender-typed play and behavior to the point that children might model LG-parent behavior. Lesbian mothers tend to be more liberal in their attitudes toward their children’s genderrelated behavior than heterosexual mothers. For example, lesbian mothers might encourage their daughters more than heterosexual mothers do to play with toy trucks. Gay fathers might deliberately choose to deconstruct gender stereotypes by allowing their children to pick out which toys they want to play with, and allowing their children to wear gender-neutral clothing. In general, LG parents tend to demonstrate less genderstereotyped attitudes and are more accepting of gender-unconforming behavior in their children than heterosexual parents.

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As a result, there is evidence that the children of lesbian- and gay-parent families display less gender-stereotyped play behavior than children of heterosexual-parent families. In addition, sons of lesbian mothers are typically less masculine in their play than sons of gay and heterosexual parents. However, other research has indicated that preschool-aged and elementary-aged children do not show differences in gender-typed play, regardless of their family structure. Even within same-sex– parent households, there may still be gender stereotyping, since some parents want their children’s gender performance to not be considered radical. In spite of how well-adjusted and resilient children of LG parents tend to be, many parents express the desire to provide different-sex role models for their children. Parents view these role models as important in their children’s development, wanting them to be comfortable around all genders. Lesbian mothers, for instance, might seek out male role models for their children through extended family members, teachers, caretakers, or church members. Other LG parents may not feel the need to seek out these relationships for their children, pointing out that their children are exposed to a wide range of adults through school, family members, friends, and caretakers. Discipline

Through discipline, LG parents both extend and defy heterosexual norms in parenting. LG parents are similar to heterosexual parents in discipline techniques. Time-outs, for instance, are the primary way of disciplining children. Parents put their child in a quiet corner or space, giving the child time to calm down. Positive reinforcement is also frequently used to teach children how to behave in socially appropriate ways. In comparison to heterosexual parents, gay fathers are more likely to set boundaries and limits for their children, preferring to reason with their children rather than punishing them. They tend to be more in tune with the needs of their children, and although they are more structured and strict in comparison to heterosexual fathers, they tend to set reasonable limitations on behavior

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and teach their children how to make good decisions. Lesbian mothers are less likely than heterosexual mothers or fathers to use physical punishment in disciplining their children. LG parents tend to praise and reward their children for good behavior. Many LG parents choose to share roles in order to make discipline easier. Gay fathers, for instance, may express tendencies to discipline their children in a way that is different from that of their partner. When one parent is flexible, the other can be more rigid, and when necessary they can switch roles. This ability to shift roles can reduce stress that is often associated with discipline.

Conclusion LG parents are able to defy heterosexual norms in parenting through flexibility of parenting roles. In spite of concerns that LG parents’ sexuality might negatively affect their children, LG parents are quite capable of raising them to be well adjusted. Kaitlin A. Black and Abbie E. Goldberg See also Adults With LGBQ Parents; Caregiving; Parent–Child Relationships; Stepfamily Division of Labor and Money Management

Further Readings Berkowitz, D., & Ryan, S. (2011). Bathrooms, baseball, and bra shopping: Lesbian and gay parents talk about engendering their children. Sociological Perspectives, 54, 329–350. doi:10.1525/sop.2011.54.3.329 Biblarz, T. J., & Savci, E. (2010). Lesbian, gay, bisexual, and transgender families. Journal of Marriage and Family, 72, 480-497. doi:10.1111/j.1741-3737.2010 .00714.x Bos, H., & Sandfort, T. (2010). Children’s gender identity in lesbian and heterosexual two-parent families. Sex Roles, 62, 114–126. doi:10.1007/s11199-009-9704-7 Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Goldberg, A. E., Gartrell, N. K., & Gates, G. (2014). Research report on LGB-parent families. Los Angeles, CA: Williams Institute. Retrieved November 17, 2015,

from http://williamsinstitute.law.ucla.edu/wp-content/ uploads/lgb-parent-families-july-2014.pdf Patterson, C. J., Sutfin, E. L., & Fulcher, M. (2004). Division of labor among lesbian and heterosexual parenting couples: Correlates of specialized versus shared patterns. Journal of Adult Development, 11, 179–189. doi:10.1023/B:JADE.0000035626.90331.47

LGBQ PARENTS, COMING OUT TO CHILDREN Coming out, or disclosing one’s sexual identity, to family members is a key aspect of living as a lesbian, gay, bisexual, or queer (LGBQ) adult because family is at the heart of both psychological and social life. There are two distinct contexts in which LGBQ parents come out to their children. The first is within a de novo LGBQ-parenting family (i.e., a planned LGBQ-parent family, in which children are born or adopted into a same-sex relationship). The second context is when an LGBQ parent had his or her children within a different-sex relationship (post–heterosexual parenting). Depending on the timing of the parent’s coming out, and the children’s age and other factors, children will understand the meaning and implications of the parent’s sexual identity in different ways as they grow up. When parents come out to their children, both children’s and parents’ emotional reactions may be magnified because of the importance of the parent–child relationship and a fear on both sides that the relationship may be cut off because of the disclosure.

LGBQ Parents Coming Out to Children Post–Heterosexual Parenting While being out is an ongoing challenge when parenting children who were brought up within a same-sex relationship, it is in some ways more difficult when parents come out in the context of or after the dissolution of a different-sex relationship in which the children were adopted or conceived. Other family members (including children) tend to assume that a parent is heterosexual in the absence

LGBQ Parents, Coming Out to Children

of information to the contrary. Thus, parents have to assume a new sexual identity within their preestablished identity as a mother or a father. For example, studies of gay fathers coming out of heterosexual relationships in the 1970s and 1980s vividly described how men struggled with the differing demands made of them as fathers in mainstream North American culture and when entering a gay subculture in which the concept of fatherhood was largely ignored. It often took 2 to 3 years for the family and social networks surrounding a new LGBQ parent to change or accept him through a process of integrative social sanctioning, whereby network members acknowledged and endorsed the gay father across all his social worlds. Studies with gay fathers, lesbian mothers, and the children of LGBQ parents have indicated that simply because a parent has begun a same-sex relationship, it does not necessarily mean that a child will pick up on a parent’s new sexual identity. Research with the adult children of LGBQ parents who had them within heterosexual relationships indicates a variety of different ways through which they came to know about their parent’s sexual identity. Some young people were told by their LGBQ parent at the time of or after their parents’ separation, whereas others were told by their other parent or another family member, and still others recollected a dawning awareness of their parent’s sexual identity before having any conversation with their parent on this topic. Only a minority of young people recalled finding out by accident—for example, finding a gay-related magazine or seeing their parent being affectionate with their partner. However they found out, it took time for the children to come to an understanding of what an LGBQ identity meant in terms of their parent’s life, and to appreciate the news fully. For example, a child might appear to accept a single parent’s new same-sex partner staying overnight but then seem shocked when a parent announces an LGBQ identity, or vice versa. Nevertheless, research studies have indicated that children generally tend to be more accepting of their parent’s lesbian or gay identity than parents had thought they would be. Younger children may be more accepting than older children, and research studies of lesbian

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mothers and gay fathers have suggested that adolescent daughters may be easier to talk to and more accepting of disclosure than adolescent sons. Clinical work with children of lesbian mothers has indicated that children pass through different stages of acceptance in relation to their mother’s coming out as a lesbian, moving from anger or denial through depression to subsequent acceptance and sometimes pride. Children, like other family members, may feel a sense of confusion and loss at their parent’s news and wonder what this news means for them. Young children may need reassurance that a parent will still love and care for them, and they may be concerned about changes to their daily routine. Older children may be curious as to whether their parent’s news has any implications for their own gender identity or their sexual identity. Adolescents in particular may experience concern about their parent as they become fully aware of their own sexuality. Also, children are likely to experience concern about the possible reaction of peers and teachers at school if they disclose their family background. Ultimately, children may become worried about their parent’s safety and so need information and reassurance about this. Children of LGBQ parents may often benefit from hearing the stories of other children with LGBQ parents, since children may feel they are coping alone, particularly if they live in an area without visible LGBTQ groups. Therapists have suggested the usefulness of preparatory work with the LGBQ parent prior to coming out so that the acceptance–rejection terrain of the family can be mapped and the possible implications of disclosure assessed. Coming out to children may be particularly difficult if it coincides with the LGBQ parent separating from the child’s other parent, and it may be useful to consider some joint therapy sessions that include the ex-partner. In clinical work with LGBQ parents and their children, it is important to consider that a child’s concerns may be linked to broader concerns or prejudice expressed by extended family members or within the social networks to which they belong. Both the LGBQ parent and his or her child are connected to a web of extended family relationships contained within specific religious,

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cultural, ethnic, and social class contexts. Children may not necessarily hold prejudiced views themselves but may be bothered that others they trust and respect do. Coming out as an LGBQ parent may be more difficult when religious or cultural views held by racial or ethnic groups seem to demand heterosexuality, especially when family conformity has been important in providing a safe haven from racial or ethnic prejudice. Further, older generations in a family network may not share the same views as younger members given rapid change in social attitudes over the last 50 years, creating a generation gap in terms of accepting LGBTQ equal rights. A parent in the process of coming out may consider warning his or her child that not everyone may accept an LGBQ-parent family, and the parent may have decided not to disclose to specific family members. However, while there are often good reasons to be cautious, keeping secrets within families can create resentments and may become a strain.

LGBQ Parents Coming Out to Children Within a De Novo LGBQ-Parenting Family A child born to an LGBQ-parent couple via assisted reproductive technology (ART), or who has been adopted at a young age, will have grown up with the knowledge that the child has two moms, two dads, or multiple parents. Nevertheless, children in de novo families develop a gradual awareness about the meaning of their parent’s sexual identity—for example, first knowing that they have two moms or two dads instead of a mom and a dad and only later realizing others may be prejudiced against this or that their parents have a sexual relationship. Therefore, coming out to children about parental sexual identity is about giving information about how the parents came to have children; about how other children’s family constellations are different from their own; and, later, about sexuality. In one study, many lesbian mothers reported that coming out to their preschool-aged children conceived via donor insemination had begun when their children started to ask questions about how

they came into being. The lesbian mothers had generally responded to these questions by explaining that they had gone to visit a sperm bank to fertilize an egg in a special part of the child’s birth mother’s tummy. Lesbian mothers also reported having conversations about family diversity with their children from preschool onward, in which they had introduced the idea of two women (or two men) loving each other, with some introducing the words lesbian and gay to their children alongside these explanations. Most of the lesbian mothers also emphasized the importance of being true to personal feelings of love and family membership, even though other people might be intolerant. Telling children about their adoptive parents’ same-sex relationship is easier in jurisdictions where joint adoption is legal as compared to those in which same-sex couple adoption is not possible. For children adopted by LGBQ parents, coming out is often linked to telling children about their birth family and adoption. In one study of elementary school–age adopted children in the UK, most of the lesbian and gay adoptive parents had already begun to discuss their family composition and their child’s adoption story with their child in the context of broader discussions about family diversity. In all LGBQ families, parents engage in a delicate balancing act between wanting to come out and honestly present their family form, and not wanting their child to be exposed to homophobia because of other people’s prejudice when their child talks about their family to others. Thus, it is valuable not only to consider how to come out and inform children about their family, but also to discuss how the child might manage any heterosexism or prejudice he or she could encounter in the particular local environment. Fiona Tasker See also Adoption, Openness in; Adults with LGBQ Parents; Children With LGBQ Parents, Psychosocial Outcomes; Coming Out, Disclosure, and Passing; Custody and Litigation, LGBQ Parents; Divorce and Relationship Dissolution, Psychological

LGBQ Parents and the Health Care System Experience of; Divorce and Separation, Historical Perspective on; Joint Adoption; Parent–Child Relationships; Therapy With Children of LGBQ Parents; Therapy With LGBTQ Parents

Further Readings Bozett, F. W. (1987). Gay and lesbian parents. New York, NY: Praeger. Fitzgerald, T. J. (2010). Queerspawn and their families: Psychotherapy with LGBTQ families. Journal of Gay & Lesbian Mental Health, 14, 155–162. Lynch, J. M., & Murray, K. (2000). For the love of the children: The coming out process for lesbian and gay parents and stepparents. Journal of Homosexuality, 39(1), 1–24. Mitchell, V. (1998). The birds, the bees . . . and the sperm banks: How lesbian mothers talk with their children about sex and reproduction. American Journal of Orthopsychiatry, 68, 400–409. Mitchell, V. (2013). Coming out to family: Adrift in a sea of potential meanings. In J. J. Bigner & J. L. Wetchler (Eds.), Handbook of LGBT-affirmative couple and family therapy (pp. 131–148). New York, NY: Routledge. Tasker, F., Barrett, H., & De Simone, F. (2010). “Coming out tales”: Adult sons and daughters’ feelings about their gay father’s sexual identity. Australian & New Zealand Journal of Family Therapy, 31, 326–337. Tasker, F. L., & Golombok, S. (1997). Growing up in a lesbian family: Effects on child development. New York, NY: Guilford. Van Voorhis, R., & McClain, L. (1997). Accepting a lesbian mother. Families in Society, 78(6), 642–650.

LGBQ PARENTS AND THE HEALTH CARE SYSTEM Many lesbian, gay, bisexual, or queer (LGBQ) people experience marginalization or discrimination within the health care system. When they become parents, this can also affect their children. Discrimination within the health care system may occur as a result of discriminatory attitudes or practices on the part of health care providers.

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However, more commonly, it occurs because formal systems within health care organizations are not inclusive of same-sex couples, and providers often make heterosexist assumptions about LGBQ parents and their families. This has the effect of marginalizing, and rendering invisible, LGBQ people, which may result in poorer standards of health care for LGBQ parents and their children.

Negotiating the Health Care System There are many points at which LGBQ parents or prospective parents may access the health care system. To become a parent, some lesbians or bisexual women seek fertility services, and most seek obstetric services. Gay or bisexual men may also engage fertility or obstetric services if they conceive children via a surrogacy arrangement. As parents, LGBQ adults are likely to access health care services for their children. This may include early childhood nursing, general practitioners, and pediatric services, along with other specialist clinical services as required. Negotiating the health care system for their own needs or those of their children can be complex for LGBQ parents. At an administrative level, intake or medical history forms often do not accommodate same-sex couples. At the most basic level, this can mean providers do not have appropriate information about a child’s family circumstances. But more significantly, nonrecognition of same-sex couples within health systems may mean that one parent is not recognized as a legal parent for the purposes of medical decision making or in cases where only “next of kin” are allowed visiting rights in a hospital.

Attitudes of Health Care Providers Studies conducted across the globe have shown that the attitudes of health care providers to LGBQ patients vary according to demographic characteristics of individual providers including religiosity, culture, ethnicity, and age. Negative attitudes among providers may lead to strained and difficult consultations with LGBQ patients. Some providers

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may be uncomfortable touching an LGBQ patient, make inappropriate jokes or comments, or ask invasive questions about sexuality or relationships. However, research has suggested that few LGBQ parents have experienced incidents of overt hostility or discrimination from health care providers, and most are generally satisfied with the health care they and their children have received in most settings. More commonly, LGBQ parents report indirect forms of marginalization—for example, encountering providers who are unfamiliar or uncomfortable with LGBQ families. Providers sometimes make heterosexist assumptions about an individual or family, such as assuming one parent is a friend or asking insensitive questions such as, “Who is the parent?” Providers may also insist on collecting information about a child’s genetic parentage, even where it is not relevant to the consultation. This can be experienced by LGBQ parents as insulting or disrespectful of their family makeup, as it does not acknowledge the parental care of nonbiological parents. Many LGBQ parents have also encountered providers who engage with only one parent during health care consultations, usually excluding the nonbiological or nonlegal parent. There is a small body of research on the attitudes of health care providers—including general practitioners, nurses, and specialist pediatric providers— toward LGBQ parents and their families. In these studies, many providers report that they do not consider it important to know the sexuality of patients (or a patient’s parents in the case of children) because they generally feel that this knowledge would not alter the quality of service they offer. Researchers have pointed out that this attitude places the onus on families to disclose their sexuality, rather than on providers to ensure families feel safe to do this. Several studies have shown that LGBQ parents find it anxiety provoking to “out” themselves to providers. In particular, LGBQ people fear judgmental attitudes from doctors about their capacity to be good parents.

Implications of Marginalization Concerns about judgment or discrimination may lead LGBQ parents to put off seeking care for

themselves or their children, which has potential to compromise the timeliness and quality of treatment. Some LGBQ parents may choose not to disclose their sexuality to health care providers. However, this is likely to exclude one parent from being involved in his or her child’s health care. Many LGBQ parents report that they have consciously adopted a stance of being upfront about their sexuality to health care providers that they access for their children. This has the dual benefit of demonstrating a sense of family pride for their children, while also educating providers about LGBQ-parented families. Jennifer Power See also Health Care Providers, Disclosure of Sexual Identity to; Health Care System

Further Readings Chapman, R., Watkins, R., Zappia, T., Nicol, P., & Shields, L. (2012). Nursing and medical students’ attitude, knowledge and beliefs regarding lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing, 21, 938–945. Hutchinson, M. K., Thompson, A. C., & Cederbaum, J. A. (2006). Multisystem factors contributing to disparities in preventive health care among lesbian women. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 35, 393–402. McNair, R., Brown, R., Perlesz, A., Lindsay, J., De Vaus, D., & Pitts, M. (2008). Lesbian parents negotiating the health care system in Australia. Health Care for Women International, 29(2), 91–114. Mikhailovitch, K., Martin, S., & Lawton, S. (2001). Lesbian and gay parents: Their experiences of children’s health care in Australia. International Journal of Sexuality and Gender Studies, 6, 181–191. Nicol, P., Chapman, R., Watkins, R., Young, J., & Shields, L. (2013). Tertiary paediatric hospital health professionals’ attitudes to lesbian, gay, bisexual and transgender parents seeking health care for their children. Journal of Clinical Nursing, 22, 3396–3405. O’Neill, K. (2012). Health sector attitudes to lesbian families. Kai Tiaki Nursing New Zealand, 18(7), 14.

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Shields, L., Zappia, T., Blackwood, D., Watkins, R., Wardrop, J., & Chapman, R. (2012). Lesbian, gay, bisexual, and transgender parents seeking health care for their children: A systematic review of the literature. Worldviews on Evidence-Based Nursing, 9, 200–209.

bisexual, and transgender individuals exists in reality or is merely a co-option of the sociopolitical movement for LGBT civil rights.

LGBT CONSUMER MARKET, THE

As corporate America “evolved” in its treatment of LGBT consumers, the gay social movement shifted from the calls for sexual freedom and fluidity that flourished in the 1970s and 1980s to present-day demands for equal treatment under the law. While corporations can be quickly labeled as pursuing the gay dollar, the social visibility gained from corporate attention may be seen by some LGBT individuals as pivotal to the fight for societal rights. In discussing the role of the marketplace within social movements, academic scholar Lisa Peñaloza has stated that the marketplace may be viewed as an important domain of social contestation whereby disenfranchised groups engage in ongoing struggles for social and political incorporation. She suggests that the marketplace incorporation is important in the path to social legitimization of gay males and lesbians. Hence, many LGBT consumers embrace the power of their spending by rewarding companies that are considered “gayfriendly” in terms of their corporate policies and their marketing activities. Many corporations appear to have moved beyond mere inclusion of gay consumers in their marketing activities to a role of corporate advocacy in the current decade. Recently, many corporations have shown an increasing willingness to move ahead of public policy in affording equal rights to LGBT employees. The Human Rights Campaign (HRC), an LGBT advocacy group, has tracked corporations’ positions on gay rights for more than a decade. In 2002, the first year the campaign published its Corporate Equality Index— which evaluates anti-discrimination policies, domestic partnership offerings, LGBT or diversity group resources for employees, and public commitment to the LGBT community, among other things—only 13 businesses achieved a score of 100%. In 2015, nearly 200 were given the top rating. According to the HRC, in 2009, 86% of

Since the lesbian, gay, bisexual, and transgender (LGBT) population was first labeled the “dream market” in the 1980s, corporations have changed from stigmatizing and avoiding homosexuals to establishing a gay market niche. Based on a study of New York Times news articles over three decades, social scientist Angela Ragusa suggests that corporate America moved through three distinct phases in its treatment of the LGBT population: (1) corporate shunning in the 1980s, (2) corporate curiosity and fear in the 1990s, and (3) corporate pursuit in the 2000s. The LGBT consumer market is currently estimated to have an overall buying power of over $835 billion. Over the past decade, corporate recognition of the attractiveness of LGBT consumer spending patterns has led to quite a dramatic increase in LGBT-oriented promotional activities. In 2013, annual advertising spending in LGBT print media jumped 18.2% to $381 million, according to the Gay Press Report from Rivendell Marketing and Prime Access, which tracks 284 U.S. LGBT press publications. Total circulation of LGBT print media increased 15.1% to 2.7 million over the same period. This growth in ad spending in LGBT print media contrasts with declining ad spending for consumer magazines overall. Much more has been spent in sponsorships and online advertising. Another $12 million was spent in online LGBT media, and over $7 million more was spent annually on sponsorships in the LGBT community, totaling over $231 million in annual corporate spending in the LGBT community. This entry provides a broad discussion of the LGBT consumer market and corporate activities in pursuit of the “gay dollar.” It will consider whether a consumer market composed of gay, lesbian,

From Corporate Pursuit to Corporate Advocacy

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Fortune 500 companies prohibited discrimination based on sexual orientation, while 16% of the companies also included gender identity or gender expression in their nondiscrimination policies. In 2012, companies such as Microsoft, Starbucks, and Google were among 48 corporations signing a brief arguing to the federal appeals court in Boston that the Defense of Marriage Act was bad for business. In New York, corporations were influential in persuading legislators to pass a bill legalizing same-sex marriage.

Does an LGBT Consumer Market Exist? The gay social movement’s fight for equal rights for LGBT individuals may unite gay males and lesbians for a common cause, while the marketplace may not. In order for the LGBT population to be considered as a homogeneous consumer segment, it must be defined by clearly identified segmentation variables. In reality, it is difficult to identify what binds together gay men, lesbians, bisexuals, and transgender individuals other than shared, but different, societal stigmatization and cooperative movements to counteract it. At its simplest demographic levels, the LGBT population includes individuals that vary based on sex, sexual orientation, and gender identity. Even when narrowing the focus to gay males and lesbians as a consumer population defined by sexual orientation, a lack of homogeneity would exist in a gay and lesbian consumer segment. In the vast majority of situations, sexual orientation cannot be considered a meaningful segmentation variable that results in homogeneous responses to a firm’s marketing mix. A closer examination of both of these groups’ lifestyles and resulting behavior patterns suggests meaningful difference between those of lesbians and gay men. Lesbians are more likely than gay men to be in a relationship, live with a partner, and have children. Conversely, they are less likely than gay men to socialize at gay bars or events, being more oriented toward private social and entertainment behavior, and less likely to live in urban neighborhoods. In addition, research in the social sciences suggests that a homogeneous gay identity is more

likely to exist in opposition to high societal intolerance of homosexuality. Societal shifts in attitude toward homosexuality in many countries over the past few decades may have changed the prominence of gay identity among LGBT people’s selfconcept. The majority of Americans both believe that same-sex couples should be allowed to be married and oppose job discrimination on the basis of sexual orientation. In addition, the growing fluidity of gender roles and gender expression in Western society (e.g., metrosexuals, female hockey players, female heads of state) diminishes the culturally defined link between homosexuality and gender-inappropriate behaviors. Thus, as societal stigmatization of people based on sexual orientation diminishes, it follows that a gay man or lesbian is less likely to consider that identity more definitive of his or her self-concept than identities such as sex, gender, and race. In turn, the efficacy of sexual orientation as a meaningful segmentation variable in the consumer market will diminish. To meet the criteria of a meaningful consumer segment, a consumer group must be actionable so that all consumers are homogeneous in their response to targeted marketing activities. Many observers view gay men and lesbians to be on opposite ends of an emotional and behavioral spectrum; thus, it is important that marketers fully understand both what separates and what connects these two groups and how it may affect the efficacy of various gay-oriented marketing efforts. Lesbians appear to place more importance than do gay men on LGBT-oriented corporate policies, such as provision of domestic partner benefits and LGBT nondiscrimination policies, when evaluating a company’s gay-friendliness. Lesbians also place more weight than do gay men on a company’s effort to identify itself as gay-friendly in its marketing communications and provide financial support for gay causes. Sex differences also appear to exist in gay males and lesbians’ attitude toward gayoriented advertising in general. Lesbians are less interested in appropriate homosexual portrayals in advertising than are gay men. Academic scholar Gillian Oakenfull has conducted empirical research that suggests that gay males and lesbians appear to respond differently to advertising based on whether

LGBT Consumer Market, The

the advertising content depicts gay males, lesbians, or nongendered gay imagery. Recently, it has been suggested that differences in advertising response can be attributed to fundamental differences in gay identity between the sexes. Feminist theorists claim that the lesbian identity is distinct from that of gay males, as lesbians face simultaneous oppression based on their sex as well as their sexual orientation. The late lesbian feminist Adrienne Rich believed that a definition of the lesbian existence necessitates a disassociation of lesbian from male homosexual values and allegiances. Finally, the 2004 Gay/Lesbian Consumer Online Census indicates that there are differences in media habits between the sexes, as gay males consume more of all types of gay media than do lesbians.

The Gay Consumer Market Despite calls for an appreciation of the diversity between the gay male and lesbian markets, in practice, marketers have failed to delineate between lesbians and gay men as consumers within the LGBT population. Some have gone so far as to say that they have neglected lesbians and failed to acknowledge bisexuals and transgender individuals as consumers. Since the 1980s, marketers have, almost exclusively, used gay male imagery in advertising placed in gay print media. Given the need for gay men and lesbians to unite as a homogeneous group based on sexual orientation in the public policy arena as they fight for the same basic civil rights, an explanation of the predominance of gay male–oriented ads is that advertisers may assume, while pursuing the gay male market, that a one-size-fits-all approach to the gay market will also capture lesbians. This argument would also have an implicit acceptance of the patriarchal selection of gay males to represent both gay men and lesbians. Alternately, advertisers may have simply chosen to ignore the lesbian market, preferring to devote their advertising research to the more “lucrative” gay male market. Academic research has mirrored this bias, as the vast majority of published consumer research focuses exclusively on gay men. Given the resulting

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paucity of data on lesbian consumers, advertisers eyeing the lesbian market often are left either to make assumptions about the segment’s spending and media habits or to advertise via lesbian publications and grassroots marketing efforts, which reach a tiny proportion of the market. While there’s no doubt that lesbians have different demographics and buying habits than do gay males, little is formally known about their purchase motivation or attitudes, leaving corporations to rely on stereotypes. While stereotypes about gay men have drawn the attention of marketers (they earn more money than the general population; have expensive tastes; enjoy fashion, theater, home decorating, dance, music, art, design, gourmet goods), stereotypes about lesbians have caused most mainstream marketers to stay away. Common stereotypes inaccurately label them as politically minded feminists who don’t subscribe to consumerism and, as a result, don’t like fashion, makeup, or shopping in general. In addition, lesbian couples are wrongly assumed to suffer twice as much as a heterosexual couple from the sex differential in incomes in the United States, making a lesbian household less attractive than both gay male and heterosexual households to marketers. Analysis of the U.S. Census also indicates that 57% of samesex couples have both partners of a household working, compared to 48% of opposite-sex couples. Further, in a recent survey, 59% of lesbians lived with a partner compared with 37% of gay men. Hence, while lesbians are likely to earn less than all men, lesbian households are more likely to consist of two incomes than are either gay male or heterosexual households. Marketers often defend their neglect of the lesbian market by citing the difficulty of accessibility. Katherine Sender, author of the 2005 book Business, Not Politics: The Making of the Gay Market, quotes the head of an ad agency that supposedly focuses on the LGBT market as saying, “there are just hundreds of thousands, millions of lesbians who are paired off, living together, who are living quiet lives on the edge of woods or in the heart of the city or whatever  .  .  . [and] are very hard to reach.” Apparently, what makes lesbians

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inaccessible is their lack of similarity to the distinct behavior patterns of gay men. However, rather than being insular and invisible, this places them in line with mainstream culture, especially at similar life stages. From a market segmentation perspective, lesbians may be more meaningfully similar to heterosexual women, who also are likely to have children and are less likely to socialize in bars than are gay men. It’s clear that a far more granular treatment of the LGBT population is required to delineate meaningful consumer segments from participants in the LGBT social movement. Gillian Oakenfull See also Leisure; Queer Anticapitalism; Rural and Urban Communities; Social Class

Further Readings Badgett, L. (1998). Income inflation: The myth of affluence among gay, lesbian, and bisexual americans. Amherst, MA: Institute for Gay and Lesbian Strategic Studies. Bhat, S. (1996). Some comments on marketing to the homosexual (gay) market: A profile and strategy implications. In D. Wardlow (Ed.), Gays, lesbians, and consumer behavior: Theory, practice, and research issues in marketing. Binghamton, NY: Haworth. Bristor, J., & Fischer, E. (1995). Exploring simultaneous oppression: Towards the development of consumer research in the interest of diverse women. American Behavioral Scientist, 38(4), 526–536. Burns, C. (2012, March 22). The costly business of discrimination: The economic costs of discrimination and the financial benefits of gay and transgender equality in the workplace. Center for American Progress. Retrieved November 18, 2015, from https://www.americanprogress.org/issues/lgbt/ report/2012/03/22/11234/the-costly-business-ofdiscrimination/ Ettorre, E. (1980). Lesbians, women, and society. London, England: Routledge. Experian Simmons. (2012). The 2012 LGBT report: Demographic spotlight. New York, NY: Author. Kates, S. M. (2004). The dynamics of brand legitimacy: An interpretative study in the gay men’s community. Journal of Consumer Research, 31, 455–464.

Oakenfull, G. (2007). Effects of gay identity, gender and explicitness of advertising imagery on gay responses to advertising. Journal of Homosexuality, 53(4), 49–69. Oakenfull, G. (2013). What matters: Factors influencing gay consumers’ evaluations of “gay-friendly” corporate activities. Journal of Public Policy & Marketing, 32 [Special issue], 79–89. O’Connell, M., & Feliz, S. (2011). Same-sex couple household statistics from the 2010 Census, report, U.S. Bureau of the Census. Retrieved November 18, 2015, from http://www.census.gov/hhes/samesex/ Peñaloza, L. (1996). We’re here, we’re queer, and we’re going shopping: A critical perspective on the accommodation of gays and lesbians in the U.S. marketplace. In D. Wardlow (Ed.), Gays, lesbians, and consumer behavior: Theory, practice, and research issues in marketing (pp. 9–42). Binghamton, NY: Haworth. Rich, A. (1980). Compulsory heterosexuality and lesbian existence. Signs, 5, 631–660. Schulman, S. (1998, Winter). The making of a market niche. Harvard Gay and Lesbian Review, 17–20.

LGBTQ GRANDPARENTING This entry describes the intergenerational relationships when grandparents self-identify as LGBTQ. This entry begins with a brief overview of the grandparent–grandchild relationship by focusing on the factors that influence this significant and enduring multigenerational relationship. These issues include an exploration of the salience of sexual orientation and gender identity for the grandparent–grandchild relationship as well as the grandparent–adult child (parent) relationship. To date, the available research that has focused on the centrality of sexual orientation in the grandparent–grandchild relationship has only been conducted with lesbian, gay, and bisexual (LGB) grandparents. Therefore, this entry is limited in its scope to highlighting this research with LGB grandparents. Recommendations for future research on the grandparent–grandchild relationship when grandparents self-identify as questioning or transgender are provided.

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LGBTQ Grandparents

Because of the dramatic increase in life expectancy in the United States (i.e., men 76.2 years; women 81.0 years), there is a greater likelihood that individuals will be members of multigenerational families. It is expected that children will have extended relationships with their grandparents, and it is most likely that children will also have extended relationships with their great-grandparents and possibly great-great-grandparents. Grandparenthood often begins in middle adulthood, with the average age of becoming a first-time grandparent being 47, and most grandparents can expect to experience this family role for 30 or more years. The grandparent–grandchild relationship has been examined for over 50 years by multiple researchers, and all have concluded that this relationship is significant, either directly or indirectly, for both grandparents and grandchildren. However, most researchers have also found that the significance and meaning of this relationship vary considerably depending on a host of factors that contribute to the quality and experience of the grandparent–grandchild relationship. Factors that have been found to influence the grandparent– grandchild relationship include the age and gender of the grandparent and grandchild, socioeconomic variables (e.g., employment status, educational level, economic resources), geographical proximity and frequency of contact between grandparents and grandchildren, psychosocial compatibility, personality characteristics, and disruptive life events (e.g., divorce, death of a parent). In addition, most researchers have found that parents play a tremendous role in setting the conditions by which the grandparent–grandchild relationship functions. Parents can facilitate a positive relationship between grandparents and their grandchildren or create barriers to the formation of a positive and close relationship. Therefore, any discussion of the grandparent–grandchild relationship must include a parallel discussion of the relationship between the grandparent and adult child (parent).

Despite the national recognition of the important role that grandparents play in the lives of their grandchildren, it was not until the early 2000s that researchers started to explore the significance of grandparents’ sexual orientation for the grandparent–grandchild relationship. While the research and publications of studies on LGBTQ persons who are mothers and fathers have rapidly increased within the past decade, with studies on lesbian mothers being the most published in LGBTQ family research, such studies are still limited (or nonexistent) regarding LGBTQ grandparents. There remains relatively little scholarship on bisexual or questioning grandparents, and to date there is no research on transgender people as grandparents. Therefore, the following sections will focus on the research that has explored the experiences of lesbian and bisexual grandmothers and gay grandfathers.

Lesbian and Bisexual Grandmothers The majority of early conceptualizations of lesbian or bisexual grandmothers appeared in limitedcirculation outlets. A popular lesbian magazine, for example, began to appear in the 1980s that included personal narratives of lesbian grandmothers. In these limited-circulation publications, both the struggles and joys of being lesbian grandmothers were highlighted. The struggles included stories of lesbian grandmothers who wanted to be with their female partners but did not live with them for fear of raising suspicions about their sexuality. The joys included receiving unconditional love from their grandchildren. During the 1990s, the situation comedy Roseanne introduced a key character who was a lesbian grandmother, and in 2005, a short film documented the crosscountry bicycle ride of two lesbian grandmothers who were riding for marriage equality. In 2000, the first scholarly paper reporting the experiences of self-identified lesbian grandmothers was published. In this article, however, the authors indicated that the effect of the grandmothers’

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sexual orientation was not specifically explored. Instead, the findings were compared to heterosexual grandmothers’ enacted roles, and the authors reported that all grandmothers provided emotional support to their grandchildren. In the first scientific study specifically focused on lesbian grandmothers, interviews were conducted with 14 Canadian lesbian grandmothers. All lesbian grandmothers in the study reported that they came to their identity as a lesbian late in their lives, usually after their children were adults or their heterosexual marriages ended through divorce or death. Although these lesbian grandmothers were aware of their sexual orientation prior to entering into heterosexual relationships and bearing children, they were also living within a distinct historical period in which homosexuality was considered shameful, immoral, deviant, pathological, and criminal. Therefore, they remained within their heterosexual relationships for fear that if they disclosed their homosexuality, they would risk not only custody of their children, but also the respect and love of their children and families. They viewed their delay in coming out as being rational and psychologically sound, yet tragic and a consequence of the era in which they were living. For some of the lesbian grandmothers who disclosed their sexual orientation, they faced the tragic reality of full or partial estrangement from their adult children and grandchildren. However, the majority were able to experience the acceptance of their homosexuality by their adult children and grandchildren, and these lesbian grandmothers reported being validated with the subsequent sense of experiencing a wholeness within themselves. The next development in this field was the methodical and systematic exploration of the effects of sexual orientation on the grandparent– grandchild relationship. In a study of the perceptions, attitudes, beliefs, and experiences of 12 self-identified lesbian grandmothers and 4 selfidentified bisexual grandmothers, these grandmothers discussed the psychological significance of being able to self-identify as either lesbian or bisexual and how they had to incorporate their lesbian and bisexual identities with the important identity of being a mother. There were differences as to when the lesbian or bisexual grandmothers

identified themselves as lesbian or bisexual, but all of these women reported that they grieved for the years lost when they remained in heterosexual relationships purely for the financial and emotional security that they believed the heterosexual marriage provided. Previously married lesbian or bisexual grandmothers indicated that ending their heterosexual marriages with a divorce was both a personal and social marker of their acceptance of their homosexuality or bisexuality. Managing disclosure about their sexual orientation was a primary issue for all of the grandmothers in the early published research on lesbian and bisexual grandmothers. However, their decisions to disclose were linked to social and cultural attitudes as well as familial attitudes toward homosexuality. Lesbian and bisexual grandmothers were concerned with the possibility of losing the love and respect of their children and grandchildren because of their sexual orientation. However, there were some grandmothers who specifically concealed their sexual orientation because they believed that this would protect their grandchildren from societal prejudice, especially if their grandchildren were young. Thus, the grandmothers’ disclosure of their sexual orientation was often dependent on the grandchild’s age or developmental stage. The research also found that lesbian or bisexual grandmothers believed that their adult children either facilitated or hindered their relationships with their grandchildren, and their adult children’s attitudes toward their sexual orientation played a tremendous role in the strength of the grandmother– grandchild relationship. This finding of the mediating role of parents in the lesbian/bisexual grandmother–grandchild relationship supports previous research with heterosexual grandparents that found that parents are the gatekeepers to the grandparent–grandchild relationship, and they facilitate or discourage the development of an emotionally intimate relationship between grandparents and grandchildren.

Gay Grandfathers In the late 2000s, scholars began to investigate the experiences of gay grandfathers. Research focusing on the role of gay grandfathers in the

LGBTQ Grandparenting

grandparent–grandchild relationship was especially needed since the only available information on gay grandfatherhood was on LGB elder websites or featured in newspaper articles. The gay grandfathers who were willing to share their stories in national publications about being gay and a grandfather were not hesitant about disclosing their sexual orientation. The freedom that these gay grandfathers experienced in being out to family members may have been a reflection of society’s general acceptance of older men being out to family, as compared with older women. However, research was needed to specifically examine the coming-out process of gay grandfathers to their adult children and grandchildren. In the first study on this topic, 11 White gay grandfathers who ranged in age from 40 to 79 years were interviewed in order to obtain information about their coming-out process. This research revealed that gay grandfathers believed that their adult children played a tremendous role in their coming out to their grandchildren. This research also revealed that gay grandfathers enacted their grandfathering identities and practices in ways that were shaped by their family context, specifically the middle generation. Again, this research points to the tremendous role that parents play in the development of the grandparent–grandchild connection. Another important finding was that gay grandfathers wanted to be involved in the lives of their grandchildren, but with an understanding of the cultural norm that they would support but not interfere with their adult children’s wishes for their grandchildren.

Future Research With LGBTQ Grandparents Future research focusing on the experiences of LGBTQ grandparents must place an emphasis on bisexual, transgender, and questioning grandparents. As mentioned, to date, there have been no studies that have investigated older transgender people’s relationships with their grandchildren, and this research is especially needed. Just as transgender parents face unique concerns and issues that differ significantly from those of lesbian and gay parents, transgender grandparents face various forms of

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transphobia and discrimination that would require an understanding of transgender-grandparent relationships with their grandchildren. Because the available research has only explored the experiences of LGB grandparents who conceived children when they were in heterosexual relationships, research is also needed to explore the perceptions of LGBTQ grandparents from families in which they conceived children within the context of LGBTQ relationships. To date, the available research on LGB grandparents focused on grandparents who were primarily White. Additional research is needed that would include LGBTQ grandparents of color. Research is also needed to explore the unique perceptions, attitudes, beliefs, and experiences of LGBTQ cograndparents (i.e., the partners of LGBTQ grandparents). Cograndparents are the nonbiological LGBTQ grandparents. Although their role is less visible than the biological LGBTQ grandparents, the cograndparents’ role may still be significant if their relationship status with the biological grandparent was recognized and affirmed. Most importantly, future research on LGBTQ grandparenting must include the voices of grandchildren. Very early research on heterosexual grandparenting portrayed a one-way socializing influence of grandparents on grandchildren, and more recent research has continued to explore the socializing influence of grandparents on grandchildren, but with an emphasis on the mediating role of the middle generation on the grandparent–grandchild relationship. Although the available research on LGB grandparenting also emphasizes the mediating role of adult children on the grandparent-grandchild relationship, it is also very important to investigate how other family members may influence the nature of this relationship within LGBTQ families. Future research should include all three generations in order to fully understand the grandparent– grandchild relationship in contemporary society. Exploring the issues and concerns facing LGBTQ grandparents and their grandchildren will enable the development of programs and social policy that will ideally strengthen intergenerational relationships and family well-being. Nancy Orel

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See also Aging, Social Relationships, and Support; Coming Out, Disclosure, and Passing; Families of Origin, Relationships With; Heterosexist Bias in Research

Further Readings Fruhauf, C., Orel, N., & Jenkins, D. (2009). The comingout process of gay grandfathers: Perceptions of their adult children’s influence. Journal of Gay, Lesbian, Bisexual, and Transgender Family Studies, 5, 99–118. doi:10.1080/15504280802595402 Orel, N. (2005). Lesbian and bisexual women as grandparents: The centrality of sexual orientation in the grandparent-grandchild relationship. In D. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging: Research and clinical perspectives (pp. 248–274). New York, NY: Columbia University Press. Orel, N., & Fruhauf, C. (2014). Lesbian, gay, bisexual, and transgender grandparents. In A. E Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 177–192). New York, NY: Springer. doi:10.1007/978-14614-4556-2 Patterson, S. A. (2005). Better one’s own path: The experience of lesbian grandmothers in Canada. Canadian Women’s Studies, 24, 118–122. Sevda, B., & Herrera, D. (1998). Women in love: Portraits of lesbian mothers and their families. New York, NY: Bullfinch. Walker, K., & Walker, J. (1995). Still family after all these years. In K. Arnup (Ed.), Lesbian parenting: Living with pride and prejudice (pp. 160–166). Toronto, Ontario, Canada: Canadian Scholars’ Press and Women’s Press. Whalen, D., Bigner, J., & Barber, C. (2000). The grandmother role as experienced by lesbian women. Journal of Women and Aging, 12, 39–57. doi:10.1300/ j074v12n03_04

LGBTQ HEALTH CONTEXTS

IN

NON-WESTERN

Across the globe, individuals who either are perceived to be or identify as LGBTQ are often denied basic human rights, and, depending on cultural

norms (e.g., gender role expectations), LGBTQ individuals may experience oppression and legalized discrimination based on their sexual orientation, gender identity, or gender expression. As of 2013, among the 190 member states of the United Nations, 76 countries continue to make sexual relations between same-sex adults illegal, and the consequences vary based on age and gender, among other factors. Indeed, Iran, Saudi Arabia, Yemen, Mauritania, Sudan, Northern Nigeria, and Southern Somalia continue to enforce the death penalty for individuals convicted of homosexuality, and legalized discrimination against LGBTQ individuals is allowed, if not encouraged, throughout some parts of Asia and Africa. On the other hand, there are places throughout the world where LGBTQ diverse gender identities and sexual orientations are accepted and even celebrated. This entry provides an overview of LGBTQ individuals from non-Western contexts. Specifically, it addresses LGBTQ health disparities across cultures and examines how the intersection of gender and religion impact cultural beliefs, regulations, and health care. Further, this entry considers how non-Western traditions could provide a new perspective on how to promote and advocate for equal rights for LGBTQ individuals.

Global LGBTQ Health Disparities The Pan American Health Organization (PAHO) report on LGBTQ individuals’ access to and utilization of health care services suggests that LGBTQ individuals face barriers to care such as providers who lack awareness of LGBTQ-specific health concerns; refuse to provide treatment; have insufficient availability of services; and, in turn, may make health care decisions based on assumptions or stereotypes. Indeed, many LGBTQ individuals avoid seeking mental and physical health care due to the discrimination and violence they experience from the very individuals who are supposed to help them, which in part may explain why some LGBTQ individuals prefer to self-medicate (i.e., abuse substances and use home remedies) over seeking formal health care. Because of these

LGBTQ Health in Non-Western Contexts

barriers, there is a high prevalence of depression, suicide, and anxiety, among other mental health concerns in the LGBTQ community, and in terms of physical health, LGBTQ individuals may be at risk for higher rates of cancer, HIV, obesity, and sexually transmitted illnesses (STIs), among other health concerns. The American Psychiatric Association (APA) removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1974, and the World Health Organization (WHO) followed suit in 1990; however, the International Statistical Classification of Diseases and Related Health Problems (ICD) still includes the F66 category of mental illnesses, which is labeled Psychological and Behavioral Disorders Associated with Sexual Development and Orientation, and these “disorders” can be used to diagnose LGBTQ individuals with a mental illness. There are a variety of advantages and disadvantages of maintaining diagnoses such as sexual maturation disorder, ego-dystonic sexual orientation, sexual relationship disorder, other psychosexual development disorders, and psychosexual development disorder unspecified, but they arguably cause more harm than good. For instance, in some countries, reorientation therapy is still used to attempt to change an individual’s sexual orientation or gender identity, and the F66 category of diagnoses may provide justification for this unethical practice. In fact, most medical and mental health professional organizations have stated that homosexuality is not a mental illness and have ethical codes against trying to change their clients’ sexual orientation. Further, the APA has started the process of de-pathologizing diverse gender identities and gender expressions by replacing the Gender Identity Disorder diagnosis with Gender Dysphoria in the fifth edition of the Manual (DSM 5). This decision ensures that transgender individuals who are interested in transitioning have a diagnosis for insurance purposes while at the same time acknowledging that diverse gender identities and gender expressions beyond the male–female binary are healthy and normal human expressions.

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In addition to mental health disparities, many LGBTQ individuals report physical health disparities as well. For instance, lesbian and bisexual women as well as transgender men (i.e., female-tomale) who have not had children, who avoid gynecological services, and who use substances (e.g., alcohol and tobacco) may be at greater risk for breast and cervical cancer. Similarly, men who have sex with men (MSM) may be at risk for anal cancer, but due to a lack of education, awareness, and utilization of services, these men are not getting the preventive care they need. Another underserved population is that of transgender individuals, who may face, in addition to inexperienced and prejudiced providers, the additional health burden of receiving unsupervised health care. Specifically, some transgender individuals take hormones without a prescription and may undergo nonmedical body-modification procedures (e.g., castration or use of industrial silicone) when sex reassignment surgery (SRS) is unavailable or unaffordable. Even when health care services are available, LGBTQ individuals may avoid treatment due to social, economic, and legal barriers. For example, in the countries where same-sex relations are against the law, police often target health care providers and nongovernmental organizations (NGOs) that are geared toward LGBTQ individuals. Therefore, LGBTQ individuals and advocates are at risk of imprisonment and legalized discrimination. For example, staff at LGBTQ organizations may be arrested or charged with breaking morality, prostitution, or homosexuality laws. However, depending on cultural beliefs and traditions, there are some non-Western nations that provide LGBTQ individuals not only with appropriate health care, but also with support to help cover the costs.

Impact of Patriarchy on Laws, Policies, and Health In many parts of the world, women do not enjoy the same rights and freedoms as men do. In some countries, women do not have equal access to health care, work, education, land ownership, or leadership roles, among other rights and freedoms;

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therefore, lesbian and bisexual women may be forced into marriage and are at risk of domestic violence, among other dangers. Although transgender individuals may have some leeway and fluidity to move between masculine and feminine roles, gender role expectations and legal systems that were developed on the foundation of a gender binary put many transgender individuals at risk for domestic violence, especially those who live with their families. On account of the heteronormative traditions and expectations that marriage is between a man and a woman and that gender as well as sexuality are binary, in many places across the globe everyone is assumed to be heterosexual and cisgender (i.e., sex at birth aligns with gender), and those who do not fit into the social mores do not always receive legal protection. Although laws and policies have been developed to protect women from violence, many of these codes are not extended to lesbians, bisexual women, and transgender (LBT) individuals, and in fact these laws may be used against them. For instance, LBT persons who seek legal support for domestic violence may put themselves at risk of being arrested for homosexuality. Further, sexual minorities are often charged with rape instead of homosexuality, and although the accuracy of sexual violence charges is usually false, the mislabeling of charges makes it difficult for LGBTQ NGOs to gain support in fighting for human rights. Lastly, reports from the International Gay and Lesbian Human Rights Commission describe how perpetrators of violence against LGBTQ individuals in the Middle East may receive lesser penalties if the crime was allegedly based on preserving family honor or there was unjust provocation. Hence, LGBTQ persons could be assaulted or even murdered by their relatives, and their family members could receive reduced sentences for claiming that their actions were to protect their family’s honor. Due to legalized discrimination, LBT individuals face a number of risk factors that have a direct effect on their health. LBT individuals in Africa, Asia, and other places around the world are at risk of corrective rape, in which LBT individuals are sexually assaulted as punishment or under the false

pretense that sexual orientation or gender identity can be changed. As a result, LBT individuals may be at higher risk for HIV, STIs, and unwanted pregnancies, among other health concerns from these violent crimes, and the combination of harassment, abuse, and discrimination has an impact not only on physical health but on mental health as well. Even when mental and physical health care focused on women’s needs is available, LBT individuals do not always receive equal access to these services, if they are eligible for any services at all. In some countries such as Japan and Pakistan, LBT individuals have been denied care at shelters for domestic violence, and when counseling services are available, LBT clients are not allowed to discuss their sexual orientation or gender identity, even when these characteristics are associated with the presenting problem. Hence, many individuals turn to self-medication and substance use. However, in other countries like Malaysia and Sri Lanka, LBT individuals reported that they have some access to mental health support, at least through local LGBTQ organizations.

Religion, Gender Diversity, and Sexual Orientation In addition to the patriarchal influence on gender role expectations and the legal system, religion also plays a significant role in how gender diversity is viewed in non-Western contexts. Interestingly, some Eastern religions such as Hinduism and Buddhism provide a cultural framework for recognizing and embracing gender diversity. Similarly, in some Middle Eastern countries, Islamic law has become increasingly accepting of transgender individuals who fit into the gender binary. However, as with the American Indian, Polynesian, and Asian cultures described later in this entry, colonization along with the rise and fall of ancient empires often placed long-lasting limits on social expectations of gender expression and sexuality. In India, Hinduism provides a cultural context for such diverse gender expression as hijra (men who are neither man nor woman) and sādhin (women who reject marriage and live as men).

LGBTQ Health in Non-Western Contexts

Within the Hindu religion, there are deities that are partially male and partially female as well as deities that flow between masculine and feminine forms; in addition, there are epic tales about hijras that helped to establish their place in society (i.e., offering blessings as well as entertainment at wedding and birth ceremonies). Specifically, hijras worship Bahuchara Mata (a Hindu goddess that is associated with transgender individuals and procreation) and, based on a Hindu story, they often undergo a culturally specific type of SRS. In general, hijras are forced to leave their families, live in small communities, and live as women; however, sādhins are viewed as holy men, live with their families, and are allowed to take part in some masculine as well as some feminine roles. In addition to their roots in Hinduism, these diverse gender roles have been described in ancient medical texts and rather than being attributed to mental health, gender diversity was believed to be biologically based. Therefore, in India, transgender individuals have a religious and medical context for their gender identity that is not based in pathology, and although they may experience discrimination and stigma, it appears as though there is some level of cultural acceptance for gender diversity. Regardless of the social support for gender diversity, however, sexual minorities in India have less freedom. The penal code that criminalized same-sex relations in India was overturned in 2009 based on a ruling that it interfered with HIV/AIDS prevention efforts; however, this law was reinstated in December 2013 after a religious group appealed the judgment. As a result, sexual minorities may have an increased risk of being diagnosed with HIV/AIDS among other health concerns, since many of the HIV prevention efforts are geared toward LGBTQ individuals, and seeking services may put these individuals at risk of police harassment and imprisonment. As with India, transgender individuals in Iran have more freedom than sexual minorities. After the fall of the Ottoman Empire, Iran returned to Sharia law (i.e., Islamic law) and the use of capital punishment for homosexuality. However, Islamic law has also been used to give transgender

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individuals in Iran more rights. Specifically, in 1967, Ayatollah Khomeini issued a fatwa (legal opinion) stating that SRS was acceptable for intersex individuals, since this would help their bodies and souls align. In 1985, the Ayatollah of Iran reissued and expanded this fatwa to include transgender individuals. Although transgender individuals in Iran are sanctioned to have SRS or to live as certified nonoperative transsexuals, some individuals continue to face discrimination and prejudice. For instance, transgender individuals must complete months of therapy to confirm they are not sexual minorities trying to pass as transgender, they are required to have their chromosomes and hormone levels assessed before they can become a certified transsexual, and throughout the process they must carry documentation of their referrals and letters from their providers in case of random searches by the police. Despite the hurdles that transgender individuals experience in Iran, after they receive certification they become eligible for health insurance, assistance with covering the cost of surgery, and military exemptions. Individuals whose gender expression does not align with their sex and are not “certified” are at risk of breaking dress code laws, and even certified nonoperative transgender individuals may be suspected of being a sexual minority. Further, sexual minorities are often pressured to have SRS as a preventive measure against such risks as the death penalty if convicted of homosexuality. Unfortunately, given the religious sanctions, there may be a push for individuals to have SRS without being fully informed about its risks and benefits. For example, individuals convicted of homosexuality may be offered SRS instead of the death penalty; however, this option could have significant consequences on interpersonal relationships. Moreover, Iranians who have SRS may lose their eligibility for refugee status since gender identity is not explicitly listed under the 1951 Convention and 1967 Protocol. Buddhism, like Hinduism, also references sexual and gender identities that extend beyond the binary, and Buddhist teachings about tolerance and karma provide a framework for how

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transgender individuals may be perceived in Thailand. For instance, high proportions of transgender individuals in Thailand reported that they were accepted by their family members and viewed their gender identity as karma for their behavior in a past life. Despite the influence of Buddhism on Thai culture, LGBTQ individuals have been historically ostracized in Thailand, and it was not until recently that these individuals began to receive more cultural acceptance. Currently, kathoey (transgender individuals) do not have equal rights since they are not allowed to change the gender on their documentation, and although there is limited financial support and access to SRS, more SRS procedures are performed in Thailand than in any other country. Moreover, unlike India and Iran, same-sex relations in Thailand are legal and sexual minorities have more freedoms. These are just a few examples of how religion can impact the legal system and social norms, especially as they relate to LGBTQ individuals. Although religious teachings and religious leaders provide transgender individuals and their families with some rationale for their gender identities and gender expression, many penal codes only recognize two genders, and transgender individuals are often forced into this binary. In some cases, transgender individuals are recognized by their gender identity, whereas other nations only label an individual based on his or her assigned sex at birth. Hence, having a religious context for one’s gender expression may be associated with higher levels of wellbeing, especially when the gender identity fits into a binary, but it appears as though religious support is a source of validation that may or may not be associated with mental and physical health benefits.

Acceptance of Gender Identity and Gender Expression In some non-Western cultures across the world, diverse gender expression and identities have been embraced and woven into cultural traditions, whereas sexual orientation often remains a stigmatized identity. For instance, some American Indian cultures, as well as those of Polynesia and Indonesia, have historically been more accepting of

gender expression and gender identities beyond the binary, and despite the impact of colonialism, Christianity, and Islam, many of these traditions have either remained or have been reclaimed over the years. While transgender individuals in many Western cultures are often diagnosed with gender dysphoria and may have a higher prevalence of risk for certain health concerns such as suicide, substance abuse, and STIs, as well as having such potentially medical necessities as hormones or surgery, some of these issues are not as prevalent in many non-Western cultures. Specifically, in some Polynesian cultures, boys may be raised as girls, and identify as fa’afafine in the Republic of Samoa and as fakaleiti in the Kingdom of Tonga, and it is not unusual for parents to be accepting and supportive of their children’s gender expression. For instance, fa’afafine tend to be more socially accepted within their cultures, and these individuals do not experience distress over their gender expression and gender identity. As with other identities that may fit under the transgender umbrella, individuals who identify as fa’afafine and fakaleiti do not fit neatly into the gender binary and have the capacity to move between the masculine and feminine. Due to their assigned sex at birth, fa’afafine and fakaleiti may receive some forms of male privilege; however, since Samoa and Tonga are both patriarchal societies, these individuals may experience some of the same oppressions as do cisgender women. Further, in many Polynesian countries, sexual acts between individuals of the same sex remain illegal. Therefore, sexual relationships between heterosexual men and fa’afafine or fakeleiti appear to be culturally acceptable, since they are not viewed as same-sex relationships, whereas some fa’afafine and fakeleiti consider same-gender relationships with women as sinful. Prior to colonization, many American Indian cultures had a rich history of accepting and celebrating gender diversity, and although some individuals transitioned between masculine and feminine expression of their gender depending on their roles in society, others subsumed all characteristics of the other gender. For instance, in the Mohave culture, men who identified as women were referred to as alyha and would go through a

LGBTQ Health in Non-Western Contexts

ceremony that celebrated their transition to womanhood. Comparable to the fa’afafine of Samoa, gender diversity among children was often identified based on their interests, and at times their parents encouraged diverse gender expression. Indeed, in some American Indian cultures, transgender individuals played such key roles as shamans, warriors, and priests. Another commonality between gender-diverse individuals in Polynesian and American Indian cultures is how their beliefs about sexual orientation appear to be tied to gender instead of sex. Same-gender relationships were highly disapproved of, but a relationship between two people of the same sex was acceptable as long as one individual was transgender. Over the past 20 years, many American Indians have reclaimed the Algonquin term niizh, or twospirit, which refers to an individual’s gender fluidity. Although the contemporary use of this term refers to LGBTQ individuals, two-spirit is more akin to gender diversity, especially since sexual relationships are tied to gender roles. Unlike the fa’afafine, much of this gender diversity in American Indian cultures was lost during the colonization process, since Christian Europeans viewed same-sex relationships, regardless of gender identity, as sinful and unacceptable. In fact, research suggests that two-spirits often report histories of trauma, substance use, symptoms of anxiety, and posttraumatic stress symptoms in higher proportions than heterosexual American Indians, and perhaps some of these negative outcomes may be associated with the ongoing homonegativity and transnegativity that stem from Western culture. Similarly, Indonesia is a culturally diverse nation with a strong history of gender diversity, and such groups as the bissu (priests who live as a different gender from what they were assigned at birth), warok (gender-diverse actors), waria (men who express themselves as females), and tomboi (women who express themselves as males) have evolved over time due to Arab and European influences. For instance, until 2002, Indonesia did not have any laws prohibiting same-sex relations between individuals of consenting age. However, in the Aceh and Palembang regions, Sharia law has been implemented for Muslims, making same-sex relations illegal.

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Currently, waria live throughout Indonesia, tend to have higher social status than sexual minorities, and often believe that they have the body of a man and the soul of a woman. Some waria and LGBTQ individuals use their religion (i.e., Islam) to accept their gender identity or sexual orientation. For example, waria may embrace their femininity during their daily routines but will pray as men, whereas gay men may recognize that although their sexual orientation was created by God, what matters is their actions and cultural duties (i.e., marriage and family). More recently, resources that promote the intersection of gender identity and religion have emerged. Specifically, an Islamic school for waria was opened in Yogyakarta, and in addition to religious teachings, waria receive vocational training that may provide a range of job opportunities other than sex work. This training is especially important, since evidence suggests that waria are more likely to report that they have HIV or other STIs in comparison to MSM and male sex workers, regardless of their knowledge of HIV prevention. In response to some of these health disparities, a medical clinic (Bali Medika) geared toward LGBTQ individuals recently opened, and many LGBTQ organizations such as the Gaya Dewata Foundation are devoted to addressing some of these sexual health disparities among LGBTQ individuals. Despite having the knowledge and resources to address LGBTQ health concerns, some barriers to accessing health care remain. Worldwide, LGBTQ individuals are at risk for numerous health disparities due, in part, to stigma and discrimination. However, there are multiple non-Western cultures that have a history of accepting if not embracing some diversity in terms of sexual orientation and gender diversity. Perhaps further examination of these non-Western traditions may help Western cultures learn to be more accepting and supportive of LGBTQ individuals.

Conclusion Individuals who either are perceived to be or identify as LGBTQ do not always receive basic human rights, and in some countries, sexual minorities

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still face imprisonment or the death penalty if convicted of homosexuality. Therefore, LGBTQ individuals may not have access to appropriate mental and physical health care, and as a result they may have a higher prevalence of suicide, certain types of cancer, and STIs, among other health concerns. Despite the tendency to pathologize and criminalize LGBTQ individuals, in some non-Western nations, religion and cultural traditions provide a somewhat supportive context for them. Although many of the examples provided in this entry still place boundaries on what is considered to be culturally acceptable expressions of LGBTQ identities and the issue of discrimination appears to be a constant, there are important lessons to be learned. To begin with, although the APA and WHO have determined that homosexuality is not a mental illness, there are diagnoses in the DSM and ICD that can be used to pathologize and criminalize LGBTQ individuals; therefore, additional advocacy work is needed to depathologize LGBTQ persons. Further, in response to the human rights violations and legalized discrimination against LGBTQ individuals, an international panel of experts (LGBTQ NGOs, UN officials, and academics) introduced the Yogyakarta Principles: Principles on the Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity in 2007, and while it is not legally binding, this document provides recommendations and encourages nations to ensure that all individuals are recognized as having basic human rights, regardless of sexual orientation, gender identity, and gender expression. Aside from the Yogyakarta Principles, additional research, advocacy, and dissemination of knowledge are needed to work toward reducing lesbian, gay, bisexual, and trans (LGBT) health disparities. Moreover, in some parts of the world gender inequality contributes to the risks that lesbian, bisexual, and trans (LBT) individuals face; thus, enhancing collaborations with women’s rights movements may help to reduce some barriers to care. For instance, if LGBTQ organizations provided outreach to women’s rights groups, at minimum, LBT individuals could be referred to appropriate resources instead of being turned away. In addition, non-Western cultural

traditions and religious teachings appear to have some ameliorating effects, which suggests that having some sources of support such as family acceptance, religious validation, and social acknowledgement may, on some level, balance the negative impact of discrimination. Perhaps Western cultures could examine previous research that suggests transgender individuals in non-Western cultures often experience a high level of distress over their gender identities and consider how the Western world can better address the needs of LGBTQ individuals through validation and acceptance. Lastly, this entry demonstrates that LGBTQ individuals are represented throughout history and across cultures, and it is essential to think about how we can better address health disparities so LGBTQ individuals can thrive. Megan C. Lytle See also Health Disparities

Further Readings Balsam, K. F., Huang, B., Fieland, K. C., Simoni, J. M., & Walters, K. L. (2004). Culture, trauma, and wellness: A comparison of heterosexual and lesbian, gay, bisexual, and two-spirit Native Americans. Cultural Diversity and Ethnic Minority Psychology, 10(3), 287. Boellstorff, T. (2004). Playing back the nation: Waria, Indonesian transvestites. Cultural Anthropology, 19(2), 159–195. Cochran, S. D., Drescher, J., Kismödi, E., Giami, A., García-Moreno, C., Atalla, E., et al. (2014). Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11). Bulletin of the World Health Organization, 92, 672–679. Farran, S. (2010). Pacific perspectives: Fa’afafine and Fakaleiti in Samoa and Tonga: People between worlds. Liverpool Law Review, 31, 13–28. International Gay and Lesbian Human Rights Commission. (2011). Human rights violations on the basis of sexual orientation, gender identity, and homosexuality in the Islamic Republic of Iran. Retrieved October 15, 2014, from http://iglhrc.org/ content/human-rights-violations-basis-sexualorientation-gender-identity-and-homosexuality-islamic

LGBTQ (In)Visibility Within College Contexts Itaborahy, L. P., & Zhu, J. (2013). State-sponsored homophobia: A world survey of laws: Criminalization, protection, and recognition of samesex love. Retrieved October 15, 2014, from http://old .ilga.org/Statehomophobia/ILGA_State_Sponsored_ Homophobia_2013.pdf Najmabadi, A. (2008). Transing and transpassing across sex-gender walls in Iran. Women’s Studies Quarterly, 36, 23–42. Nanda, S. (2000). Gender diversity: Crosscultural variations. Long Grove, IL: Waveland Press. Pan American Health Organization. (2013). Addressing the causes of disparities in health service access and utilization for lesbian, gay, bisexual and trans (LGBT) persons. Retrieved October 15, 2014, from http:// www.who.int/hiv/pub/populations/lgbt_paper/en/ Penrose, W. (2001). Hidden in history: Female homoeroticism and women of a “Third Nature” in the South Asian past. Journal of the History of Sexuality, 10, 3–39. Pillay, N. (2011). No place for homophobia here. Retrieved October 15, 2014, from http://www.iglhrc .org/cgi-bin/iowa/article/publications/reportsand publications/1416.html Pisani, E., Girault, P., Gultom, M., Sukartini, N., Kumalawati, J., Jazan, S., et al. (2004). HIV, syphilis infection, and sexual practices among transgenders, male sex workers, and other men who have sex with men in Jakarta, Indonesia. Sexually Transmitted Infections, 80, 536–540. Poore, G. (2014). Violence: Through the lens of lesbians, bisexual women, and trans people in Asia. Retrieved November 19, 2015, from https://www.outright international.org/content/violence-through-lenslbt-people-asia Rao, T. S., & Jacob, K. S. (2014). The reversal on gay rights in India. Indian Journal of Psychiatry, 56, 1–2. Vasey, P. L., & Bartlett, N. H. (2007). What can the Samoan “Fa’afafine” teach us about the Western concept of gender identity disorder in childhood? Perspectives in Biology and Medicine, 50, 481–490. Winter, S. (2006). Thai transgenders in focus: Their beliefs about attitudes towards and origins of transgender. International Journal of Transgenderism, 9, 47–62. Winter, S. (2012). Lost in transition: Transgender people, rights and HIV vulnerability in the Asia-Pacific region. Retrieved October 15, 2014, from http:// www.undp.org/content/dam/undp/library/hivaids/

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UNDP_HIV_Transgender_report_Lost_in_Transition_ May_2012.pdf The Yogyakarta Principles: Principles on the application of international human rights law in relation to sexual orientation and gender identity. (2007). Retrieved November 19, 2015, from http://www .yogyakartaprinciples.org/

LGBTQ (IN)VISIBILITY WITHIN COLLEGE CONTEXTS Higher education policies, initiatives, and organizations often reflect general societal values and attitudes regarding LGBTQ individuals. For example, American higher education administrators of the 1950s responded to the Diagnostic and Statistical Manual of Mental Disorders’ (DSM’s) classification of homosexuality as a mental disorder by expelling or “treating” students engaged in or accused of same-sex activity or attraction (e.g., with sexual orientation conversion therapy). Similarly, transgenderism—referred to as transsexualism in the DSM prior to 1973—was also regarded by college administrators as an innate psychological deficiency that could be cured with appropriate psychological interventions. Following the 1973 DSM declassification of homosexuality as a disorder, sexual- and gender-minority student visibility increased alongside social and campus activism regarding institutional and health reforms (e.g., Stonewall Riots, Campus Pride). While sexual- and gender-minority students’ rights continue to improve, current U.S. legislation is limited by its focus on preventing overt aggression rather than promoting LGBTQ student integration (e.g., Tyler Clementi Higher Education Anti-Harassment Act of 2014). As a result, LGBTQ college and continuing education students often report subtle, although damaging, hostilities (termed microagressions) as well as social exclusion at both an institutional and interpersonal level (e.g., fraternity and sorority life, sports teams/student athletics, religious organizations). Moreover, such campus dynamics often intimidate undisclosed LGBTQ students, preventing them from

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coming out and joining LGBTQ support networks. Higher education researchers describe this as the (in)visibility dynamic: Campus awareness of sexual- and gender-minority students (visibility) is often discriminatory in nature, leading to LGBTQ identity repression (invisibility). In addition, higher education researchers such as Ronni Sanlo suggest that LGBTQ student invisibility is further exacerbated by a lack of college campus information regarding LGBTQ student needs. However, further information regarding LGBTQ college students is imperative given that an estimated 3% to 10% of students will identify as transgender; gendernonconforming; and/or lesbian, gay, bisexual or queer/questioning while attending college. The goal of the present entry, therefore, is to analyze the prevailing issues sexual- and gender-minority students encounter within college contexts as well as how administrators and activists are addressing LGBTQ campus (in)visibility.

(In)Visibility and Campus Climate College signifies a primarily emerging adulthood milestone (18–29 years) that is often characterized by a sense of general instability and identity exploration on the part of students. This complex developmental period is often associated with a variety of stressors, potentially limiting students’ academic, physical, and psychological development. For example, the American College Health Association reports that depression and anxiety are among the top obstructions to academic performance, with 31% of college students being too depressed and 50% being too anxious to function within academic settings. Alcohol is often used as a means of coping; indeed, approximately 4 out of every 5 college students consume alcohol on a weekly basis, and about half of these students binge drink (i.e., consume multiple drinks within a limited time period). Unfortunately, emerging-adulthood stressors are further compounded for sexual- and gender-minority college students due to hostile campus interactions. Indeed, many scholars suggest that it is the combined stress of emerging adulthood and campusbased LGBTQ hostilities that lead to the higher

rates of depression and substance abuse among LGBTQ college students. LGBTQ Campus Climate

LGBTQ students often first encounter their campus (in)visibility when applying to college, since many applications either ignore sexual and gender orientation as an identity marker or only acknowledge these complex categories as a binary status (e.g., male/female). Moreover, gender identification has become a particularly challenging issue on women’s campus applications, as Title IX funding may be lost if biologically male students identifying as female (MtF) are admitted. While these issues are legally and politically complex for college administrators to navigate, the effects of the resulting policies can negatively impact the campus climate for LGBTQ students. Educational psychologists have defined campus climate as the collective behaviors, standards, and attitudes of college employees and students concerning the inclusion of, as well as access and level of respect for, individuals and groups possessing different identities and unique needs. The LGBTQ campus climate is determined by the following: (1) LGBTQ persons’ perceptions and experiences of the college community, (2) heterosexual students’ perceptions about LGBTQ persons in the college context, and (3) the status of campus policies and programs designed to improve the experiences of LGBTQ students. Annually assessing the LGBTQ campus climate is important, as the vast majority of United States colleges/universities are only just beginning to address heterosexist policies (e.g., campus housing, restrooms, fraternity/sorority membership). In addition, recent research suggests that sexual and gender minorities tend to perceive the college campus climate as being more hostile and dangerous than do their non-LGBTQ peers. Moreover, nonheterosexual, transgender, and gendernonconforming students are more likely to consider leaving school, stop attending classes, and avoid campus locations necessary for their socioemotional development (e.g., gymnasiums, campus health clinics, student housing, student centers).

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Furthermore, gender-minority students tend to view the campus climate more negatively than do sexual-minority students, possibly due to the lack of emphasis placed on most educational and psychological research initiatives with respect to the trans population. A hostile campus climate may also prevent LGBTQ students from disclosing their identities and orientation, leading to psychological strain. Alternatively, research has found that LGBTQ students who are either entirely or mostly out within the campus community have overall higher academic performance and are more likely to engage in extracurricular activities and LGBTQ advocacy work within the campus community as compared to undisclosed LGBTQ students. By the same token, similar research argues that positive encounters on campus, such as acceptance from heterosexual or gender-conforming peers, improves the level of comfort that sexual- and gender-minority college students who are coming out experience. However, it is important to note that disclosed LGBTQ students are more likely to experience personal and overt verbal and physical harassment from their peers, often with the harasser(s) receiving little to no institutional consequences either because of LGBTQ students’ fear of reporting the incident or the lack of formal campus policies. The (In)Visibility of Multiple Minorities

LGBTQ college students with intersecting minority social identities, such as racial/ethnic minority or disability status, tend to rate the campus climate even more negatively than persons of only one minority identity. For example, racial/ ethnic minority students of color who also identify as nonheterosexual and/or trans and/or gender nonconforming experience a compounded marginalization and invisibility. The assumed phenotypic markers of students’ racial and ethnic groups may isolate them from largely White campus communities, while the cultural values of minority racial/ ethnic groups may prevent them from disclosing their sexual or gender identities. For example, some gay Latinos engage in secretive (i.e., “down low”) homosexual activities adhering to the cultural value of machismo, which is often associated

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with stereotypical traits of masculinity (e.g., strength). In the same vein, African American men often identify as men who have sex with men (MSM) instead of affiliating with a gay community that is culturally viewed as being White and effeminate. Similarly, although psychological research tends to concentrate on an individual’s visible disability (e.g., cerebral palsy) or invisible disability (e.g., learning disability) separately from his or her sexual or gender identity, college students with disabilities have reported the additional strain of being desexualized by others—both within and outside of the LGBTQ community. Disabled sexual and gender minorities signify a unique population of college students considering they may not have faculty, peers, or family member who look like them, while also not being accepted by the LGBTQ community due to their visible difference. These complex interactions of identity, unfortunately, further contribute to the psychological and physical complications experienced by LGBTQ college students. Campus Climate and LGBTQ Faculty

LGBTQ higher education employees may also experience campus tension and risks. For example, multiple studies have reported that the majority of college students prefer heterosexual and gendernormative professors. Specifically, approximately 9 out of 10 college students indicate a preference for having a straight instructor in the classroom as opposed to a gay instructor. In addition, despite institutional nondiscrimination clauses, coming out or being out in the college atmosphere is also financially risky for LGBTQ instructors due to limited federal protection—and as a result, many LGBTQ professors remain invisible (i.e., undisclosed/closeted) for their personal safety despite promises of academic freedom. Moreover, disclosed LGBTQ faculty also report more negative perceptions of the campus climate’s LGBTQ sensitivity than do both disclosed and undisclosed LGBTQ students. Although researchers are uncertain of how to explain this differential, it is possible that LGBTQ employees have a heightened awareness of discriminatory actions due to the

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financial and professional risks they incur within their employment settings. Unfortunately, a damaging although unintentional outcome of faculty members not disclosing their sexual- or genderminority status is the absence of positive role models and mentors for LGBTQ college students. Moreover, this problem is further exacerbated by reports that heterosexual colleagues and administrators do not positively view LGBTQ research during tenure reviews (e.g., “LGBTQ research is not real research”).

Improving LGBTQ Visibility on College Campuses Given the historic and present conditions regarding sexual- and gender-minority (in)visibility within college contexts, educational activist organizations such as Campus Pride recommend that colleges develop extensive LGBTQ campus support networks, such as LGBTQ resource centers, Gay–Straight Alliance organizations, free or lowcost counseling support groups, LGBTQ residential options, and LGBTQ faculty–student mentoring programs. In addition, activists encourage the development of campuswide training programs in order to increase student, staff, and faculty member general sensitivity toward, and awareness of, LGBTQ issues. For example, the Minority Conflict Mediation (MCM) Lab at Barnard College, led by Chana Etengoff, explores gender-minority and -majority student perspectives regarding the policy of accepting legally female students identifying as queer or male to a women’s college. The MCM project aims to identify students who are successfully negotiating gender-based campus tensions (e.g., “positive deviants”) in order to develop peerled conflict-mediation programs. Similar efforts by Meredith Worthern have been met with success in the U.S. South, suggesting that ally and peer LGBTQ programs can be a successful model across a diverse range of campus communities. Such student-empowerment programs are particularly timely, since the majority of researchers largely approach LGBTQ campus inclusion as a student issue to be mediated by administrators,

educators, and school counselors. However, scholars have not yet adequately addressed how majority and minority students independently negotiate such conflicts outside of administratively structured settings. Lastly, activists recommend the inclusion of additional courses and lessons about the lived experiences and historical oppression of sexual and gender minorities. Implementing the above recommendations is likely to lead to the development of more inclusive college contexts for LGBTQ students (e.g., LGBTQ anti-bullying policies and guidelines), hopefully positioning this entry as a historical review rather than a statement of current LGBTQ issues on college campuses. Charles Joseph Polihronakis, Chana Etengoff, and Eric M. Rodriguez See also Activists in College; Campus Climate; College Athletes; College Students; Down Low; Microagressions; Transgender Inclusion on College Campuses

Further Readings Blumenfeld, W. (2012). LGBTQ campus climate: The good and the still very bad. Diversity & Democracy: Association of American Colleges and Universities, 15(1), 20–21. Connolly, M. (2000). Issues for lesbian, gay, and bisexual students in traditional college classrooms. In V. Wall & N. Evans (Eds.), Towards acceptance: Sexual orientation issues on campus (pp. 109–130). Lanham, MD: University Press of America. D’Augelli, A. R. (1989). Lesbians and gay men on campus: Visibility, empowerment, and educational leadership. Peabody Journal of Education, 66(3), 124–142. D’Augelli, A. (2006). Coming out, visibility, and creating change: Empowering lesbian, gay, and bisexual people in a rural university community. American Journal of Community Psychology, 37(3/4), 203–210. Hart, J., & Fellabaum, J. (2008). Analyzing campus climate studies: Seeking to define and understand. Journal of Diversity in Higher Education, 1(4), 222–234. Minority Conflict Mediation Lab, Barnard College, Columbia University. https://sites.google.com/a/ barnard.edu/mcmlab/

LGBTQ Issues in K–12 Education Across Global Contexts Oswalt, S. B., & Wyatt, T. J. (2011). Sexual orientation and differences in mental health, stress, and academic performance in a national sample of U.S. college students. Journal of Homosexuality, 58(9), 1255–1280. Rankin, S. R. (2006). LGBTQA students on campus: Is higher education making the grade? Journal of Gay & Lesbian Issues in Education, 3(2/3), 111–117. Sanlo, R. (2004). Lesbian, gay, and bisexual college students: Risk, resiliency, and retention. Journal of College Student Retention: Research, Theory & Practice, 6(1), 97–110. Worthen, M. G. (2011). College student experiences with an LGBTQ ally training program: A mixed methods study at a university in the southern United States. Journal of LGBT Youth, 8(4), 332–377.

LGBTQ ISSUES IN K–12 EDUCATION ACROSS GLOBAL CONTEXTS K–12 LGBTQ students comprise nearly 15% of the world’s population; however, LGBTQ students across the globe still report experiencing marginalization (e.g., powerlessness and isolation), stigmatization (e.g., feelings of disgrace due to their social identity), invisibility (e.g., feeling overlooked or suppressed), as well as overt and covert discrimination. For example, 84% of K–12 U.S. LGBTQ students report being harassed for their sexual orientation, and more than 45% of these students report that the term gay is used derogatively within school contexts. Moreover, close to 90% of LGBTQ middle and high schoolers worldwide report experiencing antigay slurs, suggesting that LGBTQ hostility increases during adolescence. Hostile K–12 environments are particularly concerning given the amount of time students are in school at this age as well as the central role that peer interactions play in K–12 student development. Researchers in the United Kingdom reported in 2000 that 40% of bullied LGBTQ students attempted suicide or engaged in self-harming behaviors such as cutting and burning—with more

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than 16% reporting posttraumatic stress disorder (PTSD) later in life. In addition, although some countries have established policies to protect the rights of sexual- and gender-minority youth within educational contexts, research suggests that most K–12 students are hesitant to address harassment and discrimination due to the fear of reprisal and the perceived lack of administrative response (e.g., 60% of harassed LGBTQ K–12 students in the United States did not file harassment reports). In addition, while the age of initial sexual orientation and gender-minority awareness differs across studies, most researchers agree that the pressure to conform to heteronormative standards begins during childhood. The goal of this entry, therefore, is to highlight the multidimensional challenges encountered by LGBTQ students in global K–12 educational contexts and how best to address them. It includes a discussion of educational policies from an (inter) national perspective, followed by an exploration of the impact of non-inclusive K–12 educational context on the psychological and physical health of sexual and gender minorities. Further analyzing the adverse effects of these environments, this entry then addresses the unique experiences of LGBTQ persons possessing more than one minority identity. Lastly, several recommendations aimed at improving K–12 educational contexts across global contexts, and in turn the educational experiences of sexual and gender minorities within these settings, will be presented.

LGBTQ K–12 Policies Across Global Contexts The current global climate regarding sexual- and gender-minority persons ranges from varying levels of acceptance to overt hostility. For example, while same-sex unions have been legal in Norway since 1989, Nigeria and Malaysia continue to prohibit homosexual interactions, and many other countries still limit LGBTQ rights (e.g., marriages/civil unions, adoption, college admittance). This global ambivalence concerning LGBTQ issues sets the tone for LGBTQ K–12 student experience, with

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nearly 25% of elementary school students and 40% of K–12 teachers worldwide reporting gender-nonconforming name-calling (e.g., sissy, faggot, dyke). Foreign affairs research suggests that the supportiveness of governmental policies regarding LGBTQ minors and education exists on a continuum. For instance, policies can be described as persecutorial (e.g., corporal and capital punishment in the Middle East and Africa); homophobic (e.g., criminalization of male–male sexual behavior in Jamaica); heteronormative (e.g., police harassment and army service restrictions in Japan); supportive (e.g., anti-discrimination legislation in Israel); or proactive (e.g., Dutch Federation of Associations for the Integration of Homosexuality). Researchers suggest that the sociopolitical climates of a nation, in conjunction with its traditional cultural roots (e.g., religious/spiritual affiliation and the existence of indigenous transgender persons), have a direct impact on LGBTQ policies. For example, Chinese researchers report that both personal and structural conservative religious beliefs prevent sexual-minority youth in Hong Kong from receiving necessary counseling and mental health services. Moreover, many Middle Eastern countries (e.g., Sudan, Yemen, Iran) explain the illegal status of homosexuality and the persecution of sexual- and gender-minority youth based on religious grounds. For example, although Saudi Arabia signed and ratified the UN Convention on the Rights of the Child (UNCRC), the document’s promise of young people’s universal protection from harm is undermined by Saudi Arabia’s reservation regarding articles that seemingly conflict with Islamic law such as same-sex relationships/orientation. Within such cultural climates, LGBTQ rights are absent from all contexts—including educational settings. Contrastingly, Scotland recently began an initiative to respond to young people’s concerns that the UNCRC was not being equitably applied to sexualand gender-minority youth. In 2004, Scottish LGBTQ student activists worked together with government representatives and educators to draft the LGBT Youth Charter of Rights, which emphasizes specific UNCRC rights that are particularly

important to LGBT youth such as the right to a safe education, as well as the right to privacy and the right to protected health information. While Scotland has a strong Christian Protestant history that is often associated with anti-homosexual attitudes, it is possible that the country is sensitive to LGBTQ rights due to its cultural narrative as an oppressed minority of the British Empire. Other countries with supportive LGBTQ policies (such as Israel, France, and Australia) have embedded legal or constitutional rights for LGBTQ persons, protecting them from discrimination (e.g., education, workplace, adoption, marriage). Some of these initiatives precede the ratification of the UNCRC, such as France’s efforts to incorporate LGBTQ information into its schools’ health education curriculum, while other countries’ efforts are more recent. For example, British Columbia’s 2002 incorporation of K–12 LGBTQ literature within school libraries was a legislative milestone decades after the UNCRC (e.g., Chamberlain vs. Surrey School Board). However, it is important to note that there is often a gap between federal policies and their local/regional implementation. For example, despite Israel’s more inclusive educational policies, recent research suggests that nearly 50% of Israeli students ages 11 to 18 report hearing homophobic remarks from their teachers, and 33% report experiencing peer harassment regarding sexual- and gender-minority issues. Such conflicts between policy and practice have more than likely led to the mixed results regarding gay students’ health in Israel—although Israeli gay youth are more likely to report more depressive symptoms and negative affect than their heterosexual peers, they are also more likely to report a high level of positive affect. Researchers suggest that these negative and positive emotions may facilitate adaptation among gay Israeli youth, although further research is still needed. Gaps between policy and application are often further complicated by the judicial tensions between the rights of religious freedom and the rights of LGBTQ persons, and as such, many religious schools in progressive countries still employ discriminatory policies. In a similar vein, some

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activists note that the United States’ struggle between the personal freedoms of the family and children’s need for governmental protection prevented the United States from ratifying the UNCRC in 1989 and still continues to limit LGBTQ K–12 student protections. For example, while many LGBTQ activists advocate for the inclusion of LGBTQ issues in sex and health education curricula, states and districts will often defer to parental preferences on these issues because they view sex education as a protected parental right.

LGBTQ K–12 Student Experience in the United States The United States Department of Education’s Title IX of the Education Amendments of 1972 was amended in April 2014 to protect transgender and gender-nonconforming persons from discrimination within educational contexts. However, recent general population surveys indicate that most transgender and gender-nonconforming individuals are unaware of this amended federal right. In this vein, 33% of U.S. elementary school students report that they have been instructed by educators and peers regarding what they should and should not wear with respect to their sex, and 70% of U.S. LGBTQ middle and high school students report being regularly harassed about their nonconforming gender expression. Moreover, there is still no federal protection from sexual identity discrimination, and as a result, educational policies regarding lesbian, gay, and bisexual youth vary from state to state. For example, only 17 states and the District of Columbia have anti-bullying/harassment legislation in relation to gender identity and sexual orientation. Likewise, only 12 states require local school systems to provide discussions regarding sexual orientation. However, just 9 of these 12 states encourage inclusive discussions, while the remaining 3 provide only negative data regarding LGBTQ identities (e.g., HIV, suicide, substance abuse). Moreover, eight states have established “No Promo Homo” policies that forbid the positive portrayal of homosexuality in K–12 contexts, thereby perpetuating the invisibility of LGBTQ students. This

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complex sociopolitical landscape has contributed to the statistics regarding LGBTQ bullying, with 90% of LGBTQ students in U.S. middle and high schools being verbally harassed (e.g., called names or threatened) and 60% being physically harassed (e.g., being pushed or shoved) in school because of their sexual orientation. Moreover, 80% of these students report being harassed on a daily basis, thus highlighting the lack of administrator response.

The Impact of Non-Inclusive School Environments Throughout their K–12 education, LGBTQ students often experience isolation—increasing the likelihood of internalized homophobia and decreases in self-esteem. International and crosscultural research suggests that LGBTQ youth’s lower levels of self-esteem, combined with the avoidance of hostile academic settings (e.g., high rates of absenteeism), may contribute to poor academic performance and lower levels of extracurricular involvement. For example, almost half of all transgender students worldwide reported skipping a class or missing at least 1 day of school in the past month because they felt unsafe or uncomfortable. Similarly, more than 15% of LGBTQ high school students internationally are likely to withdraw from school due to harassment and assault, further hindering their academic pursuits. Homophobic and heteronormative messages from peers, educators, parents, and the media may also prevent LGBTQ adolescents from addressing identity development. LGBTQ students who become aware of their sexual and romantic attractions, as well as their gender identity, during this developmental stage may begin to repress these desires and thoughts, preventing them from achieving self-acceptance. Unfortunately, the lack of selfacceptance, in conjunction with the lack of social acceptance (i.e., sexual-minority stress), can contribute to the development of mental health challenges. For example, LGBTQ students across the globe may experience heightened levels of anxiety related to the fear of peer harassment and the

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perpetual strain of identity suppression. In addition, negative self-perceptions may lead to suicide attempts and the development of a major depressive disorder. Lastly, it is important to note that many of these issues are compounded by the comparatively higher rates of parental rejection and related homelessness among LGBTQ youth. As a means of coping with these intense emotions, many LGBTQ students self-medicate with substances (e.g., alcohol and marijuana) and engage in risky sexual behavior due to the lack of viable confidants and resources within the school community. Indeed, LGBTQ students are more likely to engage in potentially dangerous sexual behavior, as well as to contract HIV and STIs, in comparison to their heterosexual counterparts. Moreover, transgender individuals—particularly male-to-female (MtF) transgender persons—have a statistically significantly higher prevalence of HIV/STIs in comparison to other sexual-minority populations. Researchers suggest that this disparity may be due to a combination of abstinenceonly programs (e.g., in the United States or Uganda), religious homophobia, and a lack of information regarding sexual activities among nonheterosexual and transgender populations.

LGBTQ Intersectionality: Navigating Multiple Minority Identities The aversive experiences of sexual and gender minorities within global K–12 educational contexts becomes even more complex when considering intersectionality—the ongoing interaction of multiple social identities (e.g., gender and sexual identity, race/ethnicity, socioeconomic status, religion, [dis]ability, etc.). Though research focusing on intersectionality is fairly new—and therefore sparse—there is a general consensus among experts in this area that LGBTQ youth with intersecting minority identities are faced with more frequent discrimination and prejudice during their lifetime. For instance, learning disabilities (e.g., dyslexia, auditory processing disorder), which are diagnosed due to a discrepancy between an individual’s expected level of achievement and actual performance, have historically served as justification for

discrimination against students, from both peers and educators. Educational research often describes students with learning disabilities as being on the margins of the school community, as educators often have limited expectations for them, and peers may isolate them from social interactions (e.g., group projects). Thus, LGBTQ students with learning disabilities experience a dualistic marginalization in the K–12 educational context, which has the potential to further inhibit social functioning, self-esteem, and academic performance. In addition, researchers suggest that LGBTQ African American and Hispanic/Latino students, as well as most other students who identify as persons of color, tend to be at an increased risk of depression and suicide. Moreover, gay males of color are at a higher risk of contracting HIV/STIs compared to White heterosexual males. Psychologists and public health researchers suggest that such health disparities may be due to culturally biased health education information. Scholars also attribute health inequalities to the perpetual feelings of isolation and discrimination LGBTQ students of color encounter. Furthermore, researchers note that African Americans and Hispanics/Latinos have strong religious/spiritual traditions— many of which are reported to be associated with homophobia. Alternatively, an emerging body of research suggests that individuals identifying as both LGBTQ and a cultural minority are more resilient to hostile circumstances than individuals with only one minority identity. Researchers who explore LGBTQ intersectionality, such as Bonnie Moradi and Melanie Brewster, report that racial/ethnic-minority LGBTQ persons may have lower levels of comingout anxiety than White LGBTQ persons because LGBTQ persons of color are able to generalize their coping skills from racist to homophobic contexts. It is important to note that researchers are still attempting to determine if such forms of resilience are universally experienced by LGBTQ youth of any cultural minority group or if resilience is a culturally specific phenomenon. For example, analyses of U.S. Add Health data in 2000 determined that same-gender attraction was a significant predictor of depression and suicidal ideation

LGBTQ Issues in K–12 Education Across Global Contexts

for White, African American, and Hispanic/Latino youth—although not for Asian or Pacific Islander youth. Follow-up research by developmental scholars Yuko Homma and Elizabeth Saewyc suggest that it is only Asian youth from supportive family environments who are likely to demonstrate this type of resilience. Further research is still needed to determine if there are common cultural values and supportive skills displayed across LGBTQ youth of multiple minority statuses (e.g., family cohesiveness, coping skills).

Improving LGBTQ K–12 Environments Responding to the negative effects of heteronormative school climates and biased curricula, civil rights activists and organizations such as the Gay, Lesbian & Straight Education Network (GLSEN) have developed reform efforts to enhance educational settings for LGBTQ students. For example, the United States’ Dignity for All Student Act (DASA) and New Zealand’s Human Rights Act of 2001 prohibit LGBTQ bullying. In addition to the development of legislative reforms—both nationally and internationally—LGBTQ activists worldwide have encouraged the integration of sensitivity training and workshop programs for students, employees, and parents as well as the implementation of Gay–Straight Alliances within schools. Through these programs, members of the school community learn how to effectively address student bullying and harassment and are informed of the unique experiences of LGBTQ youth. Emerging research suggests that such programs are highly effective, with U.S. researchers in Oregon finding that lesbian and gay Grade 11 students from school districts promoting inclusive antibullying policies are 2.25 times less likely to attempt suicide than those living in counties with fewer participating school districts. Similarly, lesbian, gay, and bisexual U.S. youth living in cities and states with more protective school climates report fewer suicidal thoughts than those living in communities with less protective climates. Feminist researchers such as André Grace and Kristopher Wells also argue that LGBTQ information should be incorporated into educational

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curricula through the lens of queer theory. Originally developed in the 1990s, queer theory challenges the dichotomous relationship associated with heterosexuality and homosexuality and postulates an understanding of sexuality and gender that highlights shifting boundaries. Queer theory challenges heterosexuality as a social-sexual norm and rejects the social construct of stable identity categories. Educational reforms motivated by queer theory may consist of including queer literature in a school’s library and curriculum, featuring LGBTQ issues within physical and health education classrooms, or discussing the LGBTQ civil rights movement in a history class. Educational psychology research on these and similar initiatives suggest positive improvements in LGBTQ students’ academic performance and their mental and physical health as well as the development of an increasingly integrated school community. Charles Joseph Polihronakis, Chana Etengoff, and Eric M. Rodriguez See also Education; Gay, Lesbian & Straight Education Network (GLSEN); Internalized Homophobia; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ-Parent Involvement and Advocacy in Schools; Queer Theory

Further Readings Birkett, M., Espelage, D. L., & Koenig, B. (2009). LGB and questioning students in schools: The moderating effects of homophobic bullying and school climate on negative outcomes. Journal of Youth and Adolescence, 38, 989–1000. Casement, R. (2002). Breaking the silence: The stories of gay and lesbian people in children’s literature. New Advocate, 15(3), 205–213. Chesir-Teran, D. (2003). Conceptualizing and assessing heterosexism in high schools: A setting-level approach. American Journal of Community Psychology, 31(3–4), 267–279. D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17(2), 148–167.

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Fox, M. (1993). Politics and literature: Chasing the “isms” from children’s books. The Reading Teacher, 46(8), 654–658. Grace, A. P., & Wells, K. (2009). Gay and bisexual male youth as educator activists and cultural workers: The queer critical praxis of three Canadian high-school students. International Journal of Inclusive Education, 13(1), 23–44. Griffin, P., & Ouellett, M. (2003). From silence to safety and beyond: Historical trends in addressing lesbian, gay, bisexual, transgender issues in K–12 schools. Equity and Excellence in Education, 36(2), 106–114. Homma, Y., & Saewyc, E. M. (2007). The emotional wellbeing of Asian-American sexual minority youth in school. Journal of LBGT Health Research, 3(1), 67–78. Horn, S. S., & Nucci, L. (2003). The multidimensionality of adolescents’ beliefs about and attitudes toward gay and lesbian peers in school. Equity and Excellence in Education, 36, 136–147. Kosciw, J. G., Greytak, E. A., & Diaz, E. M. (2009). Who, what, where, when, and why: Demographic and ecological factors contributing to hostile school climate for lesbian, gay, bisexual, and transgender youth. Journal of Youth and Adolescence, 38(7), 976–988. Lesser, L. K., Burt, T., & Gehaw, A. (2005). Making room in the circle: Lesbian, gay, bisexual and transgender families in early childhood settings. San Rafael, CA: Parent Services Project. Moradi, B., Wiseman, M., DeBlaere, C., Goodman, M., Sarkees, A., Brewster, M. E., et al. (2010). LGB of color and White individuals’ perceptions of heterosexist stigma, internalized homophobia and outness: Comparisons of levels and links. Counseling Psychologist, 38, 397–424. Saewyc, E. M., Singh, N., Reis, E., & Flynn, T. (2000). Intersections of gender, racial, and orientation harassment in school and associated health risks among adolescents. Journal of Adolescent Health, 26, 148.

LGBTQ ONLINE COMMUNICATIONS: BUILDING COMMUNITY THROUGH BLOGS, VLOGS, AND FACEBOOK In recent years, the Internet has become more accessible and socially oriented—leading to its key role in sexual-minority identity formation,

self-acceptance, and disclosure. For example, 70% of LGBTQ American college students report using the Internet to research their sexual orientation. Moreover, health psychologist Gary Harper suggests that LGBTQ youth primarily use the Internet to connect with supportive peers—leading to increases in sexual orientation knowledge, selfawareness, and comfort. In addition, anonymous online sexual/gender orientation disclosures and explorations are particularly appealing to those living within communities that disapprove of or persecute LGBTQ persons. For example, gay men from Christian and Orthodox Jewish backgrounds use online communications more frequently (61%) than religious supports such as prayer or religious counseling (34%) to make sense of the coming-out period. Moreover, research indicates that the ability to continuously create and edit new online profiles (personas) can help users to enact and merge multiple, and often conflicting, identities. While it may be challenging to assert a gay Muslim identity within a traditional mosque or to live life as a masculine, gay, Black man, Internet communities can often provide a safe place to integrate and negotiate multiple identities. In this vein, gay Mormon youth have responded to a lack of support from the Latter Day Saints community by developing an elaborate online community network via the MoHo Directory—a global listing of over 100 gay Mormons and their blogs. For many, the MoHo Directory functions as a family of choice—a committed relationship network bound by friendship rather than blood. Sociocultural psychologists Chana Etengoff and Colette Daiute suggest that online family-of-choice structures are characterized by members’ access to and awareness of other individual members, dialogues about positive and negative experiences, empathy and relatedness, as well as unconditional group membership. Establishing supportive and validating systems of nonbiological relations is often imperative for LGBTQ persons, as this can help facilitate relational resilience (i.e., providing and receiving social support), thereby buffering the impact of minority stress (i.e., tensions between majority and minority culture) and family-of-origin (birth) rejection. It is important to note that

LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook

such online mental health benefits seem to be LGBTQ-specific; indeed, in contrast, many media scholars report that online engagement is generally associated with increases in anxiety, loneliness, and social isolation. It is possible that LGBTQ persons are more likely to benefit from online communications than heterosexual persons, as LGBTQ social networking is more focused on redefining cultural narratives and identity development. However, further research is still needed to determine whether these online communication goals generalize to all members of the LGBTQ community or across online communication systems (e.g., Twitter, LinkedIn). In light of this emerging body of research regarding the distinctive nature of LGBTQ online engagement, the present entry will focus on how blogs, vlogs, and Facebook—all of which will be defined below—contribute to LGBTQ community development.

LGBTQ Blogs: A Forum for Collective Action Blogs (short for weblogs), an online network of publicly searchable journals/diaries, have become increasingly popular—with approximately 8 million Americans using blogs to post updates, videos, and links for nearly 57 million American blog readers. Commercial reports indicate that sexual minorities (54%) use social networking and blogs more than do heterosexuals (40%). However, the Pew Research Center has drawn an important distinction between the rates of LGBTQ active, online participation versus readership: For example, while 84% of LGBTQ persons reported reading about LGBTQ issues online, only 16% of LGBTQ persons reported discussing LGBTQ issues online. That being said, sexual-minority respondents are more likely to read blogs about sexual-minority issues (35%) as compared to blogs about politics (22%), music (16%), or travel (16%), suggesting that sexual minorities primarily use blogs as an avenue to address sexual-minority experiences and stress. Moreover, LGBTQ blog use peaks immediately before and during the coming-out period and then steadily declines as the time since initial disclosure increases.

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Israeli counseling psychologists Azy Barak and Meyran Boniel-Nissim of Haifa University have found that blog writing improves self-esteem and reduces social-emotional difficulties for youth at a higher rate than other writing tasks, thereby positioning blogs as a potentially helpful LGBTQ resource. Moreover, online writing allows authors to filter life experiences through narrative lenses that can provide new meaning to challenging events (i.e., sense-making). For example, recent qualitative research exploring online identity integration has found that 61% of American gay men from Christian and Jewish backgrounds make sense of their complex coming-out experiences by authoring blogs—a process often reported to be healing and cathartic. In addition, comingout blogs by gay men wrestling with their sexual and religious identities are often designed to be collaborative—with the majority of bloggers linking their blog to another blog, Google followers, or a Facebook page, or posting the number of times their blog was viewed. Similarly, UK life history researcher Sue George notes that the interactive relationship between the reader/commenter and blogger is the key beneficial factor of coming-out blogging. However, George cautions that once a blog becomes public, it is vulnerable to critical and condemnatory feedback as well. It is important to note that blog use and its benefits may vary between sexual- and gender-minority groups. For example, media scholars report that 83% of youth blogs discussing homosexuality are authored by men, and there is a notable lack of lesbian bloggers. Although researchers have yet to determine the cause for this disparity, it is possible that this is an outgrowth of lesbians feeling marginalized and repressed due to both their gender and sexual orientation—perhaps leading to a general reduction in mediated interaction or an alternative focus and forum. It is additionally possible that these variations in LGBTQ blog use may be culturally specific, as emerging research suggests that Egyptian lesbian and queer women’s blogs are also actively addressing both their personal and political identities. Although differences between Egyptian lesbian/queer women’s and gay men’s blogs continue to emerge, gay men’s blogs have

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largely focused on legal concerns and the freedom from homophobic violence, whereas lesbian/queer women’s blogs have emphasized community building and collective action. In either case, the Middle Eastern queer emancipation movement is largely limited to online, blogging forums—highlighting the need for further research regarding LGBTQ blogging activism across the globe.

Vlogs: A Vehicle for Identity and Cultural Transformation Online communications offers opportunities for individuals to achieve relational goals that may otherwise be beyond their reach (e.g., supportive relationship networks/families of choice). For example, many LGBTQ youth have developed serial video blog streams, otherwise known as vlogs, to make sense of challenging coming-out experiences such as religious conflicts, employment discrimination, difficult family reactions, and social ignorance/prejudice. Vlogs have been defined as a public archive of feelings and a medium of transformation for minority groups struggling to make meaning of stigma and trauma. While vlogs have been used by a diverse range of individuals within the LGBTQ community, the greatest number of LGBTQ-related vlog channels seem to be produced by the transgender community—often referred to as transvlogs. At the time of this writing, a YouTube search for transgender video blogs yielded 6,774 results, illustrating the growing popularity of this medium for the transgender community. Vlogs may be particularly popular within the transgender community due to their longitudinal and serial presentation— the living narratives simultaneously document and contribute to the ever-evolving FtM (female-tomale) and MtF (male-to-female) trans-identity construction. Social media and transgender scholar Tobias Raun also suggests that these online video narratives of transgender development often serve as helpful resources for others struggling with trans-identity concerns. In addition, the selfpublishing nature of vlogs offers transgender individuals an opportunity to assertively develop their community and create change within cultures that

have otherwise silenced them. For example, many transgender vlogs are focused on developing collaborative knowledge regarding medical misinformation, hormone usage, intersecting minority statuses (e.g., gender, sexual orientation, socioeconomic status, and racial/ethnic identity) and the general coming-out process.

LGBTQ Facebook Networks: A Medium of Disclosure A social networking site with an estimated 850 million global users, Facebook enables individuals to (1) construct a public or semipublic profile consisting of photos, links, short status updates, and longer narrative posts; (2) share this profile with select users who are then publicly listed as friends; (3) visit and engage with friends’ profiles; (4) connect to like-minded (i.e., LGBTQ-supportive) groups and organizations; and (5) create and join (“like”) group pages. Similar to most social networking sites, Facebook provides users with a profile template consisting of optional demographic points such as name, date of birth, place of residence, relationship status, and sexual orientation. Facebook users can select privacy controls that enable information to be publicly or privately accessible. While the Pew Research Center reports that 56% of lesbian, gay, bisexual, and transgender (LGBT) persons disclose their sexual/gender orientation on Facebook, the remaining 44% may not feel comfortable posting a sexual orientation status due to the high rates of LGBTQ online bullying—by some estimates, LGBT youth encounter online bullying 3 times as often as their heterosexual peers. In this vein, a recent Gay, Lesbian & Straight Education Network (GLSEN) study reported that 42% of LGBT youth encounter online bullying, and 27% report feeling unsafe online—a problem that can be exacerbated by Facebook’s requirement that users list their legal name. In addition, the rates of social network disclosure seem to differ across LGBTQ groups—50% of gay men and lesbians have come out on a social network as compared to only 34% of bisexuals. In a similar vein, transgender youth

LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook

report higher levels of online victimization compared with gay and bisexual youth. It is possible that such differentials are due to bisexual and transgender persons’ reports of being excluded from both sexual-minority and heterosexual networks. While research focused on LGBTQ Facebook communications is currently limited, Chana Etengoff and Colette Daiute suggest that family allies can productively use Facebook to facilitate their LGBTQ relative’s online and offline disclosure. For example, family members have reportedly attempted to educate hostile relatives by posting endorsements of LGBTQ rights on Facebook. In light of the foregoing, it may be useful for clinicians to incorporate online community participation into the therapeutic process for both LGBTQ clients and their families. However, perhaps due to its relative novelty, social media networks such as Facebook are still not widely used within clinical contexts.

Conclusion Given the increasing popularity of social networks, it is likely that LGBTQ researchers and therapists will begin to focus more attention on LGBTQ online engagement and community building in the coming years. In addition to online networks facilitating interpersonal development (e.g., relational resilience, meaning-making), social media is now playing a pivotal role in political disclosure and debate. For example, Dan Savage’s 2010 “It Gets Better” YouTube campaign quickly garnered celebrity and political attention—culminating in 50,000 videos in support of LGBTQ teens, including videos by President Barack Obama and former Secretary of State Hillary Rodham Clinton. Similarly, Twitter reported a peak of 9,188 tweets minutes after the 2013 repeal of the Defense of Marriage Act, including a victory tweet from President Obama that reached 150 million people. In this way, integrated Internet networks provide collaborative tools for creating new forums for LGBTQ and ally community development. Chana Etengoff and Eric M. Rodriguez

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See also Bisexual People and Community; Bullying, Rates and Effects of; Families of Choice; Media Representations of LGBTQ People; Social Media, Use for Recruitment; Transgender Identities

Further Readings Bond, B. J., Hefner, V., & Drogos, K. L. (2009). Information-seeking practices during the sexual development of lesbian, gay, and bisexual individuals: The influence and effects of coming out in a mediated environment. Sexuality & Culture, 13(1), 32–50. Boniel-Nissim, M., & Barak, A. (2013). The therapeutic value of adolescents’ blogging about social-emotional difficulties. Psychological Services, 10(3), 333. doi:10.1037/a0026664 Etengoff, C., & Daiute, C. (2015). Online coming out communications between gay men and their religious family allies: Family of choice and origin perspective, Journal of GLBT Family Studies, 11(3), 278–304. doi:10.1080/1550428X.2014.964442 George, S. (2011). Blogging bisexuals and the coming-out process. Journal of Bisexuality, 11(2–3), 320–328. GLSEN. (2013). Out online: The experiences of lesbian, gay, bisexual and transgender youth on the Internet. Retrieved November 24, 2015, from http://www.glsen .org/press/study-finds-lgbt-youth-face-greaterharassment-online Harper, G. W., Bruce, D., Serrano, P., & Jamil, O. (2009). The role of the Internet in the sexual identity development of gay and bisexual male adolescents. In P. L. Hammack & B. J. Cohler (Eds.), The story of sexual identity: Narrative perspectives on the gay and lesbian life course (pp. 295–325). New York, NY: Oxford University Press. Harris. (2010). Gay and lesbian adults are more likely and more frequent blog readers. Retrieved November 24, 2015, from http://www.prnewswire.com/news-releases/ gay-and-lesbian-adults-are-more-likely-and-morefrequent-blog-readers-98317299.html Huffaker, D. A., & Calvert, S. L. (2005). Gender, identity, and language use in teenage blogs. Journal of Computer-Mediated Communication, 10(2). MoHo Directory—Gay Mormon Blogs. http://www .mohodirectory.com Pew Research Center. (2013). A survey of LGBT Americans: Attitudes, experiences and values in changing times. Retrieved November 24, 2015, from http://www.pewsocialtrends.org/2013/06/13/a-survey-oflgbt-americans/

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Raun, T. (2014, January 16). Video blogging as a vehicle of transformation: Exploring the intersection between trans identity and information technology. International Journal of Cultural Studies. Retrieved November 24, 2015, from http://ics.sagepub.com/content/early/2014/0 1/13/1367877913513696.abstract#cited-by Shaw, D. F. (1997). Gay men and computer communication: A discourse of sex and identity in cyberspace. In S. Jones (Ed.), Virtual culture: Identity and communication in cybersociety (pp. 133–145). Thousand Oaks, CA: Sage. Walsh-Haines, G. (2012). The Egyptian blogosphere: Policing gender and sexuality and the consequences for queer emancipation. Journal of Middle East Women’s Studies, 8(3), 41–62.

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This entry describes the distinctions between different sexual and gender identities and how the development and navigation of these identities can be different for LGBTQ people of color. It discusses how LGBTQ people of color have to negotiate racism and sexism within mainstream, White, heterosexual-dominant or White LGBTQ spaces, as well as navigate heterosexism, homophobia, and transphobia within ethnic/racial minority communities. It explores the use of an intersectional framework within research and practice, and how LGBTQ people of color experience identity from an intersectional lens, working through multiple and converging oppressions. In addition, the entry discusses how some LGBTQ people of color (particularly gay, bisexual, and queer [GBQ] men of color) may differentially experience oppression, and how GBQ men of color have points of access, privilege, and engagement in patriarchy— which can at times marginalize feminized, woman, and transgender people of color. Moreover, the entry examines how resilience and strength through community engagement, group formation, and political resistance have benefited LGBTQ people of color. Finally, the entry addresses how future research and practice need to (1) increase the visibility of LGBTQ people of color both within academic/practice work and in leadership and

executive roles and (2) further explore LGBTQ people of color’s interpersonal relationships and families.

Identity and Intersectionality Locating and incorporating a common identity language for identifying and describing LGBTQ people within research and practice is important for two key reasons: (1) It allows us to be specific with regard to our population(s) of focus, and (2) it ensures that we are respecting the individually preferred identities and language that identify the people we are seeking to describe and serve. This is particularly true for exploring the lives of LGBTQ people of color, who often must navigate ethnic/racial identity, sexual orientation identity, and gender identity. For some LGBTQ people of color, there may be a desire to distance themselves from mainstream White LGBTQ culture. LGBTQ people of color may do this by choosing to identify using other terms such as “same-gender loving,” “same-gender practicing,” “two-spirited,” or deliberately or inadvertently placing one’s racial or ethnic identity in front of his or her sexual and gender identity (e.g., Black gay man compared to gay Black man; Latina transgender woman compared to transgender Latina woman). In addition, given that the racial and ethnic identities of this population are often lost within a White-dominant LGBTQ culture, LGBTQ people of color may go through an active negotiation of blending or navigating their sexual, gender, racial, and ethnic identities in various spaces and contexts. One construct that can be useful in understanding and exploring the multiple, and sometimes complex, identities of LGBTQ people of color is intersectionality. Intersectionality helps to advance our understanding of the range of human experiences for LGBTQ people of color by allowing for the consideration of various political and social categories, with attention to how all people embody multiple identities and core social statuses. The general concept of intersectionality is in part rooted in the writings of Black and Chicana feminist activists, many of them lesbian identified. Intersectionality, as an academic term, was initially

LGBTQ People of Color

coined by Kimberlé Crenshaw to refer to the sociopolitical position of Black women within U.S. culture in the context of critical race studies, a subfield of legal studies. Although intersectionality has its roots in activism among women of color and academic legal scholarship, subsequent researchers and practitioners have explored intersectionality through terms such as multiple identities, reflecting the more varied ways scholars have examined individuals from multiple (usually minority) groups. These approaches to studying multiple identities examine various levels of the human experience, and offer insights into how people understand, construct, and navigate their lived experiences of both individual and institutionalized oppression. LGBTQ people of color may experience varying degrees of acceptance, as well as oppression and marginalization, from their intersectional communities. The presence of strong religious influence in ethnic communities may account for differential treatment of LGBTQ people of color by community members, given that some religious doctrine has historically been used to justify discrimination against LGBTQ people. For example, the hostile sociopolitical climate for LGBTQ individuals living within some African, Latin American, or Caribbean states that have criminalized or marginalized nonheterosexual or gendernonconforming behavior has historical origins in the religious colonization that was imposed by European states. Assimilation into White mainstream LGBTQ culture also may not be a priority for LGBTQ people of color, as some believe that assimilation renders their ethnic/racial identities invisible. For example, Sylvia Rivera, a Latina bisexual transwoman and transgender activist, and Marsha P. Johnson, an African American transgender activist and drag queen, discussed how the mainstream White gay movement often excluded people of color, transgender and gender-nonconforming individuals, and drag queens and was working to assimilate into heteronormativity. For LGBTQ youth of color, integrating an ethnic/racial identity into their overall sense of self is an important developmental task. Experiencing

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differential treatment in both their ethnic/racial community and mainstream White LGBTQ community may negatively impact ethnic/racial identity development among LGBT youth of color, and may lead young people to conceal aspects of their various identities, depending on the context of their interactions with others. This may result in youth experiencing varying degrees of visibility and invisibility within their own intersectional communities. Researchers have noted this process of LGBTQ concealment among youth of color, as they found that lesbian and gay youth of color may exclude themselves from cultural activities to avoid bringing shame to their families. Other forms of concealment and self-censorship have also been demonstrated among LGBTQ adults, including role flexing, whereby youth intentionally alter their actions, dress, and mannerisms to conform to standards of masculinity (including committing verbal or physical antigay violence toward others); censoring information about their sexuality to others; and avoiding confronting others who made antigay statements. It is important to note, however, that not all LGBTQ people of color manage oppression and marginalization by engaging in identity concealment and self-censorship. Researchers have noted how LGBTQ people of color may challenge heterosexist comments within their communities and develop ties with members of their social support network in order to assist with integrating their sexual orientation and gender identities with their racial/ethnic identity. These instances of ethnic/ racial and LGBTQ identity integration demonstrate the complex ways that LGBTQ people of color may integrate their multiple intersecting identities. Future work in the area of intersectional identities for LGBTQ people of color will benefit from exploring stories of resilience and success, and better understanding the ways in which people navigate and negotiate their multiple identities. Such work should acknowledge changing norms within various communities of color, and recognize that labeling ethnic/racial communities as virulently more homophobic compared to White communities is problematic

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for—and hindering the progress being made within—many ethnic/racial communities.

Multiple Layers of Oppression: Fluidity of Oppression, Access, and Privilege LGBTQ people of color may evidence varying degrees of well-being as a function of their experiences with, and reaction to, multiple forms of oppression related to their sexual orientation, gender identity, and ethnicity/race. Both individuallevel and institutionalized racism, heterosexism, and transphobia may lead to rejection, isolation, discrimination, harassment, violence, and microaggressions, as well as limited economic opportunities and lack of access to ameliorative services. All of these experiences can negatively impact an LGBTQ person of color’s physical and mental health. It is important to continually explore the ways in which societies impose differential sanctions upon their citizens who may be different, and the impact this may have on those individuals and communities. Unfortunately, given the intersectional nature of LGBTQ people of color, they may experience such oppression and sanctions related to different aspects of their identity. Some scholars, for example, have documented the racialized struggles that sex work policy can present for transgender women of color. In addition, racial profiling by police, police brutality, and criminalization/incarceration have had negative and far-reaching effects on the well-being of LGBTQ people of color. For example, HIV-exposure criminalization laws disproportionately affect Black men more often and more severely than they do White men. Although all LGBTQ people may share experiences of oppression related to their sexual orientation or gender identity, their membership in other identity groups (e.g., ethnicity/race, gender, social class) may provide varying levels of social power and privilege that can compound the societal challenges they experience. In addition, the interplay between oppressed and privileged statuses related to gender, race/ethnicity, social class, and sexual orientation has been shown to have differential effects on an individual, depending on the composition and visibility of his or her oppressed and privileged statuses.

When locating men of color within LGBTQ communities, it is helpful to explore how their access and privilege as men and their participation in patriarchy impact the lives of LGBTQ women of color. This examination will not diminish the marginalization that is experienced by gay, bisexual, and queer (GBQ) men of color. Heterosexism, racism, and sexual risk have been studied among gay and bisexual men of color, and there is clear and growing documentation of how GBQ men of color experience oppression and marginalization. However, an examination of sexism, misogyny, and patriarchy within LGBTQ communities of color will hold GBQ men of color accountable for their role in the individualized and institutional oppression of other bodies, particularly feminized, woman, or transgendered people.

Resilience and Strength Among LGBTQ Communities of Color Despite the multiple layers of oppression that LGBTQ people and communities of color may face, there are many narratives of strength and success among LGBTQ people of color. Resilience provides a strengths-based framework for understanding how individuals who are exposed to the threats and risks detailed in the prior section not only survive but thrive in the face of oppressive forces. Resilience has been viewed as a dynamic process whereby a person is able to positively adapt within the context of significant adversity and overcome the negative effects of risk exposure. LGBTQ people of color have promoted resilience through community action, group formation, and political resistance. For example, although Latina lesbians were involved in many of the social activist activities of the gay rights/liberation movement in the 1960s, they began organizing in autonomous groups in the early 1980s in major U.S. cities as a way to show solidarity and to provide support and assistance to each other. Many of these women organized themselves as networks, as opposed to formal organizations that were often viewed as hierarchical, and groups such as Las Buenas Amigas were formed to create a safe space for Latina lesbians to build connections with other Latina lesbians in other parts of the world.

LGBTQ People of Color

Resilience has also been documented among Black GBQ men who used different political and community-organizing strategies to cope with and combat the HIV/AIDS epidemic. The framework of resilience and strengths-based approaches is exceedingly different from deficiency-based approaches that are often employed in research and practice. The latter typically focus only on examining experiences of oppression and marginalization among LGBTQ people of color. While it is necessary to document and interrogate such injustices in order to bring light to situations and circumstances that may otherwise be “swept under the rug” by people in positions of power and privilege, doing so without also celebrating the successes and strengths of LGBTQ people and communities of color presents a biased view that may further serve to marginalize the community. While researchers are expanding the literature that examines resilience within LGBTQ communities of color, more work needs to be done in this area by those in LGBTQ studies, as such work may help to promote resistance against the difficulties faced by LGBTQ people of color.

Future Directions for Research, Theory, Practice, and Social Action Although there has been increasingly more research dedicated to LGBTQ people of color, there is still a need for more work that is geared toward increasing positive outcomes among this community. For example, within public health there are a limited number of empirical studies and interventions that focus on the experiences of GBQ men of color, and this gap increases for lesbians, queer women, and transgender people of color and the health risks that they face. There has also been a lack of scholarship within other LGBTQ studies fields that have brought visibility to the realities faced by LGBTQ people of color. Furthermore, major LGBTQ political organizations and media outlets often fail to account for the diverse experiences of LGBTQ people of color. Major LGBTQ organizations have been criticized for their lack of inclusion of LGBTQ people of color, and they do not always address the specific ethnic/racial issues impacting this community.

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Many religious institutions that serve communities of color, and that are composed of community members, also fail to include LGBTQ people of color within their organizational and community structure. Moreover, inclusion within research, theory, practice, political advocacy, and activism means more than just being aware of, speaking about, targeting, or sampling LGBTQ people of color. It also includes intentionally placing LGBTQ people of color within leadership and executive roles and approaching issues with a more complex framework or understanding. Future research, theory, practice, and social action efforts should not only explore the lived experiences of LGBTQ people of color as individuals, but also examine their multiple and varied connections and relationships with others. The role of interpersonal relationships of all types (e.g., romantic, sexual, friendship, work) among LGBTQ people of color is a fruitful area of inquiry and discovery, including those that involve interactions with people who have shared identity characteristics and those that do not (e.g., interracial romantic relationships). While marriage among LGBTQ people in the United States has become a topic of much public policy and social discourse, future efforts may explore the extent to which these conversations are including LGBTQ people of color and are exploring other ways to socially validate romantic and sexual unions. Viewing interpersonal relationships through an intersectional lens will be helpful in understanding the complexity of such interactions. The navigation of families of birth, and the construction and negotiation of families of choice, is another fruitful area of exploration among LGBTQ people of color. These families may not follow a traditional nuclear family format, and may include various individuals across generations, sexual orientations, gender identities, ethnicities/races, and other identity characteristics. For some, the family unit in its many conceptualizations and permutations can serve as a source of strength, support, and affirmation; while for others it can serve as a source of distress, rejection, and alienation. Thus, it will be important to understand how to best support the creation and maintenance of family structures that will provide the support and nurturance

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needed to promote the resilience and well-being of LGBTQ people of color, especially LGBTQ youth of color. The growing amount of research, theory, and practice targeting LGBTQ people of color is important to creating more sustainable and holistic approaches and models that can eliminate the disparities and inequities experienced by this population. Gary W. Harper, Kenneth M. Pass, and Ryan M. Wade See also African American Sexualities; Latina/o Sexualities; LGBTQ Social Movements (Assimilation vs. Liberation); Racialized Masculinity; Transgender Identities; Transgender Sexualities

Further Readings Bailey, M. M. (2013). Butch queens up in pumps: Gender, performance, and ballroom culture in Detroit. Ann Arbor: University of Michigan Press. Byrd, R. P., & Guy-Sheftall, B. (Eds.). (2001). Traps: African American men on gender and sexuality. Bloomington and Indianapolis: Indiana University Press. Cohen, C. J. (1999). The boundaries of blackness: AIDS and the breakdown of black politics. Chicago, IL: University of Chicago Press. Collins, P. H. (2004). Black sexual politics: African Americans, gender, and the new racism: New York, NY: Routledge. Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 140, 139–167. Gopinath, G. (2005). Impossible desires: Queer diasporas and South Asian public cultures. Durham, NC: Duke University Press. Manalansan, M. F., IV. (2003). Global divas: Filipino gay men in the diaspora. Durham, NC: Duke University Press. Moraga, C., & Anzaldúa, G. (1983). This bridge called my back: Writings by radical women of color. New York, NY: Kitchen Table: Women of Color Press. Reddy, C. (2011). Freedom with violence: Race, sexuality, and the U.S. state: Durham, NC: Duke University Press.

Toro-Alfonso, J., Díaz, N. V., Andújar-Bello, I., & Nieves-Rosa, Luis, E. (2006). Strengths and vulnerabilities of a sample of gay and bisexual male adolescents in Puerto Rico. Revista Interamericana de Psicología, 40(1), 55–64. Tremble, B., Schneider, M., & Appathurai, C. (1989). Growing up gay or lesbian in a multicultural context. Journal of Homosexuality, 17(3–4), 253–267. Wilson, B. D. M., & Miller, R. L. (2002). Strategies for managing heterosexism used among African American gay and bisexual men. Journal of Black Psychology, 28(4), 371–391.

LGBTQ SOCIAL MOVEMENTS (ASSIMILATION VS. LIBERATION) Conflicts over whether to pursue assimilationbased or liberation-based strategies on behalf of LGBTQ communities have consistently arisen in LGBTQ social movements. Assimilationist approaches have been described as seeking to pursue greater rights and access for LGBTQ communities within existing social and political contexts and institutions. In contrast, liberationist approaches have focused on transforming or restructuring society overall, as opposed to working for inclusion in existing institutions. The two approaches contain differences in method, with assimilationists characterized typically as working within existing systems to pursue rights, and liberationists more interested in working outside of existing systems and favoring a broader array of political strategies in pursuit of their goals. These strategies are not necessarily mutually exclusive, with both informing tactics and goals in social movements at various times, sometimes simultaneously. Assimilation and liberation have also taken on evolving meanings at different points in time, depending on social context and other factors. This entry discusses some key contexts in which LGBTQ social movements have grappled with the tension between assimilation and liberation. Examples here will mainly be drawn from movements in the United States, but it should be

LGBTQ Social Movements (Assimilation vs. Liberation)

noted that many of these tensions have been present in other countries, and more globally.

Assimilation Versus Liberation in Early Social Movements “Homophile” (meaning “loving the same”) groups during the 1950s and 1960s addressed discrimination against lesbian and gay people in housing and the workplace, advocated to ensure safer social environments, and engaged with the scientific community about its views of same-sex sexual orientation. These groups generally used approaches aimed at increasing understanding and minimizing differences based on sexual orientation. Although rooted in communist ideology and aspirations toward overarching social reform at its founding in 1951, the Mattachine Society, the leading homophile organization, came to be primarily identified by the late 1960s—like the lesbianfocused Daughters of Bilitis—with the goal of public education in pursuit of social acceptance. Assimilationist tactics of mainstream homophile groups came under scrutiny at the time of the police raids on the Stonewall Inn in New York City’s Greenwich Village on June 28, 1969, and the ensuing resistance, often referred to as the Stonewall Rebellion or Stonewall Riots. Critics challenged Mattachine for seeking to work with law enforcement to end violence following the Stonewall raid. Gay liberation activists, many of whom were connected to the African American civil rights and the anti–Vietnam War movements, sought societal transformation in lieu of pursuing rights within existing institutions. The Gay Liberation Front (GLF) envisioned widespread societal reform in coalition with organizations outside of the LGBTQ sphere. As embodied by Carl Wittman’s “Refugees From America: A Gay Manifesto,” the gay liberation movement relied heavily on the rhetoric of liberation and freedom from oppressive social institutions. The idea of liberation also informed the GLF’s concern with language. Through the GLF’s influence, “coming out” came into common use during this period, referring to the liberatory, public act of

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self-identification as gay or lesbian. This approach broke with homophile groups’ preference for greater privacy to ensure safety for LGBTQ communities. Further manifesting the tension between liberation and assimilation, the Gay Activists Alliance (GAA) was formed in 1969 following the Stonewall Rebellion. The GAA’s founders had grown concerned that the Gay Liberation Front’s alliances across the political left, including with the Black Panther Party and the antiwar movements, undermined the goal of achieving gay rights. The GAA sought to pursue the single issue of gay rights through political organizing within the electoral system rather than through efforts aimed at broadbased societal reform. Although viewed by some (particularly former GLF members) as assimilationist, the GAA used direct confrontation tactics (called “zaps”) in public places to draw attention to its issues. Lesbian feminist organizations emerging in the 1970s, including The Furies and Radicalesbians, drew from the liberation politics of the time to challenge prevailing social institutions. This included critiquing sexism within the gay liberation movement and homophobia within the women’s rights movement. The experience of marginalization led some, but not all, lesbian feminists to advocate for social and political separatism.

Assimilation Versus Liberation in Modern U.S. Social Movements Debates about liberation as compared to assimilation have persisted in issues addressed by modern LGBTQ movements. The following are some key examples. AIDS Activism

Strands of assimilation- and of liberation-based approaches emerged in activism regarding AIDS in the 1980s and 1990s. AIDS activist groups have historically used both insider and outsider tactics to bring public awareness to the AIDS crisis and advocate for public funding, treatment availability, medical coverage, federally controlled and funded

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needle-exchange and condom-distribution programs, sex education, and nondiscriminatory treatment of people with HIV and AIDS. Organizations like the AIDS Coalition to Unleash Power (ACT UP), Lesbian Avengers, and Queer Nation used nonviolent direct-action tactics to draw public attention. Targets of ACT UP’s highly visible protests, for instance, included pharmaceutical companies, hospitals, government agencies, and the Catholic Church to accelerate and broaden access to drugs and drug trials, reduce the price of medication, urge more effective government responses, and push for condom distribution and establish needle exchanges. Other organizations like the AIDS Action Council and the Treatment Action Group (TAG) focused on working directly within the political system to pursue their agendas to create federal policy for improved HIV/AIDS care and services, for effective HIV prevention, and for expeditious and vigorous drug development and research. These efforts included legislative lobbying within established political circles. Some AIDS groups, however, adopted assimilation- and liberation-based approaches simultaneously or over time. For instance, the Gay Men’s Health Crisis (GMHC), founded in 1981, emerged to serve the specifically articulated need for the gay community to serve the gay community. Later, GMHC came to be viewed as an established voice with access to government and influence in policymaking circles. Debates about assimilation and liberation approaches have pervaded questions facing AIDS activists, including how much to associate AIDS with gay people in the public eye, how much to challenge the existing medical care system, and whether to use insider or outsider tactics in AIDS advocacy. Military Policy and Don’t Ask, Don’t Tell

Political debate concerning the status of lesbian and gay people in the military during the 1990s raised questions of assimilation and liberation. President Bill Clinton’s election in 1992 appeared to many as a sign that the ban on lesbian and gay

people serving in the military would be overturned. During his campaign, Clinton had voiced support for lesbian and gay service members and had supported overturning the ban. LGBTQ groups saw the failure to overturn the ban and the compromise Don’t Ask, Don’t Tell policy (signed into law in 1993 and in effect until 2011), which banned lesbian and gay service members from being open about their sexuality, as furthering discrimination in harmfully assimilationist ways. The tension between assimilation and liberation also emerged in the very discussion of whether LGBTQ energy should focus on access to the military in the 1990s. Some, for example, resisted focusing on military access based on concerns that such an agenda reinforced the legitimacy of war and controversial exercises of American military power. Marriage

The contemporary movement in support of same-sex marriage arose against a backdrop of internal discussion about the value of, and tactics in pursuing, same-sex marriage in the context of assimilation and liberation. Individual lesbian and gay people sought legal access to the rights of marriage starting from the early 1970s, but discussions have circulated within LGBTQ movements for the past several decades about the wisdom of pursuing marriage as part of a movement agenda. Many gay liberationists and lesbian feminists of the 1960s and 1970s disfavored pursuing access to marriage, pointing to its associations with heterosexuality and patriarchy and its conflict with more pluralistic notions of kinship and intimate association. In later years, a pair of essays by leaders of the major LGBTQ organization Lambda Legal Defense and Education Fund appeared in Out/ Look National Gay and Lesbian Quarterly in 1989 and encapsulated the debate over assimilation and liberation in the context of marriage. In one essay, Thomas Stoddard, then executive director of Lambda, argued that obtaining access to marriage was key to eliminating discrimination against lesbians and gay people because of the special place of marriage in our social structure.

LGBTQ Social Movements (Assimilation vs. Liberation)

In contrast, Paula Ettelbrick, then legal director of Lambda, questioned the assumption that pursuing marriage would yield benefits for lesbian and gay people. Ettelbrick argued that marriage would threaten lesbian and gay identity and culture by forcing assimilation and would undermine the lesbian and gay movement’s interest in protecting and recognizing a diverse array of relationships. Addressing concerns about inequality between women and men in marriage, some scholars have argued that same-sex couples’ access could transform marriage into a more egalitarian institution. For example, legal scholars William Eskridge and Nan Hunter argued that same-sex marriage would disrupt gender-based patterns and divisions of labor in marriage. These debates about assimilation and liberation continued through the 1990s and 2000s, as marriage took an increasingly prominent place on the agendas of LGBTQ organizations. The call for greater societal transformation beyond marriage took the form of a statement in 2006 titled “Beyond Same-Sex Marriage: A New Strategic Vision for All Our Families and Relationships,” organized by Queers for Economic Justice. The statement, signed by numerous lesbian, gay, bisexual, and transgender activists, as well as scholars, educators, writers, artists, lawyers, journalists, and community organizers, urged the LGBTQ movement to adopt a vision seeking recognition of diverse families, partnerships, and relationships, beyond those fitting the marriage model. On June 26, 2015, the United States Supreme Court issued a decision in the case of Obergefell v. Hodges that extended the right to marry to samesex couples nationwide. The Supreme Court issued its decision based on principles of liberty and equality for same-sex couples. Impacts of the legal change on social movements and on debates about liberation and assimilation remain to be seen.

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and gay movements. Early organized transgender activism took the form of protests against police harassment and discrimination in daily life. One such instance of resistance, the Compton’s Cafeteria Riot in San Francisco in the late 1960s, stemmed from and catalyzed the formation of several transgender organizations, with more organizations emerging throughout the 1970s. These organizations were focused on public education, societal reform, and providing support for transgender individuals. Transgender activists have alternately worked alongside lesbian, gay, and feminist movements and critiqued them for overlooking transgender concerns. Transgender activists Sylvia Rivera and Marsha P. Johnson, who founded the Street Transvestite Action Revolution (STAR) in 1970, experienced this marginalization as part of the GLF and GAA. Transgender activists have criticized the lesbian and gay movement’s assimilative focus on marriage for same-sex couples instead of targeting a variety of forms of oppression. Focusing on classand race-based bias, some transgender activists have faulted mainstream LGBTQ movements for focusing on issues of concern to more privileged Whites, instead of considering the interests of communities of color, the economically disadvantaged, the incarcerated, and other marginalized groups. Additional issues facing the transgender movement implicate tensions between assimilation and liberation. These include the legal and social implications of living in stealth as opposed to being out about being transgender; conforming to binary sex categories; recognition of marriages with transgender partners; and whether being transgender should be viewed as a psychiatric condition, a medical condition, or neither. At stake in each of these disputes are the daily consequences for transgender and gender-nonconforming people regarding important rights, access to meaningful support and institutions, and social and political recognition.

Transgender Identity and Rights

Movements in favor of recognition and rights for transgender and gender-nonconforming people have struggled with debates about assimilation and liberation internally and in relation to lesbian

Bisexual Identity and Rights

Bisexual identity, activism, and scholarship have been viewed as posing challenges to dichotomous (and assimilationist) understandings of sexual

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orientation and identity. Bisexual social organizations founded in the 1970s and more explicitly politically active groups that emerged in the 1980s and 1990s comprised movements focused on greater visibility and inclusion of bisexual communities in society in general, within lesbian and gay political efforts, and within queer studies. The recognition of bisexual identity has been viewed as an important, and liberatory, move away from understanding sexuality in exclusively binary terms, consisting solely of either same-sex orientation on one hand or different-sex orientation on the other. The efforts of bisexual advocacy organizations, activists, and scholars to highlight the experience of bisexuality have challenged “biphobia” and the phenomenon of “bisexual erasure,” whereby bisexuality’s existence is questioned and, relatedly, dismissed as a transitional phase between heterosexuality and lesbian/gay identity. Organizations like the American Bisexuality Institute, founded in 1998, continue to contest bisexual erasure by supporting academic research, including research that confirms the existence of bisexuality. By the mid- to late 1980s, new bi political organizations were aggressively pushing for inclusion, including in AIDS public outreach materials, college organizations, and titles of national marches. With efforts aimed at inclusion meeting resistance (with skepticism focused on perceived benefits of heterosexual privilege enjoyed by some bisexuals and related questions about the legitimacy of bisexuality as an identity), bisexual advocacy organizations in the 1990s like BiNet USA began to succeed in their efforts to convince gay groups to add “B” for “bisexual” to their organization names. The very category of bisexuality, however, has been the subject of dispute even among those who study bisexuality or identify as such. While the concept of bisexuality challenges the dominant model of monosexuality (whether lesbian/gay or heterosexual), some scholars and activists have argued that the continued use of the term bisexual threatens to reinforce rigid categorization of sexual identity. Based on this perspective, the use of the term bisexual may be viewed as a form of assimilation into conventional understandings of

sexual orientation. For some who view the category of bisexual as assimilationist, the term queer presents a productive alternative to binary understandings of sexuality. Queer Identity and Rights

The concept of queerness, and its relationship to other identity categories, has embodied tensions between assimilation and liberation in LGBTQ social movements. Originally used as a pejorative term to refer to same-sex sexuality (used alternately with fairy by the early part of the 20th century, although the terms bore different in-group meanings), queer came to be reappropriated by the 1990s as an act of political resistance by sexualminority groups, including by the activist organization Queer Nation, founded in 1990. For some, the concept of queerness, as reclaimed in the 1990s, served as an alternative to the dominant and limited category of gay and lesbian, providing a more encompassing umbrella for the diverse range of gender- and sexuality-nonconforming identities challenging heterosexual privilege. As an umbrella term, queer has been used to include bisexual, gay, lesbian, and transgender identities. It has also sometimes been used to include intersex communities as well as other sexual identities or practices, such as sadomasochism (S/M), non-monogamy, or asexuality. Some also embrace queer identity as a more liberatory alternative to mainstream sexuality or gender classification or dominant binaries. Queer theorists Teresa de Lauretis, Judith Butler, and Eve Kosofsky Sedgwick, writing in the late 1980s and 1990s, established a basis for understanding identity as untethered from categorical understandings of gender and sexuality. Despite the appeal of queer identity as a broad umbrella or as a discursive alternative to dominant classification schemes, some scholars and activists have raised concerns that the concept of queerness lacks specificity or sufficient content for effective political mobilization. Similarly, some have raised concerns that the more expansive identity category obscures or neutralizes the lived experience of particular minorities who might fall under the mantle

LGBTQ Umbrella

of queer. Since at least the 1990s, scholars have highlighted the need for activism and academic work to examine the intersectional nature of queer experience, as it interacts, for example, with race, ethnicity, class, education, and other aspects of identity. Suzanne A. Kim See also Bisexual Inclusion in the LGBTQ Rights Movement; Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Gender Binaries; Homonormativity; Military and LGBTQ People; Nonbinary Genders; Queer

Further Readings Alexander, J., & Anderlini-D’Onofrio, S. (Eds.). (2012). Bisexuality and queer theory: Intersections, connections, and challenges. New York, NY: Routledge. Bronski, M. (2011). A queer history of the United States. Boston, MA: Beacon Press. Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. Currah, P., Juang, R. M., & Minter, S. (Eds.). (2006). Transgender rights. Minneapolis: University of Minnesota Press. de Lauretis, T. (1987). Technologies of gender: Essays on theory, film, and fiction. Bloomington: Indiana University Press. Eaklor, V. L. (2008). Queer America: A people’s GLBT history of the United States. Westport, CT: Greenwood. Eng, D., Halberstam, J., & Munoz, J. E. (Eds.). (2005). What’s queer about queer studies now? Durham, NC: Duke University Press. Rimmerman, C. A. (2008). The lesbian and gay movements: Assimilation or liberation? Boulder, CO: Westview. Sedgwick, E. K. (1990). Epistemology of the closet. Berkeley: University of California Press. Stryker, S. (2008). Transgender history. Berkeley, CA: Seal Press. Udis-Kessler, A. (1996). Identity/politics: historical sources of the bisexual movement. In B. Beemun & M. Eliason (Eds.), Queer studies: A lesbian, gay, bisexual, and transgender anthology (pp. 53–63). New York, NY: New York University Press.

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LGBTQ UMBRELLA The LGBTQ umbrella is an inclusive term for members of sexual- and gender-minority groups. LGBTQ is an acronym representing lesbian, gay, bisexual, transsexual (or transgender), and queer people, and though this is the most commonly used ordering of the letters, no specific order is necessary. The unifying metaphor of the umbrella has been used to represent a larger community and to combine the efforts of many nonheterosexually and non-cisgender–identifying members in addressing problems affecting the community such as a lack of legal recognition, discrimination, and violence. To this effect, the LGBTQ umbrella has been important in assisting its identifying members to fight for equality. However, in more recent years, the LGBTQ umbrella has come under scrutiny by a more diverse community. The umbrella has been criticized for being exclusionary, Whitedominated, unable to support the needs of its members universally, and for the marginalization of bisexual and trans* issues. Reactions to these criticisms include additional letters in the acronym and using more general terms such as “queer” and “gender and sexual minorities” (GSM). The first umbrella term used for the sexual minority community was the “gay community,” which by the mid-1980s became the “gay and lesbian community.” At first there was resistance to the inclusion of other groups representing sexual and gender minorities for reasons including the desire for a cohesive group message, and some bi- and transphobia. However, bisexuals were added under the umbrella, followed by the trans* communities, in order to strengthen the fight against inequality for all groups, creating the shorthand LGBT acronym that is familiar today. In 1996, the LGBTQ umbrella was born with the addition of a Q to represent people who identified as either queer or questioning. However, the Q primarily represents queer, as it can be used as a catch-all term for other groups that are currently unrepresented in the acronym. Therefore, the LGBTQ umbrella is generally used to include all individuals who feel unrepresented by the current social norms of gender and sexuality.

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LGBTQ Umbrella

The LGBTQ umbrella has been instrumental in bringing about greater equality for those it encompasses, and in the continued fight toward furthering that equality and ending discrimination and violence. LGBTQ umbrella organizations such as GLAD (Gay & Lesbian Advocates & Defenders) and PFLAG (Parents, Families, Friends, and Allies United with LGBTQ People) have done much to further the rights of those they represent, such as removing sodomy laws, fighting for health coverage of transition-related care, defending against discrimination, and supporting marriage equality. By bringing many smaller groups together into a larger, more powerful, and more influential group, the LGBTQ umbrella can be more effective in bringing about change. Although creating a label such as the LGBTQ umbrella has resulted in many positive outcomes, there are also consequences to having a static boundary around any identity. In recent years, the label of the LGBTQ umbrella has come under fire for a variety of reasons, primarily regarding the inclusion of people whose identities are already a part of the LGBTQ umbrella. For example, some have criticized the LGBTQ umbrella for not distinguishing differences between sexual orientation and gender identity. This can be especially difficult for those in trans* communities who feel their concerns are not as commonly addressed by the LGBTQ umbrella and that trans* issues are not an intrinsic part of the LGBTQ movement. Bisexually identified people have also felt unwelcomed in the umbrella because of biphobia within the gay community. In addition, many people of color who identify as LGBTQ feel separated from that community because of the predominance of Whites. Importantly, the LGBTQ umbrella is also confronting the issue of inclusion. There are many sexual- and gender-minority individuals who are not represented with the five-letter acronym. Some have suggested adding letters to account for this, such as the increasingly more common LGBTQIQA, which includes I for intersex, Q for questioning, and A for allies (heterosexually identified people who support LGBTQ causes). However, that does not even scratch the surface of the possibilities for additions such as A for

asexual, F for fetish, H for HIV-affected, 2 for Two-Spirit (people in the Native American tradition who simultaneously have both a masculine and feminine spirit), U for unsure, C for curious, P for Pansexual, P for Polyamorous, an additional T to delineate transsexual and transgender, T for transvestite, and O for other. If all of these groups were included, the result would be LGBTIQQAAFH2UCPPTTO, which many argue defeats the purpose of using an acronym in the first place. Yet even then there are many who are left out such as those who identify as mostly heterosexual, genderqueer, hijra, swingers, sexually fluid, gender fluid, third gender, nonbinary, agender, aromantic, and others. Because of this, the possibility of a non–label-identifying and allencompassing term has been proposed, though none has gained the popularity or has the historical clout of the LGBTQ umbrella. These alternatives include queer, though many remember the use of this term in a derogatory fashion; LGBTQ+, which still has the problem of prioritizing the named groups; gender and sexual minorities (GSM); and most popularly and inclusive, gender and sexual diversity (GSD) or gender, sexual, and romantic diversity (GSRD). Sarah M. Merrill, Matthew C. Stief, and Ritch C. Savin-Willams See also Bisexual Inclusion in the LGBTQ Rights Movement; LGBTQ People of Color; Queer; SexualIdentity Labels; Transgender Inclusion in the LGBTQ Rights Movement

Further Readings Barclay, S., Bernstein, M., & Marshall, A. (2009). Queer mobilizations: LGBT activists confront the law. New York, NY: New York University Press. Fassinger, R. E., & Arseneau, J. R. (2007). I’d rather get wet than be under the umbrella: Differentiating the experiences and identities of lesbian, gay, bisexual, and transgender people. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 19–49). Washington, DC: American Psychological Association.

LGBTQ-Parent Families With More Than Two Parents Stone, A. L. (2009). More than adding a T: American lesbian and gay activists’ attitudes towards transgender inclusion. Sexualities, 12(3), 334–354.

LGBTQ-PARENT FAMILIES WITH MORE THAN TWO PARENTS Although many children are raised by more than two adults who function as parents, the law rarely entertains the possibility that a child could have more than two legal parents. In a stepfamily situation, for example, a child’s custodial parent has remarried and the stepparent may function as a parent. As long as the child also has a noncustodial parent, the stepparent customarily cannot attain the status of a legal parent. Lesbians and gay men may wish to form families with more than two parents in a number of situations. Like children of heterosexual couples, a child raised from birth by a same-sex couple may acquire a stepparent if the parents separate and acquire new partners or spouses. Because partners in same-sex couples do not both have a genetic relationship to their child, it may seem more natural than it is for heterosexuals for a third adult with no genetic connection to the child to assume a parental role. Similarly, lesbians and gay men may embark on parenting with chosen family in circumstances where more than two adults will raise a child together. Because a lesbian couple cannot have a child without semen from a man, and a gay male couple cannot have a child without both an egg from a woman and a woman who will bear the child, the possibility of more than two parents arises for same-sex couples before a child is conceived. A lesbian couple that plans to be their child’s only parents will use semen from an anonymous donor or a known donor who agrees not to be a parent. A gay male couple may similarly choose a gestational surrogacy arrangement in which an egg is obtained from an anonymous donor, and a woman who will bear the child is identified and screened by an agency specializing in such arrangements. Sometimes, however, lesbian couples intend that

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the donor (and perhaps his partner) will also be the child’s parent. Although less frequent, a gay male couple may plan to coparent with a woman who is the child’s genetic and/or birth mother. The legal status of the adults functioning as parents matters for a number of purposes. If there is disharmony among the adults about where the child should live, how much time the child should spend with each adult, who should make major decisions, or who must support the child financially, a court will have to resolve that dispute, and in the process will identify the child’s legal parents. If one adult dies, the child’s eligibility to receive benefits or to inherit may also depend upon whether the deceased was the child’s legal parent. Customarily, legal parentage is an all-or-nothing situation whereby an adult is a parent for all of the above purposes or has none of the rights or responsibilities of a parent. A child can have more than two such parents when a court grants an adoption naming more than two parents or when more than two individuals meet the legal criteria to be declared a parent under a state’s law and the state does not limit the number of parents a child can have. Both of these scenarios remain unusual. There are no published court opinions allowing adoptions that create more than two parents for a child. However, lawyers report that such adoptions have been granted by trial judges in Alaska, California, Florida, Massachusetts, Oregon, Texas, and Washington. It is possible there have been such adoptions in other states; adoption records are sealed and therefore come to light only if someone with knowledge of the adoption reveals it publicly. A small number of statutes authorize a determination that a child has more than two parents. In the District of Columbia, three legal parents are possible when conception takes place through donor insemination. The woman giving birth and the partner with whom she intends to raise the child can agree that they will both be the child’s parents. Although the semen donor is ordinarily not a legal parent, the statute provides that he is if he and the woman giving birth so agree in writing. In Canada, British Columbia has a statute that allows a couple who plan to raise a child conceived

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LGBTQ-Parent Involvement and Advocacy in Schools

through assisted conception to include the egg or semen donor, or the woman who bears the child in a surrogacy situation, as the child’s third parent. All three parents can be listed on the child’s birth certificate. This approach has been rightly criticized because a lesbian couple and a gay male couple may wish to raise a child as four parents, but the law will recognize only three. In 2014, a judge in Brazil determined that the three adults who planned for a child—the birth mother, her female spouse, and the biological father—should all be listed as parents on the child’s birth certificate. In California, a child may have more than two parents if more than two individuals meet the statutory criteria for presumed parental status. A presumed parent includes a person who receives a child into his or her home and holds out the child as his or her own; a biological relationship with the child is not necessary. A judge must determine that it would be detrimental to the child to recognize only two parents. In Delaware, a child with two parents may acquire a third parent if that person meets the statutory criteria to be a de facto parent, which include exercising parental responsibilities for a long enough time to develop a bonded parent– child relationship. The two original parents must consent to the formation of the parent-like relationship. The term de facto parent can be confusing. Although the Delaware de facto parent is a full legal parent, in other states courts have assigned limited parental rights or responsibilities to individuals who may be called de facto parents or may simply meet certain criteria. For example, in a Minnesota dispute over a child conceived with a known donor who was involved in the child’s life, the court awarded joint custody to a biological mother and her former partner and gave visitation rights to the donor. In Pennsylvania, a court resolved a dispute over child support by determining that the biological mother, her former partner, and the semen donor who had been involved in the child’s life were all responsible for supporting the child. In New Jersey, a court awarded visitation rights to a lesbian stepmother who had raised the

child with the biological mother for many years, even though the child had an adoptive mother— the biological mother’s former partner—as well. This is a newly evolving area of law made more complex by the fact that every state establishes its own legal definition of parentage. When more than two adults wish to be considered a child’s legal parents, they should consult an attorney with specialized expertise in this area. Nancy D. Polikoff See also Adoption, Legal Considerations in; Assisted Reproductive Technologies (ARTs); Coparenting; Families of Choice; Joint Adoption; Legal Rights of Nonbiological Parents; Polyamorous Parenting; Second-Parent Adoption; Sperm Donors, Known

Further Readings Bennett, D. (2010, October 24). Johnny has two mommies—and four dads. Boston Globe, p. K1. Jacobs, M. B. (2007). Why just two? Disaggregating traditional parental rights and responsibilities to recognize multiple parents. Journal of Law and Family Studies, 99, 309–339. Joslin, C., Minter, S., & Sakimura, C. (2014). Lesbian, gay, bisexual and transgender family law. Eagan, MN: Thomson West. Kelly, F. (2014). Multiple-parent families under British Columbia’s new Family Law Act: A challenge to the supremacy of the nuclear family or a method by which to preserve biological ties and opposite-sex parenting? University of British Columbia Law Review, 47, 565–595. Lovett, I. (2012, July 14). Measure opens door to 3 parents, or more. New York Times, p. A9.

LGBTQ-PARENT INVOLVEMENT ADVOCACY IN SCHOOLS

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The concepts of parent involvement and advocacy in schools have been widely explored in research and practice, and these terms have been defined in a variety of ways. However, there are key components that characterize meaningful parent involvement

LGBTQ-Parent Involvement and Advocacy in Schools

and advocacy in schools. This entry provides a comprehensive definition for these terms, based on common factors across the literature and the most recent research. Parent involvement in school refers to the active participation in the education of one’s child, including, but not limited to, assisting in the learning process at home and being actively involved in communicating with the child, the school’s personnel, and all other parties involved in the child’s education. Parent involvement is a key component in a child’s academic and emotional success in school. Advocacy in schools describes the act of speaking on behalf of students or parents for the purpose of helping them address their needs and rights in schools. It is important to mention that in addressing advocacy in schools, there are several key parties that play a crucial role, including parents, teachers, administrators, mental health professionals, and other school personnel. As will be explored in this entry, depending on the circumstances, parents could be viewed as advocates (when speaking on behalf of their children or other parents) or the ones being advocated for (when other parents or school personnel stand up for their rights). However, while parent involvement and advocacy are natural for some parents, they are quite challenging for others. For example, some parents avoid questioning school personnel and school district representatives because they fear being perceived as intrusive. Further, some school districts do not allow individual parents to be part of the district’s plans of action, and make it clear that there is a power differential that favors the system and not the parents. In addition, parent involvement and advocacy may be difficult for parents from diverse backgrounds, including LGBTQ parents. Taking into consideration the importance of and barriers to parent involvement and advocacy, researchers and practitioners suggest a series of strategies for being an active parent and advocate. Some of these strategies include partnering with active advocates, networking, and self-education. Partnering with active advocates is a powerful resource for those parents who would like to

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advocate for their children but do not know the best way to do so. Research suggests that partnering with active advocates can provide beginner advocates a voice within the child’s school and the school system while demonstrating how to interact with school personnel in a nonthreatening but assertive manner. In addition, networking, or building relationships with different influential individuals in the school system (e.g., principals, school representatives, and superintendents), will allow school personnel to realize the importance of incorporating parents in the decision-making process regarding policies and rules that directly affect students and their parents, regardless of the parents’ diverse backgrounds. Furthermore, when parents take the initiative to gain greater awareness of the laws, policies, and procedures of the education system, the effect is to lessen the imbalance of power between schools and parents to their mutual benefit, as parents are better able to understand and communicate with education professionals. However, it is important to discuss ways in which school personnel can advocate for students and parents of diverse backgrounds, including LGBTQ parents and their children. According to researchers and practitioners, the most effective way in which schools can advocate for LGBTQ parents and their children is by creating an inclusive school environment and by school personnel becoming active agents of change within the school system. Inclusive school policies lead to safe environments where LGBTQ parents can be active members of the schools their children attend. Also, when schools have policies that are inclusive of LGBTQ individuals, including parents, it is a good indication that the school is invested in the protection of diverse families, which enables LGBTQ parents to have greater security and trust in the school system. In addition, while many states across the United States have laws and policies that protect the rights of LGBTQ individuals, this is not true for all states. Therefore, creating inclusive school policies that protect the rights of LGBTQ parents, regardless of state support toward LGBTQ individuals, can provide a safe haven for LGBTQ-parent families. Moreover, in creating a

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LGBT/Queer Studies Programs

supportive school environment and advocating for LGBTQ parents and their children, some recommendations include displaying LGBTQ-friendly symbols (e.g., rainbow stickers and “safe zone” posters) around the school; incorporating LGBTQ history and literature within the school curriculum, with the goal of challenging stereotypes that are oppressive toward LGBTQ individuals (including parents and their children); joining LGBTQ national organizations that could provide reading and other education materials for school libraries; and creating clubs and other extracurricular activities to allow the school community to discuss LGBTQ issues. Becoming an active agent of change is perhaps the most important step toward parent involvement and advocacy of LGBTQ parents and their children. Within a system that values the traditional family unit of one cisgender (someone who conforms to the gender he or she was assigned at birth) mother and one cisgender father, school personnel can provide a strong voice in advocating for LGBTQ parents and their children. However, advocacy is a collaborative effort that must be a priority for all school personnel, from the district superintendent and staff to individual school members. Research suggests that school districts would be well served by creating mandatory workshops for all school personnel in order to explore and understand issues that affect LGBTQ people and ways in which school personnel can advocate for these families. Also, considering that school districts play a crucial role in how curricula for all subject areas are presented, school districts could become essential advocates of LGBTQ parents by mandating schools to showcase LGBTQ individuals in a positive and celebratory manner. At a school level, principals and other administrative staff, as the most influential leaders within the school, can set an example by providing opportunities for LGBTQ parents to be active members of the school and have a voice in the implementation of policies that directly affect LGBTQ individuals (e.g., students and families) within the school. In addition, teachers play a crucial role in parental involvement and advocacy of LGBTQ parents, as they interact directly with students and parents on

a daily basis. Teachers could advocate for LGBTQ parents and their children by inviting parents to visit their classrooms and collaborate on lesson plans that explore diversity, such as LGBTQ issues. Furthermore, teachers could advocate for LGBTQ parents during parent–teacher conferences by validating LGBTQ parents’ experiences and becoming an ally in advocating for their rights within the school system. Finally, other school staff, such as secretaries and teaching assistants, could promote parent involvement and advocacy by getting to know LGBTQ parents and inquiring about how to better make their experiences more pleasant within the school and school system. Roberto L. Abreu and Alicia L. Fedewa See also Home–School Partnerships in LGBTQ-Parent Families; Schools as Heteronormative Spaces

Further Readings Byard, E., Kosciw, J., & Bartkiewicz, M. (2013). Schools and LGBT-parent families: Creating change through programming and advocacy. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 275–290). New York, NY: Springer Science+Business Media. doi:10.1007/978-1-4614-4556-2_18 Lamme, L. A. (2001). Welcoming children from gay families into our schools. Educational Leadership, 59(4), 65–69. Rapp, N., & Duncan, H. (2012). Multi-dimensional parental involvement in schools: A principal’s guide. International Journal of Educational Leadership Preparation, 7(1), 1–14.

LGBT/QUEER STUDIES PROGRAMS This entry briefly describes the origins of lesbian, gay, bisexual, and transgender (LGBT)/queer studies as an academic field as well as the development of specific academic programs in LGBT/queer studies and the debates over the naming of the field. It then turns to the current state of the field, outlining the extent of available academic programs

LGBT/Queer Studies Programs

and discussing both the growing acceptance of LGBTQ issues in academia as well as some of the recent controversies the field has experienced.

Origins of the Field LGBT/queer studies is an interdisciplinary field of academic study that has as its focus the experiences and ideas of LGBT/queer people and communities. Queer studies emerged in the 1960s and 1970s, with the first scholarly journals, conferences, and college courses specifically focused on homosexuality coming into being during those decades. Initially, the field was called gay studies, and later gay and lesbian studies, while queer studies programs did not come into being until the 1980s. These name changes reflect broader political debates within LGBTQ communities: Just as in LGBTQ communities more generally, the exact terminology individuals prefer to use to refer to this field as well as who exactly is contained within its boundaries are contested topics. Thus, the initial focus on gay studies left many lesbians feeling excluded. The expanded title of gay and lesbian studies was challenged as limited and exclusionary by scholarship on bisexual and transgender people and scholars who identified as such. Queer studies as a title seemed to represent a more inclusive category, permitting consideration of a wide variety of concepts and ideas that might not have fit under the LGBT umbrella, such as non-normative heterosexual sex practices. But it is exactly this inclusivity that is seen as problematic by some scholars, who do not want to see the field’s original focus on gay and lesbian lives diluted. Today, although many students and scholars use the field’s different names interchangeably, these different names do suggest a slightly different research and teaching focus. Gay and lesbian studies focuses more on assimilation; equal rights; the naming and claiming of sexual self-identity; and the inclusion of gay and lesbian people and themes in studies of literature, history, and culture. In contrast, queer studies is more radical and involves strong linkages to postmodernism, a critique of sexual and political conventionality, gender and

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sexuality fluidity and inclusion, sexual power, and the deconstruction of categories. Queer studies tends to draw heavily on the concepts, texts, and ideas of queer theory. Of course, in real life, many scholars and academic programs do work that transcends these distinctions. Queer studies exists both as a broader field of study and as a specific academic program at some colleges and universities. The first major in gay and lesbian studies was established at San Francisco City College in 1989, and that program hired the first full-time, tenure-track faculty member in gay and lesbian studies in 1991. While a number of colleges and universities developed minors and other academic programs through the 1990s and 2000s, such programs have remained rare, and full academic majors are even less common. As of 2014, less than a dozen colleges and universities in the United States and Canada offer full majors in queer studies or closely related fields, including “sexuality studies” programs that may offer only a minority of coursework in queer studies areas. More common are minors, certificates, concentrations, or other programs—well over 50 such programs exist in North America as of 2014. While graduate programs in queer studies remain rare, a handful of North American colleges and universities, and at least two in the United Kingdom, allow students to formally specialize in queer or sexualities studies.

The Current State of Queer Studies Today, students interested in queer studies often find courses and faculty in other fields, such as women’s and gender studies, sociology, and literature, that help them pursue their academic and intellectual goals even in the absence of formal academic programs in queer studies on their campuses, and most humanities and social science fields permit graduate students to focus their research on LGBTQ issues. This openness to LGBTQ experiences and topics has been one of the most important accomplishments of queer studies. Specifically, the emergence of queer studies brought LGBTQ experiences into college classrooms and academic scholarship—especially scholarship

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Living Arrangements of Children After LGBQ Divorce/Separation

concerned with issues other than sex acts themselves—and helped legitimize academic research on LGBTQ topics. Despite this growing acceptance of LGBTQ issues in both the classroom and academic research, queer studies has continued to face opposition from both inside and outside the academy. Opponents of queer studies sometimes argue that the course topics divert attention from the traditional canon, that programs are too radical or use unusual pedagogical methods, or that queer studies is not appropriate preparation for high-demand career fields. In addition, social conservatives worry that queer studies coursework exists to “convert” young people to “the homosexual lifestyle.” These critiques have kept queer studies out of conservative—especially religious—colleges and universities and have led to funding battles for some public colleges and universities. For example, two institutions in South Carolina selected books with gay or lesbian themes as texts to be used in common reading programs for all first-year students in 2014, and the state legislature responded by passing legislation reducing both institutions’ budgets. Queer studies has also faced territorial struggles within the academy. Since queer studies is an interdisciplinary field, it draws its concepts, methods, and scholars from a wide variety of disciplines, especially those in the social sciences and humanities. Given the increased willingness of traditional disciplines, and of women’s and gender studies, to focus on LGBTQ issues and experiences in their own coursework and scholarship, queer studies programs sometimes have to fight for students, funding, and even survival. Yet despite these difficulties, queer studies programs have continued to emerge and grow. Queer studies programs and scholarship are vital to ensuring that LGBTQ experiences, identities, and issues are not marginalized in the academy. Mikaila Mariel Lemonik Arthur See also Activists in College; College Students; Disciplinary Tensions in Studying LGBTQ Populations; Psychological Approaches to Studying LGBTQ People; Queer Theory; Transgender Inclusion on College Campuses

Further Readings Arthur, M. M. L. (2011). Student activism and curricular change in higher education. Surrey, England: Ashgate. Dynes, W. R. (1993). Queer studies: In search of a discipline. Academic Questions, 7(1), 34–52. Gross, L. (2005). The past and the future of gay, lesbian, bisexual, and transgender studies. Journal of Communication, 55(3), 508–528. Halberstam, J. (2003). Reflections on queer studies and queer pedagogy. Journal of Homosexuality, 45(3/4/5), 361–364. Minton, H. L. (1992). The emergence of gay and lesbian studies. Journal of Homosexuality, 24(1/2), 1.

LIVING ARRANGEMENTS OF CHILDREN AFTER LGBQ DIVORCE/SEPARATION In cases of lesbian, gay, bisexual, or queer (LGBQ) divorce or separation, family living arrangements involve difficult, stressful, and often ambiguous decisions attached to child custody. Types of custody include sole, joint legal, and joint physical, and custody determines children’s living arrangements. Courts often decide custody and living arrangements on the basis of parental income, children’s age, children’s needs, fitness of parents, home environment stability, proximity, and other factors that aim to serve “the best interest of the child.” During LGBQ divorce or separation proceedings, custody has usually been determined outside of the courtroom, and often on the basis of the parents’ biological relatedness to the child. With the introduction of same-sex marriage and legal partnership recognition, however, living arrangements are increasingly determined inside the courtroom. This entry discusses the ways in which LGBQ couples have decided the living arrangements of children after a divorce or separation. Parental rights within same-sex couples often hinge on the presence or absence of biological ties between parent and child. Most children in LGBQ families result from one or both partners’ previous heterosexual relationships or marriages. In cases of

Living Arrangements of Children After LGBQ Divorce/Separation

alternative insemination and gestational surrogacy, the biological parent—often referred to as the birth mother in research on two-mother, lesbian-parent families—is afforded the same legal and social ties to children as heterosexual biological parents. Likewise, in cases of surrogacy among gay men, the biological father is granted automatic parental rights. Nonbiological parents instead create ties to children through legal means (e.g., marriage, second-parent adoption) or demonstrate their ties to children through more informal methods (e.g., taking on last names, legal guardianship). In cases of adoption, neither parent has a biological connection to the child. Often, it is a singleparent adoption or joint adoption. Single-parent adoption often occurs in cases where state law prohibits same-sex couple adoption or individual adoption agencies are unwilling to place children in a same-sex parent household. Here, parents must decide which parent will legally adopt the child or children—a decision that is often made on the basis of income, each partner’s respective desire to have children, or anticipated caregiving arrangements (i.e., who will be the primary caregiver for the child).

Living Arrangements in LGBQ Divorce or Separation Living arrangements in the aftermath of LGBQ divorce or separation are understudied, and most research in this area has been conducted on lesbian mothers. Of the existing research on lesbian mothers, most mothers had an amicable breakup and the non–birth mother often maintained contact with the birth mother and child. As found in heterosexual divorce literature, post-LGBQ divorce living arrangements and parent–child contact varied. Some instances of same-sex parent divorce resulted in joint or shared custody, allowing children to split time spent in each household equally between the birth and non–birth mothers; others resulted in the birth mother restricting contact between the child and the non–birth mother. On rare occasions, the birth mother relinquished responsibility for the child, and the child lived with the non–birth mother full-time.

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Over time, postdivorce living arrangements may change. Some families have stayed in the same geographical proximity, living around the corner from each other, while other families have had one expartner or spouse move away. When there was more than one child, children’s living arrangements were often dependent on parent–child biological relatedness, such that children remained with their biological mother and former siblings were raised in separate households. In most lesbian-mother households, both mothers repartnered or remarried after divorce or separation. Therefore, children’s living arrangements can become more complicated after LGBQ divorce, as new partners may mean the possibility of a new geographical location or of creating a new stepfamily, and introducing new siblings. Few studies have explored how new LGBQ family formation can impact postdivorce living arrangements. Because research on gay fathers’ divorce is essentially nonexistent, our knowledge of living arrangements comes from personal stories and anecdotes. For decades, gay fathers have decided children’s living arrangements through informal arrangements, but in recent years they are increasingly turning to the courts. Children rarely live with the nonbiological parent, especially after a nonamicable breakup.

Parental Rights In same-sex partner dissolution between unmarried LGBQ parents, living arrangements have been most often decided through informal conversations, with the biological parent taking primary custody and agreeing to grant the nonbiological parent visitation or shared living arrangements. While judges have decided living arrangements based on a variety of factors, and sometimes considered nonbiological parents’ parental involvement in their ruling, nonbiological and nonlegal parents ultimately have no legal claim to the child. For those couples with access to second-parent adoption or joint adoption, both parents have legal ties to the child; thus, second-parent and joint adoptions are ideal to ensure both parents have rights.

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Long-Term Same-Sex Couples

In same-sex divorce, the nonbiological parent is granted the same rights as the biological parent. By having entered into a legal marriage, the nonbiological parents gained legal standing in divorce proceedings to request and negotiate for children’s living arrangements. Moreover, these parent–child ties are legally equivalent to biological relatedness, granting nonbiological parents equal say. Although same-sex marriage is now legally recognized in all U.S. states, access to divorce can be restricted due to varying state laws; this variation can complicate a seemingly straightforward divorce.

Implications Determining the living arrangements in the aftermath of an LGBQ divorce or separation has legal, economic, and psychological consequences for all family members. Having contact with both parents and amicable terms of divorce positively impact children’s psychosocial well-being. For mothers in nonamicable divorces, a drawn-out battle to determine contact and living arrangements has psychological and emotional consequences. In the absence of legal protections, nationwide second-parent or joint adoption, and alternative avenues to establish parentage without marriage, nonlegal and nonbiological parents have been cut off from their children. Indeed, these mothers have experienced ambiguous loss (i.e., a sense of emotional and physical fracturing of the family) with few, if any, ways of connecting with their children. Living arrangements in the aftermath of LGBQ divorce hinges on both social institutions and interpersonal relationships. Researchers and scholars point to the important role that formal predivorce agreements play in determining custody, and the increased use of the judicial process, to determine the “best interests of the child.” Emma C. Potter and Katherine R. Allen See also Child Support After LGBQ Divorce/Separation; Coparenting; Custody and Litigation, LGBQ Parents; Divorce, Legal Issues in; Legal Recognition of Nonmarital Same-Sex Relationships; Legal Rights of Nonbiological Parents

Further Readings Beekman, J. C. (2012). Same-sex marriage: Strengthening the legal shield or sharpening the sword—The impact of legalizing marriage on child custody/visitation and child support for same-sex couples. Washington and Lee Journal of Civil Rights and Social Justice, 18, 215–252. doi:10.2139/ssrn.1840749 Gartrell, N., Box, H., Peyser, H., Deck, A., & Rodas, C. (2011). Family characteristics, custody arrangements, and adolescent psychological well-being when lesbian mothers break up. Family Relations, 60, 572–585. doi:10.1111/j.1741-3729 .2011.00667.x Goldberg, A. E., & Allen, K. R. (2013). Same-sex relationship dissolution and LGB stepfamily formation: Perspectives of young adults with LGB parents. Family Relations, 62, 529–544. doi:10.1111/ fare.12024 Haney-Caron, E., & Heilbrun, K. (2014). Lesbian and gay parents and determination of child custody: The changing legal landscape and implications for policy and practice. Psychology of Sexual Orientation and Gender Diversity, 1, 19–29. doi:10.1037/ sgd0000020 National Center for Lesbian Rights. (2014). Legal recognition of LGBT families. Retrieved November 24, 2015, from http://www.nclrights.org/wp-content/ uploads/2013/07/Legal_Recognition_of_LGBT_ Families.pdf

LONG-TERM SAME-SEX COUPLES Recent data indicate that the average relationship duration for same-sex couples is just under 13 years. This entry provides details on the experiences of long-term (roughly defined as 5 years or longer) same-sex couples by presenting information on (1) demographic characteristics of samesex couples in the United States; (2) families of same-sex couples; (3) relationship quality and relationship dynamics in long-term same-sex couples; (4) relationship stability and dissolution; (5) same-sex relationships and health; and (6) some of the unique challenges faced by aging same-sex couples, particularly in relation to health.

Long-Term Same-Sex Couples

Demographic Characteristics of Same-Sex Couples In the 2013 American Community Survey, there were over 726,000 same-sex couples in the United States, with 34.6% of those couples describing themselves as married. As a result of the Supreme Court’s June 2015 ruling, the option of marriage for same-sex couples has become available not just in some states but nationwide, and these legal changes mean that the percentage of same-sex couples that are married is rapidly increasing. However, due to past legal barriers to marriage for same-sex couples, most long-term same-sex couples are now in cohabiting unions. About a quarter of same-sex couples in the United States have been together for 10 years or longer. The average age of people in same-sex unions is about 44, whereas the average age of heterosexual couples is about 50. In addition, same-sex partners are more educated than individuals in heterosexual couples; 2011 data show that about 46% of same-sex couples and 32% of heterosexual couples had a college degree.

The Families of Same-Sex Couples Many same-sex couples have children. Women are more likely than men in same-sex relationships to be raising children; about 48% of women and 20% of men live with a child under the age of 18. One reason that women in same-sex couples are more likely to be raising children is that many of these women had children in heterosexual marriages, and women are more likely than men to retain primary custody of their children following divorce. The pathways to parenthood for same-sex couples have changed over time, with younger couples more likely to become parents through adoption or surrogacy, whereas most older couples became parents through prior heterosexual unions. Same-sex partners tend to be more egalitarian than heterosexual partners when it comes to sharing parenting tasks and responsibilities. Same-sex and heterosexual parents are similar in their overall levels of mental health and in providing a supportive environment for raising children, but some

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research has found that same-sex parents are less likely than heterosexual parents to use physical punishment as a way to discipline children. Although there have been heated debates over the effects of having gay or lesbian parents, the preponderance of the research evidence indicates that children of gay and lesbian parents are similar to children of heterosexual parents on social, psychological, and achievement outcomes. Because of their sexual-minority status, individuals in same-sex relationships are more likely than those in heterosexual relationships to have strained ties with their families of origin. Relationships with families of origin may improve as more same-sex couples are able to marry in the United States. Marriage holds tremendous symbolic value that may help families of origin to more fully embrace the same-sex relationships of their family members. Although same-sex partners may, on average, have more strained relationships with their families of origin, most people in same-sex relationships are involved with their own parents, as well as their partner’s parents. Indeed, men and women in same-sex relationships typically play an important role in caring for their aging parents. Whereas it is primarily women in heterosexual relationships who provide care for aging parents and their parents-in-law, men and women in samesex relationships are more likely to share in the work of providing care for each other’s parents. Although long-term same-sex couples are less likely than their heterosexual counterparts to have children and more likely to have strained relationships with their families of origin, same-sex couples often have extremely close and supportive ties with friends who are considered their “families of choice.”

Relationship Quality and Dynamics of Same-Sex Couples Same-sex and heterosexual couples are similar in many ways, including their overall relationship happiness and satisfaction, levels of conflict, and reasons for conflict. But same-sex and different-sex unions differ in several ways, including the division

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Long-Term Same-Sex Couples

of household labor and sharing of parental responsibilities, with greater equality in same-sex unions. This greater equality may occur because the gender difference between the members of heterosexual couples produces differences between partners’ values and their approaches to relationships. In contrast, the gender similarity in same-sex partners may produce similarities in these dimensions. Same-sex partners also report more satisfaction with their sexual relationships and less conflict about their sex lives than heterosexual couples. Male same-sex couples are more likely than female same-sex couples or heterosexual couples to permit sexual encounters outside the primary relationship, and report little conflict about such encounters. Yet recent studies suggest that the majority of men in long-term same-sex relationships are sexually monogamous, even if they espouse permission for sexual affairs. Same-sex and heterosexual couples are similar in that they tend to experience declining sexual frequency over time, yet they also report increasing emotional intimacy. Despite such increases in emotional intimacy, overall levels of relationship satisfaction tend to diminish over time for both same-sex and heterosexual long-term couples. Many of the differences between the relationship dynamics of same-sex and heterosexual couples are driven by gender. For example, compared to men, women generally place more value on sharing personal thoughts and feelings with their partner as a way to promote emotional intimacy— regardless of whether they are in a relationship with a man or a woman. Hence, same-sex female couples often have higher levels of intimate disclosure than either male–male or heterosexual couples, because of the presence of two women in the relationship. Also, because women tend to value sharing of feelings, women involved with other women report agreeing about the importance of monitoring each other’s feelings and talking about those feelings, whereas women involved with men report more disagreement with their partners about how to achieve emotional intimacy. While stereotypes have sometimes painted same-sex relationships as deficient in comparison

with heterosexual relationships, the preponderance of evidence suggests that this is not the case. However, one distinct area of disadvantage for same-sex partners is higher levels of stress that can take a toll on their intimate relationships. Individuals in same-sex relationships, particularly those in long-term relationships that were formed during a period of greater intolerance and discrimination regarding sexual minorities, have faced higher levels of sexual-minority stress throughout their lives. Thus, same-sex couples must cope with sexualminority–related stressors in addition to the typical life stressors that all couples face.

Relationship Stability and Dissolution Although same-sex cohabiting couples are more likely than heterosexual married couples to break up, they are not more likely to break up than heterosexual cohabiting couples. This supports the view that legal marriage serves as a general barrier to dissolution for all couples, and that the availability of legal marriage to same-sex couples will contribute to greater relationship stability. Other factors associated with more stable same-sex relationships include older age, more education, and living in a state that provides legal recognition to same-sex couples. Although a vast literature shows how difficult divorce is for heterosexual couples (with adverse effects on financial resources, psychological well-being, and health), the effects of divorce (or breakup) on long-term same-sex partners is not yet documented. An overlooked issue for many same-sex couples is the loss of a long-term relationship when one partner dies. Most same-sex partners, even those who have been together for many years, historically have not had the protections offered by legal marriage, thus they have often faced legal barriers to inheritance of shared property and financial assets. This occurs at the same time that they are dealing with the loss of their most important relationship, a relationship that may not have been acknowledged by others. The death of a long-term partner is the most stressful life event that the majority of people ever

Long-Term Same-Sex Couples

experience, and acknowledgment and support from others are especially important following this loss.

Same-Sex Relationships and Health Involvement in close relationships benefits health and even reduces mortality risk. Of all close relationships that have been studied, the marital relationship seems to be most beneficial to health and longevity, but studies documenting this association have considered only heterosexual marriages. A growing body of evidence points to the health benefits of involvement in same-sex relationships. National data show that individuals in same-sex and heterosexual cohabiting relationships are healthier than unmarried individuals, although cohabitors are not as healthy as married heterosexuals. Marriage may benefit health more than cohabitation because marriage provides greater access to health insurance and other resources that enhance health. Marital relationships may be particularly important for the health of sexual-minority populations given that sexual minorities experience elevated risk of depression and anxiety, less frequent use of preventive health services, and poorer overall health than heterosexuals. Accordingly, therapists and medical professionals need to be aware of the relationship experiences of longterm same-sex couples, experiences that are characterized by unique resources and challenges that have real consequences for the health and wellbeing of men and women. Long-term same-sex partners may influence each other in a number of ways that promote health and longevity, through shared and reciprocal processes that operate similarly for men and women in same-sex couples. For example, samesex partners may encourage each other to engage in healthier eating and exercise habits, and they may engage in these behaviors together. This is in contrast to heterosexual couples, where partners are much less likely to describe this kind of teamwork. In heterosexual relationships, a more onesided process often occurs in which women try to influence men.

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Aging Same-Sex Couples The longest-term same-sex couples tend to be middle-aged or older, and this is a period in the life course when chronic conditions and significant health concerns are more likely to emerge. A committed relationship with a supportive partner may be even more important with advancing age because of age-related increases in health problems and disability rates. The percentage of same-sex couples including a senior (aged 65 or older) has increased over time to a current rate of nearly 10%. In addition, while about 10% of individuals in same-sex and heterosexual relationships are disabled, same-sex couples are twice as likely as heterosexual couples to have only one partner with health insurance. Despite these demographic facts, issues of aging and health are an unaddressed problem for many same-sex couples. When they experience significant health problems, same-sex partners (like heterosexual partners) are more likely to rely on each other rather than someone outside their relationship. This makes nationwide legality of same-sex marriage even more significant, as medical care facilities have often restricted a patient’s access to one’s spouse or immediate family. A partner’s participation in health care and health care decisions benefits the health and wellbeing of the patient and reduces stress for both partners. Debra Umberson See also Aging, Social Relationships, and Support; Couples Therapy; Defense of Marriage Act (DOMA); Marriage Equality, Effects on Well-Being and Relationships

Further Readings Goldberg, A. E. (2013). “Doing” and “undoing” gender: The meaning and division of housework in same-sex couples. Journal of Family Theory & Review, 5, 85−104. Kurdek, L. A. (2006). Differences between partners from heterosexual, gay, and lesbian cohabiting couples. Journal of Marriage and Family, 68, 509–528.

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Rosenfeld, M. J. (2014). Couple longevity in the era of same-sex marriage in the United States. Journal of Marriage and Family, 76, 905–918. Rothblum, E. S., Balsam, K. F., & Solomon, S. E. (2011). The longest “legal” U.S. same-sex couples reflect on their relationships. Journal of Social Issues, 67, 302–315.

Umberson, D., Thomeer, M. B., & Lodge, A. (2015). Intimacy and emotion work in gay, lesbian, and heterosexual relationships. Journal of Marriage and Family, 77(2), 542–556. U.S. Census Bureau. (2013). American Community Survey 1-year data file. Retrieved November 24, 2015, from https://www.census.gov/programs-surveys/acs/

M MARRIAGE, REASONS AND AGAINST

Among these are reasons related to civil equality, politics, parenting, and social and interpersonal relationships.

FOR

Civil Equality. The most common reasons offered by LGBTQ people for being in favor of legal recognition of same-sex marriage can be covered under the umbrella of civil equality. LGBTQ people describe feeling like “second-class citizens” when and where their romantic relationships have not been eligible for the same civil recognition as male–female couples, prior to the June 2015 Supreme Court decision legalizing same-sex marriage nationwide. In many locations, this “secondclass citizen” status has meant that same-sex couples were not eligible for tax benefits, parental rights, spousal insurance benefit coverage, shared property benefits, proxy medical decisions, and other civil and legal rights afforded to male–female married couples. Legally recognized same-sex marriage eliminates the unequal treatment of same-sex and male–female married couples under the law. Thus, many LGBTQ people see same-sex marriage as a tool to gain civil equality.

This entry describes the reasons that LGBTQ people are for or against same-sex marriage. First, it describes the reasons that LGBTQ people offer for being in favor of marriage as a legal option for same-sex couples and/or their decision to marry. The entry then describes reasons that LGBTQ people offer for being against marriage as a legal option for same-sex couples and/or their decision not to marry. Although much of the findings discussed in this entry apply to LGBTQ people, it should be noted that transgender individuals, bisexual individuals, and individuals who identify as queer are sampled less frequently in the research literature than are people who identify as lesbian or gay. Distinctions by LGBTQ identity are noted when literature explicating differences by identity is available.

Reasons for Being in Favor of Same-Sex Marriage

Political Reasons. LGBTQ people also cite political reasons for being in favor of same-sex marriage. Many LGBTQ people have seen universal legal recognition for same-sex marriage as an important goal of the LGBTQ rights movement, and they support same-sex marriage as a continuation of the overall political movement in support of LGBTQ

LGBTQ people may be in favor of same-sex marriage or may decide to get married for various reasons depending on each person’s individual experiences. However, the research on LGBTQ people’s opinions about and experiences with same-sex marriage suggests some common reasons that they may be in favor of same-sex marriage. 729

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people. They have described marriage as a way to be “counted” not just as couples, but as people who have an important voice in the political debates and decisions of their communities. Marriage has also been described by LGBTQ people as a tool in the politics of visibility in which being identified as LGBTQ is seen as a way to increase political awareness of LGBTQ needs and decrease discrimination against LGBTQ people. In addition, LGBTQ people who favor marriage often do so in the face of political movements to impose restrictions on same-sex relationship recognition. Thus, LGBTQ people have often supported same-sex marriage in order to defeat proposed same-sex relationship recognition restrictions that have been shown to have negative psychological, financial, and health effects on LGBTQ people and their families. Raising Children. Another common set of reasons that LGBTQ people give for being in favor of same-sex marriage relates to having and raising children together. First, same-sex marriage may make it easier for LGBTQ people to become parents. Without the civil and legal recognition provided by same-sex marriage, same-sex couples may encounter difficulties with becoming legal guardians, becoming foster parents, adopting a partner’s child or a previously nonrelated child, working with a surrogate, or accessing donor insemination through clinic- and hospital-based services. LGBTQ people have also reported the belief that being married will make same-sex parents more visible and more accepted by society. Further, having married parents is believed by LGBTQ people to benefit the children, in that the family will be more easily defined, accepted, and supported by peers and society in general. Social Reasons. A fourth category of reasons that LGBTQ people offer for being in favor of same-sex marriage are social reasons, which are those related to perceptions of and meaning assigned to LGBTQ individuals and same-sex relationships in society and within social networks. One social reason that LGBTQ people are in favor of same-sex marriage is because marriage functions as a way of defining the same-sex couple within society. In other words, being legally married is seen as transferring a type

of legitimacy, respect, and social identity to samesex couples. Further, marriage is seen by some LGBTQ people as a mechanism for positively affecting the ways that same-sex couples are perceived and situated within their social networks, which may include family, friends, acquaintances, and coworkers. For example, LGBTQ people sometimes explain that marriage is a way for samesex couples to be more accepted by their families of origin. Some LGBTQ people also believe that marriage will enable the committed relational status of same-sex partners to be more readily understood and more respected by LGBTQ and non-LGBTQ friends, coworkers, and acquaintances. Relationship Reasons. LGBTQ people are also in favor of same-sex marriage for interpersonal or relationship-related reasons. For example, the belief that same-sex romantic love and commitment should be recognized and valued is one reason that LGBTQ people support same-sex marriage. In addition, feelings of love for one’s partner and the desire to formally and publicly express that love are often cited as reasons that LGBTQ choose to marry. Long-term same-sex couples have described marriage as a way to confirm their love and commitment to one another. LGBTQ people also offer religious reasons for supporting same-sex marriage. Same-sex marriage is viewed as a way to have one’s relationship blessed and supported within a religious community and within a religious belief system. Religious LGBTQ people who choose to get married have described positive feelings of fulfillment and completeness in terms of both their faith and relationship. Finally, LGBTQ people have expressed support for same-sex marriage because getting married is seen as an important stage in a person’s life and relationship. In this sense, marriage is a way of fulfilling a relational script that leads from courtship to marriage.

Reasons for Being Against Same-Sex Marriage A minority of LGBTQ people do not support same-sex marriage. Their reasons for nonsupport include political concerns, identity concerns, and concerns about safety. In addition, regardless of

Marriage, Reasons for and Against

how they think about same-sex marriage as a legal option, LGBTQ people have also described interpersonal reasons that they choose not to get married. Political Reasons. LGBTQ people who do not support same-sex marriage have expressed political misgivings about marriage itself. These misgivings include rejection of the idea that government should be involved in labeling, defining, and regulating romantic relationships. Further misgivings include feminist critiques of marriage, which include the perspective that marriage is a way of controlling and limiting people (especially women), and distrust of the institution of marriage given its long history as a means of treating people (especially women) as property. In addition, some LGBTQ people have concerns that marriage equality has become the focal point of the LGBTQ movement. This focus on marriage is viewed as misguided because it does not adequately address all of the forms of discrimination that LGBTQ people face, and privileges some members of the LGBTQ community and one relationship form over other possibilities. Moreover, LGBTQ people have expressed concerns that marriage is a way of “mainstreaming” them and their relationships to be less unique, less creative, less diverse, and more like those of heterosexual people. Identity. Another category of reasons offered by some LGBTQ people who are not in favor of samesex marriage includes those related to identity. Research has shown that some members of the LGBTQ community feel that marriage may serve to obscure the uniqueness of identities, especially bisexual and transgender identities. Some bisexual men and women have expressed concerns that marriage to a same-sex partner will make their bisexual identity invisible to both LGBTQ and non-LGBTQ others. Some transgender individuals have expressed misgivings with same-sex marriage because, much like male–female marriage, it is based on a binary perception of sex and gender. Safety. For some LGBTQ people, same-sex marriage is perceived as threatening to personal safety and the safety of other LGBTQ individuals. That

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is, LGBTQ people who have been threatened or attacked because of their sexual orientation or identity have expressed concerns that by getting married, same-sex couples are making themselves more easily and publicly identifiable and, therefore, more vulnerable. LGBTQ people have also indicated that getting married to a same-sex partner may lead to them being discriminated against in the workplace or fired from their jobs. Concerns about personal safety and well-being related to same-sex marriage reflect the history of discrimination and abuse faced by LGBTQ people. Interpersonal Reasons. In addition to reasons for being against marriage as a legal option for samesex couples, LGBTQ people have offered interpersonal, or relationship-related, reasons for choosing not to marry. Some same-sex couples have chosen not to marry because they do not value marriage as a form of expressing their commitment to one another. Other couples choose not to marry because they previously expressed their commitment to one another via another form of relationship recognition and see marriage as redundant and unnecessary. LGBTQ people have described challenges with how much to follow traditional aspects of engagements and weddings as a reason to not marry. Finally, some same-sex couples have expressed not wanting to marry because they did not feel that their relationship was ready for marriage-level commitment. Pamela Lannutti See also Adoption, Legal Consideration in; Families of Origin, Relationships With; Marriage Equality, Effects on Well-Being and Relationships; Same-Sex Weddings

Further Readings Badgett, M. V. L. (2009). When gay people get married: What happens when societies legalize same-sex marriage. New York, NY: New York University Press. Bernstein, M., & Taylor, V. (Eds.). (2013). The marrying kind? Debating same-sex marriage within the lesbian and gay movement. Minneapolis: University of Minnesota Press. Fingerhut, A. W., Riggle, E. D. B., & Rostosky, S. S. (Eds.). (2011). Marriage restriction amendments and

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the same-sex marriage debate: The social, psychological, and policy implications [Special issue]. Journal of Social Issues, 67(2). Galupo, M. P. (Ed.). (2009). Bisexuality and same-sex marriage. New York, NY: Routledge. Lannutti, P. J. (2014). Experiencing same-sex marriage: Individuals, couples, and social networks. New York, NY: Peter Lang. Stiers, G. A. (1999). From this day forward: Commitment, marriage, and family in lesbian and gay relationships. New York, NY: St. Martin’s Griffin. Wharton, G., & Philips, I. (Eds.). (2004). I do, I don’t: Queers on marriage. San Francisco, CA: Suspect Thoughts Press.

MARRIAGE EQUALITY, EFFECTS ON WELL-BEING AND RELATIONSHIPS With the U.S. Supreme Court having recently declared same-sex marriage legal in all 50 states, social scientists are increasingly focusing their attention on the effects of marriage equality on those most directly affected: same-sex partners and any children they have. While the available studies addressing issues related to marriage equality are still few, mostly exploratory in nature, and complicated by methodological limitations, the evidence they provide offers some preliminary answers to inquiries about the potential benefits and costs of the expansion of legal rights for persons in samesex relationships. In doing so, this small but growing body of work makes an important and timely contribution to the study of LGBTQ people and their family and personal relationships. In a few instances, researchers have been able to examine the effects of marriage equality directly, using data that included same-sex spouses from states or countries where same-sex marriage is legal or where same-sex couples have had legal rights resembling those of people in different-sex marriages. However, because marriage equality legislation, like the Court’s ruling in Obergefell v. Hodges, is still relatively new, most studies have had to rely on an indirect approach—for example,

by comparing outcomes for individuals in “marriage-like” same-sex relationships to that of their peers in different-sex marital or nonmarital cohabiting relationships. Suffice it to say, much of the findings from the emerging literature should be interpreted with caution. This entry provides an overview of research exploring the effects of same-sex marriage and other legally sanctioned same-sex relationships (e.g., domestic partnerships, civil unions), as well as findings for nonmarital, same-sex cohabiting relationships. Because data on the effects of legal same-sex unions are relatively scarce, this entry will also discuss the effects of marital and nonmarital different-sex relationships when relevant. The sections that follow explore a number of topics, including health and well-being, child-rearing, divorce and stability, and the division of household labor.

Health and Well-Being A number of studies have considered whether same-sex marriages or marriage-like same-sex relationships confer the same intangible benefits as marriage between a man and a woman, including favorable health and well-being. Obviously, marriage, regardless of who enters into it, provides tangible benefits, including income tax benefits; inheritance, insurance, and survivorship rights; and spousal benefits, such as social security and public pensions, and these benefits may indirectly influence health and well-being. However, research among the general (mostly heterosexual) population also suggests that marriage and relationships that resemble marriage can directly enhance the health and well-being of individual men and women. Indeed, a positive relationship between marriage and physical and psychological wellbeing has been documented in literally hundreds of studies over a period of decades. Historically, researchers have found that married people live longer lives than unmarried people, whether single, separated, divorced, or widowed. They also have fewer acute and chronic health problems, a higher self-rated health status, and lower rates of substance abuse and problem drinking. There also is

Marriage Equality, Effects on Well-Being and Relationships

evidence that people who are married are better off psychologically, with lower instances of depression and a lower likelihood of suicide. Married people also tend to perceive themselves as happier and more satisfied with life than their unmarried peers, both those who have never married and those who are divorced or widowed. In fact, in a comparative study, married respondents were found to be happier than the unmarried in 16 of 17 industrial nations, the one exception being Northern Ireland, where there were no significant differences between the two groups. For the most part, these physical and psychological health benefits of marriage are greater for men than they are for women. Although part of the advantage of the married over the unmarried is due to the self-selection of healthy and well-adjusted individuals into marriage, most scholars who have studied the data believe that there is something about marriage that also enhances people’s health and well-being. According to the prevailing view, marriage enhances well-being because it provides substantial benefits not enjoyed by the unmarried, including interpersonal relationships and emotional, social, and financial support. In theory, marriage provides individuals with someone who will monitor their health and health-related behaviors. Marriage also provides lifelong companionship, a sense of belonging, and emotional ties, and thus may serve as a defense against loneliness and isolation, particularly in later life. Thus far, the available evidence on same-sex marriage and “marriage-like” same-sex relationships suggests that individuals do, in fact, benefit from their involvement in such arrangements. However, the evidence is less clear about whether individuals in these relationships benefit as much as those in different-sex marriages. On the one hand, several studies using data from nationally representative samples indicate that while persons in same-sex relationships usually report better outcomes than those who are single, and equivalent outcomes to those in nonmarital, different-sex, cohabiting relationships, they typically report worse outcomes than persons in different-sex marriages, at least on some measures of health and

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well-being. For example, merged data from the General Social Survey (GSS), the National Health and Social Life Survey (NHSLS), and the Chicago Health and Social Life Survey (CHSLS) show that while persons reporting a same-sex romantic partner perceive themselves to be just as happy as their peers in different-sex, nonmarital, cohabiting relationships, they perceive themselves to be less happy, on average, than their peers in different-sex marriages. This finding holds for both those in male–male relationships and female–female relationships. Similarly, studies using data from the National Health Interview Survey, conducted by the National Center for Health Statistics, indicate that while same-sex cohabiters—both male and female—have similar levels of self-rated health to different-sex cohabiters, they tend to rate their health lower than that of different-sex spouses. This finding holds even with controls for demographic variables, including race/ethnicity, gender, and socioeconomic status. What this evidence tells us is that “marriagelike” same-sex relationships such as same-sex cohabitation, similar to different-sex cohabitation, are not exactly equivalent to marriage in terms of the psychological or physical health benefits they afford. The reason for this is not entirely clear, though it may be that marriage differs from other forms of intimate living, not necessarily because of the companionship, sexual relations, or economic cooperation that marriage provides, but because of the institutional nature of marriage, which involves norms of obligation and formal laws—guidelines that define how individuals should act toward one another in intimate life. This difference may explain the advantage of the married, relative to those in nonmarital same-sex and different-sex relationships. On the other hand, the available studies do not provide a consistent picture that same-sex partners fare worse than partners in different-sex marriages. For example, while data from the GSS, NHSLS, and CHSLS indicate that same-sex partners are less happy, on average, than different-sex spouses, the same data suggest that same-sex partners are no different from different-sex married

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persons in how they rate the status of their physical health. In fact, according to these data, samesex partners in general, and male–male partners in particular, report higher mean levels of health than their different-sex married peers. In addition, the data suggest that when same-sex partnered respondents are separated into different relationship-type categories, those who classify themselves as being “married,” even if not legally married, report levels of happiness that are comparable to those of married heterosexuals. Further, a few studies, including at least one using data from a large representative sample, suggest that, like their heterosexual peers, sexualminority persons receive equivalent psychological benefits from same-sex legal marriage and other types of legally recognized same-sex relationships (e.g., civil unions, registered domestic partnerships). For example, according to data from the 2009 California Health Interview Survey, there are no statistically significant differences in psychological distress between heterosexual individuals, regardless of marital status, and same-sex married, lesbian, gay, and bisexual persons and lesbian, gay, and bisexual persons in registered domestic partnerships. Moreover, persons in each of these relationship categories are less likely to experience psychological distress than lesbian, gay, and bisexual persons who are not in any type of legally recognized relationship. Such findings suggest that providing legal avenues for same-sex couples to marry or register their relationships may offer at least the possibility of improved psychological health. In this sense, individuals who choose to enter into legal same-sex unions may experience a “marriage benefit” similar to their different-sex married peers. Clearly, more research is needed to explore how the health and well-being of individuals in samesex relationships are shaped by the legalization of same-sex marriage. In the future, researchers will need to consider whether associations between same-sex marriage and health and well-being are causal or due to selection effects. Further research should use longitudinal data to address this limitation. Future studies of same-sex marriage and health and well-being should also consider whether

the average effects of marriage equality are the same for persons of differing social categories. In other words, while same-sex marriage on average may confer health and well-being benefits, this positive association may not hold across different contexts or groups of people. For some, same-sex marriage may be unrelated to physical or psychological health or even be harmful to it. Finally, while this area of research is relatively new, future work should examine how other physical or psychological health measures—such as substance use, body weight, mental health (e.g., depression symptoms)—relate to union status for sexualminority populations.

Other Outcomes In addition to research exploring the potential benefits to individual health and well-being associated with marriage, numerous studies have investigated the relationship between marriage and child well-being, relationship stability, and household labor patterns. Given that few studies examine same-sex marriage relationships (seeing as how most jurisdictions that have legalized same-sex marriage have done so only recently), much of the information in this section will detail existing research about unmarried same-sex couples and different-sex marriage partnerships in relation to these topics. Child Well-Being

Dozens of studies utilizing a diversity of datasets, research methods, and sampling strategies compare the well-being of children raised in same-sex and different-sex parent households. Although more research is needed, the current literature indicates that children who are raised by same-sex and different-sex couples fare equally well on a variety of indicators, including social development, psychological development, performance in school, and sexual health. Research on children’s wellbeing indicates that differences in outcomes between various family types are influenced by a variety of factors, including socioeconomic status and transitions in family structure (for example,

Marriage Equality, Effects on Well-Being and Relationships

individuals with children entering into new partnerships), but not the gender composition of the couple or the sexuality of individuals raising the children. Having considered the effects of same-sex parenting more generally on the well-being of children, it is now important to examine the effects of marriage itself. Given that same-sex marriage is a recent social development, little research detailing the effects of stable, married same-sex couples on the well-being of children—versus stable, cohabiting same-sex couples—currently exists. Using more general data from different-sex partnerships, however, it is possible to see a general trend in the literature: Children of single parents tend to fare worse on many social indicators (e.g., teen pregnancy rates, juvenile delinquency, academic performance) than children of cohabiting parents, who in turn perform more poorly than children of married couples. Many researchers have found similar differences between children living with cohabiting parents compared to a biological/stepparent cohabiting arrangement, and between children living with married parents compared to a biological/ stepparent marriage. Although socioeconomic status plays a large role in these differences, research suggests that the effects of marriage— such as institutional support and greater relational commitment by both partners—also contribute to these disparities. Many same-sex couples live in “marriage-like” relationships without a marriage certificate, due in part to factors such as a historical lack of legal recognition in many places and the social acceptability of having nonmarital partnerships in many lesbian, gay, and bisexual (LGB) communities. As such, future research is necessary to determine whether outcomes similar to those with different-sex partnerships are observed with the children of cohabiting versus married same-sex couples. Divorce and Stability

Little research has been conducted on the stability of either legal same-sex unions (marriages, registered partnerships, etc.) or same-sex cohabiting relationships, so this topic must be approached

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with caution. Existing data from Norway and Sweden suggest that legal union dissolution is much higher for gay and lesbian couples than it is for different-sex marriages. Similarly, data from the Netherlands and Britain indicate that separation between cohabiting same-sex couples is much higher than it is for cohabiting different-sex couples, which in turn is higher than it is for differentsex married couples. Disparities in dissolution likelihood remain after taking into consideration age differences between partners, age of entry into the relationship, and the presence of children. This evidence falls in line with other research about cohabitation, which demonstrates that cohabiting couples, as well as married couples that cohabited prior to marriage, have less stable relationships than couples that did not cohabit before marriage. Greater relationship instability of same-sex couples (legal or within a cohabiting relationship) may be partially explained by a variety of factors: less institutional support of same-sex relationships, fewer legal barriers to separating, a greater prevalence and acceptance of singlehood in LGB communities, and less relationship investment by same-sex partners because of (1) internalized homophobia and (2) a desire to maintain low relationship visibility due to widespread prejudice. Accordingly, same-sex couples may not experience similar benefits of marriage to different-sex couples until social prejudice is lessened and full legal rights are granted. Relationship Dynamics: Household Labor

There is a large body of research about the division of household labor within different-sex and same-sex relationships. Much research shows that different-sex cohabiting couples have a more egalitarian division of housework than different-sex married couples, and that different-sex married couples that cohabited prior to marriage have a more equal division than married different-sex couples that did not cohabit. In addition, most research demonstrates that same-sex couples, both male and female, have a more egalitarian division of housework, child care, and finances than

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different-sex couples. This is perhaps because same-sex partners must undergo an active process of negotiation about household labor, rather than relying on conventional gender-related roles. Concerning between-partner differences in household labor performed by same-sex couples, the data suggest that this is explained in part by hours worked in the labor market; income generated in paid jobs; and a partner’s performance of femininity, with the more feminine partner performing more housework. Although same-sex couples generally divide their household labor more equally than different-sex couples, some research suggests that this difference has narrowed over time. This could be explained by one of two factors: (1) greater egalitarianism among differentsex couples over time or (2) less egalitarianism among same-sex couples over time. It remains to be seen whether same-sex couples will stay more egalitarian than different-sex couples in marriages and other legal arrangements, or whether same-sex couples in legal unions will undergo a “traditionalizing effect” and more closely reflect married different-sex couples in household labor.

New Directions Research exploring the effects of same-sex marriage needs to expand beyond the topics discussed above. One issue to consider is how legalized same-sex marriage affects the sex lives of same-sex couples. In general, married people have sex more frequently than people who are not married, and they are typically more satisfied with their sex lives. It will be of interest to see whether such findings apply to persons in same-sex unions. Similarly, researchers should consider the economic outcomes of same-sex marriage, and whether they are similar to those of different-sex marriage. For example, when compared to never married, divorced, and widowed people, different-sex married persons have been found to have more money and economic security, even when accounting for racial and ethnic differences. Finally, there is a need for research that explores whether and how marriage equality influences the prevalence and

dynamics of domestic violence. Among male– female couples, being married tends to reduce women’s risk of experiencing violence. It is unclear whether the same pattern will extend to women and men in same-sex marriages. Chris Wienke and Tony James Silva See also Children With LGBQ Parents, Psychosocial Outcomes; Division of Labor in LGBTQ-Parent Families; Health Disparities; Long-Term Same-Sex Couples; Minority Stress

Further Readings Andersson, G., Noack, T., Seierstad, A., & WeedonFekjaer, H. (2006). The demographics of same-sex marriages in Norway and Sweden. Demography, 43, 79–98. Denney, J. T., Gorman, B. K., & Barrera1, C. B. (2013). Families, resources, and adult health: Where do sexual minorities fit? Journal of Health and Social Behavior, 54, 46–63. Perlesz, A., Power, J., Brown, R., McNair, R., Schfield, M., Pitts, M., et al. (2010). Organising work and home in same-sex parented families: Findings from the Work Love Play Study. Australian & New Zealand Journal of Family Therapy, 31, 374–391. Schmeer, K. K. (2011). The child health disadvantage of parental cohabitation. Journal of Marriage & Family, 73, 181–193. Wienke, C., & Hill, G. J. (2009). Does the “marriage benefit” extend to partners in gay and lesbian relationships? Evidence from a random sample of sexually active adults. Journal of Family Issues, 30, 259–289. Wight, R. G., LeBlanc, A. J., & Badgett, M. V. L. (2013). Same-sex legal marriage and psychological well-being: Findings from the California Health Interview Survey. American Journal of Public Health, 103, 339–346.

MARRIAGE EQUALITY, LANDMARK COURT DECISIONS In the United States, major advancements in marriage equality have been secured through court

Marriage Equality, Landmark Court Decisions

challenges on both the state and federal levels. The first same-sex marriage cases date from the 1970s and the early days of the gay liberation movement. However, the concerted push for marriage equality did not begin until the mid-1990s, when a series of positive decisions from the Hawai’i state courts signaled that same-sex couples could secure the right to marry under state constitutional law. The Hawai’i marriage litigation provoked a popular backlash, and voters in many states amended their state constitutions to prohibit same-sex marriage, thereby eliminating the power of the courts to use state constitutional protections to compel samesex marriage. Beginning in 2009, the focus of the marriage litigation shifted from the state level to the federal level, as litigants began to argue that same-sex marriage was protected under the U.S. Constitution. In 2015, the U.S. Supreme Court recognized that marriage was a fundamental right guaranteed under the Due Process Clause and the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution in Obergefell v. Hodges. Obergefell invalidated the state-level marriage bans and mandated nationwide marriage equality. While the Hawai’i litigation was ongoing, the U.S. Congress enacted the Defense of Marriage Act (DOMA), which erected a federal barrier to marriage equality. The 1996 statute declared that for all federal purposes, a marriage was only between one man and one woman. It also authorized states to refuse to honor same-sex marriages performed in other states. DOMA was challenged in federal court on the grounds that it violated the Due Process Clause and the Equal Protection guarantees of the Fifth Amendment to the U.S. Constitution. After numerous favorable appellate court decisions, the U.S. Supreme Court agreed to hear the case of United States v. Windsor and rule on the constitutionality of DOMA. In its 2013 landmark decision, the U.S. Supreme Court invalidated the portion of DOMA that established the federal marriage prohibition. This decision led to the widespread recognition of same-sex marriage at the federal level, pending the Court’s 2015 decision in Obergefell. This entry outlines the major

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marriage equality cases that challenged the state and federal marriage prohibitions. It first discusses the cases that argued for marriage equality and sought to invalidate the state-level marriage prohibitions. It then discusses the cases that challenged the federal marriage prohibition, DOMA.

The Early Marriage Cases, 1970s Several same-sex marriage cases date from the 1970s when gay activists in a number of jurisdictions applied for and were denied marriage licenses. In some instances, the same-sex couples who had been denied marriage licenses challenged the decisions in state court. These early claims for equal marriage rights were rejected by the courts largely on definitional grounds. Although the plaintiffs raised federal constitutional claims, the courts ruled that marriage, by definition, could only exist between a man and a woman. In the 1973 case of Jones v. Hallahan, the Court of Appeals of Kentucky consulted three different dictionaries for the definition of marriage before ruling that Marjorie Jones and Tracey Knight were not eligible to receive a marriage license. Even though the Kentucky marriage statute was genderneutral and did not expressly require the parties to be of different sexes, the court reasoned that Jones and Knight were “prevented from marrying, not by the statutes of Kentucky or the refusal of the County Court Clerk of Jefferson County to issue but rather by their own incapability of entering into a marriage as that term is defined” (Jones v. Hallahan, p. 589). The Minnesota Supreme Court had reached a similar decision in the 1971 case of Baker v. Nelson. Jack Baker and Michael McConnell sued in state court after being denied a marriage license by the clerk of Hennepin County District Court in Minnesota. Even though the Minnesota statute was silent regarding the gender of the parties to a marriage, the Supreme Court of Minnesota held that marriage, by definition, was between a man and a woman. The court rejected the plaintiffs’ reliance on Loving v. Virginia, the 1967 U.S. Supreme Court case that had invalidated

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antimiscegenation laws. The plaintiffs appealed to the U.S. Supreme Court, but the Court dismissed the case in 1972, citing the lack of a “substantial federal question.” The case garnered media attention, and Baker and McConnell were featured in a 1971 Look magazine article, The Homosexual Couple. As late as 2014, some federal courts continued to cite Baker v. Nelson for the proposition that same-sex marriage was not protected under the U.S. Constitution. The early marriage litigation highlighted the fact that many states had gender-neutral marriage laws. By 1978, a total of 15 states had amended their state laws to remedy this omission and specifically define marriage as a union between one man and one woman. The cases also showed that courts were not ready to entertain federal constitutional arguments in favor of same-sex marriage. It would take more than 30 years before the first courts ruled that the U.S. Constitution protected the right of same-sex couples to marry.

Hawai’i Marriage Litigation, 1993 to 1998 Instead of seeking relief under the federal constitution, same-sex couples looked to state constitutions for protection. The first pro-marriage state supreme court decision came from Hawai’i in 1993. In Baehr v. Lewin, the Hawai’i Supreme Court ruled that the failure to issue marriage licenses to same-sex couples presumptively violated the Equal Rights Amendment to the Hawai’i Constitution because the denial constituted discrimination based on gender. The Supreme Court of Hawai’i remanded the case to the trial court to determine whether the prohibition against samesex marriage could be justified by a compelling state interest. After extensive fact-finding and hearings, the trial court ruled in 1996 that the state had failed to meet its burden of proof. At this stage of the litigation, the name of the case was changed to Baehr v. Miike to reflect the name of the new state director of health who had replaced Lewin as the defendant of record. While an appeal was pending, the Hawai’i legislature passed the Reciprocal Beneficiaries Act in 1997 in an attempt to avoid judicially mandated

same-sex marriage. The legislation extended some rights that were associated with marriage to samesex couples, as well as to certain different-sex couples. The following year, while the case was still being appealed to the state supreme court, the voters amended the Hawai’i state constitution to provide that the definition of marriage could only be changed by legislative action. The Supreme Court of Hawai’i eventually affirmed the trial court decision in favor of marriage equality, but by then the constitutional amendment had rendered the court’s decision moot because it no longer had the power to alter the definition of marriage. The Hawai’i litigation prompted antimarriage legislation at the state and federal level, including the enactment of the federal Defense of Marriage Act (DOMA) in 1996. It also illustrated the effectiveness of voter initiatives and referenda to reverse or prevent pro-marriage court decisions through the adoption of state constitutional amendments. By 2004, a total of 45 states had laws or constitutional amendments restricting marriage to a union of one man and one woman, and a number of states had both. Nineteen states eventually amended their state constitutions to prohibit not just samesex marriage, but also the grant of any of the “incidents of marriage” to same-sex couples. In addition to marriage, these broader amendments were designed to prohibit any nonmarital form of relationship recognition, including civil unions, domestic partnerships, municipal registries, and the grant of domestic partner employee benefits to public employees.

Baker v. Vermont, Vermont (1999) Following Hawai’i, the next state to consider marriage equality was Vermont. In 1999, the Vermont Supreme Court ruled in Baker v. Vermont that same-sex couples were entitled to the same rights and privileges afforded to married couples under the Vermont Constitution. The decision did not mandate same-sex marriage. Instead, it suspended the issuance of marriage licenses to same-sex couples until the state legislature could attempt to remedy the situation. A year later, the Vermont legislature enacted civil union legislation rather

Marriage Equality, Landmark Court Decisions

than extend marriage to same-sex couples. The legislation complied with the court ruling because parties to a civil union were entitled to “all the same benefits, protections and responsibilities . . . whether they derive from statute, administrative or court rule, policy, common law or any other source of civil law, as are granted to spouses in marriage” (Knauer, 2006, p. 62). The Vermont civil union legislation represented the first time a state created a parallel status for same-sex couples that was equivalent to marriage.

Goodridge v. Department of Public Health, Massachusetts (2003) In 2004, Massachusetts became the first state to issue marriage licenses to same-sex couples. A year earlier, the Massachusetts Supreme Court held in Goodridge v. Department of Public Health that the Massachusetts Constitution requires equal treatment of same-sex couples with respect to marriage. In an advisory opinion, the majority of the Justices of the Massachusetts Supreme Court concluded that Vermont-style civil union legislation would not cure the constitutional infirmity, noting that the difference between civil unions and civil marriage “is more than semantic” (Knauer, 2006, p. 291). Anti–marriage equality voters mobilized around a state constitutional amendment that would have prohibited same-sex marriage. The advent of same-sex marriage in Massachusetts created a lack of uniformity on the federal level because same-sex couples who were legally married in Massachusetts were considered unmarried for all federal purposes, including taxes and social security benefits. In an effort to limit the spread of same-sex marriage to other states, thenGovernor Mitt Romney instructed the Attorney General of Massachusetts to enforce a 1912 state law that forbade issuing a marriage license to a nonresident couple if the marriage would be void in the couple’s state of residence. At the time, this would have included every other state in the union. The statute had been originally enacted to respect antimiscegenation laws that were prevalent in the southern states by not permitting residents of those

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states to circumvent their state law by traveling to Massachusetts to marry.

In re Marriage Cases, California (2008) Same-sex marriages began taking place in California in June 2008, but marriage equality in the most populous state was short-lived. The California State Supreme Court mandated same-sex marriage in the 2008 case of In re Marriage Cases. The court held that sexual orientation was not a sufficient basis for withholding or restricting the fundamental right to marry guaranteed under the California Constitution. Prior to In re Marriage Cases, the California legislature had been gradually expanding its legal recognition of same-sex relationships. In 2004, the legislature extended to “registered domestic partners” a number of rights traditionally reserved for spouses, including inheritance rights, certain health care decision-making authority, and standing to sue for wrongful death. The next year, the legislature granted registered domestic partners substantially all the rights and responsibilities enjoyed by spouses under California law. The legislature then twice passed legislation that would have legalized same-sex marriage, but Governor Arnold Schwarzenegger vetoed both bills. In November 2008, California voters approved Proposition 8, a ballot proposition that amended the California Constitution to restrict marriage to a union between a man and a woman. After Proposition 8, California continued to recognize the marriage-equivalent status of “registered domestic partners,” as well as approximately 18,000 same-sex marriages that took place during the brief period when same-sex marriage was legal.

Hollingsworth v. Perry (2013) Hollingsworth v. Perry was a much-anticipated federal case that was decided by the U.S. Supreme Court in 2013. Unlike the earlier marriage litigation, Hollingsworth raised federal constitutional claims on behalf of two same-sex couples who had been denied marriage licenses in California because of Proposition 8. The case challenged Proposition

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8 in federal court under the Due Process and Equal Protection Clauses of the Fourteenth Amendment of the U.S. Constitution. Because the case challenged a marriage prohibition under the U.S. Constitution rather than a state constitution, it had the potential to mandate marriage equality nationwide. Although the Supreme Court decision in Hollingsworth resulted in same-sex marriage once again being recognized in California, it did not have any impact beyond California because it was decided on very narrow grounds. The case was originally filed in the U.S. District Court for the Northern District of California in 2009. When the State of California declined to defend Proposition 8, the conservative action organization Alliance Defense Fund was granted permission to take its place, but the governor remained the named defendant. The Alliance Defense Fund took over defending Proposition 8 and was referred to as the “defendant-intervenor.” The City of San Francisco was also granted permission to intervene on behalf of the same-sex couples challenging Proposition 8. The plaintiffs made two separate constitutional arguments under the Fourteenth Amendment, which protects individuals from the actions of state governments. They first argued that Proposition 8 violated the Due Process Clause of the Fourteenth Amendment because it substantially impaired their fundamental right to marry that the Court had recognized in Loving v. Virginia when it invalidated antimiscegenation laws in 1967. This is the same claim that had been brought in the early marriage cases from the 1970s. When a state action substantially burdens a fundamental right, the action is unconstitutional unless the state can prove that the action is narrowly tailored to further a compelling state interest. This level of review is known as “strict scrutiny” and is the highest standard of review that a state must satisfy in order to justify an official action. In Hollingsworth, the plaintiffs argued that the defendantintervenor had not only failed to identify a compelling state interest, but had also failed to identify a single legitimate state interest. This level of review is referred to as “rational basis review”

and is the lowest standard of proof that is required to justify state action. The plaintiffs also claimed that Proposition 8 violated the Equal Protection Clause of the Fourteenth Amendment. State action that burdens the exercise of a fundamental right or discriminates against a “suspect class” of individuals who deserve special protection from the courts is also subject to strict scrutiny under the Equal Protection Clause. At trial, the plaintiffs argued that gay men and lesbians qualify as a suspect class because they (1) have been subjected to a long history of discrimination, (2) are defined by a characteristic that bears no relationship to their ability to contribute to society (i.e., sexual orientation), and (3) are subject to political disabilities. If federal courts recognize gay men and lesbians as a suspect class, then any state action that disadvantages them would be subject to strict scrutiny and most likely fail constitutional review. Accordingly, a finding that gay men and lesbians constitute a suspect class would have wide consequences beyond marriage equality. In defense of Proposition 8, the defendantintervenor asserted that it furthered the following state interests: (1) procreation, (2) “responsible procreation,” (3) tradition, (4) recognition of California marriages by other states, (5) administrative convenience, and (6) moral disapproval. The plaintiffs charged that the stated reasons were mere pretense, and Proposition 8 was, in fact, motivated by animus. They argued that animus against gay men and lesbians is not a legitimate state interest according to the 1993 U.S. Supreme Court case Romer v. Evans. Romer invalidated Amendment 2 to the Colorado Constitution that had outlawed anti-discrimination protections based on sexual orientation. In 2010, the federal District Court for the Northern District of California ruled that Proposition 8 violated the plaintiffs’ rights under the Equal Protection and Due Process Clauses of the U.S. Constitution. Although the trial court was willing to apply strict or at least a heightened form of scrutiny, it specifically ruled that the defendantintervenor had failed to satisfy even the lowest

Marriage Equality, Landmark Court Decisions

burden of proof required to justify Proposition 8 because it was found to serve no legitimate state interest. The ruling enjoined the State of California from enforcing Proposition 8, but the decision was stayed pending appeal. Two years later, the Ninth Circuit Court of Appeals affirmed the lower court decision, but on more narrow grounds that were limited to the particular facts and circumstances surrounding the passage of Proposition 8. It did not reach the question of whether the U.S. Constitution guaranteed a fundamental right to same-sex marriage. Basing its decision on the lower rational basis standard, the court held the following: Proposition 8 serves no purpose, and has no effect, other than to lessen the status and human dignity of gays and lesbians in California, and to officially reclassify their relationships and families as inferior to those of opposite-sex couples. The [United States] Constitution simply does not allow for “laws of this sort.” (Perry v. Hollingsworth, 2012, p. 1063)

The 2013 U.S. Supreme Court decision was both confusing and anticlimactic. It did not mandate nationwide same-sex marriage by finding a fundamental right to same-sex marriage or a violation of Equal Protection as many commentators had predicted. Instead, the Court declined to reach the merits of the case, finding in a 5-to-4 decision that the defendant-intervenor did not have the required appellate standing to defend the case. Without legal standing, Hollingsworth did not meet the constitutional requirement of a “case or controversy,” and the Court was without power to render a decision. The Court returned the case to the Ninth Circuit with instructions to vacate its prior ruling. The result was to reinstate the decision of the District Court and dissolve the stay on same-sex marriages, which then allowed same-sex marriage to begin in California for the second time.

Obergefell v. Hodges (2015) Two years later, in 2015, the Supreme Court had the opportunity to revisit the issue of marriage

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equality in Obergefell v. Hodges. In a landmark 5-to-4 decision, the Court held that same-sex couples have a fundamental right to marry under the Due Process Clause and the Equal Protection Clause of the Fourteenth Amendment. It invalidated state laws prohibiting same-sex marriage and further held that no state had the right to refuse to recognize a same-sex marriage performed in another state. Obergefell also overturned Baker v. Nelson. As a result of the opinion, marriage equality is now the law in the United States. Obergefell actually involved four consolidated cases from four different states (Kentucky, Michigan, Ohio, and Tennessee) that all presented substantially the same question of law. In each case, the state had either refused to grant a samesex couple a marriage license or refused to recognize a marriage performed in another state. The plaintiff in the lead case, Jim Obergefell, had a particularly poignant story. When his partner of many years, John Arthur, was diagnosed with amyotrophic lateral sclerosis (ALS), they travelled to Maryland, where they could legally marry. By that time, Arthur was extremely frail and had to travel on a medical transport plane. On July 11, 2013, Obergefell and Arthur were married in Baltimore on the tarmac at the airport. Arthur died three months later, and Ohio refused to list Obergefell as his spouse on the death certificate. Obergefell sued to be included as surviving spouse on his husband’s death certificate and to have his husband’s status at death recorded as “married.” The federal District Court for the Southern District of Ohio ruled that Ohio must recognize outof-state marriages and ordered that Arthur’s death certificate reflect his marriage to Obergefell. The Ohio Attorney General appealed the case to the U.S. Court of Appeals for the Sixth Circuit. The Sixth Circuit ruled 2 to 1 that Ohio’s ban on samesex marriage did not violate the U.S. Constitution, stating that it was bound by the Supreme Court 1972 decision to dismiss Baker v. Nelson “for want of a federal question.” The majority opinion concluded that “[n]ot one of the plaintiffs’ theories . . . makes the case for constitutionalizing the definition of marriage and for removing the issue

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from the place it has been since the founding: in the hands of state voters” (Deboer v. Snyder, 2014, pp. 402–403). Obergefell appealed the decision to the U.S. Supreme Court. In January 2015, the Supreme Court agreed to review the case and consolidated it with three other same-sex marriage cases that were pending before the Court. The arguments in favor of samesex marriage closely tracked those that had been made in Perry v. Hollingsworth 2 years earlier. On June 26, 2015, the Court ruled in favor of marriage equality in a 5-to-4 opinion. The opinion was announced on the second anniversary of United States v. Windsor and the twelfth anniversary of Lawrence v. Texas, which had invalidated criminal sodomy laws. Justice Anthony Kennedy authored the majority opinion and was joined by Justices Ginsburg, Breyer, Sotomayor, and Kagan. Justice Kennedy’s opinion cited Loving v. Virginia and affirmed that marriage is a fundamental right guaranteed under the Due Process Clause of the Fourteenth Amendment. It further found that the denial of that right violated that amendment’s Equal Protection Clause. The Court rejected the argument that the decision should be left to the states, as well as the argument that allowing samesex couples to marry would harm the institution of marriage. The majority opinion concluded, No union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice, and family. In forming a marital union, two people become something greater than once they were. As some of the petitioners in these cases demonstrate, marriage embodies a love that may endure even past death. It would misunderstand these men and women to say they disrespect the idea of marriage. Their plea is that they do respect it, respect it so deeply that they seek to find its fulfillment for themselves. Their hope is not to be condemned to live in loneliness, excluded from one of civilization’s oldest institutions. They ask for equal dignity in the eyes of the law. The Constitution grants them that right. (Obergefell v. Hodges, p. 2608)

Chief Justice Roberts and Justices Scalia, Thomas, and Alito all authored separate dissenting opinions. Chief Justice Roberts’s dissent was joined

by Justices Scalia and Thomas. The Chief Justice disagreed with the majority’s Due Process and Equal Protection analysis, but his dissent is most notable for its claim that the Court had overstepped its constitutional authority. According to Chief Justice Roberts, the question of marriage equality should have been left to the political process rather than decided by the Court. He also warned that the majority opinion would have negative consequences for religious liberty and said that Justice Kennedy had unfairly maligned the opponents of marriage equality.

DOMA Litigation After the federal marriage prohibition, DOMA, was enacted in 1996, it took another 8 years before Massachusetts became the first state to issue marriage licenses to same-sex couples. Not surprisingly, the first federal cases challenging the constitutionality of DOMA came from Massachusetts and did not arise until the late 2000s. Once states began to adopt marriage equality, the inequalities created by DOMA became clear. Couples who were legally married under state law were considered unmarried for federal purposes and denied access to a wide range of important federal benefits. This section discusses the three main cases that challenged DOMA: Gill v. Office of Personnel Management, Massachusetts v. HHS, and the groundbreaking U.S. Supreme Court decision United States v. Windsor that invalidated the definition section of DOMA and led to the widespread federal recognition of same-sex marriage. All of the challenges were successful, although they presented different arguments. Gill v. OPM and Massachusetts v. HHS both originated in Massachusetts and were companion cases that were considered at the same time by the U.S. District Court for the District of Massachusetts and the First Circuit Court of Appeals. DOMA

Enacted in response to the Hawai’i marriage litigation, DOMA was designed to stop the potential spread of same-sex marriage. The 1993 Hawai’i Supreme Court decision, Baehr v. Lewin, had

Marriage Equality, Landmark Court Decisions

signaled the possibility that states could require same-sex marriage as a matter of state constitutional law. The recognition of same-sex marriage by even a single state would have had repercussions on the federal level and created a domino effect in other states. Prior to DOMA, a same-sex couple who were married under state law would have been considered married for all federal purposes because marriage was traditionally a matter of state law. Other states might also have been required to recognize the marriage under the Full Faith and Credit Clause of the U.S. Constitution that requires states to honor the judgments of other states. DOMA addressed each of these concerns through two separate provisions. Section 3 of DOMA adopted a restrictive federal definition of marriage that defined marriage as a union of one man and one woman. Section 2 authorized states to refuse to recognize out-of-state same-sex marriages. The U.S. Department of Justice (DOJ) had initially defended DOMA in the federal court challenges, although it stated in pleadings that the Obama “Administration believes the Defense of Marriage Act (‘DOMA’) is discriminatory and should be repealed.” During the course of the DOMA litigation, the U.S. Attorney General, Eric Holder, announced that the DOJ would no longer defend DOMA because he had determined that it violated the U.S. Constitution. Congressional interests intervened, and the U.S. House of Representatives Bipartisan Legal Advisory Group (BLAG) continued the defense of the statute in federal court. Gill v. OPM

In Gill v. OPM, eight same-sex couples who were legally married in Massachusetts and two surviving spouses challenged Section 3 of DOMA. One of the surviving spouses was Dean Hara, who had been married to the first openly gay member of Congress, former Representative Gerry Studds. Mr. Hara had been denied federal spousal benefits despite his valid marriage to Congressman Studds under Massachusetts law. The plaintiffs argued that DOMA, as applied to their particular circumstances, denied them equal protection guaranteed

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under the Fifth Amendment to the U.S. Constitution. DOMA claims arose under the Fifth Amendment rather than the Fourteenth Amendment because DOMA was a federal statute. The Fifth Amendment protects individuals from overreaching federal action, whereas the Fourteenth Amendment protects individuals from state action such as Proposition 8. The plaintiffs argued that DOMA should be subject to a heightened level of judicial review, and, in the alternative, that DOMA did not satisfy even the lowest level of judicial review because it is not rationally related to a legitimate state interest. Plaintiffs further alleged that even if heightened review were not warranted, DOMA failed to satisfy rational review under the precedent of Romer v. Evans because its enactment was motivated by animus toward same-sex relationships. Animus is defined as a desire to harm motivated by hostility or ill will. To support their allegation that DOMA was motivated by animus, the plaintiffs cited liberally from the official comments regarding DOMA that were in the Congressional Record and reflected the fiery and inflammatory rhetoric of the day. In 2010, the U.S. District Court for the District of Massachusetts found for the plaintiffs, ruling that irrational prejudice never constitutes a legitimate government interest. Although the court found that Section 3 of DOMA lacked a rational basis, it did not address the question of whether heightened scrutiny was warranted. A unanimous decision by the First Circuit Court of Appeals affirmed the lower court decision and declared Section 3 of DOMA unconstitutional. BLAG appealed the decision to the U.S. Supreme Court, but the Court dismissed the case the day after it decided United States v. Windsor. Massachusetts v. HHS

In Massachusetts v. HHS, the core issue was federalism or states’ rights, not individual rights. Brought by the Commonwealth of Massachusetts, the case asserted that DOMA violated the Tenth Amendment and the Spending Clause of Article I of the U.S. Constitution. Specifically, Massachusetts claimed that DOMA impermissibly interfered with its distribution of Medicare and

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Medicaid funds and its management of certain cemeteries that are funded by the U.S. Department of Veterans Affairs. The Tenth Amendment to the U.S. Constitution expressly reserves to the states all powers except those limited powers granted to the federal government. Massachusetts argued that these retained powers include the authority to regulate and define marriage for its citizens. The trial court decided Massachusetts v. HHS on the same day as Gill v. OPM. The U.S. District Court for the District of Massachusetts ruled that DOMA Section 3 violates the Tenth Amendment and falls outside Congress’s authority under the Spending Clause of the Constitution. A unanimous decision by the First Circuit Court of Appeals affirmed the lower court decision and declared Section 3 of DOMA unconstitutional. With Gill v. OPM, BLAG appealed to the U.S. Supreme Court, but the Court dismissed both cases the day after it decided United States v. Windsor. United States v. Windsor

The 2013 landmark U.S. Supreme Court case United States v. Windsor invalidated Section 3 of DOMA that had established a federal definition of marriage as a union between one man and one woman. The decision opened the door for recognition of same-sex marriage at the federal level. Its rationale has also served as the basis for court decisions invalidating state marriage prohibitions under the U.S. Constitution. The case was brought by Edie Windsor, an 83-year-old widow who had to pay over $363,000 in federal estate tax when her same-sex spouse, Thea Spryer, died because the federal government did not recognize their marriage. Windsor and Spryer were together for over 40 years before they were married in Canada in 2007. Their marriage was recognized under the law of the state of New York, where they lived at the time of Spryer’s death, but it was not recognized at the federal level due to DOMA. Windsor has remarked on this, saying that if Thea’s name had been “Theo,” everything would have been different. Windsor challenged Section 3 of DOMA, arguing that it violated the U.S. Constitution. Her

arguments were very similar to those made in Gill v. OPM. Windsor argued that Section 3 violated the Due Process Clause and Equal Protection guarantees of the Fifth Amendment of the U.S. Constitution. She also argued that heightened scrutiny was the appropriate level of review for state action that involved matters of sexual orientation. In 2011, the District Court for the Southern District of New York held that Section 3 of DOMA did not pass the rational basis test. The decision ordered the federal government to refund Windsor the tax that she had paid. Later that year, the Second Circuit of the U.S. Court of Appeals affirmed the District Court opinion, but also held that heightened judicial scrutiny was the appropriate level of review. It was the first federal appellate court opinion that adopted the standard of heightened scrutiny for cases involving sexual orientation. In 2013, the U.S. Supreme Court issued a 5-to-4 decision invalidating Section 3 of DOMA. Justice Kennedy authored the majority opinion and was joined by Justices Ginsburg, Breyer, Sotomayor, and Kagan. Justice Kennedy’s opinion speaks in sweeping terms regarding the disabilities that DOMA imposed on married same-sex couples, noting that Section 3 of DOMA “demean[ed] the couple, whose moral and sexual choices the Constitution protects.” Applying what seems to be a rational basis test, Justice Kennedy concluded, The federal statute is invalid, for no legitimate purpose overcomes the purpose and effect to disparage and to injure those whom the State, by its marriage laws, sought to protect in personhood and dignity. By seeking to displace this protection and treating those persons as living in marriages less respected than others, the federal statute is in violation of the Fifth Amendment. (United States v. Windsor, 2013, p. 2696)

Chief Justice Roberts and Justices Scalia and Alito authored dissenting opinions that were joined by Justice Thomas. Justice Scalia’s dissent expressed concern that the majority ruling in Windsor would be used, improperly in his view, to overturn state marriage prohibitions. Justice Scalia’s concern proved to be well founded. Numerous federal court decisions invalidating state marriage

Masculinities

prohibitions under the U.S. Constitution cited Windsor as precedent. The invalidation of Section 3 of DOMA meant that legally married same-sex couples were considered married for all federal purposes and eligible to receive federal spousal benefits. However, Windsor did not address what state law would apply to determine whether a couple would be considered married for federal purposes—the law in the state where the couple was married or in the state where the couple lives. Although it was clear that a married same-sex couple who resided in a state that recognized same-sex marriage would be considered married for both state and federal purposes, it was not clear what would happen in the case of a married same-sex couple who lived in a state that did not recognize same-sex marriage. In response to this uncertainty, the Obama Administration announced that it would recognize same-sex marriages under a “state of celebration” rule wherever permitted by relevant statutory provisions. Under this rule, a married same-sex couple would be considered married for federal purposes provided their marriage was valid in the state of celebration, even if it is not valid in their state of residence. In some instances, such as social security benefits, the federal government had to apply a “state of residence” rule because of a statutory requirement that the marriage be recognized by the state of the couple’s residence. This uncertainty was resolved in 2015 when Obergefell v. Hodges mandated nationwide marriage equality and also invalidated Section 2 of DOMA.

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Baker v. Vermont, 744 A.2d 864 (Vt. 1999). Chauncey, G. (2004). Why marriage? The history shaping today’s debate over gay equality. New York, NY: Basic Books. Cott, N. (2002). A history of marriage and the nation. Cambridge, MA: Harvard University Press. Deboer v. Snyder, 772 F.3d 388 (6th Cir. 2014). Defense of Marriage Act, Pub. L. No. 104-199, 110 Stat. 2419 (1996). Gill v. Office of Personnel Management, 682 F.3d 1 (1st Cir. 2012). Goodridge v. Dep’t of Pub. Health, 798 N.E.2d 941 (Mass. 2003). Hirshman, L. (2013). Victory: The triumphant gay revolution. New York, NY: HarperPerennial. In re Marriage Cases, 183 P. 3d 384, 452 (Cal. 2008). Jones v. Hallahan, 501 S.W.2d 588 (Ky. 1973). Knauer, N. (2006). The recognition of same-sex relationships: Comparative institutional analysis, contested social goals, and strategic institutional choice. Hawai’i Law Review, 28, 23–83. Knauer, N. (2014). LGBT elders in a post-Windsor Windsor world: The promise and limits of marriage equality. Texas Journal of Women and the Law, 24(1). Koppelman, A. (2002). The gay rights question in contemporary American law. Chicago, IL: University of Chicago Press. Lawrence v. Texas, 539 U.S. 558 (2003). Massachusetts v. HHS, 682 F.3d 1(1st Cir. 2012). Obergefell v. Hodges, 135 S.Ct. 2584 (2015). Perry v. Hollingsworth, 671 F.3d 1051 (9th Cir. 2012). Perry v. Hollingsworth, 133 S. Ct. 2652 (2013). Singer v. Hara, 522 P.2d 1187 (Wash. App. 1974). United States v. Windsor, 133 S. Ct. 2675 (2013).

Nancy J. Knauer See also Domestic Partnership; Legal Recognition of Nonmarital Same-Sex Relationships; Marriage, Reasons for and Against

Further Readings Baehr v. Lewin, 852 P.2d 44, 53 (Haw. 1993). Baehr v. Miike, No. 91–1394, 1996 WL 694235, at *21 (Haw. Cir. Ct. 1996), aff’d 950 P.2d 1234 (Haw. 1997). Baker v. Nelson, 191 N.W.2d 185 (Minn. 1971), appeal dismissed, 409 U.S. 810 (1972).

MASCULINITIES This entry is focused on masculinity as it is constructed, maintained, and challenged by LGBTQ populations. The entry begins by providing gender development concepts and some of the theoretical orientations used to examine how masculinity has been constructed within various contexts (e.g., psychology, culture, society). The second section examines the historical and traditional definitions of masculinity in the United States through a Foucauldian-based analysis. This entry concludes

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by considering the transactional associations between masculinity and international LGBTQ communities. Throughout, the entry considers various ways in which people perform what is deemed “masculine,” and the varying ways such a performance may interact with other identities (e.g., race/ethnicity, socioeconomic status [SES], gender, sexual orientation, immigration status).

Gender Development Once a child’s biological sex is ascertained at birth, family and society typically place the child into socially constructed and compartmentalized roles that consist of masculine and feminine schematic ideals. Some of these gendered beliefs have changed across time, while others are more stable and impose gender and other social roles in familial and other intrapersonal domains (e.g., employment). Within the psychological and sociological literature, gender has been described as a socially produced construct that is contextualized within a system of behaviors, beliefs, attitudes, and even stereotypes, all operating within contemporary culture. Gender theorists have described gender idealization as a system of gender inequality that devalues certain naturally occurring features of gender while at the same time overvaluing others, thus introducing gender-based inequalities in power and life opportunities. In other words, the natural ecology does not introduce gender inequalities. Instead, these inequalities, such as valuing males over females, are introduced and perpetuated by socially constructed gendered beliefs, attitudes, and practices that are based on idealized schemas of behavior. If one adopts the concept of gender idealization, then gender is a malleable and complex idea that is socially constructed rather than an innate biological entity, and as is the case within many cultures, the practice of gender idealization often imposes power inequality. In the case of gender schema theory, internalized gender schemas consist of mental representations of the most appropriate forms of behavior for each biological sex. These schemas are developed through early interactions with family and society. Furthermore, gender idealization does not occur as an individual’s choice or pursuit. Rather, it is a form of imposed social

status that perpetuates a “gender binary” (i.e., male and female traits are separate and unequal). Gender roles often intersect with other social identities, including sexuality and race/ethnicity. For example, for many adult, African American, lesbian females who are single heads of households, social pressures to be self-reliant, strong, and assertive have expanded flexibility in female gender roles. In the past, these traits and their related behaviors would have been considered “masculine.” Ironically, this emergent gender equality with males can empower women to accept these more traditionally masculine gender roles, which are not biologically determined, and thus these women and their social groups can more easily accept these new “masculine” roles within themselves. Nonetheless, such changes may still be tied to a class system that has been built on a foundation of patriarchy and racism. For example, researchers found that among African American heterosexual parents, the gender socialization of their children was mediated by social class status and patterns of social mobility. Results indicated that African American heterosexual parents who supported gender equality and who socialized their children accordingly were able to do so only because they were secure in their social and economic status. However, some research has indicated that African American heterosexual parents of gay sons experience distress and concern for the safety of their sons due to their child’s perceived inability to perform the role of hypermasculinity within the African American community (e.g., emotional stoicism, toughness, and hyperheterosexuality). The young African American gay men in these studies also reported experiencing immense pressure to reproduce Black male gender-role expectations, and when they failed, they also experienced alienation, loneliness, and anxiety. Thus, these examples illustrate that the performance of masculinity is transactional, in that both the performer and idealized masculinity are continually and mutually defined.

Foucault and Masculinity in the United States The work of French philosopher and social theorist Michel Foucault (1928–1984) regarding,

Masculinities

among many other aspects of human experience, sexuality, gender, and mental illness continues to play a role in contemporary understanding and study of human lives. From a Foucauldian perspective, one’s gender identity and the respective gender-related behaviors associated with that identity are grounded in the power relations and social discourse that is shared and perpetuated by varying levels within one’s life (e.g., at the macro level, sociopolitical bodies; and at the micro level, family of origin). Indeed, the privilege associated with behaving in a manner consistent with one’s perceived gender begins at birth, and these behaviors are continually monitored, shaped, and judged within the cultural confines of one’s society. Moreover, the meaning that is associated with “appropriate” behavior, as defined by an individual’s collective discourse and shaped by social learning, may be deemed more important than the actual behaviors, due in part to the amount of power and privilege that is provided to those who successfully actualize gendered behaviors associated with one’s perceived biological sex. Yet, as Foucauldian theorists assert, gender norms are not consistent and are at times contradictive of how masculinity may have been previously defined. Thus, men, and those who seek to be masculine, must be vigilant for the dominant gender norms of what a society deems as normative male behavior. For example, in the United States early constructs of masculinity were defined by a man’s position in the household as sole provider. In Colonial America, this may have included a specific trade (e.g., carpenter, blacksmith) or farming. In addition, men were the only ones entitled to own land and hold high positions in the community, government, and religious institutions. These forms of masculinity changed in later periods (e.g., industrial revolution, American frontier settlement, California gold rush), where men left the home to work in factories, mining operations, land procurement, and other vocations that made them dependent on others for food production. During these times, the concept of the “self-made man” began to take hold and change how men perceived of themselves in the social hierarchy, allowing them to transcend legal and cultural barriers to achievement. As a result, these new American

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notions of masculinity championed the ideals of democracy, equality, and individualism, and for the first time masculinity was no longer defined by class and social duty. Nonetheless, men still retained their power. At times, violence and aggression were also celebrated aspects of masculinity, underscoring the belief that men require space to vent their “natural male passions,” leaving behind the Puritan masculine ideal of self-control.

Performing Masculinity: LGBTQ Populations/Communities Body comportment—the way one carries oneself—is influenced by gender norms regarding the ways that people shape and hold their bodies, the types of clothing they wear, and how the hair is styled. Early on, these practices were modeled largely by family members, and later they were modeled and shaped by society outside of the family. Gender norms and racially/ethnically identified practices are also used as functions of body comportment. Moreover, body comportment and gender norms are politically charged and have been used throughout U.S. history as a means to control Native Americans and later, immigrant populations. In this way, the body became the “body politic,” and has been used as a means to declare a person deviant and unworthy for citizenship in a host country (i.e., naturalization). For example, in the American colonial past, regional borderland laws and moralities transformed Mexican and Native American bodies into those that were similar to the American ideal (e.g., in Indian boarding schools). In addition, scholars have noted that in order for non-White, gay Latinos to assimilate and gain access to the United States, they needed to disidentify with their queer identity so as to perform like their heterosexual masculine counterparts. Thus, a Latina/o attempting to cross the border had to perform the appropriate gender practices or lose the ability to migrate. Moreover, immigration officials previously used genderstereotyped body comportment as a means to detain those who did not perform gender “appropriately” through their clothing and hairstyles. They believed homosexuals were sexual “inverts” and that gay men acted effeminate, lesbians were

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masculine, and those who were transgender would be the “easiest” to identify. Otherwise, immigration service agents during that time believed there was no measureable way to determine the difference between a heterosexual and a homosexual body. The Western medical model has also used non– gender-normative body comportment to determine deviance or pathology. In 1853, the medical literature first presented the term transsexualism, which was then regarded as a “mental illness” characterized by deviations from socially prescribed and culture-specific social roles that were expected for one’s sex (i.e., one’s gender role). Transgender individuals were thus believed to suffer from a disorder (i.e., sexual inversion) that caused the individual to confuse his or her gender, and that may have included a same-sex attraction. In efforts to target children who displayed “unusual” amounts of “cross-gender behavior,” a number of psychiatrists in the 1970s began to study and treat children who were perceived to be at risk for “adult transsexualism.” Although certain subcultural groups within the United States persist in pathologizing individuals who display atypical gendered behaviors, other subcultural groups embrace non-normative gendered behavior. For example, in the LGBTQ community, there are several cultural practices that support non-normative gender performance (e.g., live shows featuring drag queens and drag kings) and that also allow for others to engage in gendernormative behaviors (e.g., masculine—Bear community; feminine—lipstick lesbians). Masculinity in mainstream U.S. culture has also been influenced by LGBTQ culture and has in a way given permission for heterosexual men to engage in female-typical hygiene and dress behaviors (i.e., as a metrosexual). Thus, the subcultures within the LGBTQ community are still a part of the broader U.S. mainstream culture, and the performance of masculinity is challenged and upheld in varying degrees within a gender binary. Some cultures do not abide by a gender binary wherein individuals who do not identify with the roles or behaviors of their own sex must adopt the

opposite gender role. Within these cultures, some individuals can be neither male nor female; indeed, they fall under a separate gender classification. For example, Samoan fa’afafine adopt an alternative gender role for biological males, and are not uniformly feminine. Moreover, the fa’afafine live in a culture that is tolerant toward feminine males, and feminine men do not experience the same levels of distress associated with transgender individuals in the United States. In the Mexican state of Oaxaca, the term Muxe is used to refer to men who dress and live as women. While Muxes hold an honored place within their local communities as models of feminine dress, makeup, and domestic skills such as cooking, Muxes still perform within the boundaries of a gender binary, although this binary is not shrouded with negative attitudes about the propriety of taking on this gender identity. Similarly, accounts of the Kaska Indian tribe of the Subarctic note that parents can choose to “transform” their young daughter into a son by conducting a ceremony, after which she is treated by the community as a male. These transgender men go on to become skilled hunters and warriors and can take a woman as a wife. Thus, cultural and social norms have a significant influence on individual and group masculinity formation that, depending on norms, can yield multiple identities, or a more orthogonal gender binary.

Conclusion Masculinity is a diverse and precarious construct that is best understood through a critical analysis of the cultural, theoretical, and historical discourse that has shaped the multiple definitions and performance of masculinity. Moreover, in examining the ways that other identities (e.g., race, class, sexuality, culture) intersect with masculinity, this entry has maintained that there are transactional associations between performers and their idealized masculinity. Indeed, hegemonic masculinity within the LGBTQ community is both maintained and challenged, and can also have a negative impact on those who are unable to attain their

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perceived notion of masculine behavior or body comportment. Joshua G. Kellison See also Gender Binaries; Masculinity Stereotypes; Racialized Masculinity; Transgender Identities

Further Readings Butler, J. (2004). Undoing gender. New York, NY: Routledge. Connell, R. W. (2005). Masculinities. Los Angeles: University of California Press. Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19, 829–859. doi:10.1177/ 0891243205278639 Foucault, M. (1986). The history of sexuality (R. Hurley, Trans.). New York, NY: Pantheon. (Original work published 1978) Goldberg, A. E. (2013). “Doing” and “undoing” gender: The meaning and division of housework in same-sex couples. Journal of Family Theory & Review, 5, 85–104. doi:10.1111/jftr.12009 Kimmel, M. S., & Messner, M. A. (Eds.). (2013). Men’s lives (9th ed.). New York, NY: Pearson Education. La Sala, M. C., & Frierson, D. T. (2012). African American gay youth and their families: Redefining masculinity, coping with racism and homophobia. Journal of GLBT Family Studies, 8, 428–445. doi:10.1 080/1550428X.2012.729948 Luibheid, E. (2002). Entry denied: Controlling sexuality at the border. Minneapolis: University of Minnesota Press. Peplau, L. A., & Huppin, M. (2008). Masculinity, femininity, and the development of sexual orientation in women. Journal of Gay & Lesbian Mental Health, 12, 145–165. doi:10.1300/ J529v12n01_09 Rotundo, E. A. (1993). American manhood: Transformations in masculinity from the Revolution to the modern era. New York, NY: Basic Books. Spence, J. T., & Buckner, C. E. (1995). Masculinity and femininity: Defining the undefinable. In P. J. Kalbfleisch & M. J. Cody (Eds.), Gender, power, and

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communication in human relationships (pp. 105–138). Hillsdale, NJ: Lawrence Erlbaum. Zitz, C., Burns, J., & Tacconelli, E. (2014). Trans men and friendships: A Foucauldian discourse analysis. Feminism & Psychology, 24, 216–237. doi:10.1177/0959353514526224

MASCULINITY

AND

PREGNANCY

Masculine pregnancy is contested terrain. While medical/legal frameworks for the most part presume that body parts determine sex, which determines gender, pregnant butch women, transmasculine people (i.e., people assigned female at birth who identify with masculinity), and trans men challenge this rigid gender binary and subsequently the communities, services, and institutions they encounter. This entry explores the experience, significance, and social implications of masculine pregnancy.1 In North American culture, assumptions about sex, gender, and reproduction are so naturalized that they typically go unnoticed. Lara Karaian, a criminologist focused on gender and sexuality studies, argues that repronormativity (i.e., the inevitability and naturalness of gendered assumptions regarding reproduction, and the binding of identities to bodies) is more powerful than heteronormativity. The assumptions of what Judith Butler calls the “heterosexual matrix” involve gendered body parts (ovaries, uterus, testicles, penis) producing gendered gametes (sperm, eggs) that are tied to sexed bodies (male/female) with binary gender identities (man/woman), normative gender expressions (femininity/masculinity), normative sexual orientation (heterosexual), and normative sexual practices (heterosexual intercourse—which is called “sex”). The desire to have children in a heterosexual context is taken to be “natural,” as are a set of feelings, attitudes, and behaviors associated with womanhood and manhood, femininity and masculinity, and maternity and paternity. Adrienne Rich, in her groundbreaking 1976 book, Of Woman Born, differentiates between the

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experience of motherhood and the institution of motherhood. She suggests that the institution of motherhood is oppressive in that it defines women through pregnancy, childbirth, and motherhood. Bolstered by consumer culture and the medical system, pregnancy is positioned as a universally desired and quintessentially female experience that enhances and reinforces femininity and womanhood. Michelle Walks, a queer feminist medical anthropologist, suggests that the cultural obsession with the association of femininity with pregnancy is so powerful and pervasive that it can be labeled a fetish. Many, if not most, cisgender (i.e., not transgender) women, queer and straight, have pregnancy, childbirth, and parenting experiences that do not line up with gendered social expectations. Femmeidentified queer women who struggle with queer invisibility often find that pregnancy renders their queerness even less apparent. Further, of course, butch, transmasculine people, and trans men, who are the focus of this entry, complicate any easy associations between gender identity and pregnancy. Historically, LGBTQ people have been denied the right to become parents, and have had children taken away from them. Many of the arguments used to discredit LGBTQ people as parents rely on assumptions about the gendered nature of parenthood and the best interests of children, i.e., the essential need for a female and a male parent, a mother and a father, or at the very least, male and female “role models.” At the root of these arguments are assumptions about the binary nature of both sex and gender: Sexed bodies are either female or male, and gender identity is tied to one’s body—those with “female” body parts (womb, cervix, ovaries) are women and mothers, and those with “male” body parts (testicles, penis) are men and fathers. Those who identify as butch or trans contradict these assumptions, challenging the fundamental premises of the discourse that ties body parts to sex and to gender. So, what of the bodies and identities that are not culturally intelligible in a framework that assumes repronormativity? The man with a womb? The father who gives birth? The pregnant butch? The

lesbian dad? Cherríe Moraga, Karleen Pendleton Jiménez, and A. K. Summers, among others, have written about being pregnant and butch, underscoring their experiences of feeling like gender outsiders, both within queer and trans communities and outside them. Rachel Epstein, a sociologist and LGBTQ parenting activist, explores the ways that butch pregnancy, by linking a queer masculinity and sexuality to the attachments of the female body, offers possibilities for the reconfiguration of butch to include new relations to vulnerability, dependence, and attachment, while at the same time reconfiguring motherhood as a sexualized subject position. The fields of trans and queer studies continue to grapple with social and theoretical frameworks that can account for the complexities of sex, sexuality, and gender. In contrast, medical/legal frameworks, for the most part, continue to assume a rigid gender binary through which bodies and gender identities remain neatly categorized. People are either men or women, and trans people are defined as those who wish to transition from one to the other. A trans person’s desire to reproduce has been interpreted by medical/legal professionals as confusion or ambivalence about a gender transition, and has been used to deny access to surgeries, hormones, and fertility care, including assisted reproductive technology and fertility preservation, as well as to changes to governmentissued identification. In this framework, a trans man who wants to get pregnant, or a trans woman who wants to use her sperm to reproduce, loses credibility as a “true” or “authentic” transsexual. Most countries that allow gender reassignment surgery have, until recently, predicated access to surgery on the assumption that, postsurgery, one would lose the capacity to biologically reproduce—in other words, the surgery would mean forced sterilization. These assumptions are shifting, and trans reproductive rights are rapidly becoming more widely recognized and reflected in policies and practice, as evidenced by the 2012 World Professional Association for Transgender Health (WPATH; see http://www.wpath.org)2 guidelines that recognize trans people’s right to

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reproduce, recommending that people be advised about their reproductive options prior to transitioning. However, normative assumptions about gender and reproduction remain powerful. Masculine pregnancy, which was until recently viewed as an impossibility, and subsequently, a joke, has produced a new social category: the pregnant man. In 2007, the LGBTQ Parenting Network (at Sherbourne Health Centre) and the 519 Church St. Community Centre in Toronto, Canada, offered an 11-week course for transmasculine people considering pregnancy. That same year, Thomas Beatie went public in the mainstream media with the first of his three pregnancies, including a much-publicized appearance on The Oprah Winfrey Show and a multipage writeup in People magazine. Despite positioning himself as “the world’s first pregnant man,” Beatie was not the first trans man to get pregnant. However, his very public presence did significantly contribute to the visibility of male pregnancy. As of 2015, increasing numbers of trans men are choosing pregnancy as a viable route to parenthood, spurring a conversation within queer and trans communities, among perinatal service providers and legal workers, and in the broader culture, about its meaning and significance. Trans people are publishing personal accounts of their journeys to parenthood; service providers and legal workers are being pushed to modify their assumptions and to develop practice guidelines to address the needs of trans clients; and researchers, including T. Garner, Maura Ryan, Jasper Verlinden, Michelle Walks, Rachel Epstein, Sarah James-Abra, and Lori Ross, are contributing to a growing body of research and theoretical reflections related to trans reproduction. Masculine pregnancy is contested terrain, involving a complex negotiation with femininity and with the world. Some butch, transmasculine people and trans men have no desire to carry a child, for a range of reasons, including the association of pregnancy with a particular kind of femininity, and sometimes vulnerability, with which they may not identify. Others are grateful for the capacity of their bodies to reproduce, but do not

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find pregnancy a pleasurable experience, positioning it as a functional sacrifice or as something to endure in service of a long-term pragmatic goal. Many describe negative reactions from families and friends, at times rooted in what is perceived as a policing of masculinity within queer/trans communities, as well as transphobia in individuals and social institutions. Some see themselves acting as a surrogate or gestational carrier or as an incubator or vessel, housing a guest. Often, people describe a contrast between their experience of being pregnant at home; in private; with their loved ones; and the reception they receive in the larger social world where they are frequently read as female, or sometimes, as non-pregnant, fat men. Some describe pregnancy as affirming of their maleness—rather than seeing themselves as engaging in a feminine or womanly act, they view pregnancy as an experience for which they are uniquely equipped, as men who have the capacity to carry a child. Some feel comfortable in their bodies during pregnancy in a new and unique way—experiencing their bodies as having a purpose, doing what they were supposed to do. A desire to get pregnant can sometimes involve difficult dilemmas with regard to the timing of a gender transition. The decision to delay a transition or to go off testosterone in order to become pregnant can be emotionally complicated, particularly as going off testosterone can have a feminizing effect which, when coupled with a pregnancy, can mean being read as female in many situations. This is coupled with myriad ways that pregnant masculine people are rendered unintelligible or invisible in public and institutional settings. LGBTQ people across the board experience barriers to receiving good and appropriate health care, and trans people face particular challenges. The 2009–2010 Trans PULSE survey (http:// transpulseproject.ca), conducted in Ontario, Canada, documented the systemic barriers that trans people experience in the form of informational and institutional erasure in the health care system. The 2011 U.S. Trans Survey found that health outcomes for trans people illustrate the effects of social and economic marginalization, including

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much higher rates of HIV infection, smoking, drug and alcohol use, and suicide attempts than the general population. Trans people are more likely to be unemployed, to live in poverty, and to be homeless or underhoused, and most find it difficult to find health care practitioners who have the skills, knowledge, and attitudes necessary to provide good health care. In the U.S. Trans Survey noted above, 19% of respondents reported being refused medical care due to their transgender or gendernonconforming status, with even higher numbers among people of color; 50% reported having to teach their medical providers about transgender care; and many reported that when they were sick or injured, they postponed medical care due to discrimination (28%) or inability to afford it (48%). The survey also found that few health care providers address reproductive needs, desires, and options with their trans clients, although the majority of trans people are interested in parenting. Pregnancy-related services, including fertility clinics and sperm banks, midwifery, obstetrics and gynecology, and lactation services are designed for heterosexual, cisgender women. Though all these services are being challenged and are slowly shifting, fertility clinics operate from a paradigm of heterosexual infertility, midwifery from a paradigm of “women-centered” care, and lactation is about the “nursing mom.” Butches, transmasculine people, and trans men are typically unintelligible in these settings, resulting in various forms of invisibility and erasure. Some people are denied service altogether, and there have been instances where Child Protective Services has been called in when it becomes known that a parent is trans. Those who do receive service must endure bathrooms, waiting rooms, ultrasound and andrology labs, maternity wards, and other sex-segregated spaces that can become painfully difficult to negotiate, particularly when one is referred to by the wrong gender, pronoun, or name. Masculine people who are pregnant often feel like a spectacle, severely out of place in institutions that are entirely premised on service to women. As masculine pregnancy becomes more common, service providers are recognizing the policy

and practical work involved in making their services welcoming. Butches, transmasculine people, and trans men who are pregnant require access to providers who respect, understand, and support their gender identities. They need information related to reproductive options and goals, and forms and documentation that reflect a diversity of sexual orientations, gender identities, and family structures. Inclusive practice requires the use of language that does not presume heterosexual, cisgender identities, for example, referring to the “pregnant person” rather than the “mother”; to “internal reproductive organs” and “external reproductive organs,” rather than “vagina” or “testicles”; and, in general, respecting the terms people use to refer to their bodies. Fundamentally, queer and trans people require respectful and compassionate treatment that challenges the assumption that body parts determine one’s sex or gender, or that sex or gender is determined by the ability to reproduce in a particular way. Queer and trans reproductive practices call for the separation of body parts from gender, and gender from parenting roles—separations that stand to free all pregnant people and parents from the confines of rigid and culturally idealized assumptions about womanhood and manhood, femininity and masculinity, and motherhood and fatherhood. Rachel Epstein See also Assisted Reproductive Technologies (ARTs); Butch–Femme; Children With LGBQ Parents, Female/ Male Role Models; Custody and Litigation, LGBQ Parents; Custody Issues in Transgender Parenting; Transgender Health Care; Transgender Identities; Transgender Parents and Well-Being; Transition to Parenthood for LGBTQ People

Notes 1. Masculine pregnancy refers to pregnancy in those who identify as transmen, female-to-male (FtM) or on the FtM spectrum, transmasculine, boi, butch-identified lesbians/queer women, genderqueers, or others who identify as masculine of center. 2. The World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin

Masculinity Stereotypes International Gender Dysphoria Association (HBIGDA), is a nonprofit, interdisciplinary professional and educational organization devoted to transgender health. WPATH aims to promote evidence-based care, best practices, and supportive policies that promote health, research, education, respect, dignity, and equality for transgender, transsexual, and gender-variant people in all cultural settings.

Further Readings Bauer, R. B., Hammond, R., Travers, R., Kaay, M., Hohenadel, K. M., & Boyce, M. (2009). “I don’t think this is theoretical; this is our lives”: How erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20(5), 348–361. Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York, NY: Routledge. De Sutter, P. (2009). Reproductive options for transpeople: Recommendations for revision of the WPATH standards of care. International Journal of Transgenderism, 11(3), 183–185. Epstein, R. (2002). Butches with babies: Reconfiguring gender and motherhood. Journal of Lesbian Studies, 6(2), 41–57. Epstein, R. (2015). Married, single or gay? Queerying and trans-forming the practices of assisted human reproduction services. Unpublished doctoral dissertation, York University. URI: http://hdl.handle .net/10315/27697 Garner, T. (2011). Stitching up the natural: “Manboobs,” pregnancy, and the transgender body. Unpublished doctoral dissertation, Simon Fraser University. http:// summit.sfu.ca/item/12080. Identifier: etd6994. James-Abra, S., Tarasoff, L. A., Green, D., Epstein, R., Anderson, S., Marvel. S., et al. (2015). Trans people’s experiences with assisted human reproduction services: A qualitative study. Human Reproduction, 30(6), 1365–1374. doi:10.1093/humrep/dev087 Jimenez, K. P. (2011). How to get a girl pregnant. Toronto, Ont., Canada: Tightrope Books. Karaian, L. (2012). Pregnant men: Repronormativity, critical trans theory and the re(conceive)ing of sex and pregnancy in law. Social & Legal Studies, 22(2), 211–230. Light, A. D., Obedin-Maliver, J., Sevelius, J. M., & Kerns, J. L. (2014). Transgender men who experience pregnancy after female-to-male gender transitioning. Obstetrics & Gynaecology, 124(6), 1120–1127.

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Moraga, C. (1997). Waiting in the wings: Portrait of a queer motherhood. Ithaca, NY: Firebrand. Nixon, L. (2013). The right to (trans) parent: A reproductive justice approach to reproductive rights, fertility, and family-building issues facing transgender people. William & Mary Journal of Women and the Law, 20(1), 73–103. Rich, A. (1976). Of woman born: Motherhood as experience and institution. London, England: Virago Press. Ross, L. E., Tarasoff, L. A., Anderson, S., Green, D., Epstein, R., Marvel, S., et al. (2014). Sexual and gender minority peoples’ recommendations for assisted human reproduction services. Journal of Obstetrics and Gynaecology Canada, 36(2), 146–153. Ryan, M. (2013). The gender of pregnancy: Masculine lesbians talk about reproduction. Journal of Lesbian Studies, 17, 119–133. Summers, A. K. (2014). Pregnant butch: Nine long months in drag. Berkeley, CA: Soft Skull Press. Verlinden, J. (2012). Transgender bodies and male pregnancy: The ethics of radical self-refashioning. In M. Hampf & M. Snyder-Korber (Eds.), Machine: Bodies, genders, technologies (pp. 107–136). Heidelberg, Germany: Universitätsverlag. Walks, M. (2014). Stratified reproduction: Making the case for butch lesbians’, transmen’s, and genderqueer individuals’ experiences in British Columbia. In S. Paterson, F. Scala, & M. Sokolon (Eds.), Fertile ground: Exploring reproduction in Canada (pp. 74–93). Montreal, Quebec, Canada: McGill-Queen’s University Press. Ware, S. M. (2009). Boldly going where few men have gone before: One trans man’s experience. In R. Epstein (Ed.), Who’s your daddy? And other writings on queer parenting (pp. 65–72). Toronto, Ontario, Canada: Three O’Clock Press. WPATH. (n.d.). Standards of care (SOC) for the health of transsexual, transgender, and gender nonconforming people (7th version). Retrieved June 25, 2015, from http://www.wpath.org

MASCULINITY STEREOTYPES The gender binary system of Western culture is based on a masculine–feminine dichotomy. While the masculine gender consists of cultural and social attributes, behaviors, norms, and roles associated

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with being boys and men, the feminine gender consists of the cultural and social elements associated with being girls and women. Masculinity stereotypes refer to the categorically particular and fixed expectations and ideas pertaining to attributes, behaviors, norms, and roles of a biologically sexed male within cultural contexts. These stereotypes emerge through processes of gender assignment, identity, roles, and attribution. The dichotomous relationship between masculine and feminine positions the stereotypical characteristics of masculinity in opposition to femininity. When boys or men enact stereotypically feminine characteristics, they violate social and cultural expectations and face negative outcomes. These processes and performances have significant value to LGBTQ studies.

Gender and Stereotyping Cognitive psychologists have focused on stereotypes as cognitive processes that work as shortcuts to reduce the burden on the brain of minute details in everyday life. However, stereotypes are also criticized for biasing perceptions and experiences while relying on gross overgeneralizations of large groups of people. Gender stereotypes are attitudes and beliefs about the characteristics and behaviors that are appropriate for men or women. Gender stereotyping works as a categorization and organization system for thinking about people based on their gender, which influences their expectations not just of others but also of themselves. Gender stereotypes are one way that individuals learn how others see them. To gender stereotype is to form a judgment about someone based solely on gender, overlooking an individual in favor of an overgeneralization. As soon as children begin to learn about gender, they begin gender stereotyping. There are three stages of gender stereotype development. In the first stage, children under 4 years of age learn things directly associated with each gender, such as who plays with which toy. During the second stage, around 4 to 6 years old, children begin to learn complex and indirect associations for their own gender and begin self–gender stereotyping. By the third stage, around 8 years old, children

understand the associations of their own gender and those of the other. The older children get, the more stereotypic judgments they begin to make. However, around 8 years old, gender-stereotypic thinking peaks and begins to decline. Once children learn gender stereotyping, the possibility of encountering something counter-stereotypical exists. Through a phenomenon known as illusory correlation, children and adults are able to perceive that gender and specific attributes are related to each other, even when they are not. In a sense, people see what they want to see in order to uphold their attitudes and beliefs. This bias is a mechanism for maintaining gender stereotypes and, in this case, the gender binary system. Gender stereotypes limit access to specific traits and behaviors based on gender. Gender stereotypes can be considered along four dimensions that distinguish masculine from feminine: physical appearance, traits, gender role behaviors, and occupation. Each dimension has different gendered expectations for masculine and feminine. When someone learns something about a person he or she has just met along one of the dimensions, the individual can begin, on the basis of gender stereotypes, to make inferences about the other dimensions. While learning information about someone’s occupation can affect inferences about gender role behaviors, finding out information about someone’s gender role behaviors leads to inferences about traits. For example, learning that a woman is a CEO may cause someone to stereotypically infer that she is competitive and aggressive. Physical appearance influences inferences made on traits, gender role behaviors, and occupations more strongly than all three affect judgments based on physical appearance.

Gender Assignment, Identity, Roles, and Attribution Gender stereotypes are often learned from family, friends, school, religion, and the media. Masculinity stereotypes are enacted and acted upon through the interrelationships of gender assignment, gender identity, gender roles, and gender attribution. Gender assignment refers to cultural and social rules that assign one gender to individuals from the

Masculinity Stereotypes

moment they are born (if not in utero). Gender identity differs from gender assignment in that individuals make sense of their gendered selves in relation to how they have been culturally and socially positioned through interactions with others. Again, family members, friends, school, religion, the government, and the media largely influence this. Gender roles are the social and behavioral norms set within specific cultures and times and are dictated largely by biological sex. The more closely individuals perform the gender roles that are associated with their assigned gender, the more they will be perceived as conforming to gender norms and, in most cases, gender stereotypes. Finally, gender attribution refers to the everyday interactional practices of individuals being interpreted by others as man or woman and masculine or feminine. Those interpreting another’s gender generally distinguish their gender expectations based on how they perceive the other’s biological sex—often correlating back to gender assignment. This is integral to the stereotyping process because it invokes social and cultural expectations of gender roles. Masculinity stereotypes are manifested in gender roles.

Characterizing Masculinity Stereotypes Scholars have recently noted that little has changed during the last 30 years in terms of masculinity and what it means, culturally and socially, to be a boy or man and how to accomplish that. One way to characterize masculinity is through its committed rejection of femininity. Conversely, femininity does not necessarily rely on its juxtaposition with masculinity in order to be defined. As a result, the foundational stereotypical characteristics of masculinity are rooted in denying the feminine. It is not possible to provide an exhaustive list of masculinity stereotypes. Instead, common characteristics and processes of masculinity stereotypes will be discussed. As gender scholars have long known, the gendering process begins before we are even born. For example, consider the gender stereotype that blue is for boys and pink is for girls. Family members, friends, and the media socialize children from the

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start that there are boy things and certain accomplishments that count toward being a boy. These social constructions of gender and color typify the way in which gender stereotypes portray a binary through an oversimplification of the subjects at play and misrepresentation of the categorical groups that they attempt to describe. In fact, gendered colors as we know them did not exist until the early 20th century—blue was designated for girls and pink for boys. It was not until the mid20th century that the colors were switched. Today, if a boy wears pink, he faces the potential of being ridiculed for not acting like a boy. Another characteristic of masculinity stereotypes is embedded within the interactional and prescriptive discourse of telling someone, or being told by someone, to “act like a man.” Consider, for example, the idiom “man up.” This gendered discourse illustrates the relational aspect of masculinity. When someone instructs another to act like a man, the instruction is meant to alter the behavior of that person to conform to masculine expectations. Masculine ideology includes prescriptions for how to behave, attitudes to hold, ways to look, and expectations to meet in order to be a man. It follows, then, that masculinity dictates how men and boys move through the world with others, rendering behaviors desirable, acceptable, or not acceptable. Gender has been conceptualized as an act for which there is always an audience. This audience is not tacitly compliant. Sexist idioms and expressions, such as “man up,” are all used to pressure boys and men into conforming to cultural and social ideals of masculinity and masculine behavior. As such, the colloquialisms of masculinity stereotypes are embedded in everyday discourses. They are methods of conveying that, for a male (boy or man), there are clear rules and rigid expectations. When expectations are violated, violators may be punished through teasing and, potentially, violence. However, when boys, for example, get into trouble, the “boys will be boys” idiom may be deployed in their defense to excuse misbehavior. This reinforces the masculine stereotype that men, who boys are supposed to be aspiring to become, are just bound to get into some trouble along the

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way to manhood. In a sense, it rewards the efforts toward becoming a man while maintaining a culture that is tolerant of misbehavior from boys. Whereas this idiom positively reinforces masculine behaviors, others work through punishment such as, “you run like a girl.” This simultaneously guides boys toward masculine behavior, through disparaging femininity, and subordinates girls and women. Indeed, the rejection of femininity underscores many masculinity stereotypes. Masculinity stereotypes have not always existed as we now experience them. For example, the idiom “boys don’t cry” serves the same punishment function as “you run like a girl”: to decrease feminine behaviors in favor of masculine behaviors. A look back in time, as recently as the 19th century, reveals that men who cried were considered to have had good character. With the modern invention of homosexuality, masculinity stereotyping undergirded by the rejection of the feminine became coupled with enacting homophobia. Scholars have argued that masculinity feeds on homophobia. Gay men are deviant not just because they have sex with men but also because of their gender performance. In gay men, masculinity is threatened by the possibility of subverting the directive to reject femininity. As such, being mistaken for gay is akin to being gendered feminine and implicates an unacceptable gender performance because a man, by definition, does not act feminine. Influenced by social and cultural factors, the social construction of masculinity and masculinity stereotypes ranges widely depending on location, context, and time. As individuals establish their gender identities, intersecting identity factors, such as race, class, and sexuality, play a large role. Masculinities vary greatly, but broad masculinity stereotypes remain socially and culturally institutionalized. In addition to rejecting the feminine and enacting homophobia, masculinity stereotypes in Western culture generally dictate that men control their emotions; be competitive, aggressive, and physical; aspire for status and success; relate through doing, not talking; and be like a sturdy oak that stands alone and needs no one.

Masculinity Stereotypes and LGBTQ Studies Masculinity stereotypes and their supporting masculine gender roles intersect with the identities and lives of all LGBTQ people. For example, butch lesbian identities have been scrutinized as a result of masculinity stereotype constructs, and queer theorists have written on female masculinity. Gay men’s masculinities have been characterized as subordinated, the lowest of all masculinities. Yet straight-acting gay men are revered in gay culture, while homophobia is argued to be the bedrock of masculinity. Masculine gender roles have been cited as perpetuating the critique that male bisexuality does not exist, and female bisexuality exists solely for the pleasure of masculinity. Trans* masculinities are often wrapped up in desires for passing and fears of not doing so. Finally, queer is caught in and animated by the heteronormativity of hegemonic masculinity. Masculinity stereotypes are significant to many facets of LGBTQ studies. Derek M. Bolen and Devin B. Collins See also Cisgenderism; Effeminacy; Gender Binaries; Gender Nonconformity, Youth; Hypermasculinity; Masculinities; Racialized Masculinity; Sissyboy Experience

Further Readings Basow, S. (1992). Gender: Stereotypes and roles (3rd ed.). Pacific Grove, CA: Brooks-Cole. David, D., & Brannon, R. (Eds.). (1976). The forty-nine percent majority: The male sex role. Reading, MA: Addison-Wesley. Garfinkel, P. (1985). In a man’s world: Father, son, brother, friend and other roles men play. New York, NY: New American Library. Kimmel, M. (1994). Masculinity as homophobia: Fear, shame, and silence in the construction of gender identity. In H. Brod & M. Kaufman (Eds.), Theorizing masculinities (pp. 119–141). Thousand Oaks, CA: Sage. Kimmel, M. (2011). Manhood in America: A cultural history. New York, NY: Oxford University Press. Martino, W. (2006). Straight-acting masculinities: Normalization and gender hierarchies in gay men’s

Media Representations of LGBTQ People lives. In C. Kendall & W. Martino (Eds.), Gendered outcasts and sexual outlaws: Sexual oppression and gender hierarchies in queer men’s lives (pp. 35–60). Binghamton, NY: Harrington Park Press. Nardi, P. M. (Ed.). (2000). Gay masculinities. Thousand Oaks, CA: Sage. O’Neil, J. M. (1981). Patterns of gender role conflict and strain: Sexism and fear of femininity in men’s lives. Personnel and Guidance Journal, 60(4), 203–210. Seem, S. R., & Clark, M. D. (2006). Healthy women, healthy men, and healthy adults: An evaluation of gender role stereotypes in the twenty-first century. Sex Roles, 55(3–4), 247–258.

MEDIA REPRESENTATIONS LGBTQ PEOPLE

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Representations of LGBTQ people in various types of media ranging from film, television, and print to the Internet and other forms of new media have evolved and changed through time. As a process whereby a social group—in this case, LGBTQ people—is symbolically created, defined, maintained, perpetuated, and challenged in the larger social domain, media representation has been an important personal, social, cultural, and political concern for sexual minorities. This process involves power in at least two ways. First, representation is a complex negotiation of power, such as the question of who gets to represent a group (e.g., heterosexuals with limited knowledge about sexual minorities creating widespread images of LGBTQ people) and what abilities and resources a group has to negotiate, and possibly resist, such representation in society (e.g., how sexual minorities deal with homophobic representations). Second, representation is also powerful: It enables and constrains how society understands a social group (e.g., how society gets to view sexual minorities) and how members of such a group understand themselves (e.g., how sexual minorities develop and maintain their identities based on mainstream cultural images). Recognizing the ongoing oppression and marginalization of sexual minorities, this

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entry describes three important historical moments of representation of LGBTQ people in the United States: silence and invisibility, emerging visibility, and the new visibility.

Silence and Invisibility The emergence of mass media, such as print and film and later television, created opportunities for massive distribution of mediated images of various social groups to communities, nations, and the world. Historically, LGBTQ people have been socially, legally, and politically persecuted by culturally endorsed forms of prejudice and discrimination. For example, homosexuality was considered a sin against nature, a biological abnormality, a mental illness, and a general threat to society and national security, which created numerous forms of state-sanctioned behavior, including violence, against lesbians and gay men (e.g., social stigma, employment discrimination, police brutality). Reflecting this hostile cultural climate, media industries and producers attempted to eradicate any representation of homosexuality through silence and erasure. As such, LGBTQ people became invisible, through the lack of acknowledgment of their very existence, in mediated representations.

Emerging Visibility Cultural repression and symbolic annihilation could not remain absolute and complete as LGBTQ representations started emerging in the media. Although rarely labeled explicitly as lesbian or gay, stereotypes of these groups surfaced to signify their deviant status. Three prominent stereotypes appeared: the effeminate gay man and the mannish lesbian, whose “nonconforming” gender performance and behavior were used to signal homosexuality; the sexual degenerate, whose excessive and abnormal sexual desires and appetites (e.g., cross-dressing and taboo sexual fetishes) were deployed to signal sexual deviance; and the gay or lesbian murderer, who was portrayed as a sociopathic killer and danger to mainstream society. Such stereotypes, presented in print and film, reflected and perpetuated the U.S. cultural fears of the 1940s and 1950s.

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Along with the increasing visibility of stereotypical lesbian and gay characters in mainstream media, Hollywood started portraying them in its cinematic releases. However, such films culminated in the predictable tragic ending. Perhaps a warning to mainstream culture about transgressing boundaries of normativity, the story lines of sexual-minority characters did not end happily in the narrative. Lesbian and gay killers were blown up. Repressed and neurotic sexual minorities committed suicide. Freakish and maladjusted sexual and gender minorities were condemned to lonely and unhappy lives. Self-hating and violent lesbian and gay lovers ended their relationships tragically. Although not a commercially successful film, Christopher Larkin’s A Very Natural Thing (1973) provided a romantic and hopeful ending to a gay male relationship, marking the beginning of a shift in mediated representations of sexual minorities. Although homosexuality was often framed as a “problem,” U.S. television programs, such as That Certain Summer (1972), An American Family (1973), and A Question of Love (1978), started presenting less violent, troubling, and tragic representations of lesbians and gay men. At the same time, openly lesbian and gay filmmakers started producing their own independent films, which created representations that reflected their own lived experiences as sexual minorities rather than the homophobic images of heterosexual producers. This trend was complicated by the advent of the HIV/AIDS epidemic at the beginning of the 1980s. Fear of AIDS along with pervasive homophobia in U.S. culture fueled images of sexual minorities— gay men, in particular—as threats to the moral fabric of society and the health of the nation. Although such images are troubling, homosexuality was becoming a more mainstream topic in mediated representations, which was a positive step. The increasing presence of LGBTQ characters on television, in film, and in the news, along with the emergence of the “new queer cinema” in the early 1990s and new forms of media years later, became the cultural backdrop for a dramatic shift in representation of sexual minorities.

The New Visibility Global media corporations, driven by market expansion and profit, were largely involved in the production of what media scholars such as Suzanna Danuta Walters have referred to as the “new gay visibility.” In particular, the new visibility was fueled by neoliberalism, which is characterized by an aggressive push toward commodification, privatization, and government deregulation while eliminating funding for public services and community development. Media industries, in an attempt to tap into new global markets to pursue “pink dollars,” created a particular brand of media visibility for sexual minorities. As such, the new visibility is a complex state of hypervisibility wherein once explicitly ostracized groups (e.g., lesbians and gay men) now find themselves at the center of a stage, built on market demands and corporate greed rather than sexual liberation, represented for mainstream consumption and profit. While society is moving toward a tentative inclusion of nonnormative sexual and gender identities, it is, along with media industries, concurrently attempting to normalize their very existence. In the process, new standards of normal—new normativities—are created for sexual minorities in mainstream media. Heteronormativity sought to create an idealistic version of the cisgender, heterosexual experience, assuming that a person’s gender identity and sexual identity would—by default—lead him or her to particular sexual experiences. Homonormativity functions in similar ways for creating the ideal version of the homosexual experience based on the heterosexual prototype. In other words, heteronormativity refers to the societal assumption that all people are cisgender, straight, and participate in “vanilla” sexual practices. It relies on Whiteness; able-bodiedness; the gender binary; and a dichotomous view of sexuality situated in a Western, urban setting to produce the “ideal” version of sexual and romantic relationships and experiences. In an attempt to replicate experiences that are familiar, relatable, nonthreatening, and easily digestible, homonormativity maintains a strict

Media Representations of LGBTQ People

binaried view of gender and celebrates imitations of heterosexual sex practices, monogamy, and nuclear families within LGBTQ communities. Earlier versions of homonormativity assumed that LGBTQ people wanted to assimilate into heteronormative cultural values of monogamy and “true love.” Later versions added the goal of equality and visibility through political change within social institutions like marriage and military service. Changed by neoliberal expansion in a globalized world, the “new homonormativity” presents lesbians and gay men as depoliticized consumers who adhere uncritically to the domestic ideals of heteronormativity. Created by media industries, the new homonormativity is a commodified version of homosexuality designed for mainstream consumption. Through prevalent images in film, television, print, and the vast ocean of the Internet, there has been a shift in the representation of LGBTQ identities. The “new visibility” has two key features: denial of homophobia through celebration of homonormativity, and a simultaneous hypersexualization/asexualization of LGBTQ identities. The first feature of the new visibility is the denial of homophobia through the celebration of homonormativity. Sometimes referred to as “rainbow washing,” media outlets have been flooded with positive stories to generate the cultural myth that homophobia is a phenomenon of the past and that LGBTQ identities are becoming widely accepted and celebrated. This often includes an abundance of rainbow flags, gay and lesbian couples sharing their first married kisses on the steps of their local courthouses, and viral images of gay fathers holding their newborn babies. In a world where gay politics are becoming more visible transnationally and globally, rainbow washing serves to paint a picture of a false reality, as illustrated by perusal of the online comments in response to these articles, for U.S. sexual minorities, many of whom continue to experience implicit and explicit forms of homophobia, thwarting the need for deep cultural change. In U.S. television and film, gay, lesbian, and trans characters have increased in number, are

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more visible within plotlines, and are portrayed as a “normal” part of everyday life—participating in immediate and extended familial units and upholding heteronormative ideals. As these characters are often portrayed through a heteronormative lens, images of LGBTQ identities have become depoliticized, nonthreatening, and digestible to presumably heterosexual audiences. The second feature of the new visibility is the creation of a sexual conundrum of the LGBTQ person. In U.S. film and television, these characters operate within a strict dichotomy of oversexualization and asexualization. On one hand, LGBTQ characters, specifically gay men, are portrayed as promiscuous, engaging in unsafe behaviors and talk about sex more frequently and openly than their heterosexual counterparts. This side of the conundrum serves to reify popular stereotypes and cultural myths surrounding LGBTQ identities. On the other hand, they are seldom depicted as actively engaging in explicit sexual acts (e.g., anything from hand holding and kissing to oral sex and intercourse) when compared to their heterosexual counterparts. When lesbian, gay, or bisexual characters engage in explicit sexual acts, their bodies are normative (e.g., young, thin, fit, White appearing, and able) and the depiction is obscured (e.g., in the dark, under bedcovers, shot from fragmented camera angles). This side of the conundrum serves as a means of placating those who are calling for more visibility of queer sex, while still maintaining a palatable, nonthreatening, and consumable version of queer sexuality. The sexual conundrum affects trans characters in unique ways because they are simultaneously hypersexualized and asexualized. Popular portrayals of trans identities like Laverne Cox’s Sophia Burset on the Netflix original series Orange Is the New Black depict hyperfeminine trans women of color who are passable as their desired gender. Their story lines (if they are given them) tend to be focused around their physical—specifically genital—transitions, reducing their identities to that of their “non-normative” gender expression. Though there is a focus on their sexual

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functionality, transgender characters are seldom, if ever, seen actively engaging in any range of romantic or sexual practices. As the new visibility continues to produce and maintain certain LGBTQ representations on a global stage, it is critical to examine which experiences (e.g., normative relational arrangements such as monogamy, normative erotic practices such as vanilla sex) and identities (e.g., White, middle-class, cisgender, able-bodied, U.S. individuals) are legible and celebrated while others become invisible, erased, and marginalized. Representations of LGBTQ people have changed over time, but they remain personally, socially, culturally, and politically important as sexual minorities seek deep cultural and political change. Gust A. Yep and Sage E. Russo See also Effeminacy; Heteronormativity; Homonormativity; Homophobia; Homosexuality, Female; Homosexuality, Male; Transgender Identities; Visual Arts

Streitmatter, R. (2009). From “perverts” to “fab five”: The media’s changing depiction of gay men and lesbians. New York, NY: Routledge. Walters, S. D. (2001). All the rage: The story of gay visibility in America. Chicago, IL: University of Chicago Press. Yep, G. A., & Elia, J. P. (2012). Racialized masculinities and the new homonormativity in LOGO’s Noah’s Arc. Journal of Homosexuality, 59, 890–911.

MEN WHO HAVE SEX WITH MEN (MSM) This entry describes the term men who have sex with men (MSM). It begins by defining the term MSM, giving its historical context. Then, it discusses the benefits and controversies to using the term in research and intervention. The entry next provides a general overview of the types of interventions using an MSM-tailored framework, and it concludes with a guide for future directions regarding MSM’s intervention and research needs.

Further Readings Alwood, E. (1996). Straight news: Gays, lesbians, and the news media. New York, NY: Columbia University Press. Becker, R. (2006). Gay TV and straight America. New Brunswick, NJ: Rutgers University Press. Duggan, L. (2003). The twilight of equality? Neoliberalism, cultural politics, and the attack on democracy. Boston, MA: Beacon. Dyer, R. (2003). Now you see it: Studies on lesbian and gay film (2nd ed.). London, England: Routledge. Gross, L. (2001). Up from invisibility: Lesbians, gay men, and the media in America. New York, NY: Columbia University Press. Peele, T. (Ed.). (2007). Queer popular culture: Literature, media, film, and television. New York, NY: Palgrave Macmillan. Phillips, J. (2006). Transgender on screen. New York, NY: Palgrave Macmillan. Rich, B. R. (2013). New queer cinema: The director’s cut. Durham, NC: Duke University Press. Russo, V. (1987). The celluloid closet: Homosexuality in the movies (Rev. ed.). New York, NY: Harper & Row.

Describing Men Who Have Sex With Men The term men who have sex with men has been used in research to describe a route of HIV transmission during same-sex encounters in epidemiologic HIV studies. Early in the HIV/AIDS epidemic, this term was intended to remove sexual orientation identities from the disease as a strategy to remove identity-based stigma toward the gay community. The term has since gained popularity in medicine and public health due to its behavioral— rather than identity—focus for varying populations. Some scholars have argued that the term is beneficial because it includes all same-sex sexual identities for males, and because it is sensitive to the fact that individuals’ identities, behaviors, and desires are not always aligned. Moreover, many scholars point to how it was successful in helping to remove much of the stigma that labeled HIV as a gay male–specific disease (i.e., HIV/AIDS was originally discussed as the “Gay-Related Immune

Men Who Have Sex With Men (MSM)

Deficiency” or GRID). The label MSM pointed out that one of the routes by which HIV could be transmitted was through sexual behaviors in samesex relations, irrespective of whether men identified as gay or homosexual. This shift from identity to behavior paved the way for future research to investigate other HIV-risk behaviors among many different groups. The term has similar benefits in fields of study outside HIV/AIDS, as it allows investigators to look at multiple populations at once that all have similar sexual behaviors, irrespective of their defined sexual identity. On the other hand, there has been significant criticism of the use of the term MSM, both within and outside the field of sexual health. Much of the criticism is that the term is insensitive to individuals’ self-determined sexual identity. Some argue not only that labeling people as MSM undermines the importance of sexual identity development in men’s lives, but also that many men would not feel that MSM is an accurate description of themselves or their communities. This has significance in both research and politics, as using a blanket term such as MSM may alienate some men and make gay, bisexual, and queer communities less visible. For example, some critics have noted that the term MSM may have a potentially stigmatizing component, in which the term gay is traditionally associated with a White male—whereas the term MSM has implied, in some research, poor men of color, while referencing the disproportionate burden of HIV/AIDS that they experience. Another concern raised with regard to the term MSM is that its focus on behavior detracts from important social elements of public health. Scholars have argued that without looking at local and selfdetermined community identities, we miss out on cultural variations and understanding of how sociodemographic and psychosocial identities relate to HIV and other disease transmission, prevalence, and prevention. Finally, a major complaint about the term MSM is that it is not an accurate description of behaviors that may be linked to HIV/STI (sexually transmitted infection) exposure. For example, for research intending to examine sexual health–risk behaviors, simply

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knowing that a male has sex with another male may not be sufficient. Rather, examining specific behaviors (e.g., condomless anal intercourse with a partner who is HIV-positive) may provide greater understanding. While acknowledging the foregoing critiques of the term MSM, this entry will proceed in discussing men using MSM as a terminology, in order to maintain a broad approach that parallels the research and interventions that have coined and employed the term.

Common Topics in Research Overall, there is more research regarding MSM than there is regarding sexual-minority women or gender-minority individuals. Most research on MSM is conducted in the sphere of public health, and the majority of it focuses on HIV transmission, prevalence, treatment, and prevention. Within the purview of HIV/AIDS research, there is a growing body of interdisciplinary research between the social sciences and medical and public health fields. For example, researchers are increasingly acknowledging the importance of sexual identity, mental health, social context, and stigmatization among MSM. There is also emerging work looking at relationships among MSM, and their implications for physical and psychological health. However, the body of literature on MSM relationships is still quite small compared with that regarding heterosexual males.

MSM and Interventions Since its development, the term MSM has been used in reference to health interventions for sexual-minority men. Given MSM’s vulnerability to HIV/AIDS and other STIs across the life course, researchers have sought to identify and promote risk-reduction strategies. Several successful interventions were scaled up by governments and became known as evidence-based interventions (EBIs). These EBIs focus on a series of outcomes including promotion of condom use, reduction of the number of sexual partners with whom men

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have unprotected sex, HIV/STI testing initiatives, and adherence to antiretroviral medications for HIV-positive MSM. These programs are commonly implemented by health departments and community-based organizations.

Future Directions Although there have been great advancements in HIV/STI interventions using behaviorally focused approaches, there is still much work that needs to be done—especially for MSM. Despite the increasing body of research regarding MSM’s sexual health, the amount of research and interventions focused on MSM’s social well-being and nonsexual health outcomes has trailed behind. As research and interventions potentially advance with the use of the MSM terminology, it is important to be cognizant of the possible downsides of the term. As mentioned above, there are several ways in which the term MSM falls short, or proves insensitive. Thus, while using MSM is advantageous for placing the focus on behavior, it may oversimplify the complexities of individuals when it comes to their identities, attractions, and behaviors. José A. Bauermeister and Peter J. D. Ceglarek

Kertzner, R. M., Meyer, I. H., Frost, D. M., & Stirratt, M. J. (2009). Social and psychological well-being in lesbians, gay men, and bisexuals: The effects of race, gender, age, and sexual identity. American Journal of Orthopsychiatry, 79(4), 500–510. Mustanski, B. S., Newcomb, M. E., Du Bois, S. N., Garcia, S. C., & Grov, C. (2011). HIV in young men who have sex with men: A review of epidemiology, risk and protective factors, and interventions. Journal of Sex Research, 48(2–3), 218–253. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019–1029. Preston, D. B., Augelli, A. R. D., Cain, R. E., & Schulze, F. W. (2010). Issues in the development of HIV-preventive interventions for men who have sex with men (MSM) in rural areas. Journal of Primary Prevention, 23(2), 199–214. Schnall, R., Travers, J., Rojas, M., & Carballo-Diéguez, A. (2014). eHealth interventions for HIV prevention in high-risk men who have sex with men: A systematic review. Journal of Medical Internet Research, 16(5), e134. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health, 95(7), 1144–1149.

See also Dating, Sexual-Minority Men; Health Disparities, Transgender People; HIV and Treatment

Further Readings

MENTORING

Grossman, C. I., Forsyth, A., Purcell, D. W., Allison, S., Toledo, C., & Gordon, C. M. (2011). Advancing novel HIV prevention intervention research with MSM— meeting report. Public Health Reports, 126(4), 472–479. Grov, C., Breslow, A. S., Newcomb, M. E., Rosenberger, J. G., & Bauermeister, J. A. (2014). Gay and bisexual men’s use of the Internet: Research from the 1990s through 2013. Journal of Sex Research, 51(4), 390–409. Jiwatram-Negrón, T., & El-Bassel, N. (2014). Systematic review of couple-based HIV intervention and prevention studies: Advantages, gaps, and future directions. AIDS and Behavior, 18(10), 1864–1887. doi:10.1007/s10461-014-0827-7

This entry provides an overview of scholarship on mentoring, applying it to LGBTQ mentoring. Although no known research addresses LGBTQ mentoring specifically, study in related areas (e.g., gender and race in mentoring, psychology graduate training, LGBTQ career issues) offers considerations for LGBTQ mentoring. Mentoring is an interpersonal process in which an experienced individual (the mentor) provides professional guidance to a less experienced person (the mentee or protégé). Guidance typically occurs in two domains: career-related or instrumental support (often termed sponsorship in the corporate world), including such activities as coaching,

Mentoring

network building, fostering opportunities, and facilitating exposure; and psychosocial support, consisting of emotional support, counseling, rolemodeling, and friendship. Mentoring is considered important to educational and professional success and has been linked to many related variables: academic participation, grades and honors, promotions and advancement, compensation, career and organizational commitment, specific kinds of productivity (e.g., completing school, publishing research), job and career satisfaction, self-efficacy and self-esteem, and avoidance of difficulties (e.g., delinquency, premature workplace exit). Attention to mentoring began in the 1970s business arena, and spread to education, health, the sciences, and many other professional fields, resulting not only in a robust scholarly literature but also in the development of innumerable mentoring programs for particular groups of people (women in science, disadvantaged youth, racial/ethnic and sexual-minority college students, etc.). Moreover, the traditional focus on formal dyadic mentoring relationships in which age, experience, and hierarchical positions are disparate has broadened to include more informal kinds of arrangements such as peer mentoring, mentoring in groups or teams, and engagement of multiple mentors at different career stages. These trends have made mentoring more accessible, and many educational and professional organizations offer mentoring opportunities targeted toward specific individuals, including sexual minorities. For example, the American Psychological Association’s graduate student association (APAGS), as well as its division focused on sexual-minority issues (Division 44; Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transgender Issues), sponsor mentoring and other professional development activities for LGBTQ students.

Mentors and Mentees Although mentors and mentees who are similar (demographically, and in interests, values, styles, and worldviews) often report the most satisfying mentoring relationships, research on actual

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outcomes suggests that mixed-pair relationships also are successful—often more so if the mentor’s power and status can advance the mentee in ways others cannot. This is good news for women, people of color, and others (e.g., sexual minorities) who are marginalized in contemporary workplaces. Because leadership in most organizations remains firmly in the hands of White, heterosexual men, it is unlikely that members of marginalized groups will find mentors who are demographically similar. However, research finds that diverse women, for example, receive mentoring (some of it even by demographically similar mentors), but it is mostly psychosocial (e.g., advice on personal development, managing multiple roles) rather than instrumental (in contrast to men, who more often receive career sponsorship); this leaves women feeling supported but not necessarily advancing in their careers at the same pace as men. Research on mentors themselves indicates that women tend to provide more psychosocial mentoring, whereas men focus more on career-related functions, reinforcing the likelihood that marginalized group members may be seeking and obtaining mentoring from similar others, but those mentors may not be positioned powerfully enough in organizational hierarchies to offer instrumental support. Thus, being mentored by those who actually possess power is as important to successful outcomes as demographic matching. For sexual-minority individuals, pervasive societal heterosexism and sexual stigma (the disregard, decreased status, and disempowerment that society accords nonheterosexuals) render it unlikely that most education and work settings will have visible LGBTQ leaders in them; thus, mentoring will be done by non-LGBTQ individuals, and research indicates that positive outcomes can ensue.

Mentoring Process Mentoring is a relational process, with all of the attendant issues that emerge in any close relationship. Research on psychology graduate training finds that dysfunction arising in mentoring relationships can include such factors as a bad match between the expectations or styles of the two parties,

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boundary violations (e.g., sexual harassment), incompetence, conflict, cross-gender or cross-race concerns, or undermining of the mentoring relationship by outsiders. Successful mentoring relationships are linked to shared goals and styles, open communication, willingness to address disagreements and conflicts, and commitment to the process and the relationship by both the mentor and the mentee. For mentoring relationships in which one or both people are LGBTQ, there is unique potential for both challenge and support. For example, an “out” mentor’s influence on a sexual-minority mentee looking for role models or struggling with identity can be transformative (this is borne out in narrative studies of LGBTQ student experiences), but there also is potential for the mentee to use the mentor as a therapist or the mentor to impose an identity-disclosure approach on the mentee that is inappropriate. In educational settings, there may be pressure on mentees to work with the only LGBTQ mentor available, whose interests may or may not match those of the mentee, or there may be inflexibility in the system to allow the mentee to work with multiple mentors. Mentors or mentees who are not “out” may be challenged by the identity disclosure of the other in ways that may be uncomfortable or threatening, but they also may find inspiration for living a more authentic existence. Finally, although mentoring relationships are established for the benefit of the mentee, mentors also often find them rewarding experiences of professional collaboration and growth, and even though mentoring tasks may end formally, the collegiality of the relationship can last throughout the lives of both people. Ruth E. Fassinger See also Career Development and Trajectories; Education; Employment Non-Discrimination Act (ENDA); Work Environments; Workplace Discrimination; Workplace Policies

Further Readings Brown, R. T. (Ed.). (2009). Special section: Mentoring in professional psychology, Parts I, II. Professional

Psychology: Research and Practice, 40(2), 181–212 and 40(3), 284–320. Croteau, J. M., Lark, J. S., Lidderdale, M. A., & Chung, Y. B. (2005). Deconstructing heterosexism in the counseling professions: A narrative approach. Thousand Oaks, CA: Sage. Mohr, J. J., & Fassinger, R. E. (2013). Work, career, and sexual orientation. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 151–164). New York, NY: Oxford University Press.

METHODOLOGICAL DECISIONS RESEARCHERS OF LGBTQ POPULATIONS

BY

Social scientists make many methodological decisions that can influence their research findings and the conclusions they draw about them. Scholars must decide how they will define their key concepts, design survey questions that measure these concepts appropriately, conduct multiple data analyses, decide which analyses make the most sense, and carefully identify the claims that they can make based on the entirety of their research. These challenges apply to all kinds of research, but may be even greater for scholarship that examines LGBTQ populations, as well as other groups that constitute a small percentage of the population. This entry reviews some key methodological issues and highlights one example of research to illustrate key issues that researchers examining LGBTQ populations may encounter and should be especially mindful of if their goal is to produce highquality research.

Research on LGBTQ Families One of the most controversial articles that purportedly studied lesbian, gay, and bisexual (LGB) families was written by sociologist Mark Regnerus. This study provides a compelling example of both the challenges of studying LGBTQ populations and the many problems that scholars might find in

Methodological Decisions by Researchers of LGBTQ Populations

their own and in others’ research. Using data from the New Family Structures Survey (NFSS), which he constructed, Regnerus concluded that adult children from same-sex families experience greater disadvantages than do children from two–biological parent families. This conclusion is counter to the social scientific consensus on this topic, a consensus that is based on the extant research on samesex families. Research in sociology, psychology, and other social behavioral sciences has consistently documented minimal differences between children who were raised in same-sex households and their counterparts who were raised in father– mother households. Regnerus’s study elicited strong reactions, some positive, but mostly negative. It has been referred to positively by those in favor of same-sex marriage bans and critiqued by those that oppose such bans. Although critiques and reanalyses of the NFSS data have pinpointed serious problems in the methodological decisions made by Regnerus and noted that his findings are highly contingent on these decisions, this study has been cited in multiple court cases nationwide, as evidence that states should not recognize same-sex marriage. In a “Brief of Amicus/Amici Curiae Social Science Professors,” for example, Regnerus and his colleagues argued that his study supported the claim that government should continue to restrict the definition of marriage to a union between a woman and a man. The small group of scholars who have defended Regnerus’s study claim that he relied on highquality data. Specifically, they argue that the NFSS is the best survey on children’s outcomes because it relied on the population-based random sampling techniques preferred by most social scientists and it measured a broad range of outcomes. This group of scholars favorably compares this study to other studies that, because of the difficulty of capturing such a small portion of the population, use nonrandom, convenience samples. The assessment by this group ignores the multiple studies that use population-based random sampling techniques and find minimal differences between children from LGB and heterosexual families.

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Although efforts to obtain a population-based sample of LGB families are laudable, these efforts also must be accompanied by careful attention to all methodological decisions. Critics of Regnerus’s study maintain that the findings from the study were a product of methodological decisions that do not reflect the standard recommendations of LGB scholars and the social and behavioral sciences more broadly. In other words, it is difficult to have confidence in the patterns reported in his article because there are serious concerns regarding measurement and data analysis. In the following sections, this entry discusses some of these concerns to show how methodological decisions during the design and analysis phases of research play a large role in shaping researchers’ conclusions.

Design In order to produce high-quality survey research, scholars must design surveys that measure what they claim to measure. This is a matter of validity. Admittedly, it is not straightforward to come up with valid measures, especially when studying LGB families. Without valid measures, however, even the most representative data sets cannot yield believable results. This concern has been directed to the Regnerus study as scholars have questioned whether Regnerus was really examining children who were raised in same-sex families. Defining and Measuring Concepts

There are several different measurement issues that scholars who study LGB people and issues will encounter. First, researchers must consider how they define “lesbian” and “gay.” Regnerus only used relationship history to define the respondents’ parents as lesbian or gay, which may underestimate the number of same-sex families because some individuals who identify as lesbian and gay may not have been in a relationship with someone of the same sex. Researchers should ask questions about individuals’ sexual attraction and behaviors, as well as how individuals define their sexual orientation.

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Second, scholars need to be specific about how they define LGB families. For example, researchers should consider the amount of time a child should reside in a family in order to be defined as “raised” in that family structure. In Regnerus’s definition of same-sex family, he included children who reported that they never had lived with a lesbian or gay parent or spent as little as 1 year living in a household with a parent who had had a same-sex romantic relationship. Since Regnerus’s study was used—by others and himself—to advocate against same-sex marriage, it also is important to distinguish between children who were raised by a single parent who had had a same-sex romantic relationship; children who were raised by two same-sex parents; and children who experienced family transitions, such as parental divorce, that might lead to disadvantages for them, regardless of the relationship history of their parents. Third, researchers have to consider whether they have constructed appropriate comparison groups. Regnerus’s definition of same-sex families was very broad (it included mostly unmarried and single-parent families), but his definition of two– biological parent families was quite specific (it only included two-parent married families). Some critics suggest that to fairly and systematically compare these groups, Regnerus should have focused on parents who identified as lesbian or gay and who were also married and in a relationship prior to having children together. Survey Pretests

Researchers need to test their survey questions before conducting the survey to understand how respondents will interpret their questions. Frequently, respondents do not interpret the questions in the way that the researcher intends or may not understand certain words or questions. This problem may be exacerbated when being asked questions regarding sexuality or sexual relations. In fact, subsequent analyses of the Regnerus study suggest that a non-negligible number of respondents misinterpreted questions about parental relationship history, resulting in a

mislabeling of several respondents as being raised in same-sex households.

Analysis Even after survey data are collected and recorded, researchers must make many decisions during the data analysis phase. Scientists should take multiple steps, known as sensitivity analyses, to ensure that their results are not tied to just one of the many possible methods of analysis and data presentation. In other words, they should double-check and triple-check their results using multiple methods. If the original findings change in the subsequent analyses, this is evidence that results are tied to a particular method, and the researcher should determine and use the most logical analysis strategy, regardless of whether that strategy results in the findings the researcher expects or wants to find. Once again, it is helpful to use Regnerus’s study as an example of the analysis problems that arise when conducting research. In order to identify whether Regnerus’s findings changed based on different types of analyses, University of Connecticut sociologist Simon Cheng and Indiana University sociologist Brian Powell reanalyzed the NFSS data and conducted many sensitivity analyses. They carefully examined respondents’ data because they were concerned that some respondents may not have answered questions correctly because they (1) misinterpreted the meaning of the questions, (2) accidentally clicked on the wrong answer, (3) gave a response as a joke, or (4) were not paying attention. Cheng and Powell found that some of the responses did not make sense. For example, one respondent categorized as being raised in a samesex family also claimed that he was 25 years old, was 7 feet, 8 inches tall, weighed 88 pounds, had been married 8 times, and had 8 children. Another respondent reported being arrested as a 1-year-old. These examples are accompanied by other implausible answers by respondents who were categorized as being from a same-sex family. When respondents have apparent errors in their reports, research should, at minimum, assess the extent to

Methodological Decisions by Researchers of LGBTQ Populations

which the key findings are due to these cases. Cheng and Powell concluded that over one third of the cases that Regnerus had categorized as a “same-sex family” were unreliable or inconsistent, and they could not confidently categorize these individuals as children raised in same-sex families. There are many other analysis techniques that researchers must use to make sure that their findings are robust. For example, Cheng and Powell used statistical techniques to ensure the differences found between same-sex families and two– biological parent families were not a result of other potential differences between these two family types, such as family income and region of residence. When Cheng and Powell performed these analyses on the NFSS data, they found that there were few differences between same-sex families and two–biological parent families. Cheng and Powell concluded that Regnerus’s findings were a product of one particular analysis strategy, which did not reflect the preferred methods of the field. In addition, the differences that did remain, which Regnerus called “disadvantages,” were not in fact disadvantages (e.g., whether or not the respondent identified as entirely heterosexual and the number of sex partners the respondent had had).

Conclusion Social scientists must make many methodological decisions about measurement and analysis. These decisions will shape their findings and the conclusions they make about their data. Data on small groups, such as LGBTQ populations, are particularly sensitive to analytical decisions. Therefore, it is even more essential to carefully design surveys and to use multiple statistical techniques to make sure one’s findings are not the product of any single method of analysis. Although this entry uses a single study to illustrate methodological pitfalls, other studies may be limited because of data design and analysis strategies. Researchers in any field should carefully consider whether they can make certain claims based on their research design and methods of analysis. For example, Regnerus claimed he was measuring the outcomes of adult

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children who were raised in same-sex households. Yet much of his sample consisted of children who had no sustained experience living with lesbian or gay parents, and even fewer lived in a household with two same-sex parents—making it imprudent, at minimum, to conclude from his findings that children raised in same-sex families experience any disadvantages. The methodological limitations of his study make it difficult to reject the longstanding empirical consensus in the social and behavioral sciences that there are minimal differences between children raised by LGB parents and those raised by heterosexual parents. Kristin Kelley and Brian Powell See also Children With LGBQ Parents, Academic Outcomes; Children With LGBQ Parents, Psychosocial Outcomes; Ethical Research With Sexual and Gender Minorities; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity; Quantitative Research; Scientific Integrity, Debates About

Further Readings American Sociological Association Committee on Professional Ethics. (2008). ASA code of ethics. American Sociological Association. Retrieved February 22, 2015, from http://www.asanet.org/images/asa/docs/ pdf/CodeofEthics.pdf Barrett, D. (2012). Presentation, politics, and editing: The Marks/Regnerus articles. Social Science Research, 41, 1354–1356. Brief of Amici Curiae Social Science Professors in Support of Defendants. Robicheaux, et al., v. James D. Caldwell, et al. (May 12, 2014) (No. 13–5090). Brief of Amicus Curiae American Sociological Association in Support of Respondent Kristin M. Perry and Respondent Edith Schlain Windsor. Dennis Hollisgworth et al. v. Kristin M. Perry, et al. and United States v. Edith Schlain Windsor (February 28, 2013) (Nos. 12–144, 12–307). Cheng, S., & Powell, B. (2015). Measurement, methods, and divergent patterns: Reassessing the effects of samesex parents. Social Science Research, 52, 615–626. Cohen, P. N. (2013, August 6). Regnerus affair timeline, with maze. Family Inequality. Retrieved February 17, 2015,

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from https://familyinequality.wordpress.com/ 2013/08/06/regnerus-affair-timeline-with-maze/ Cohen, P. N. (2015, February 13). Children in same-sex parent families, dead horse edition. Family Inequality. Retrieved February 17, 2015, from https:// familyinequality.wordpress.com/2015/02/13/ children-in-same-sex-parent-families/ Gates, G. J., et al. (2012). Letter to the editors and advisory editors of social science research. Social Science Research, 41, 1350–1351. Herek, G. (2008, July 1). From Russia with hate: Paul Cameron at Moscow State U. Sociology Dept. Beyond Homophobia. Retrieved February 17, 2015, from http://www.beyondhomophobia.com/blog/category/ junk-science/ Meadow, T. (2013, August 14). Queer numbers: Social science as cultural heterosexism. Social (In)Queery. Retrieved February 17, 2015, from http:// socialinqueery.com/2013/08/14/queer-numberssocial-science-as-cultural-heterosexism/ Moore, M. R., & Stambolis-Ruhstorfer, M. (2013). LGBT sexuality and families at the start of the twenty-first century. Annual Review of Sociology, 39, 491–507. Osborne, C. (2012). Further comments on the papers by Marks and Regnerus. Social Science Research, 41, 779–783. Perrin, A. J., Cohen, P. N., & Caren, N. (2013). Are children of parents who had same-sex relationships disadvantaged? A scientific evaluation of the no-differences hypothesis. Journal of Gay & Lesbian Mental Health, 17, 326–336. Regnerus, M. (2012). How different are the adult children of parents who have same-sex relationships? Findings from the New Family Structures Study. Social Science Research, 41, 752–770. Regnerus, M. (2012). The New Family Structures Study. Austin: Population Research Center, the University of Texas at Austin. Regnerus, M. (2012). Parental same-sex relationships, family instability, and subsequent life outcomes for adult children: Answering critics of the New Family Structures Study with additional analyses. Social Science Research, 41, 1367–1377. Sherkat, D. E. (2012). The editorial process and politicized scholarship: Monday morning editorial quarterbacking and a call for scientific vigilance. Social Science Research, 41, 1346–1349.

Stacey, J., & Biblarz, T. J. (2001). (How) does the sexual orientation of parents matter? American Sociological Review, 66, 159–183.

MICROAGGRESSIONS Individuals who identify as LGBTQ face overt discrimination (e.g., physical violence) as well as less conspicuous forms of stigmatization, which are denoted as microaggressions. Microaggressions are subtle experiences of discrimination that communicate derogatory messages to members of marginalized groups (e.g., women, people of color, and LGBTQ people). Microaggressions frequently go unrecognized, typically resulting from unconscious beliefs regarding the characteristics of specific groups. For example, someone may tell a lesbian that she is “too pretty to be gay.” Although intended as a compliment, such a statement communicates a derogatory message (that lesbian women must be unattractive) based upon a potentially unrecognized personal belief (that lesbian women are usually unattractive). Microaggressions can be grouped into three categories: microassaults, microinsults, and microinvalidations. Microassaults are explicit attacks, such as using the phrase “that’s so gay!” to describe something as undesirable. Microinsults are communications (verbal or nonverbal) that demonstrate insensitivity regarding an individual’s identity, such as expressing disgust when observing a same-sex couple. Microinvalidations are statements that belittle the experiences of oppressed groups, such as claiming that an LGBTQ individual is just going through a phase. Microaggressions can be grouped into eight common themes: use of heterosexist or transphobic terminology, endorsing heteronormative/ gender-normative culture, assuming a universal LGBTQ experience, exoticization, discomfort with/disapproval of LGBTQ experiences, denying the existence of heterosexism/transphobia, assuming that sexual and gender minorities have a form of sexual pathology or perversion, and denying

Microaggressions

one’s own heterosexism. Examples of each type of microaggression are provided below. Examples of heterosexist terminology include terms such as “faggot,” “dyke,” “tranny,” and the use of “gay” as a negative descriptor. Examples of endorsing heteronormative/gender-normative culture include telling someone to not “act gay in public” or requiring a transgender child to dress according to social expectations for his or her birth sex (e.g., pink for children assigned female at birth, blue for boys). Such practices communicate to LGBTQ individuals that they should conform to heterosexist norms for gender-related dress and behavior, imposing a sense of shame for individuals whose gender expression may not conform to these standards. Examples of assuming a universal LGBTQ experience include assumptions that all lesbians identify and dress in a masculine fashion or that all gay males have effeminate mannerisms. To assume that all LGBTQ individuals look, think, feel, or act in a specific, stereotyped manner invalidates their individualism. Examples of exoticization include treating sexual and gender minorities as objects rather than complex human beings. For instance, an individual may declare a specific erotic preference for sexual or gender minorities or may claim that “I’ve always wanted a gay best friend!” These processes serve to dehumanize LGBTQ individuals. Examples of expressing discomfort/disapproval regarding LGBTQ experiences include visible behaviors communicating stigma and discrimination. Regardless of whether these behaviors are verbal (e.g., shouting “there are children here!” to a same-sex couple holding hands) or nonverbal (e.g., glaring or covering a child’s eyes), these behaviors imply that being LGBTQ is socially undesirable and that LGBTQ people should remain hidden from mainstream society. Examples of denying the reality of heterosexism/transphobia include telling LGBTQ individuals that they are just being paranoid, that discrimination against LGBTQ individuals does not exist, and that LGBTQ individuals need to “get over it” or “stop complaining.”

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Examples of assuming sexual pathology/perversion among sexual and gender minorities include holding beliefs that LGBTQ individuals are sexually deviant by virtue of their LGBTQ identities. This may include hypersexualizing LGBTQ people (focusing disproportionately on sexual encounters when considering the person’s identity, or assuming that LGBTQ are more interested in sex and more sexually active than heterosexuals) as well as the incorrect assumptions that all gay men have HIV/AIDS, that LGBTQ people are pedophiles, or that all transgender women are sex workers. These false beliefs communicate that LGBTQ people are inherently worthy of fear and disgust, thus invalidating their actual experiences, intentions, and desires. Examples of denying one’s own heterosexism include insisting that one has no personal biases regarding LGBTQ individuals, often communicated through statements such as, “I’m not homophobic. I have a gay best friend!” Denial of one’s own biases invalidates the realities of an LGBTQ person who experiences discrimination and marginalization and communicates that the LGBTQ person’s experience is invalid or unworthy of acknowledgment. Denying biases such as heterosexism (normalization of heterosexual lifestyles) or cis-sexism (normalization of gender as corresponding directly and exclusively to birth sex) further marginalizes the LGBTQ population. Research finds that LGBTQ individuals cope with microaggressions behaviorally (by changing one’s actions), emotionally (by changing one’s feelings), and cognitively (by changing one’s thoughts about oneself and the world). Behaviorally, some react overtly, such as responding to a verbal slur (e.g., being called a “faggot,” “dyke,” or “tranny”) by physically assaulting or shouting at the perpetrator. Others may respond with self-protective behaviors aimed at avoiding future attacks, such as taking a different route home in the future. Emotionally, some individuals experience sadness or diminished self-worth after experiencing a microaggression, while others may feel an enhanced sense of pride in their LGBTQ identity. Cognitively, some individuals may view the world as a

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cruel, harsh place following a microaggressive experience, whereas others may view it as a space in need of activism, education, and open dispersal of accurate information. These examples show that LGBTQ individuals have diverse positive and negative responses to microaggressions. However, regardless of how an LGBTQ individual copes with microaggressions, repeated discriminatory experiences have the ability to wear down defenses over time, resulting in negative impacts on physical and psychological health. Studies have reliably shown that LGBTQ individuals are at increased risk for physical health problems, symptoms of anxiety, depression, traumatic disorders, and panic disorder, and for suicidal ideation, suicide attempts, and substance abuse. These risks are significantly higher for transgender individuals, who face increased discrimination and increased disparities in the availability and quality of health care (psychological or physiological). LGBTQ individuals experience microaggressions regularly. How these individuals cope varies widely, as does the nature of discrimination experienced. Regardless, a number of common themes have emerged regarding the types of discrimination experienced, how individuals cope, and the negative psychological and physical impacts of increased discriminatory experiences. Chassitty N. Whitman and Kevin L. Nadal See also Biphobia; Discrimination Against LGBTQ People, Cost of; Heteronormativity; Homophobia; Minority Stress; Queer; Transphobia

Further Readings Makadon, H. J., & American College of Physicians. (2008). The Fenway guide to lesbian, gay, bisexual, and transgender health. Philadelphia, PA: American College of Physicians. Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association. Sue, D. W. (2010a). Microaggressions and marginality: Manifestation, dynamics, and impact. Hoboken, NJ: Wiley.

Sue, D. W. (2010b). Microaggressions in everyday life: Race, gender, and sexual orientation. Hoboken, NJ: Wiley.

MILITARY

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LGBTQ PEOPLE

This entry describes the current and past policies of the United States military toward LGBTQ individuals. Effective September 2011, the United States military now allows lesbian, gay, bisexual, and queer (LGBQ) individuals to serve openly, with equal pay and opportunity for promotion and access to benefits; this change, however, was preceded by decades of shifting arguments and policies that previously restricted the full participation of LGBTQ individuals. Here, we focus on the following issues connected to LGBQ individuals and the military: the policies that previously determined their suitability for service; arguments for inclusion and exclusion; the impact of current policies on LGBQ service members; and transgender people in the military. Although LGBQ and transgender individuals often are grouped together, their acceptance and integration in the United States military are different, especially in legal terms. This entry deals with LGBQ personnel only, until the last section, which discusses the unique experiences and stressors shaping the experience of transgender individuals in the military.

Policies on Service of LGBQ Military Personnel Over Time The laws regarding LGBQ individuals and military service have fluctuated over time. During World War I, the military did not concern itself with homosexuality. Commanders determined how troops who identified as homosexual were to be integrated into their units, which led to variability in treatment, and often an overlooking of homosexual behavior. Following World War I, the first governing regulations concerning homosexual conduct emerged under the Articles of War of 1916, which limited the use of sodomy charges to assault cases that involved the act, or the intent to

Military and LGBTQ People

commit. Medical experts viewed homosexuality as an illness during this time, so efforts were made to identify and treat homosexuals. Those whose behavior did not change with treatment were removed for psychological unfitness. Oversight and regulations focused on homosexual behaviors, rather than identity and orientation; thus, service members who identified as being gay were allowed to serve. Under these lax prohibitions, LGBQ individuals served in World War II; however, there were limitations on their service. Commanders placed LGBQ individuals, whether self-identified or perceived, into jobs viewed as not requiring masculine characteristics and deliberately removed them from the combat arms. Following World War II, changes within the Uniform Code of Military Justice led to a ban of sodomy among all service members, regardless of the sex of the partner. It was not until the mid-1970s when the institutional perspective on LGBQ individuals moved beyond commander discretion and the treatment and separation model. The Carter Administration supported the view that “homosexuality is incompatible with military service” and called for the mandatory separation of all homosexuals. It was perceived that LGBQ individuals threatened good order and discipline, violated privacy norms, and soiled public respect for the military. This new Department of Defense directive prevented homosexuals from enlisting or serving in the Armed Forces. Those in violation of this directive faced administrative discharge, or if in violation of the Uniform Code of Military Justice, of court-martial with the possibility of a punitive discharge. Thus, post–World War II, homosexuals observed a closing of the institution. Homosexuals were banned from military service because of institutional concerns and irrespective of individual behavior. This policy of mandated separation of homosexuals, regardless of conduct or self-identification, did not change until President William J. Clinton directed the 1993 implementation of “Don’t Ask, Don’t Tell, Don’t Pursue” (commonly referred to as Don’t Ask, Don’t Tell [DADT]) policy. LGBQ individuals were allowed to serve in the military;

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thus, orientation alone was not a bar to service. Admission of homosexual orientation or homosexual conduct, however, led to a mandated investigation, and if proven, resulted in discharge. By making sexual orientation a private manner, this policy prevented the investigations of the past, but it also furthered the idea that homosexual orientation alone should prevent enlistment or continued service. This policy was vastly criticized because it assumed that the conduct of LGBQ individuals— regardless of the actual behavior itself—had a negative effect on the military’s ability to fulfill its mission. The policy also required LGBQ individuals to purposefully mask their sexual orientation, even if it required deceit, to stay in compliance. However, proponents of the policy argued that it granted LGBQ individuals the right of military service by preventing investigations based on hearsay. They also argued that it protected the rights of service members who were uncomfortable with serving alongside LGBQ individuals. Calls to repeal DADT continued through the next decade, but were not seriously heeded until President Barack Obama announced in 2010 that he would work with Congress and the Department of Defense to repeal the policy. At that time, the Pentagon began to loosen enforcement guidelines; it also published a scientifically sound study arguing that the repeal of DADT would have minimal to no impact on military effectiveness. Citing this research as justification, as well as broader appeals for the human rights and dignity of LGBQ service members, a Democratic-led House and Senate voted to repeal DADT in December 2010. President Obama signed the repeal into law a week later, but gave the Joint Chiefs of Staff time to prepare all service members for the policy change. The repeal officially went into effect on September 20, 2011. Although the repeal of DADT allowed LGBQ service members to serve openly without fear of investigation or discharge, they still experienced inequities in accessing benefits available to heterosexual service members and their families due to the federal government’s Defense of Marriage Act (DOMA). Benefits they were excluded from

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included health care, housing, and next-of-kin casualty notification. A critical provision in the act was ruled unconstitutional by the Supreme Court in 2013, allowing the families of LGBQ service members access to federal benefits. Current policy now allows for the open service of LGBQ service members and, if legally married, provides equal benefits to their spouses and children.

Reasons for Exclusion and Inclusion of LGBQ Service Members Prior to the policy changes in 2011, opponents of open service and full integration of LGBQ service members used various categories of arguments to frame their opposition. These arguments, generally, have fallen into two categories: framing the individual competencies of LGBQ individuals as deficient and, after that argument faded, focusing on the perceived negative consequences LGBQ service members would have on their units. Initially, opponents claimed that LGBQ service members were physically weak and morally compromised; their sexuality, it was argued, made them incompetent and a security risk. Both in the past and today, gay men are associated with feminine traits, such as physical weakness, that are not valued within the combat-driven armed forces. In addition, scientific opinions, such as past characterizations in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, linked homosexual orientation and behaviors to psychological and social illness and emphasized the need for rehabilitation and military separation. In addition to past mental characterizations, gay men also have had to negotiate the stereotypically associated behavior of sexual deviance and promiscuity. Although gay men are perceived as lacking the masculinity, and by extension the aggressiveness, necessary for military effectiveness, they are characterized as sexual deviants that undermine privacy and subvert the heteronormative, masculine behaviors of the military. Lesbians, in contrast, are stereotypically portrayed as too masculine and, therefore, as threats to the hegemonic masculinity of the military. These

arguments fell out of favor in the early 1990s when performance reviews demonstrated that LGBQ service members, in the aggregate, performed at a comparable level to their colleagues. Once individual performance concerns were addressed, the dominant argument for excluding LGBQ personnel focused on their potentially negative impact on the social cohesion, and as a consequence, the overall effectiveness of military units. There was concern that gay men and women disrupted the social norms and rituals found in singlesex military units critical for group solidarity. There is modest evidence that highly cohesive groups are more effective in task accomplishment than less cohesive groups. At its basic level, cohesion traditionally is defined as a type of social glue that keeps individuals tied to the group; it is conceptualized mainly in terms of peer relationships. Methodological and theoretical advances have led to increased specification of different types of cohesion, with the greatest difference existing between “social cohesion” and “task cohesion.” Social cohesion describes positive interpersonal attractions where individuals develop group friendships. This affective bonding extends beyond formal military duties to informal interactions; the individuals, in short, are friends and like to spend time together. Socially cohesive groups tend to be socially homogeneous as well. In contrast, task cohesion is the shared dedication to a goal and the ability of the group to come together for its completion. Rather than relying on social homogeneity, task cohesion relies on group recognition that each individual brings a different, yet valued, skill set. The focus on social cohesion not only overstates the importance of homogeneity and affective bonding, but also overlooks the importance of task cohesion, and the role of each individual member in completing the group’s goals. With the integration of gay men and lesbians (as well as other minority groups), the military has had to rely more on task cohesion than on social cohesion; a decrease in military effectiveness as was feared with this change has not been noted. Reasons for including gay men and lesbians in the military focus more on individual rights and

Military and LGBTQ People

responsibilities. The military often is viewed as a desired employer, particularly because it offers “pull factors” such as standardized pay, equal entry at the bottom ranks, and a willingness to train unskilled personnel. In addition, in the citizen-soldier tradition of the United States, military participation is viewed as a civic duty, like voting, that implies shared responsibilities in exchange for equal citizenship. As a result, LGBQ individuals have sought to join the military as a way to benefit from its economic stability as well as to demonstrate their willingness to serve as equal citizens. At the organizational level, allowing gay men and women to serve openly moves the policies of the United States military to be more in line with 25 other countries that already allow open service. Since many military missions now involve international coalitions—the International Security Assistance Force in Afghanistan has involved most of these 25 countries—our service members already were serving alongside openly gay men and lesbians from allied countries.

How Policies Affect Military Units Prior to the repeal of Don’t Ask, Don’t Tell, civilian and military opponents asserted that military cohesion and readiness would suffer to the point of catastrophic failure. Claims included an inability to recruit and retain qualified people because they would not serve with openly gay service members, as well as other concerns voiced in opposition about the prevalence of assaults and harassment and ruining morale of military units. However, the data provided very different outcomes after the repeal of DADT. Specifically, there was no evidence to support any overall negative impact in relation to readiness, morale, cohesion, recruitment, retention, assaults, and harassment. In fact, there was reason to believe there were enhancements to areas of morale, cohesion, and readiness in terms of discipline, command, and family readiness. The repeal of DADT created higher levels of trust among service members through the ability of LGBQ individuals to be honest about their sexual identity and not hide anymore. Morale for LGBQ

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service members has improved because they no longer live in fear of reprisals such as losing their job or career. Military leaders who administer and adjudicate military rules and regulations report a higher level of integrity within their units where a higher sense of professionalism based on dignity and respect has improved the command climate. LGBQ service members can now serve with dignity and honor as the profession of arms demands.

How Policies Affect LGBQ Personnel While the repeal of DADT has largely improved the quality of life for LGBQ service members, there are still policies and lingering effects of the policy. In addition to the repeal of DADT, the repeal of DOMA in June 2013 was critical for LGBQ military families. This repeal allowed LGBQ service members’ families official recognition and benefits almost identical to heterosexual military families. Benefits provided to legally married same-sex couples by the repeal of the Defense of Marriage Act include Department of Defense identification cards, TRICARE health care benefits, basic allowance for housing, family separation allowance, Service Members Group Life Insurance beneficiaries, Death Gratuity benefit, Commissary and Exchange privileges, Wounded Warrior designated caregiver, Thrift Savings Plan beneficiaries, Survivor Benefit Plan beneficiaries, casualty notification, person eligible to receive effects of deceased persons, presentation of the flag of the United States, hospital visitation rights, and joint duty assignments for dual military couples. The landmark ruling involving DOMA in 2013, however, did not change the patchwork of state laws on same-sex marriage. LGBQ service members could enter into a same-sex marriage in a state where it was legal—such as Iowa—and then get stationed in a state where their marriage was not recognized and where fundamental rights and protections were not offered to LGBQ families. For example, spouses of gay National Guard personnel in states where gay marriage was not allowed were initially denied dependent identification cards because of state bans. The workaround

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required guard personnel to enroll their spouse at a federal military installation instead. The Department of Veterans Affairs also denied some benefits to same-sex couples if they resided in states where their marriage was not recognized. However, the status of all LGBQ families positively changed on June 26, 2015, when the Supreme Court ruled that same-sex couples have the right to marry in all states. LGBQ families in the military no longer have to negotiate differing states laws regarding the legality of their union and now have full access to Department of Defense and Veterans Affairs benefits. There still remain challenges for LGBQ families who must reside in a foreign country. Command sponsorship allows service members’ families to accompany them to duty stations in other countries based on the terms of the Status of Forces Agreement (SOFA) with each country. Most importantly, SOFAs provide dependent family members exceptions to visa and passport requirements and access to military installations. Without recognition of same-sex marriage by the host country, LGBQ service members have not been able to bring their spouses to their overseas duty station. Countries with the largest numbers of U.S. military personnel include Germany, Italy, Japan, and South Korea, out of which Korea is the only country with a SOFA that does not allow same-sex couples. Currently, there are 47 countries with SOFAs recognizing same-sex families. There remain indications that the effects of DADT may still linger for LGBQ service members. However, it is challenging to measure and observe the extent of these effects because the military does not track sexual orientation of personnel. Sexual orientation only became a category for equal opportunity issues of harassment or discrimination in the military in June 2015, making it challenging to analyze. As a stigmatized group that is susceptible to bias and prejudice, LGBQ service members would be expected to have more stress-related symptoms observed by mental health care providers. However, early research shows that LGBQ service members are not comfortable disclosing their sexual orientation to medical health care

providers that may lead to inadequate care. Even with the repeal of Don’t Ask, Don’t Tell and the Defense of Marriage Act, there are still lingering effects of distrust between LGBQ military personnel and the military.

Transgender People in the Military Transgender individuals in the military—who are addressed in the subsequent entry—are not covered by the repeal of DADT and are still prohibited from military service once they publicly engage in transgender behaviors or claim a transgender identity. This omission was partly intentional, as LGBQ advocates did not want to confound an already politically charged policy change surrounding sexual orientation with issues about gender identity. However, the service of transgender military personnel currently is a visible topic of research, and there is an emerging discussion about reasons for keeping and for repealing the ban. The medical and psychological care of transgender military personnel has been the primary reason for discharge, as it has been argued that the Department of Defense does not have the expertise or resources to provide this specialized care. However, this claim has been disputed by medical professionals and senior military leaders who no longer see this as a legitimate bar to service. There is no set timetable on when the United States will repeal this ban, if it does at all; however, changes already are occurring. Although the formal policy remains in place regarding the mandatory separation of transgender personnel, the services have elevated the decision-making authority on separations to the Under Secretary of Defense for Personnel and Readiness rather than leaving it with unit commanders. If the ban is removed, the United States will join 18 other countries who already allow the service of transgender military personnel. Karin De Angelis and David G. Smith See also Defense of Marriage Act (DOMA); Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Military and Transgender People

Military and Transgender People

Further Readings Belkin, A., Ender, M. G., Frank, N., Furia, S., Lucas, G., Packard, G., Jr., et al. (2012). Readiness and DADT repeal: Has the new policy of open service undermined the military? Armed Forces & Society, 39, 587–601. Bérubé, A. (2010). Coming out under fire. Chapel Hill: University of North Carolina Press. Elders, M. J., Brown, G. R., Coleman, E., Kolditz, T. A., & Steinman, A. M. (2014). Medical aspects of transgender military service. Armed Forces & Society, 41, 199–220. doi:10.1177/0095327X14545625 Frank, N. (2009). Unfriendly fire. New York, NY: Thomas Dunne Books. Moradi, B., & Miller, L. (2010). Attitudes of Iraq and Afghanistan war veterans toward gay and lesbian service members. Armed Forces & Society, 36, 397–419. Parco, J. E., Levy, D. A., & Spears, S. R. (2014). Transgender military personnel in the post–DADT repeal era: A phenomenological study. Armed Forces & Society, 1, 1–22. Stanley, S. C., & Scott, W. (Eds.). (1994). Gays and lesbians in the military: Issues, concerns, and contrasts. Chicago, IL: Aldine Transaction.

MILITARY

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TRANSGENDER PEOPLE

This entry introduces the topic of transgender people and the military. It begins by reporting estimated prevalence rates of transgender people in the U.S. military, and then explains possible reasons to account for the particularly high percentage of transgender service members. The entry goes on to review policies that have historically banned transgender people from military service in the United States and, in contrast, policies for inclusion and treatment of transgender veterans. Since people’s opinions vary on the topic of transgender people and the military, different perspectives are provided. Finally, militaries outside the United States that allow transgender people to serve openly are considered. In this entry, the term transgender is used broadly to describe any individual who does not identify with the gender he or she was assigned at

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birth. Similarly, the term transgender service member is used generally to include transgender people who participate in the armed forces, regardless of their expressed identity at the time of service. For instance, service members can consider themselves transgender prior to enlisting in the military, but still express the gender they were assigned at birth. Service members can also begin identifying as transgender once they are part of the military— some of these individuals may still express the gender they were assigned at birth and keep their identity private, but others may choose to transition (whether socially, physically, or legally), which could risk discharge from the U.S. military. Finally, service members may not legally identify or express themselves as transgender until after they have been discharged from the military. The term cisgender is used in this entry to describe nontransgender people, that is, individuals who identify with the gender they were assigned at birth.

Prevalence In a 2014 Williams Institute report, Gary Gates and Jody Herman estimated that 150,000 transgender people had served, or were currently serving, in the U.S. Armed Forces. They further identified that 8,800 transgender service members were on active duty and 6,700 were in the National Guard or Reserve forces, totaling 15,500 current service members. An additional 134,400 transgender people were reported as being veterans or retired from the National Guard or Reserve forces. These estimates were calculated using U.S. census data and a nationwide survey of transgender people, as no data exist that could provide for a direct tabulation of transgender people in the military. However, preliminary research on transgender veterans and autobiographical accounts by transgender veterans similarly suggest a strong presence of transgender people in the U.S. military. These figures indicate that transgender people are twice as likely as others in the general population to serve in the military. Specifically, it was estimated that 21.4% of transgender people serve in the armed forces, while only 10.7% of adults in the

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United States do. Within the transgender population, individuals who were born male, such as maleto-female (MtF) transgender individuals, are more than 5 times as likely as those born female, such as female-to-males (FtMs), to serve. The general and transgender populations can also be compared by the gender someone was assigned at birth. Transgender individuals who were assigned female at birth, such as FtMs, were about 3 times more likely to serve in the military than women in the general population; and transgender people assigned male at birth, such as MtFs, were 1.6 times more likely than men to serve in the general population. Explanation

Experts on transgender people and the military have considered possible reasons to explain the especially high rates of transgender service members. Essentially, transgender individuals may be particularly drawn to the military for its emphasis on masculinity. This notion is relatively straightforward when considering the high rates of FtM transgender people in the military. Since FtMs identify more with the male gender role, they may seek opportunities that allow them to express their maleness safely. The military allows (and even encourages) individuals who are assigned female at birth to adopt masculine traits to fulfill their duties; individuals who act this way in general society more often experience discrimination and victimization. FtMs could seek military service prior to identifying as transgender, but once they take on maleoriented attributes, they form a more authentic identity as transgender. Alternatively, an FtM who identifies as transgender but decides against transition (at least for the time being) could enlist in the military—he would be choosing one of the most masculine professions while continuing to be identified by others as a woman. Military interest by MtFs is a bit more complicated since people in this group more often identify with feminine traits and roles, which are not characteristic of the military. However, long before someone forms his or her identity as transgender and considers transition, the person may seek to

repress, hide, and purge any feminine attributes. During this early stage of identity development, an MtF may seek out opportunities to take on the most masculine of roles and traits—the military is a perfect prospect. Autobiographical accounts by MtF service members elaborate on this process; for instance, people assigned male at birth recognize feminine traits in themselves and subsequently join the military, believing that it will help them become more male. Another factor that could contribute to the high proportion of transgender service members relates to the risks associated with active duty. Transgender people may seek such risks more often than others. The transgender population has been found to experience mental health problems more often than others, particularly depression. Common symptoms associated with depression include hopelessness and suicidality. When people experience these symptoms, including transgender people, they can be more likely to engage in dangerous (and even deadly) behaviors. Therefore, it is possible that some transgender individuals choose (consciously or unconsciously) the military for its risks. Finally, transgender people may seek military service for many of the same reasons as cisgender people, including patriotism, following family tradition of military service, securing financial help for school, and seeking adventure and international travel. While these interests alone do not explain the elevated rates of transgender service members, they may be a part of what attracts any given transgender service member. Autobiographical accounts of transgender service people similarly suggest that transgender people are not only interested in the military for its emphasis on masculinity or opportunities for risks—but these in combination with reasons that attract members of the general population can help explain the incidence of transgender people in the military.

U.S. Military Policies The Department of Defense has historically banned transgender people from serving in all branches of the U.S. Armed Forces. Policies for exclusion are

Military and Transgender People

outlined in the medical standards used to assess all potential recruits—this document states that transgender people are unfit to serve as a result of medical and psychological conditions. More specifically, transgender people have been considered ineligible for military service if they had had surgery to their genitals. Therefore, transgender people who chose to undergo gender-affirming surgery were automatically disqualified for military duty. A transgender individual could also have been ineligible for military service for having a psychological condition called transsexualism. Criteria for this diagnosis are not included in the medical standards, but this diagnosis can be found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980. Transgender people could have been refused entry into the military or discharged as a result of these medical standards, since it was assumed they had a medical or psychological condition that precluded service. Each individual branch of the U.S. military has policies that reflect the same prohibition of transgender service members. In July 2015, the Pentagon announced its intention to lift the general ban on transgender service members; updated guidelines are expected to be released in early 2016. In addition, current policies affecting transgender people are not to be applied without approval from a Pentagon top official. Scholars have been unable to discover the origin of policies concerning transgender people and the military. However, a few court cases are known to have dealt with transgender service members, thereby applying these policies. In the case of Doe v. Alexander (1981), an individual (MtF) was denied reentry into the Army after having undergone gender-affirming surgery. In Leyland v. Orr (1987), an Air Force reservist was discharged for having undergone gender-affirming surgery while serving. Finally, in DeGroat v. Townsend (2007), a member of the Air Force who identified as transgender was discharged for cross-dressing. Each service member could have been discharged or excluded simply due to the existing general medical standards that ban transgender service members. However, testimony was additionally used to

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further support the basis for such policies and, therefore, reject the service members. There are likely numerous other examples of transgender service members being excluded or discharged from the military, but they were never brought to court. In 2014, Jocelyn Elders and her colleagues reported awareness of about two dozen service members being discharged in recent years for being transgender. Transgender service members also could have been discharged from the service and criminally indicted using the Uniform Code of Military Justice (UCMJ). According to Article 133 of the UCMJ, if an individual is convicted of behavior unbecoming to an officer, he or she is to be punished by the court. Article 134 also states that a person is to be punished by the court, but only in the case that the person’s conduct somehow negatively impacts the military or its reputation. A transgender person might have been punished for any behaviors that are considered discrepant with the values of the military. Two such instances can be found in the cases of United Sates v. Davis (1988) and United States v. Guerrero (1991). In each case, an individual was punished, using Article 134, for cross-dressing. While it is unclear whether these individuals identified as transgender, crossdressing is a common behavior for transgender people. Therefore, a transgender person may have been discharged using these articles, especially if the person did not fit the exclusionary criteria outlined in the general medical standards.

Transgender Veterans According to a directive released in 2011, transgender veterans are entitled to the same health care benefits as cisgender veterans. In addition, transgender veterans are provided transgender-specific services, including hormone therapy, mental health treatment, presurgical evaluations, and postsurgical care; however, gender-affirming surgeries are not covered. Since it was introduced, guidelines for providing health care to transgender and intersex veterans have been implemented throughout the Veterans Health Administration (VHA), and educational workgroups have provided trainings to

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help improve staff competency for working with transgender veterans. These guidelines do not apply to active duty military, retired military, or military dependents. Therefore, a transgender veteran can only access benefits if the person does not identify himself or herself as transgender until after being discharged from the military and the person’s status changes to veteran. Research has yet to be conducted about transgender veterans following the 2011 directive. However, their experiences of accessing services at the VHA were studied in earlier research. Generally, transgender veterans reported receiving inconsistent, insensitive, and sometimes prejudiced care. Some individuals said they were denied necessary services, such as mammograms and prostate exams. Other transgender veterans reported receiving mixed responses about the type of care covered by the VHA. Because of these negative experiences, some research revealed underutilization of VHA services by transgender veterans, and that some individuals sought treatments elsewhere as a result. However, other research indicated that transgender veterans utilized VHA services more often than others because they have limited other options as part of a marginalized population.

U.S. Debate Deliberation over the inclusion of transgender people in the military seems more common now than ever before in U.S. history. The question as to whether transgender individuals should be considered for military service has been increasingly asked since 2011—when gay, lesbian, and bisexual people became allowed to serve while being open about their sexual orientation. Those in favor of including transgender people in the military are seeking removal of the existing policies, while individuals on the opposing side of the issue are seeking to uphold the policies in favor of excluding transgender people from service. In the following sections, each perspective is explored. Opponents of Transgender Inclusion

People who support the continued exclusion of transgender individuals from the U.S. Armed Forces

maintain two assertions: (1) Transgender people are mentally ill, and (2) transgender people require costly and specialized medical and mental health care. The first premise of caution relates to believing that all transgender people are inherently mentally ill. From this perspective, transgender individuals are seen as unstable and, therefore, unfit for military service. Concern is expressed for how such a vulnerable population would be impacted by the demands of serving one’s country, as their mental condition could even worsen while in the military. Going a step further, there is fear about the effect of allowing mentally ill individuals to serve alongside other service people, potentially having a negative influence on others’ mental stability as well. The second point of contention relates to the costs and sensitivity associated with caring for transgender service people. Based on the first premise, that transgender people are mentally ill, they could be assumed to need more extensive mental health care, which would be costly. Further, for those seeking physical transition, they would require specialized medical care, such as hormone therapy. Even beyond the expense, those supporting this perspective see it as unfathomable that such treatment should be provided to service people on active duty in remote locations. Advocates of Transgender Inclusion

Those in support of including transgender people in the military have challenged the above points. They deny that all transgender people are inherently mentally ill. They refer to research about the transgender population, which does indeed indicate higher rates of mental illness. However, they elaborate that this finding is similarly found among other marginalized groups, and that discriminatory institutional policies, like those of the military, contribute to this outcome. Even if a group experiences illness more commonly, this perspective asserts, not all individuals can be assumed to suffer similarly—doing so contributes to stereotyping and discrimination. Advocates in favor of inclusion also refer to the most recent, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Military and Transgender People

to discredit the belief that all transgender people are inherently mentally ill. They identify gender dysphoria as the most up-to-date diagnostic term for transgender people, but assert that not all transgender people warrant this diagnosis. They point out that the military policies use terminology taken from an outdated version of the DSM—the third edition (DSM-III), published in 1980, which was informed by research that has since been superseded. To challenge the second argument, that transgender people require costly and specialized medical and mental health care, advocates of inclusion compare the needs of transgender people with those of the general population. It is suggested that treating transgender people is not very different from handling the unique medical and mental health needs of others in the military. After all, they argue, other service members require ongoing medications (comparable to hormone therapy) and undergo corrective surgeries that require subsequent rehabilitation (comparable to genderaffirming surgery). It is pointed out that cisgender service members are sometimes provided identical treatments in remote locations, so it would be just as easy for transgender service members on active duty to receive the same care. This side also notes that not all transgender people require psychological care or seek physical changes that result from hormone therapy and surgeries. Proponents of including transgender people in the military are also concerned about current transgender service members. They state that these individuals are unprotected without policies that include them and, as a result, they could suffer even more medical and mental health problems on account of their going without necessary treatments. This outlook seeks removal of the existing policies, and recommends transgender people be evaluated for duty fitness, just like other service members. They encourage the United States to follow the examples of other countries that include transgender people in their armed forces.

International Militaries At least 18 countries worldwide permit transgender people to serve in their armed forces, including

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Australia, Austria, Belgium, Bolivia, Canada, Czech Republic, Denmark, Estonia, Finland, France, Germany, Israel, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom. Some countries have official policies for the inclusion and treatment of transgender service members, and other nations consider potential transgender service members on a case-by-case basis, similar to the recruitment and enlistment of other, cisgender service members. The United Kingdom is one example of a nation that has an established policy for recruitment and management of transgender service members. The policy, adopted in 2009, holds that transgender people should be dealt with similarly to others who have a medical condition, such that they are provided treatment, if necessary, and that their job duties may be influenced by any limitations, if necessary. It clearly states that excluding individuals on the basis of being transgender is illegal and, moreover, that people should not be directly referred for treatment as a result of being transgender, as not all transgender individuals require medical or psychological care. The United Kingdom offers transgender-related health care to its service members, except for any type of surgeries.

Limitations Despite growing interest in studying transgender people and the military, both research and literature available on this topic remain limited. In 2014, Jocelyn Elders and her colleagues reported that only 7 peer-reviewed and 3 non–peer-reviewed studies focused on transgender people and the military, and that only 7 of these 10 studies included original empirical research. Knowledge and awareness of transgender people and the military will surely expand as more research and literature become available on this topic. Furthermore, as policies for transgender service members continue to change worldwide, so will the experience of being transgender in the armed forces. Adam F. Yerke See also Gay Exclusion in the U.S. Military: Evolution and Demise of Don’t Ask, Don’t Tell; Military and

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LGBTQ People; Transgender Identities; Transgender Inclusion in the LBGTQ Rights Movement; Transphobia

Yerke, A. F., & Mitchell, V. (2013). Transgender people in the military: Don’t ask, don’t tell, don’t enlist! Journal of Homosexuality, 60(2), 436–457.

Further Readings Brown, G. R. (1988). Transsexuals in the military: Flight into hypermasculinity. In S. Stryker & S. Whittle (Eds.), The transgender studies reader (pp. 537–564). New York, NY: Routledge. Bryant, K., & Schilt, K. (2008, August). Transgender people in the U.S. military: Summary and analysis of the 2008 Transgender American Veterans Association Survey. Palm Center White Paper. Retrieved November 28, 2015, from http://www.palmcenter.org/ node/1137 Elders, J., Steinman, A. M., Brown, G. R., Coleman, E., & Kolditz, T. A. (2014, March). Report of the Transgender Military Service Commission. The Palm Center. Retrieved November 28, 2015, from http:// www.palmcenter.org/files/Transgender%20 Military%20Service%20Report_0.pdf Gates, G. J., & Herman, J. L. (2014, May). Transgender military service in the United States. Los Angeles, CA: Williams Institute. Retrieved November 28, 2015, from http://williamsinstitute.law.ucla.edu/research/ military-related/us-transgender-military-service/ Jones, F. D., Deeken, M. G., & Eshelman, S. D. (1984). Sexual reassignment surgery and the military: Case reports. Military Medicine, 149, 271–275. Kerrigan, M. F. (2011). Transgender discrimination in the military: The new don’t ask, don’t tell. Psychology, Public Policy, and Law. doi:10.1037/a0025771 McDuffie, E., & Brown, G. R. (2010). 70 U.S. Veterans with gender identity disturbances: A descriptive study. International Journal of Transgenderism, 12, 21–30. doi:10.1080/15532731003688962 Shipherd, J. C., Mizock, L., Maguen, S., & Green, K. E. (2011). Male-to-female transgender veterans and VA health care utilization. International Journal of Sexual Health, 24(1), 78–87. doi:10.1080/19317611.2011.63 9440 Witten, T. M. (2007, February). Gender identity and the military: Transgender, transsexual, and intersexidentified individuals in the U.S. Armed Forces. The Palm Center. Retrieved November 28, 2015, from http://www.palmcenter.org/files/active/0/ TransMilitary2007.pdf

MINORITY STRESS This entry describes the unique stressors that sexual and gender minorities experience as a result of their stigmatized social status. It provides a conceptual overview of minority stress theory; describes specific minority stressors; and introduces extensions of minority stress theory to the areas of physical health, interpersonal relationships, and structural stigma. This entry focuses predominantly on experiences of minority stress among lesbian, gay, and bisexual (LGB) individuals, but the application of minority stress theory to gender minorities (e.g., transgender individuals) will also be discussed. Readers are encouraged to consult the specific entries in this volume on gender minorities for more nuanced discussions of the unique stressors that they experience.

Minority Stress Theory It is well documented that rates of psychiatric disorders are higher among sexual minorities compared to heterosexuals. In his seminal work in 2003, Ilan Meyer advanced a conceptual framework— minority stress theory—to explain why sexual minorities are at increased risk for psychiatric disorders compared to heterosexuals. The main tenet of minority stress theory is that sexual minorities experience unique stress associated with their stigmatized social status (referred to as minority stress) and that this stress accounts for their increased risk for psychiatric disorders. Meyer proposed that minority stress exists on a continuum ranging from distal to proximal, in which distal stress refers to objective experiences of stress (e.g., discrimination, violence), and proximal stress refers to subjective experiences of stress that depend on an individual’s perceptions and

Minority Stress

appraisals of the experiences. Of note, an individual does not have to identify as a sexual minority to experience distal stress. If an individual is perceived to be a sexual minority, regardless of his or her actual identity, then he or she may be targeted for discrimination or violence. In contrast, given the subjective nature of proximal stress, it is more dependent on an individual’s self-identification as a sexual minority. Meyer described several proximal minority stressors, including the internalization of negative attitudes toward nonheterosexuality (internalized homophobia), vigilance for cues of potential rejection (expectations of rejection), and hiding one’s sexual identity to avoid potential negative consequences (concealment). Each of these minority stressors will be discussed in subsequent sections. While minority stress theory provides a conceptual framework for understanding why sexual minorities are at increased risk for psychiatric disorders, it does not specify the mechanisms through which discrimination influences mental health. Mark Hatzenbuehler extended minority stress theory by proposing that discrimination leads to cognitive, affective, and social processes that increase risk for mental health problems. An important aspect of his model is that it integrated general risk factors for psychopathology with those that are unique to the experiences of sexual minorities. In regard to general risk factors, he proposed that discrimination can lead to cognitive phenomena (hopelessness, pessimism, and negative views of the self), affective phenomena (maladaptive coping and emotion dysregulation), and social phenomena (social isolation), all of which are risk factors for mental health problems. For instance, experiences of discrimination may lead sexual minorities to have negative thoughts about themselves and their futures as well as difficulties regulating their emotions, which in turn may lead to depression and anxiety. In regard to unique risk factors, Hatzenbuehler advanced minority stress theory by articulating that an individual’s subjective experience of minority stress (e.g., his or her perceptions or appraisals) may be mechanisms through which

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objective experiences of minority stress influence mental health. Thus, if a sexual minority is discriminated against, then he or she may experience negative thoughts and feelings about his or her sexual orientation as well as expectations of future rejection, which in turn may result in mental health problems. In addition to describing the unique stressors that sexual minorities experience and their impact on mental health, minority stress theory also proposes that there are factors that may strengthen or weaken the impact of minority stress on mental health. Consistent with the broader literature on stress and mental health, minority stress theory posits that social support can function as a stress buffer, reducing the negative impact of minority stress on mental health. In addition, an individual’s tendency to use adaptive coping strategies in the face of minority stress may also be protective against mental health problems. For instance, responding to discrimination by seeking advice or emotional support from others or by engaging in pleasurable or meaningful activities is more likely to lead to positive outcomes compared to using substances to diminish one’s emotional pain or focusing on the causes and consequences of the discrimination. Of note, in addition to the individual-level supports that a person has and his or her coping skills, sexual minorities can also turn to others in the LGBTQ community for support and resources. This group-level coping is unique to minority group members, and it highlights the fact that belonging to a minority group involves benefits in addition to stressors. Finally, in addition to social support and coping, minority stress theory proposes that the impact of minority stress on mental health may depend on characteristics of one’s sexualminority identity. For instance, minority stress may have a stronger impact on mental health for those whose sexual-minority identities are more central to their overall sense of self. If being a sexual minority is an important aspect of one’s identity, then being targeted for discrimination or violence because of that aspect of one’s identity may be particularly harmful.

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Specific Minority Stressors Discrimination and Violence

Despite increases in societal acceptance of sexual minorities, discrimination and violence remain widespread experiences among this population. Sexual minorities report high rates of discrimination specific to their sexual-minority identity as well as high rates of other types of violence that may or may not be related to their sexual-minority identity, such as verbal harassment, threats of violence, physical assault, sexual assault, and property crime. Notably, sexual minorities report higher rates of violence compared to heterosexuals, and sexual minorities reporting high rates of discrimination and violence have poorer mental health outcomes. The work of Kevin Nadal demonstrates that even minor forms of stigmatization can be harmful. He proposed that sexual minorities frequently experience microaggressions, defined as verbal, behavioral, or environmental slights that communicate hostile, derogatory, or negative judgements about one’s sexual-minority status. He described numerous microaggressions toward sexual and gender minorities, such as the use of heterosexist language (e.g., saying “that’s so gay”), the endorsement of heteronormative or genderconforming behaviors (e.g., telling a gay person to “act straight” in public), and the assumption of a universal lesbian, gay, bisexual, or queer (LGBQ) experience (e.g., assuming that all gay men are effeminate). As with discrimination and violence, sexual minorities who report experiencing higher levels of microaggressions have poorer mental health outcomes. Further, given that microaggressions tend to be subtler than other types of discrimination, sexual minorities may experience them more frequently, thus increasing their impact on mental health. In addition to the minority stress that lesbians and gay men experience, bisexual individuals experience unique stressors related to their sexual identity. Heterosexual individuals tend to have more negative attitudes toward bisexual individuals than toward lesbians and gay men. Further, lesbians and gay men can also be the perpetrators

of discrimination against bisexual individuals. Thus, bisexual individuals can experience marginalization from heterosexuals as well as from other sexual minorities. Negative attitudes toward bisexual individuals can take many forms. First, a common misperception of bisexuality is that it is an illegitimate and unstable sexual orientation. As such, bisexuals can be perceived as confused, experimenting, in transition to a gay/lesbian identity, or in denial about their true sexual orientation. Second, bisexuals can be perceived as sexually irresponsible, such that they can be perceived as promiscuous or unable to have monogamous relationships. Finally, bisexuality can be perceived as immoral or pathological, reflecting a general hostility toward bisexuality. There are also gender differences in the types of discrimination and violence that sexual minorities experience. Studies have found that both heterosexual men and heterosexual women express more negative attitudes toward sexual-minority men than toward sexual-minority women. In addition, sexual-minority men are more likely than sexualminority women to experience discrimination from medical professionals, given common assumptions that gay and bisexual men have HIV or AIDS. In contrast, sexual-minority women are at risk of experiencing sexual objectification by heterosexual men. Heterosexual men may eroticize female same-sex sexual behavior and, in turn, proposition sexual-minority women to have sex with them and another female. Internalized Homophobia

A major consequence of living in a society that values heterosexuality over other sexual orientations is exposure to negative attitudes toward nonheterosexual attractions, behaviors, and identities. These negative attitudes can be internalized by LGBTQ people as negative thoughts and feelings about one’s own sexual identity, which has been referred to as internalized homophobia (as well as internalized heterosexism, internalized homonegativity, internalized stigma, and self-stigma). Of note is that sexual minorities can experience

Minority Stress

internalized homophobia in the absence of discrimination or violence directed at them, given their general knowledge of negative societal attitudes toward nonheterosexuality. It is common for individuals to experience some degree of internalized homophobia as they develop their sexualminority identity, and the process of overcoming this internalized homophobia may eventually contribute to the process of developing a healthy selfimage. Internalized homophobia is proposed to decrease as one moves toward developing a positive sexual identity, in part due to increased contact with the LGBTQ community and the support and resources that this contact provides. Still, given the strong impact of early life experiences and ongoing exposure to societal stigma and prejudice, it is possible that some degree of internalized homophobia could remain even after one has accepted a positive sexual-minority identity. Consistent with minority stress theory, research has demonstrated that internalized homophobia is a robust risk factor for mental health problems. However, the impact that internalized homophobia has on sexual minorities is heterogeneous and depends on an individual’s access to social support and adaptive coping skills. Expectations of Rejection

Given the presence of societal stigma and prejudice, sexual minorities often anticipate rejection from others. As a result, they learn to be vigilant toward cues of potential rejection in an effort to avoid discrimination and violence. Although vigilance may be used as a strategy to cope with a realistic possibility of rejection, it can have the unintended consequences of draining one’s cognitive and emotional resources. In fact, research has demonstrated that expectations of rejection can have a negative impact on social and academic functioning as well as mental and physical health. Similar to internalized homophobia, expectations of rejection do not require discrimination or violence to occur. A sexual minority may learn to be vigilant toward cues of potential rejection based on his or her knowledge of societal stigma and

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prejudice regardless of his or her personal experiences with discrimination and violence. Although not specifically discussed in the context of minority stress theory, rejection sensitivity is a closely related construct to expectations of rejection. Rejection sensitivity refers to the extent to which an individual anxiously expects to be rejected based on one’s stigmatized identity. It shares some features with social anxiety, such as concerns about the reactions of others, but it is unique in that it acknowledges that minority group members may have realistic concerns about rejection given their stigmatized social status. Rejection sensitivity is theorized to result from experiences of discrimination, which can lead minority group members to be vigilant for cues of potential rejection, to experience intense reactions to rejection, and to expect to be rejected. Research has demonstrated that rejection sensitivity is associated with vigilance for, and sensitivity to, cues of potential rejection as well as with mental health problems. Concealment

A common strategy used by sexual minorities to cope with the potential for discrimination is to conceal one’s sexual identity from others. However, concealing one’s sexual identity can have the paradoxical effect of leading to mental health problems, given the stress associated with doing so. The act of disclosing one’s sexual-minority identity is not a one-time experience. Sexual minorities make constant decisions about whether to disclose their sexual-minority identity to specific individuals as well as when and how to do so. Several explanations for the negative consequences of concealing a stigmatized identity have been proposed. For instance, concealment can prevent sexual minorities from identifying and affiliating with other sexual minorities, which can reduce their access to support and resources from the LGBTQ community. In addition, the process of constantly monitoring one’s behavior in an effort to avoid unintentionally disclosing one’s sexual-minority identity or behaving in ways that may be perceived as stereotypical of sexual minorities places demands

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on cognitive and emotional resources, which can lead to mental health problems.

Extensions of Minority Stress Theory Although minority stress theory was initially proposed as a conceptual framework to understand sexual minorities’ vulnerability to mental health disparities, it has since been extended to the domains of physical health and relationship functioning. For instance, sexual minorities are at increased risk for physical health problems compared with heterosexuals, ranging from poor general health status to cancer, cardiovascular disease, and HIV/AIDS. Minority stress has been identified as a risk factor for physical health problems, and research has begun to focus on the specific mechanisms responsible for this association. For instance, sexual minorities may be reluctant to seek medical care due to fear of discrimination, and the resulting delay in treatment may exacerbate physical health problems. Further, those who do seek medical care may conceal their sexual orientation, which could lead to inappropriate and ineffective treatment. In regard to relationship functioning, sexual minorities may experience unique challenges to their relationship quality and functioning due to their stigmatized status and the fact that they and their partners may be ignored or rejected by family, friends, and society. As a result, sexual minorities may internalize negative messages about their relationships as well as their sexual identity. Notably, studies have found that sexual minorities with higher levels of internalized homophobia report decreased relationship quality. Furthermore, the broader literature on stress and coping in couples suggests that each partner’s unique experience of minority stress may influence the other partner’s mental health. For instance, if one partner is verbally harassed or physically assaulted as a result of his or her sexual orientation, it could increase the extent to which the other partner fears that it could happen to him or her or that it could happen to his or her partner again. Finally, recent advances in minority stress theory have included novel operationalizations of

minority stress, particularly in regard to structural stigma. Scholars have long recognized that stigma can operate at the structural level. Structural stigma refers to societal-level conditions, norms, and institutional practices that constrain the opportunities and resources for stigmatized populations. Sexual minorities who live in areas with greater structural stigma (e.g., states in which same-sex marriage had been banned prior to the June 2015 Supreme Court decision legalizing such marriages nationwide), or communities with greater prejudicial attitudes toward sexual minorities, have higher rates of psychiatric disorders, higher rates of suicidality, and earlier mortality than those living in areas with lower structural stigma. Thus, stigma at various levels has been identified as a robust risk factor for psychiatric disorders.

Transgender Populations As noted, minority stress theory was developed to explain why sexual minorities are at increased risk for psychiatric disorders. However, it is also well documented that transgender individuals (i.e., those whose birth-assigned sex is discordant with their current psychological gender identity) are at increased risk for psychiatric disorders relative to cisgender individuals (i.e., those whose birthassigned sex is concordant with their current gender identity). Further, transgender individuals experience unique stressors associated with their stigmatized social status as gender minorities, including variations of the stressors previously described for sexual minorities. Thus, researchers have extended minority stress theory to explain why transgender individuals are at increased risk for psychiatric disorders. Transgender individuals experience particularly high rates of discrimination and violence and, as a result, they are at risk for internalizing negative societal attitudes toward gender nonconformity and for developing heightened expectations of rejection due to their genderminority identity. In addition, transgender individuals experience additional stressors that sexual minorities do not experience. For instance, transgender individuals are often concerned with

Mixed-Orientation Marriages

whether or not others will perceive them as their desired gender versus their birth-assigned sex. There is some evidence that transgender individuals at the beginning of their transition may experience more anxiety than those at later stages of their transition, which may be related to greater concern about others’ perceptions of their gender at earlier stages of their transition.

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Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30, 1019–1029. Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76, 306–317.

Brian A. Feinstein See also Biphobia; Closet, The; Hate Crimes; Heterosexism; Homophobia; Internalized Homophobia; Microaggressions; Sexual Minorities and Violence

Further Readings Budge, S. L., Adelson, J. L., & Howard, K. A. S. (2013). Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping. Journal of Consulting and Clinical Psychology, 81, 545–557. Feinstein, B. A., Goldfried, M., & Davila, J. (2012). The relationship between experiences of discrimination and mental health among lesbians and gay men: An examination of self-stigma and rejection sensitivity as potential mechanisms. Journal of Consulting and Clinical Psychology, 80, 917–927. Hatzenbuehler, M. L. (2009). How does sexual minority stigma “get under the skin”? A psychological mediation framework. Psychological Bulletin, 135, 707–730. Hatzenbuehler, M. L., McLaughlin, K. A., Keyes, K. M., & Hasin, D. S. (2010). The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: A prospective study. American Journal of Public Health, 100, 452–459. Meyer, I. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56. Meyer, I. (2003). Prejudice, social stress, and mental health in LGB populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. Nadal, K. L. (2013). That’s so gay! Microaggressions and the lesbian, gay, bisexual, and transgender community. Washington, DC: American Psychological Association.

MIXED-ORIENTATION MARRIAGES Mixed-orientation marriages are marriages between individuals of differing sexual orientations. For instance, in a mixed-orientation marriage, one partner identifies as heterosexual and the other identifies as lesbian, gay, bisexual, or queer (LGBQ). In the United States, over 2 million married couples have been or are currently in mixed-orientation marriages. Some individuals enter marriage aware of their partner’s sexual orientation, some become aware as a result of a disclosure that happened months or years into the marriage. In other cases, the LGBQ partner does not disclose until after the relationship has dissolved. Much of what we know about mixed-orientation marriages has focused on marriages of a presumed heterosexual couple where one partner “comes out” or discloses his or her sexual orientation as LGBQ. In addition, much of this work has explored the experiences of heterosexual women and their gay or bisexual male partners (which will be specified when relevant). This entry will examine the situations and issues that may arise from these mixed-orientation marriages. The following section will explore the experiences of both members of the couple; next, the entry will discuss the future of these relationships after disclosure; and lastly, it will examine the experiences of children conceived within these relationships.

The Disclosing Spouse In the late 1980s and early 1990s, researchers estimated that approximately 10% to 20% of gay men had been married to women in the past. It is also believed that the number of LGBQ people

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Mixed-Orientation Marriages

entering mixed-orientation marriages will decrease over time, owing to an increase in acceptance of LGBQ people. Older LGBQ individuals who are currently married tend to disclose their sexual orientation much later than younger people. Some LGBQ individuals get married to different-sex partners completely unaware of their own sexual orientation, because of psychological denial or not being completely sure how they identify. Others have had same-sex sexual experiences or have noticed same-sex sexual attraction before getting married to a different-sex partner. For still others, the realization of their sexual orientation doesn’t occur until after they are married to a different-sex partner. In one study, about a third of gay men disclosed their sexual interest or attraction prior to getting married, a third during the marriage, and a third after the separation or divorce. Why do LGBQ people get married to differentsex partners? For bisexual individuals, getting married to a different-sex partner is not atypical, but many of these individuals do not disclose their sexual orientation prior to marriage. Bisexual men describe wanting to marry a woman because they wished to have a family, they were in love with their partner, or they were hoping that the samesex feelings would go away. Many bisexual men report experiencing long, enduring monogamous relationships with a female partner. Many gay men, on the other hand, list society and family pressure, as well as wanting to feel “normal,” as the most important reasons for getting married. Although many report love for their different-sex spouse, after the divorce or separation some report the relationship as being more like a close friendship. Experiences of homophobia and negative views toward being LGBQ, especially due to religious beliefs, are other factors that fuel the decision to get married. Many gay men who marry women are more homophobic at the time that they got married than after their marriage dissolved, suggesting that this homophobia may be related to their own struggle regarding their sexual orientation. What does the future look like for these individuals? Of those who stay in mixed-orientation marriages, bisexual men experience less life stress

than do married gay men. Among gay men, those who stay married are less satisfied in their relationships with their female partners, less likely to disclose their sexual orientation, and have more sexual-identity difficulties, compared with those who divorce and remain single or create new relationships with male partners. For many of these men, it is incredibly difficult to integrate their identities from the past to current lives, assimilate into the LGBQ community, and define the roles of both married to a different-sex spouse and being an LGBQ person.

Spousal Response to Disclosure Often when an LGBQ person discloses his or her sexual orientation to a different-sex spouse, either deliberately or accidentally, the LGBQ person has had some time to process his or her identity. For the heterosexual spouse in this situation, however, the disclosure is often a surprise—and may be devastating, even if the spouse was previously suspicious about his or her partner’s sexual orientation. Sexual rejection by a partner is the first sign for many couples that something is wrong in the marriage. After disclosure, betrayal is the most common feeling experienced, but some spouses also experience relief as a result of finally understanding why the marriage was failing. There may be a sense of rejection or sexual inadequacy (e.g., “if my partner is LGBQ, he is saying he is not sexually attracted to me, or I could not live up to my role as a wife”). Depending on the spouse’s values or religious beliefs, this disclosure often causes the person to question his or her own belief system. In some cases, the LGBQ individual’s disclosure concerns not only the individual’s sexual identity, but also his or her own sexual infidelity. These incidences of infidelity raise concerns about the risk of sexually transmitted infections for spouses, who are often unaware of the extramarital affairs and unprotected sex. Researchers have attempted to explain what a spouse may experience when a partner discloses his or her sexual orientation. Many heterosexual spouses in mixed-orientation marriages first go

Mixed-Orientation Marriages

through a stage of disbelief and denial following the disclosure. After some time, the spouse may begin to acknowledge the new reality of the romantic relationship. The spouse may notice that the LGBQ partner has a renewed sense of self, maybe even changing his or her hair or clothing style, or integrating himself or herself into the LGBQ community. Feelings of anger and grief are often present during this time. Over time, this acknowledgment may lead to acceptance of the current situation. The spouse may begin to let go of dreams and expectations of the relationship. This often develops into a time of healing and selfreflection. For the first time, the heterosexual spouse begins thinking about his or her own wellbeing and next steps. There comes a point where one starts to reconfigure one’s own life, both for oneself and for the marital relationship. Lastly, the spouse begins to think about the future, with or without the partner, and begins moving forward. A spouse’s disclosure forces the partner to contemplate how and when the person will disclose his or her relationship situation to others. Until recently, many spouses coped with this alone or with little or no social support. However, this is changing. Currently, there are more supports available for individuals in mixed-orientation marriages than ever before. The increase in societal acceptance of LGBQ people has allowed for greater discussion and support for heterosexual spouses in mixed-orientation marriages. Peer support and therapy are beneficial options to help people process their feelings and determine the next steps in their lives. The Future of the Relationships After Disclosure

The individual context of the disclosure is important (e.g., is the disclosure voluntary or accidental? Does it include infidelity?). After disclosure, the couple need to decide what is to be the future course of their relationship. Many of these couples have been married for quite a few years. According to research conducted in the early 1990s, immediately after disclosure about

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one-third of the couples divorce or separate, about a third remain together for a year or two, and the rest try to figure out a way to make their relationship work long-term. Of the couples who attempt to make it work, about half divorce or separate within 3 years after the disclosure. The major reasons why couples attempt to save their marriage are the desire to keep their family together and their love for their spouse. The process of understanding and resolving issues surrounding the marriage can vary in length for each individual couple but on average, this process takes about 3 years. For the couples who decide to remain together, the most important strategy for making the relationship last is open and honest communication. The next most important strategy for these couples is peer support for both spouses. About half of these couples seek counseling in an attempt to understand each other’s experiences and figure out the best situation for each member of the couple. Often, these couples need to negotiate how the relationship will function after the disclosure. Some couples choose to keep their monogamous agreements, and some decide to create some type of open relationship. For couples who choose an open relationship, some elect to be informed of relationships occurring outside of the marriage and some do not. Polyamorous relationships require trust, openness, clear discussion, and negotiation. These arrangements can be difficult due to the lack of social support and societal approval surrounding polyamory and open relationships. This can cause both members of the couple to feel like they have to hide their relationship and experiences from the outside world. The biggest issue reported by couples in these situations is the negative reactions from their families of origin and from the LGBQ community. Little is known about how these arrangements and marriages fare long-term.

Children in the Context of a MixedOrientation Relationship The exact number of mixed-orientation marriages that include children is unknown.

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However, the majority of married heterosexual couples have children, and there is no reason to believe that this group would be much different. Couples in mixed-orientation marriages who have children are more likely to attempt to stay together than those who do not have children. One of the most common issues after disclosure is the decision to tell, or not to tell, the children. Some children find out accidentally, such as through reading e-mails between a parent and a lover; some find out from one or both of their parents; and some are not told at all. The additional layer to this disclosure is that these discussions often include talking about the parents’ separation and divorce. Reactions vary depending on the child’s age at disclosure and are unique for each child and situation. Usually, it is the divorce, not the parent’s sexual orientation, that causes children the most emotional turmoil. As with any divorce, some children feel abandoned or confused. Very young children may not completely understand and usually have a neutral-to-positive reaction. Some children may be fearful that their peers will learn of the family’s situation and will tease or make hurtful antigay remarks. For an adolescent, this new information may create personal feelings of confusion about his or her own sexuality, identity, and belief system. By adulthood, children have typically resolved most of their negative feelings and have learned to accept their parent as a human being, however complex, and not simply in terms of sexual orientation. Little is known about LGBQ parents in mixed-orientation marriages, but one study found that gay fathers in mixed-orientation marriages experience similar levels of parenting-related stress compared to men who separated from their wives and remained single or had a relationship with a male partner.

Conclusion Mixed-orientation marriages are not a new phenomenon. However, there is reason to believe that the number of LGBQ people who are entering different-sex marriages will decrease as a result of the changes in social acceptance of LGBQ people.

Same-sex marriage is beginning to be seen as an acceptable avenue to love, children, and a family. With greater social acceptance of LGBQ people and marriage between same-sex partners, there will be a likely shift in how these marriages are created and how they function over time. Mixedorientation marriages can include intense emotions and an array of different needs and personal feelings from both members of the couple. Counselors, social workers, and other professionals who work with these families need to acknowledge the uniqueness of each family and work with individuals to figure out the best situation for everyone involved. Samantha L. Tornello See also Bisexuality, Female; Bisexuality, Male; LGBQ Parents, Coming Out to Children; Monogamy and Non-Monogamy

Further Readings Buxton, A. P. (1994). The other side of the closet: The coming-out crisis for straight spouses and families. New York, NY: Wiley. Buxton, A. P. (2005). A family matter. Journal of GLBT Family Studies, 1, 49–70. Buxton, A. P. (2006). Counseling heterosexual spouses of bisexual men and women and bisexual–heterosexual couples: Affirmative approaches. Journal of Bisexuality, 6, 105–135. Hernandez, B. C., Schwenke, N. J., & Wilson, C. M. (2010). Spouses in mixed-orientation marriage: A 20-year review of empirical studies. Journal of Marital and Family Therapy, 37, 307–318. Higgins, D. J. (2006). Same-sex attraction in heterosexually partnered men: Reasons, rationales, and reflections. Sexual and Relationship Therapy, 21, 217–228. Malcolm, J. P. (2008). Hetoersexually married men who have sex with men: Marital separation and psychological adjustment. Journal of Sex Research, 45, 350–357. Tornello, S. L., & Patterson, C. J. (2012). Gay fathers in mixed-orientation relationships: Experiences of those who stay in their marriage and of those who leave. Journal of GLBT Family Studies, 8, 85–98.

Monogamy and Non-Monogamy

MONOGAMY

AND

NON-MONOGAMY

This entry defines and provides examples of monogamy and non-monogamy. Monogamy and nonmonogamy are relationship formations that are rooted in gendered and heterosexually imbued social structures and institutions. Monogamy is the exclusive sexual coupling of two individuals in a long-term relationship. Non-monogamy is the practice of an individual having multiple, concurrent sexual partners. Marriage is a social mechanism that distinguishes monogamy from non-monogamy. Marriage as an institution and social norm provides assumptions and relationship rules regarding monogamy upon which to compare forms of nonmonogamy such as cheating, hooking up, polyamory, polygamy, and others.

Construction of Monogamy Through (Heterosexual) Marriage Monogamy is defined as exclusive, dyadic sexual and intimate coupling. Those who practice monogamy sexually and emotionally commit to only one partner over some period of time. The legal institution of marriage requires monogamy as a central tenet. However, monogamy is also important in exclusive-coupled relationships in which marriage is not a part. In Western culture, the typical sexual model is a dyad, or two individuals in a committed relationship, rather than multiple partners or sexually nonpartnered individuals. Exclusive coupling is the foundational organizational component of the institution of marriage and nuclear family formation. Monogamy is the taken-for-granted yet defining characteristic of the institution of marriage, for it is the grounds on which, if cheating occurs, a divorce court decision can be made. European predecessors and founders of the United States defined monogamy as a religiously based mode of controlling the sexuality of citizenry and defined marriage as the means of harnessing sexual desire. Normalizing marriage and monogamy assured that families would form, creating more stable economic foundations upon

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which to procreate. Reproducing the heterosexual structure of the family assured (at least theoretically) that women and children were cared for and that the workforce would be reproduced. Further, structuring the family in this way (again, theoretically) assured bloodlines and kinship for the generational production, reproduction, and passage of wealth.

Construction of Non-Monogamies Non-monogamies are generally socially constructed as deviant in relation to monogamy. Importantly, however, Western culture dictates that individuals pass through a life stage in which it is appropriate to date. Being single and dating, although a form of non-monogamy, is constructed as a normal stage of the life course in which one searches for a marriageable partner. Only when the individual violates some norm of dating does “dating” become deviant. Non-monogamies come in many forms and function in different ways. Some forms of non-monogamy include marriage. Despite the social construction of monogamy as a single dyadic relationship rooted in marriage, all marriage does not specifically entail monogamy.

Cheating/Infidelity Cheating occurs when individuals secretly pursue relationships outside of the primary, dyadic, monogamous relationship. Cheating is defined as any sexual behavior that is not made public in the dyadic relationship and would be met with disapproval by one’s partner. This includes kissing and touching as well as outside sexual-emotional contact. It is important to delineate between cheating and infidelity. Cheating suggests that the partners in the primary relationship are not married; instead, they are monogamous in their long-term, committed relationship. Infidelity, then, is a term used to show that an individual is married. In cases of legal divorce proceedings, infidelity in the marital relationship can be used to call the validity of the marriage into question, to determine parental competence and moral aptitude in final court judgments.

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Scholars in the area of cheating and infidelity use and critique the 19th-century notion that men, generally, have a furious sex drive that must be contained and restrained. In other words, men must fight the urge to “spread their seed” because the rule of marriage and monogamy is the norm according to religious and governmental institutions. Feminist critiques of this naturalized account of men’s sexuality reveal that institutional valuation of men’s sexuality is a means of social control and is, thus, socially constructed to reflect the social values of those in power: religious figures and governmental bodies. Institutions that naturalize men’s “wild sexual urges” take for granted the ways in which men are socialized to harness their sexuality and dismiss women’s sexuality. Outcomes of this sexual inequality make women subordinate to men in the sex act and devalue women’s sexual agency. Further, scholars state that it is difficult to interpret research findings on rates of cheating and infidelity in relationships because measurement varies widely from study to study. For example, some studies define and measure cheating/infidelity as all intimate touch (kissing, petting, and the sex act), while others define and measure cheating/ infidelity as only the sex act. To complicate matters further, the addition of online cheating and infidelity tends to be a variable that is measured and defined in multiple and inconsistent ways. Because online relationships take place in a different context from face-to-face relationships, research studies have had to look more closely at the emotional dimension (rather than simply rates) of cheating and infidelity. Overall, and most importantly, research shows that cheating and infidelity remain prevalent and rather commonplace in Western culture.

Singles/Dating/Hooking Up Scholars in the area of singlehood, dating, and hookups find that there have been cultural shifts in the norms around teenage dating and time spent in relationships before marriage over the last century. Premarital, monogamous, heterosexual coupling of the 1950s variety has been supplanted by a culture of hookups. Hookup culture allows for

multiple sexual partners without the commitment. Hookups are, thus, defined as casual sexual encounters. Hooking up is viewed as a temporary alternative to one’s participation in marriage/ monogamy culture. Currently, hookups seem to be the primary form of intimate interaction among college students. Studies point to college campuses as spaces in which hookup culture is regularly practiced. These encounters often include large amounts of alcohol consumed and close contact with many people. Social events like clubbing or partying tend to be the primary means to meet potential hookup partners. Research suggests that all individuals do not participate in hookup culture equally. Participation in hookup culture varies by gender, social class/ status, race, sexuality, and other social phenomena. For some, hooking up is advantageous because of the little time commitment and patience it requires compared to a dyadic, long-term, monogamous relationship. For others, moral and ethical concerns sometimes rooted in religious beliefs trump the appeal of hookup culture. These individuals prefer to find companions who are equally committed to a long-term, monogamous relationship.

Polyamory Polyamory is defined as an intimate relationship form in which one has multiple, long-term, simultaneous, loving, sexual partnerships. The relationship configuration is open and clearly communicated to all involved individuals. Polyamory need not involve marriage, although married couples too participate in polyamory. Many times, “swinging” and polyamory are conflated. Swinging is the non-monogamous practice of having multiple sexual partners specifically to engage in sex acts. In contrast to this, polyamory is the non-monogamous practice of engaging in longterm, simultaneous, intimate relationships that may or may not include sex. Fidelity, jealousy, and equal time given to each partner are concerns for polyamorous individuals. Commitment to multiple partners, while described as fulfilling, nurturing, and loving, can be difficult to maintain. Further, because polyamory distorts norms of relationship and family formation, the

Monogamy and Non-Monogamy

practice is policed and persecuted. Polyamorous families have found themselves in dire straits in the courtroom. The “deviant” family form has been cited as amoral and an unethical site to raise children despite children’s access to multiple loving adults for guidance. Subsequently, children have been removed from polyamorous families. Research on polyamorous relationships and families focuses on relationship dynamics of polyamorous people, relationship satisfaction, and family formation. Because polyamorous individuals engage in emotional attachment differently, and perhaps more regularly, than their monogamous peers, research interest in multiple attraction and attachment among polyamorous triads (three or more people in the relationship), quads (four or more people in the relationship), and more is on the rise. In addition, questions about jealousy and relationship satisfaction tend to come up in these studies. Similarly, studies on families formed around and by polyamorous individuals have become more visible. Polyamory persists despite the fact that it is not a legal family form. Studies have found that children thrive in such family forms, despite social pressures to conform. Children in polyamorous families tend to have more adult figures in their lives upon which to rely. This structure makes the child feel nurtured and cared for while simultaneously spreading parental duties over more individuals. However, the cushion of home cannot prevent what the child faces outside of the home when others are made aware of the unusual family form. Bullying and teasing and other threats of violence are concerns that arise for children in polyamorous families.

Polygamy/Polygyny/Polyandry Polygamy is a broad term to refer to one person who has multiple spouses. The language used in the definition is specific to married individuals and is rooted in religious doctrine. Therefore, most LGBTQ individuals are excluded from these practices. To have a nonheterosexual identity is considered unacceptable by the religions considered here. The most visible form of polygamy is polygyny, or one man married to multiple wives. However,

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polygyny as a family formation is only one global example of religion-based non-monogamies. Polygyny is rooted in teachings of the Latterday Saints (LDS) or Mormons, and is the principle upon which the Church was founded in the United States. Joseph Smith (1805–1844), the church’s founder, believed that it was incumbent on the LDS man to marry many women. It was, thus, his job to care for the women economically and to form families on this basis. The LDS Church has experienced a waxing and waning of polygamous practice. However, an internal division over this practice initiated a break from the LDS by those more orthodox who wanted to continue to practice polygyny. Thus, the current form of the Fundamentalist Church of Jesus Christ of Latter-day Saints (FLDS) was born. Contemporary FLDS groups have come under fire for continuing to practice polygyny. Specifically, the practice of young females marrying older males has been the focus. Polyandry, the practice of one woman having multiple husbands or male partners primarily found in traditional matriarchal societies such as the Mosuo of Western China, is a relationship formation found less often. Research on polygamy/polygyny tends to have a global focus, though there is a dearth of research on the U.S.-based form of polygyny in Mormonism. Mormon polygyny, while illegal in the United States, continues to thrive through the FLDS Church. Polygyny has recently been made visible in Western popular culture with cable television shows like Home Box Office’s (HBO’s) Big Love and The Learning Channel’s (TLC’s) Sister Wives. In areas of the world such as South Africa and Muslim-identified counties in the Middle East, polygyny is a lawful religious practice. While Western feminists have often critiqued polygyny as oppressive to women, some have now stated that in countries where women are economically and socially disadvantaged, polygyny might prove useful for social mobility and to defend against HIV/AIDS. Alison Rose Moss See also Divorce, Legal Issues in; Divorce and Separation, Historical Perspective on; Families of Choice; Marriage, Reason for and Against; Monosexism; Polyamorous Parenting; Polyamory

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Further Readings Anderson, E. (2013). The monogamy gap: Men, love, and the reality of cheating. New York, NY: Oxford University Press. Barker, M., & Langdridge, D. (2010). Understanding nonmonogamies. New York, NY: Routledge. Barlow, P. L., & Mariano, S. (2014, Fall). Marriage is always complicated in Utah. Religion in the News, 12–14. Cott, N. F. (2002). Public vows: A history of marriage and the nation. Cambridge, MA: Harvard University Press. England, P., & Ronen, S. (2013). Sex and relationships among youth: An intersectional gender lens. Contemporary Sociology, 42, 503–513. Hamilton, L., & Armstrong, E. L. (2009). Gendered sexuality in young adulthood: Double binds and flawed options. Gender & Society, 23(5), 589–616. Moss, A. R. (2012). Alternative families, alternative lives: Married women doing bisexuality. Journal of GLBT Family Studies, 8, 405–417. Rubin, G. (1975). The traffic in women: Notes on the “political economy” of sex. In R. Reiter (Ed.), Toward an anthropology of women (pp. 157–210). New York, NY: Monthly Review Press. Schippers, M. (in press). Polyqueer: Compulsory monogamy and the queer potential of plural sexualities. New York, NY: New York University Press. Sheff, E. (2014). The polyamorists next door: Inside multiple-partner relationships and families. Lanham, MD: Rowman & Littlefield. Stacey, J. (2011). Unhitched: Love, marriage, and family values from West Hollywood to Western China. New York, NY: New York University Press. Vassi, M. (1997). Beyond bisexuality. In C. Queen, L. Schimel, & K. Bornstein (Eds.), Pomosexuals: Challenging assumptions about gender and sexuality (pp. 70–75). San Francisco, CA: Cleis Press.

MONOSEXISM Monosexism is a social structure operating through a presumption that everyone is, or should be, monosexual (attracted to no more than one gender). This system includes institutional and social rewards for monosexual people, and oppression

against bisexual people and others who are attracted to more than one gender. The term monosexism is used in order to address and define oppression of bisexual people as institutional and systematic rather than as personalized and individual, and to define broad trends rather than specific attitudes. Monosexism as a structure creates multiple and varied effects over bisexuality and bisexual people, including bisexual erasure and multiple disparities between bisexual and monosexual people.

Difference From Biphobia As opposed to the term biphobia, which mainly describes personalized attitudes and behaviors aimed against bisexual people, monosexism describes a broad social structure. Discussions of biphobia generally address direct negative attitudes or treatment of bisexual people, including stereotyping, rejection, discrimination, negative representation in the media, and so on. Monosexism, on the other hand, describes the base structure that enables these attitudes to take place, meaning that biphobia is only one form of monosexism. On the other hand, monosexism addresses multiple factors that are not necessarily directly or explicitly aimed against bisexuality or bisexual people, but nonetheless have the effect of eradicating their existence or legitimacy. These prominently include bisexual erasure and the privileging of monosexual identities and behaviors.

Bisexual Erasure Bisexual erasure is the widespread social phenomenon of erasing bisexuality from discussions in which it is relevant or is otherwise invoked (with or without being named). It is characterized by, among other things, a lack of representations, lack of communities, lack of awareness, lack of discussion, and lack of acknowledgment—all derived from the presumption that bisexuality does not, and cannot, exist. The fields in which bisexual erasure takes place are broad and varied, including the media; literature; history; academia; and most medical, psychological, and sexual discourses.

Monosexism

Bisexual erasure is present in multiple spheres, including the public/cultural sphere, the social/ community sphere, and the private sphere. In the public and cultural spheres, bisexual erasure is mainly characterized by a lack of representation. For example, according to a study made by the UK organization Stonewall, out of 126 hours of British television examined, only 5 minutes and 9 seconds were devoted to depicting bisexual characters. In a U.S. study by psychologist Gregory Herek, heterosexual research participants stated that—with the exception of intravenous drug users—bisexuals were the group that they felt most negatively about. In the social/community sphere, bisexual people are generally believed to be either straight or gay/ lesbian, and bisexual issues and people are often left unaddressed. Many bi people experience pressure to change their identity to anything other than bisexual (usually gay, lesbian, or straight), and experience social isolation in both heterosexual and lesbian and gay communities. In the private sphere, upon coming out as bisexual, bi people’s families and other close people often presume that they are in fact heterosexual, gay, or lesbian (depending on the situation), and continue to pressure them to “choose” heteronormativity. American legal scholar Kenji Yoshino identified three types of bisexual erasure: categorical erasure, individual erasure, and delegitimization. Categorical erasure refers to the erasure of bisexuality as a category. For example, in 2005, U.S. researcher Michael Bailey published a study reported in the New York Times under the headline “Gay, Straight, or Lying.” According to this study, bisexual men did not exist. As another example, in American theorist Judith Butler’s theory of gender melancholia, heterosexuality and homosexuality are both manifested by rejection of one another, leaving no room for a possibility of bisexuality. Individual erasure occurs when bisexuality as a category is acknowledged but, at the same time, the bisexuality of a particular person is denied. For example, UK scholar Kate Chedgzoy has shown that many Shakespeare scholars attempt to deny the bisexuality evident in his sonnets and to instead read them

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as heterosexual. As another example, American scholar Terry Castle’s film research names 1920s film star Greta Garbo as a lesbian, even after mentioning that Garbo desired men as well as women. Finally, delegitimation occurs when negative meanings are attributed to bisexuality and bisexual people. This is mainly done by stereotyping, as characteristics are attributed to bisexual people that are socially perceived as negative. For example, in heterosexual discourses, bisexual people are often described as promiscuous, treacherous, or as vectors of STIs. In gay and lesbian discourses, bisexual people are often described as closet cases, fence-sitters, or traitors to the community.

Effects of Monosexism Due to its structural nature, monosexism negatively affects the lives of bisexual people and others who are attracted to more than one gender. This can be observed through research about bisexual people that shows various disparities with other groups. For example, in the United States: • Over 40% of bisexual people have considered suicide, compared with 8.5% of straight people and 27% of gay people. • Nearly 50% of bisexual women are survivors of rape, compared with 17% of straight women and 13% of lesbians. • Nearly 45% of bisexual youth have been bullied on the Internet, compared with 19% of straight youth and 30% of gay youth. • More than 1 in 4 bisexual people (27.6%) live in poverty, compared with 18.2% of straight people and 21.6% of gay people. • About 1 in 4 bisexual people (25%) receives food stamps, compared to 15% of straight people and 14% of gay people. Nearly half of African American bisexuals (47%) and 39% of multiracial bisexuals receive food stamps. • More than 1 in 5 bisexual people (22%) suffer from poor health, compared with 9.7% of straight people and 9.8% of gay people. • In the United Kingdom, 55% of bisexual people are not out at work, compared with 8% of gay men and 6% of lesbians.

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Moreover, in the years 2008 and 2009, out of over $200 million given by U.S. foundations to lesbian, gay, bisexual, and transgender (LGBT) organizations as grants, no money went toward bisexual-specific organizations or projects.

Intersections Monosexism intersects with other oppressive social structures, such as misogyny, cis-sexism, and racism. These intersections create unique influences over bisexual women, transgender people, and people of color, for example. The fact that bisexual people are disproportionately women, trans people, and people of color is also of note.

Sapphobia Sapphobia is a word coined by bisexual blogger mercurialvixen, denoting the intersection of misogyny and monosexism. This concept is helpful in discussing and defining bi women’s particular experience of monosexism and misogyny, as separate from bi people of other genders, as well as from women of other sexual identities. One of the central ways in which sapphobia works is through the sexual objectification of bisexual women, as they are often perceived or presented as hypersexual, mainly as part of cisgender straight male fantasy (for example, as part of threesomes). This widespread trend of objectification generates a great deal of sexual and intimate violence against bisexual women. As a recent U.S. government study has found, bisexual women are far likelier than monosexual women to have experienced rape (almost 50% of bi women), sexual assault (75%), and intimate partner violence (61%). Further, bisexual women are often blamed for the violence aimed against them, using the same type of problematic discourse. Accusers suggest that bisexual women are more vulnerable to sexual violence because they are more “sexually available” to men. Bisexual women’s unique circumstances also show in statistical findings (from the United States), which indicate that bisexual women are at higher risk than monosexual people as well as bisexual men:

• An estimated 45% of bisexual women have reported suicidality. • Bisexual women are significantly more likely to experience depression and anxiety. • Bisexual women are significantly more likely to be in poverty. • Almost 1 in 3 (28%) bisexual women receives food stamps. • In the UK, 1 in 3 (31%) bisexual women suffers from poor health. • Bisexual women report the lowest levels of social support.

Monosexism and Cis-sexism Cis-sexism is the social system according to which everyone is, or should be, cisgender (identifying as the gender they were assigned at birth). This system includes the privileging of those who are cisgender, and social punishment for transgender people. The intersection between cis-sexism and monosexism negatively impacts bisexual transgender individuals. One of the central intersections between monosexism and cis-sexism is that of erasure. Bisexual trans people suffer from double erasure, as both bisexual and transgender. Not only are bisexuality and transgender erased in culture and society separately, but they are also erased in combination, as the particular existence of bisexual trans people is symbolically obliterated. This happens on all levels discussed above, including the public/cultural sphere, the social/community sphere, and the private sphere. In addition, this happens on all three levels of categorical erasure, individual erasure, and delegitimation. In these cases, bi people’s difficulty in receiving social acknowledgment or validation of their identities is exacerbated by the additional difficulty of cis-sexism and trans erasure. It is important to note that bisexual trans people not only face erasure in the context of straight culture, but must also contend with it in LGBTQ communities. Within gay and lesbian communities, both bisexual and transgender erasure is widespread, meaning that the existence of bi trans people is rarely acknowledged. Transgender

Monosexism

erasure is also present in bisexual communities, while bisexual erasure is present in transgender communities. Another way in which bisexual trans people are erased is via the accusation that the bisexual identity promotes the gender binary (the idea that there are only two opposing genders— woman and man). This argument erases the existence of bisexual trans people in particular. Due to this very erasure, little to no statistical research exists about bisexual trans people. However, it should be noted that trans people are one of the most vulnerable populations within LGBTQ communities, showing extreme disparities in comparison with cisgender people (including lesbian, gay, and bisexual [LGB] people who are cisgender). Combined with the significant disparities between bisexual and monosexual people, it might be inferred that transgender bisexual people face unique disparities as a distinct population. However, more research is needed in this area.

Monosexism and Racism Bisexual people of color often experience a combination of monosexism and racism, which negatively impacts their well-being. Like bisexual trans people, bi people of color suffer from cultural erasure and exclusion, finding little representation or acknowledgment within straight culture or within particular communities. Many report having to contend with biphobia within communities of color, and with racism in LGBTQ communities. Another prominent way in which this intersection works is through the exacerbation of racial stereotypes via biphobia. For example, both bisexual people and people of color are often stereotyped as hypersexual, as having a “wild” sexuality, or as sexual predators. Bisexual women of color experience a combination of racism and sapphobia that constructs them as exotified sexual fetishes, while bisexual men of color are often imagined as sexual predators or as vectors of sexually transmitted infections (STIs). Due to the erasure of this group, little statistical information is available regarding it. However, a recent study regarding food insecurity (i.e., limited

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access to adequate food) among U.S. LGBTQ people shows that bisexual people of color are significantly more vulnerable to it, compared both with White bisexual people and with monosexual people of color.

Gay and Lesbian People’s Complicity in Monosexism Though monosexism is a structure that is based in, and originates from, heterosexism and straight culture, gay and lesbian people are often complicit in enacting it. Bisexual people report high levels of biphobic treatment within gay and lesbian communities, including erasure, hostility, rejection, and even verbal and physical violence. Indeed, many bisexual activists and researchers theorize that the disparities between bisexual and monosexual people are partially caused by lack of resources devoted to bisexuality within LGBTQ communities. The broadest form of monosexism in gay and lesbian communities is the notion that bisexuality either doesn’t really exist, or is not valid as a sexual identity. As a result, bisexual people are broadly erased in gay and lesbian communities or have their identities invalidated. In addition, bisexual people are often stereotyped by gay and lesbian people as being either “really gay” or “really straight,” as being indecisive, or as going through a phase. Since many bisexual people come out to gay and lesbian communities looking for support around their sexuality, this negatively impacts their mental health and general well-being. Shiri Eisner See also Biphobia; Bisexual Inclusion in the LGBTQ Rights Movement; Bisexuality, Female; Cisgenderism; Gender Binaries; Heteronormativity; Heterosexism; LGBTQ People of Color

Further Readings Barker, M., Richards, C., Jones, R., Bowes-Catton, H., & Plowman, T. (2012). The bisexuality report: Bisexual inclusion in LGBT equality and diversity. Milton Keynes, England: The Open University.

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Eisner, S. (2013). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Ulrich, L. (2011). Bisexual invisibility: Impacts and recommendations. San Francisco, CA: San Francisco Human Rights Commission LGBT Advisory Committee. Yoshino, K. (2000). The epistemic contract of bisexual erasure. Stanford Law Review, 52(2), 353–461.

MORALITY

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RESPECTABILITY

The notion of morality encapsulates ideas of how positive or negative value judgments are assigned to particular sexual behaviors. These judgments are then used to label individuals as moral or immoral. The idea of “respectability” emerges when individuals conform to behaviors that are attached to positive value judgments. In order for behaviors to have positive or negative value judgments, a society has to declare these behaviors as either moral or immoral. Sexual morality in contemporary Western society has largely been shaped by Judeo-Christian values of purity and chastity. As a result, homosexuality, declared as impure and lustful, was marginalized and categorized as “immoral.” The United States was heavily influenced by its early Puritan settlers. Much of Puritan ideals of sexuality derived from biblical interpretations. This included maintaining virginity until marriage. Likewise, procreative heterosexuality was valued as the only acceptable form of sexual behavior, for it was perceived that the sole purpose of sex was to beget children. These sexual ideals extended beyond the purview of sex itself and into gendered behaviors. Women were expected to demonstrate modesty, fragility, and subservience to men. Men were also expected to be modest, but they had to take a sexually assertive role in procreation. Any deviation from this system meant that the individual was sexually deviant, and thus a sinner. There was, then, a link between theological values and the values imposed on the behaviors of the Puritans. What was sexually moral was eventually tied to ideas of being sexually natural. With an emphasis on heterosexual, procreative sexuality, sexual morality was codified into biomedical

understandings of human behavior. During the 19th century, biomedicine became a dominant institution that was used to explain human behavior. These explanations of human behavior rested on anatomy, psychology, and biology. For example, according to theories of evolution, humans naturally procreate in order to perpetuate the human species. Thus, behaviors such as those associated with heterosexuality become normalized and naturalized. Consequently, as these behaviors became characteristic of “normal” sexual behavior, heterosexuality became morally acceptable. Conversely, homosexuality was seen as pathological and therefore morally unacceptable. Also during the 19th century, women were declared “frigid” if they did not engage in heterosexual relations. Frigidity meant that women had a psychological disorder in which they were not aroused by men. This label pathologized lesbian sexuality and was placed on women who were older, unmarried, performed nontraditional female gender roles, or found other women sexually attractive. With the expansion of sexual morality into the purview of biological and psychological sciences, it became tied to issues of health and illness. For example, those infected with HIV tend to face stigma. This stigma has two layers. HIV is seen as a “marker” that connotes that an individual committed the perceived immoral act of engaging in an unprotected, same-sex—or, to a lesser extent, opposite-sex—penetrative sexual act. The second layer of stigma arises out of a rationalist tradition in Western society, in which the individual is blamed for an act that is considered socially deviant. Thus, certain diseases can mark individuals— in this case, gay men—for committing acts that are interwoven with sexual moral systems. In addition to the social processes that inculcated sexual norms into Western society, other social processes, as noted by the anthropologist Gayle Rubin, explain how communities produce sexually moral/immoral behaviors. Within particular communities, sexual morality is also tied to concepts of social control. A moral panic occurs when an individual engages in what is considered to be unacceptable behavior that is believed to harm one’s community. In the case of sexuality, the community attaches value to particular sexual

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identities/practices, which are then privileged within communities. Sexual identities/practices that fall outside of those that are privileged (such as homosexuality) are publicly condemned. Some societal institutions may use the media to portray sexually unprivileged identities/practices in a negative light. This then elicits various forms of public disapproval and hostility that define and reassert the boundaries between sexually privileged and unprivileged identities/practices. Sometimes, moral panics are solidified in terms of sex laws that outlaw certain sexual identities and practices. When individuals break said laws, they face public scorn and harsh legal sanctions. Thus, moral panics are used to attach a moral significance to sexual behaviors and identities and define boundaries of morally acceptable/unacceptable behaviors. Sexual morality intertwines with other social factors such as gender and race. Women are often held to higher standards of sexual chastity than those for men. Furthermore, sexual stereotypes of race intertwine with notions of gender. For example, White women have been seen as sexually pure, whereas women of color (e.g., Black, Latina, or Asian women) have been eroticized. As eroticized objects, they are then seen as being sexually promiscuous. This then complicates how women in communities of color are held to different standards of sexual morality, which can be seen in the stereotyping of Latina and Black women as hypersexual sex objects. This stereotype is reinforced through various discourses in various institutions, such as the media, education, and family. For instance, in the media, Black women have often been depicted as hypersexual through emphasis of certain physical signifiers such as the breasts and buttocks. In addition, depictions of women of color’s sexual behavior are also used to mark them as hypersexual objects. Latina women, for example, are often portrayed as sexually aggressive. At the same time, although some women of color are painted as hypersexual, other women of color (e.g., Asian women) are depicted as submissive and docile compared with their White counterparts. Whether depicted as hypersexual or sexually submissive, women of color face additional sanctions because they are perceived to have violated “moral codes” established by their White counterparts. This then

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means that sexual morality exists not only as a tool of social control but also as a tool that maintains preexisting social hierarchies such as those found in the case of both sexuality and gender. Angelique Harris and Omar Mushtaq See also HIV/AIDS and Gay Masculinity; HIV/AIDS and Racial/Ethnic Disparities; HIV/AIDS in Prison; Intersections Between Sex, Gender, and Sexual Identity; Queer Politics; Religious Identity and Sexuality, Reconciliation of; Sexual Norms and Practices

Further Readings Plummer, K. (1995). Telling sexual stories: Power, change, and social worlds. London, England: Routledge. Rose, J. (2005). Sexuality in the field of vision (Vol. 9). London, England: Verso. Rubin, G. (1993). Thinking sex: Notes for a radical theory of the politics of sexuality. In L. Kauffman (Ed.), American feminist thought at a century’s end: A reader (pp. 3–64). Oxford, England: Blackwell. Vance, C. S. (Ed.). (1984). Pleasure and danger: Exploring female sexuality. London, England: Routledge & Kegan Paul.

MSM See Men Who Have Sex With Men (MSM)

MULTIRACIAL LGBTQ-PARENT FAMILIES Multiracial families are increasingly common in the United States. In the context of heterosexualparent families, the term multiracial families often refers to interracial couples and their multiracial children, or to transracial adoptive families. For most LGBTQ couples, neither parent is biologically related to the child, as is the case with adoption, or only one parent is biologically related to the child (through donor insemination or surrogacy, or from a previous heterosexual relationship). LGBTQ-parent families are diverse in both family structure and racial identification, and their

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child’s racial identity might not be a product of their own racial identities. In this entry, the term multiracial LGBTQ-parent families refers to families in which LGBTQ parents have children with different racial identities from at least one parent. Multiracial LGBTQ-parent families encounter unique experiences in which sexual orientation intersects with race, gender, and family structure. This entry will address the construction of identity within multiracial LGBTQ-parent families, the types of challenges that these families often encounter, and the unique strengths of these families.

The Construction of Identity Multiracial LGBTQ-parent families hold multiple minority statuses on account of their family structure, diverse racial heritage, and parental sexual orientation. For multiracial LGBTQ-parent families, being grouped outside of multiple normative structures can add complexity to identity formation. Within the family unit itself, identity is diverse. A child’s racial identity might be similar to one parent’s identity, to aspects of both parents’ identities, or to neither parent’s identity, and the child’s identity might be very different from his or her siblings or extended family. How these children emphasize or prioritize different aspects of identity can change over time and across context. In a racially diverse setting, a multiracial teenager might feel proud of his or her racial heritage but hesitant to disclose his or her parents’ sexual orientation. Yet at an event for children with gay parents, where he or she is one of few racial minorities, he or she might feel more comfortable disclosing sexual orientation than racial identity. As another example, a transracially adopted individual might not view race as a salient aspect of identity until he or she encounters racism at school or begins to connect with others who share his or her racial heritage. The Social Construction of Race

Racial-identity formation is a complex process that involves many factors related to culture, social class, skin color, and power dynamics. Although the term race is used to group individuals

according to genetics, it is now commonly believed to be a socially constructed concept. People are assigned to racial categories based on their appearance, culture, and ethnicity, yet these categories are often adjustable. For example, President Barack Obama is often referred to as the United States’ first Black president, but because he has a White mother and a Black father, some people categorize him as biracial. One’s self-identification may not be the same as how others identify the person. A family or individual who moves to the United States from Peru, for example, might identify as Peruvian, only to be categorized as “Latino” upon entrance to the United States. Racial-Identity Socialization

When children have different racial identities from their parents, they must build a racial identity and learn to navigate racism without a parental role model. Typically, in monoracial-minority families, the parents can teach their children how to cope with discrimination based on personal experience, and they can model a positive racial identity for their children. However, parents in multiracial families face the challenge of going beyond personal experience to foster a healthy, positive racial identity in their children. Although they might not have had personal experiences with racism, some research suggests that LGBTQ parents are in a position to facilitate ongoing communication with their children about issues related to racial tensions; power dynamics; and discrimination based on skin color, ethnicity, and culture. Research on racial-identity formation in multiracial families indicates that it is important for parents to strive for cultural competency—that is, to feel comfortable talking with their children about racial identity and differences, and to understand both what they can offer and what their limitations are. With regard to research on the latter, parents have been found to turn to their broader communities for assistance in modeling positive racial identities and facilitating connections to their children’s culture of origin. For example, when they are choosing where to settle geographically, parents often consider the diversity

Multiracial LGBTQ-Parent Families

of the neighborhood and local schools, access to cultural events, and availability of family and friends who share their children’s racial heritage. LGBTQ parents are also faced with helping their children to form a positive attitude about their identity as an LGBTQ-parent family. In addition to locating access to multiracial communities, then, many parents have found it important for themselves and for the children to have connections to other LGBTQ-parent families, thus taking into account how LGBTQ-“friendly” a particular area or community is. Among both heterosexual and LGBTQ parents, research suggests that some parents choose to take a “color blind” approach to race, believing that race does not matter and emphasizing that their child is not different from them (e.g., that their child is not a person of color, but simply a person). Although these parents usually have good intentions, researchers, clinicians, and theorists argue that it is preferable for parents to take a “color conscious” approach to racial issues. Instead of ignoring differences, research has found that it is more beneficial for parents to proactively address issues of both race and sexual orientation by engaging their children in difficult discussions, encouraging them to ask questions, seeking guidance from others, and communicating openness to understanding their child’s experiences.

Challenges Faced by Multiracial LGBTQ-Parent Families Multiracial LGBTQ-parent families are marked as “different” on account of their multiracial status, their LGBTQ status, and their atypical family structure (in that the children might not be biologically related to one or both parents). LGBTQ parents face the task of fostering a positive attitude about their sexual orientation, their children’s racial identity, and their family structure. Such a task can become complicated because multiracial LGBTQ-parent families are also vulnerable to discrimination on account of their multiple minority identities. Some research highlights that, given their personal experiences as members of same-sex couples, lesbian, gay, bisexual, and queer (LGBQ)

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parents are often aware of the need to prepare their children for prejudice they are likely to encounter, and to confront issues related to sexual orientation as they arise. In addition, research has revealed some unique challenges that specifically emerge from the intersection of the family’s LGBTQ and multiracial identities. Challenges Within the Family

Multiracial LGBTQ-parent families have unique experiences within the family, in that they must navigate potential differences with each other as well as with extended family members. Research on multiracial families has demonstrated that challenges can arise when one parent identifies more with the children (or vice versa) based on a shared racial background or identity, leading to tensions or imbalance within the family. In some families, a child will automatically feel more connected to one parent’s racial identity if he or she grows up in an environment that is dominated by members of that parent’s race. For example, a biracial child living in a predominantly White neighborhood might identify more with his or her White peers, his or her White parent, and his or her White heritage than with his or her non-White parent and his or her own non-White heritage. Complications can arise with regard to skin color as well; although a child might phenotypically resemble one parent, he or she might identify more with the other parent’s racial heritage. On the other hand, for multiracial children who share aspects of racial heritage with both parents, they might feel that their racial identity aligns well with their parents. As research suggests, however, multiracial individuals hold unique experiences that a monoracial parent might not understand. Diversity within the multiracial LGBTQ-parent family can also impact relationships with extended family members, whose racial identities might be similar to or further removed from the children’s identities. A family’s multiracial status can strengthen or solidify bonds with extended family members who share similar identities with the children. However, racial tensions have been found to arise within some predominantly White families, where it is not uncommon for racial-minority

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children to feel marginalized or be viewed as “exotic” on account of their appearance. Furthermore, children with light skin who “appear” White might encounter family members who overlook or ignore their minority identity. Multiracial children sometimes culturally identify more with one side of the family, and yet still feel “different” from family members if the other parts of their heritage are not validated or embraced. Just as experts have demonstrated the necessity for parents of racialminority children to strive for cultural competency, there is evidence that it is also important for extended family to be sensitive to issues of race, in order to minimize the hurt that can result from misunderstanding, prejudice, and marginalization. In addition, research suggests that it is particularly beneficial to children of LGBTQ parents when extended family offer support, understanding, and sensitivity regarding LGBTQ issues. Many LGBTQ couples have not felt supported by extended family on account of their sexual orientation or gender identity. For some families, the presence of children exacerbates extended family members’ fear and disapproval; for example, family members might become more distant (or even estranged), with no interest in being a part of the children’s lives. An LGBTQ couple that was not entirely “out” to family before having children is now forced to disclose their relationship, with varying results. It should be noted that the presence of children often improves parents’ relationships with extended family, for example, because the couple’s identity as LGBTQ is overshadowed by their status as new parents. Extended family might focus on their wish to be a part of the children’s lives, and this can become more important than their disapproval of LGBTQ relationships. In turn, extended family can provide an important source of support to parents in terms of emotional support, practical help (e.g., babysitting), and/or financial assistance.

LGBTQ communities as well as within communities of color. Similarly to how children’s parents might not be able to relate directly to their racial identity, these family units do not necessarily have built-in communities that reflect all aspects of their identities. Sometimes they feel excluded from communities on account of their multiracial status, and at other times due to their sexual orientation/ gender identity. Many LGBTQ communities are predominantly White, and critics argue that these communities do not sufficiently attend to the unique experiences of LGBTQ people of color. In addition to people of color, bisexual and transgender individuals can feel invisible in White, gay/lesbian-dominated communities. Because many LGBTQ-parent families wish to feel like part of a community, it can be particularly hurtful when they feel judged or perceived as “different” in communities that are meant to be welcoming and inclusive. Some research suggests that whether the communities display overt racism or more subtle forms of bias, families and individuals might not feel accepted on account of their multiple forms of difference. Furthermore, multiracial LGBTQ-parent families sometimes feel they must choose between predominantly White LGBTQ communities and predominantly heterosexual communities of color. Some parents do not feel that they would be supported if they came out as LGBTQ within racialminority communities. When they do come out, some feel pressure to minimize their identity as an LGBTQ-parent family, and to focus more on their identity as a multiracial family. This can feel particularly challenging to younger children who might not understand why there would be varying levels of outness and acceptance across communities. For adolescents who strive to fit in with peers, having to hide or minimize certain aspects of their families can lead to feelings of guilt, shame, or confusion regarding their multiple minority identities.

Challenges Within LGBTQ Communities and Communities of Color

Challenges Within Mainstream Society

Hierarchies can exist even within marginalized communities. For multiracial LGBTQ-parent families, feelings of difference can emerge within

Discrimination can take shape in different forms and on many levels, from outright instances of racism and homophobia to everyday

Multiracial LGBTQ-Parent Families

microaggressions. Even for multiracial LGBTQparent families with both accepting extended family and welcoming communities, there are ways in which societal norms impose challenges. It is not uncommon for multiracial LGBTQ-parent families to feel misunderstood, invisible, or targeted in public for being different. Research has found that strangers sometimes misinterpret families with same-sex parents and racial-minority children. For example, they might assume that one parent is the nanny or that the two parents are siblings, or that the children are not theirs because of any visible differences in skin color or appearance. These types of microaggressions also occur in school systems, albeit less frequently today than in the past. Family tree assignments pose challenges for adoptive families, in that these assignments assume that each child is biologically related to his or her parents. Same-sex couples have reported feeling overlooked and invalidated when they fill out forms asking them to list the names of the child’s mother and father. Such challenges can lead to feelings of exclusion in both parents and children. It is also notable that families are impacted— both implicitly and explicitly—by media messages and societal notions of what is considered “normal.” Adults and children alike are exposed to homophobic and racist views in the media, as well as to messages that subtly convey a hierarchy of identity. Every time the news features topics such as the same-sex marriage “debate,” for example, the message being conveyed is that same-sex couples hold a lower status in society (and that their rights are worthy of being debated). It is thus not because families are LGBTQ and/or multiracial that they experience certain challenges. Rather, it is society’s discriminatory norms that privilege certain aspects of identity over others, invalidating and discriminating against families who do not fit into the normative structure.

Strengths of Multiracial LGBTQ-Parent Families To varying degrees, multiracial LGBTQ-parent families thus face unique challenges within and outside of the family unit. Feelings of difference

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and exclusion on account of multiple minority identities can be difficult for families and individuals to manage. At the same time, however, these forms of difference can be a source of pride and lead to some unique strengths. For children, learning to navigate different communities, cope effectively with challenges that arise, and internalize pride in their multicultural identity can build strength and resiliency. This strength can be a foundation for challenges that arise through childhood and into adulthood. Same-sex couples are often more open to transracial adoption than heterosexual couples, perhaps indicating greater comfort navigating differences. Research findings suggest that many LGBTQ parents have been able to apply their experiences with marginalization (on account of their sexual orientation/gender identity) to their children’s racial identity and their family’s multiracial status. In this way, LGBTQ parents have the potential to bridge differences while also being mindful that sexual orientation/gender identity and race hold different places of privilege, status, and marginalization within society. Experiences with one form of identity cannot be readily transferred to another; there are numerous ways in which the experiences of White or interracial LGBTQ couples are distinct from those of their racialminority children. Nevertheless, by drawing from their own experiences navigating differences, LGBTQ parents can provide sensitivity and support to their children.

Conclusion Meanings of race, sexual orientation, gender identity, and family structure have shifted over time and will continue to do so. In many ways, multiracial LGBTQ-parent families exemplify the 21st-century United States, in that they demonstrate the challenges and strengths of living in a diverse society. While they are vulnerable to multiple forms of stigma and discrimination, multiracial LGBTQ-parent families (and other nontraditional families) also hold the potential to explore the role of openness and communication in fostering acceptance of and pride in differences. As social constructions of identity continue

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to evolve, navigating multiple forms of difference is becoming increasingly important. Hannah B. Richardson See also Binational Same-Sex Couples and Families; Interracial Relationships; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ People of Color; Transracial Versus Inracial Adoption

Further Readings Bing, V. M. (2004). Out of the closet but still in hiding. Women & Therapy, 27, 185–201. Burton, L. M., Bonilla-Silva, E., Ray, V., Buckelew, R., & Freeman, E. (2010). Critical race theories, colorism, and the decade’s research on families of color. Journal of Marriage and Family, 72, 440–459. Gianino, M., Goldberg, A. E., & Lewis, T. (2009). Family outings: Disclosure practices among adopted youth with gay and lesbian parents. Adoption Quarterly, 12, 205–228. Goldberg, A. E. (2009). Lesbian and heterosexual preadoptive couples’ openness to transracial adoption. American Journal of Orthopsychiatry, 79, 103–117. Goldberg, A. E., & Smith, J. Z. (2009). Predicting non–African American lesbian and heterosexual preadoptive couples’ openness to adopting an African American child. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 58, 346–360. Kenney, K. R., & Kenney, M. E. (2012). Contemporary U.S. multiple heritage couples, individuals, and families: Issues, concerns, and counseling implications. Counselling Psychology Quarterly, 25, 99–112. Nadal, K. L., Sriken, J., Davidoff, K. C., Wong, Y., & McLean, K. (2013). Microaggressions within families: Experiences of multiracial people. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 62, 190–201. Richardson, H. B., & Goldberg, A. E. (2010). The intersection of multiple minority identities: Perspectives of White lesbian couples adopting racial/ ethnic minority children. ANZJFT Australian and New Zealand Journal of Family Therapy, 31, 340–353. Samuels, G. M. (2009). “Being raised by White people”: Navigating racial difference among adopted multiracial adults. Journal of Marriage and Family, 71, 80–94.

Snyder, C. R. (2012). Racial socialization in cross-racial families. Journal of Black Psychology, 38, 228–253. Stanley, J. L. (2004). Biracial lesbian and bisexual women. Women & Therapy, 27, 159–171. Szymanski, D. M., & Sung, M. (2010). Minority stress and psychological distress among Asian American sexual minority persons. Counseling Psychologist, 38, 848–872.

MUSLIM LGB PEOPLE The social sciences have long been concerned with how human beings interact with, and make sense of, their social environments; indeed, social psychology seeks to integrate the societal and psychological levels of analysis and provides the tools for understanding how the social world, and the social changes inherent in it, can impact a person’s sense of identity and psychological well-being, as well as the individual’s response to change. Drawing upon the body of available social psychological evidence that has emerged in recent years, this entry focuses upon the identities, experiences, and well-being of lesbian, gay, and bisexual (LGB) Muslims. Much of this research has centered around gay/bisexual Muslim men, but some has also focused upon Muslim lesbians. This entry begins with brief insights into the theological, legal, and social representations of homosexuality in Islamic societies; continues with empirical insights into the identities, experiences, and well-being of LGB Muslims; and concludes with recommendations for further research, and policy and practice.

Islamic Positions on Homosexuality In attempting to define the “Islamic position” on homosexuality, it is important to remember that Islam is a diverse faith group with some 1.6 billion followers on six continents. They adhere to distinct branches of Islam—Sunni, Shiite, Sufi, and others—and religious identities are often entwined with local ethnocultural norms and customs. Moreover, the legal position on homosexuality in one’s country (of origin) may shape one’s stance on

Muslim LGB People

homosexuality, especially if that country is regarded as adhering to Islamic law. Many Muslim countries that claim to adhere to Sharia (Islamic) law criminalize homosexuality, but penalties vary— while homosexual acts in Pakistan can carry a prison sentence of 2–10 years, the Islamic Republic of Iran metes out the death penalty to men “convicted” of engaging in anal intercourse. On the whole, scholars are in agreement that mainstream Islam is opposed to any theological accommodation of homosexuality. Mainstream Islamic scholars tend to invoke the Story of Lut in Islamic Holy Scripture (the Koran), which recounts the destruction of the Tribe of Lut allegedly due to their engagement in homosexual acts, as “evidence” for Allah’s condemnation of homosexuality. They also point to the verbal teachings attributed to the Prophet Mohammed (the Ahadith), which appear to condemn homosexuality. There are some Muslim groups and individuals that have attempted to promote a “reverse discourse” concerning the Islamic position on homosexuality, arguing that there is scope for the accommodation and acceptance of homosexuality within Islam. Scott Kugle, an associate professor of Islamic studies at Emory College of Arts and Sciences, has argued that the dominant interpretation of the Story of Lut may be erroneous and that the destruction of the Tribe of Lut can be attributed to the tribe’s infidelity and inhospitality, rather than to their homosexuality. Although there are some support groups for LGB Muslims, such reverse discourse is in its infancy and has faced opposition from mainstream Islamic groups. Theological, legal, and social condemnation of homosexuality in Muslim communities serves to create cultural representations that homosexuality is immoral, sinful, and dangerous to society. Many LGB Muslims themselves are embedded within these homophobic societies and are compelled to construct their identities against this cultural backdrop, which can result in threats to their sense of self, negative emotional experiences, and poor psychological well-being. These issues have fruitfully been examined through the lens of social psychological theory.

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The LGB Individual: Threats to Identity In a series of qualitative empirical studies, Rusi Jaspal, a social psychologist at De Montfort University in the United Kingdom, has examined the identities and experiences of Muslim gay/ bisexual men in the United Kingdom, and the strategies they employ for coping with threats to their sense of self (henceforth “identity threat”). The exploration of this population as a case study for examining LGB Muslim identity has also provided some insight into how acculturative processes can serve as an additional threat to identity. For instance, homosexuality has increasingly gained social acceptance in the United Kingdom, while it has remained highly stigmatized and even illegal in most Muslim-majority countries. Some Muslim gay men reportedly feel that they are viewed by other Muslims as being “too British” (that is, as having taken on the norms and values of British society) due to their sexual identity. On the other hand, British national identity can sometimes act as a buffer against threat. For instance, some individuals may reject the perceived “Islamic stance” on their sexual identity and, conversely, embrace the “British stance,” which is perceived as more readily accommodating to sexual diversity. On the whole, Muslim gay/bisexual men face severe psychological challenges in managing their sexual, religious, and ethnic identities, which in turn can problematize the construction of a psychologically satisfying sexual identity. Crucially, evidence suggests that Muslim gay/bisexual men perceive the norms, values, and representations associated with their religious and sexual identities, respectively, as being incompatible. This can lead to a decreased sense of psychological coherence. More specifically, they may feel that, because their sexual identity is at odds with what God intended and with what their religion teaches, they are either not “proper” Muslims or are engaged in highly sinful behavior that will lead to divine retribution. Individuals may feel that the two identities, which are socially represented as being “interconnected” (because Islam appears to have a stance on homosexuality), are fundamentally incompatible.

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It is easy to see how these perceptions can challenge gay/bisexual Muslim men’s sense of self-esteem. Many feel unable to derive a positive self-conception on the basis of their sexual identity, because they are exposed to homophobic representations associated with a group membership that they value—namely, their religion. Group memberships that matter to an individual will have clout in shaping their personal beliefs and representations; people use their group memberships—and particularly valued group memberships—as sources of knowledge about the world. Consequently, it is no surprise that Muslim gay/bisexual men may exhibit signs of internalized homophobia, that is, the internalization of negative social attitudes toward their sexual identity. There is evidence that some LGB Muslims experience guilt, shame, and self-hatred, potentially leading to mental distress and suicidal thoughts. They may come to the conclusion that their sexual identity is wrong and that it must and, with God’s help, will change. We know from decades of empirical research that LGB youth can experience challenges in developing a sexual identity due to the initial confusion that arises upon recognition of difference from the dominant heterosexual majority. Change is inherent to the developmental journey. A number of coming-out models have been proposed, which highlight the changes in self-definition that arise amid social developmental processes and more general social change. Research clearly indicates the grave threats of coming out to LGB Muslims’ sense of continuity, which may be considerably more traumatic than those normally experienced by non-Muslims. LGB Muslims tend to be socialized in a theological, social, and familial environment that appends hegemony to heterosexuality and, in many cases, to arranged (heterosexual) marriage. LGB Muslims themselves may aspire to fulfill this religious and cultural expectation of an arranged heterosexual marriage due to religious/cultural pressures. This can create a rupture between past, present, and future, as individuals fail to construct a coherent temporal narrative. They may feel unable to get married and, thus, see no “acceptable” future for themselves as LGB individuals, thereby threatening continuity.

The LGB Social Group Member: Stigma and Exclusion LGB Muslims face a number of social challenges that are experienced as threatening at a psychological level. These social challenges concern the LGB Muslim’s position within relevant social groups and categories, which can inhibit feelings of acceptance and inclusion from significant others. Family identity is central to many Muslims, who generally adhere to a collectivist cultural orientation and patriarchal hierarchy. Family and cultural honor are key for many Muslims, and premarital chastity and an arranged (heterosexual) marriage are widely perceived as central to maintaining honor. LGB Muslims often feel compelled to behave and to construct their identities in ways that are conducive to family honor. Typically, many conceal their sexual identities from their families, which can lead to decreased sense of identity authenticity. This can become socially challenging when their parents obliviously encourage their children to get married. LGB Muslims have reported problems in interpersonal relations with parents and other family members, as they feel unable to disclose their sexual identities, on the one hand, and are unwilling to enter into an arranged heterosexual marriage, on the other. Moreover, some LGB Muslims may decide to come out to family members, which can result in ostracism, disownment, and even psychological/physical abuse. Given the perception of incompatibility between Islam and homosexuality among many LGB Muslims and the theologically based homophobia that many are exposed to, they may themselves begin to question the authenticity of their Muslim identity. This may lead them to seek strategies for affirming their Muslim identity, often at the expense of their devalued sexual identity, which, for many LGB Muslims, is an identity that they wish to shed. There is some evidence of a “hyperaffiliation” to the religious group, as a means of compensating for any potential doubts surrounding their identity authenticity. Some have reported using Ramadan (a Muslim festival of fasting) as a symbolic opportunity for asserting their piety and for dispelling their self-accusations of inauthenticity, while

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others may espouse what they regard as prototypically “Muslim attitudes” concerning society, such as anti-Zionism and even overt homophobia. The late British social psychologist Henri Tajfel, who developed social identity theory, described the exit option, that is, the individual’s self-removal from a threatening social group identity. The process of self-removal from a group may not be so simple, given that for many Muslims, their faith constitutes a meaning system and an overarching “superordinate” identity that is entwined with other components of the self, such as family identity. Departure from a valued social group requires modification to the structure of identity, such as loss of other identity components. Some LGB Muslims have, however, reported distancing themselves from their religious/ethnic in-groups in order to align themselves with sexual in-group members, that is, other (largely non-Muslim) LGB individuals. Interview data indicate that LGB Muslims may feel other-ized and discriminated against on the (predominantly White) “gay scene,” due to rising Islamophobia and racism, in general. Crucially, racism is said to occur not only on the gay scene but also in online settings, such as on the gay social media, where messages like “no Asians” or “no Muslims” are often interpreted as rejection from the mainstream LGB community. In short, LGB Muslims may feel rejected and excluded from the sexual in-group, which can challenge their sense of belonging and lead to feelings of isolation. Social support is known to buffer threats to identity and well-being, but LGB Muslims may feel that they simply have no access to social support—from either their families or their sexual in-group—which can aggravate their threatened position. This has been compellingly demonstrated in research into how LGB Muslims cope with relationship dissolution. Due to the general lack of social support, individuals may deploy deflection strategies for coping with associated threats, such as denial and depersonalization, and further minimize contact with others (from whom they anticipate little or no support), which can be conducive to further isolation and psychological stress.

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Conclusion LBG Muslims can experience considerable individual and social challenges in attempting to manage their sexual and religious/ethnic identities. The principles of self-esteem, continuity, and psychological coherence appear to be most susceptible to threat. Individuals may experience feelings of identity inauthenticity, and perceive ostracism from relevant social groups due to homophobia and racism. This can impede access to social support networks, rendering experiences such as relationship dissolution particularly challenging at a psychological level. The research studies summarized in this entry have been conducted among LGB Muslims—there is a need to examine the identities and experiences of transgender Muslims. On a practical level, policy makers should focus their attention on attempting to engage Muslim communities in order to improve attitudes toward sexual diversity, as well as mainstream LGB communities in order to facilitate more positive relations between them and ethnoreligious-minority LGB individuals. Rusi Jaspal See also Catholic LGBTQ People; Christian LGBTQ People; Coming Out, Disclosure, and Passing; Discrimination Against LGBTQ People, Cost of; Homophobia; Internalized Homophobia; Jewish LGBTQ People; LGBTQ People of Color; Religious Identity and Sexuality, Reconciliation of; Religious LGBTQ Youth

Further Readings Jaspal, R., & Cinnirella, M. (2010). Coping with potentially incompatible identities: Accounts of religious, ethnic and sexual identities from British Pakistani men who identify as Muslim and gay. British Journal of Social Psychology, 49(4), 849–870. Kugle, S. S. A. (2010). Homosexuality in Islam: Critical reflection on gay, lesbian, and transgender Muslims. Oxford, England: Oneworld Publications. Murray, S. O., & Roscoe, W. (1997). Islamic homosexualities: Culture, history and literature. New York, NY: New York University Press.

N such, the father’s last name is assumed upon birth, and then upon marriage between a man and a woman, traditionally, the wife transfers her belonging to the husband’s lineage, assuming his last name. The topic of naming practices is of particular relevance for LGBTQ families, which are discourse-dependent, or more reliant on language to communicate their identities. Given that names function as concrete linguistic symbols of identity, symbolically representative of both individual and familial identities, naming practices can help LGBTQ family members clarify who members are to one another and who the unit is to outsiders. Moreover, given that authentic or “real” parents and families are largely considered as biologically related to their children in U.S. culture today, naming practices are symbolic resources used to help communicate authentic parental and familial identities in the absence or partial absence of biological ties. Parallel address terms for the biological and nonbiological mothers and inclusion of the nonbiological mother’s last name in the child’s last name provide two linguistic means to symbolically claim authentic maternity for the nonbiological mother. Naming practices help construct the nonbiological mother as a legitimate mother with authority and family membership equal to the biological mother internally in the family, in the eyes of the child and the comother, and externally in the eyes of society. Parallel address forms often

NAMING PRACTICES The umbrella term naming practices refers to titles and terms of address, personal names, and last names. Titles and terms of address are prefixes added to a person’s name generally used to convey respect or recognize an individual’s accomplishment or social position. While titles are used in a broad range of contexts (e.g., military, academic, religious), in the context of LGBTQ families, titles such as Mx. (a gender-neutral title), Ms. (used by adult females without reference to marital status), or Daddy and Papa (two equivalent father terms used in the context of a two-father family) are of particular relevance. Personal names refer to an individual’s first name, which differentiates the individual from other family members with a shared last name. Personal names, traditionally bestowed upon children by their parents at the time of the child’s birth (hence the synonym given name), gain relevance in the context of LGBTQ families when taking into consideration the traditionally heteronormative practices of passing down personal names in a family and the presumption that two parents are present at a child’s birth to bestow the child with his or her given name. Last names (often called surnames) refer to an individual’s family name. Last names engender relevance for LGBTQ families given their departure from the historic patrilineal presumption that an individual belongs to the father’s lineage. As 807

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take one of three forms: as a parallel derivative form of mother (e.g., “Mommy and “Mama”); as an identical derivative form of mother, distinguished by each mother’s first name or initial (e.g., “Momma Tina and Momma Mary” or “Momma T and Momma M”); or as a derivative form of mother in English for the biological mother and a derivative form of mother from another language/ culture for the nonbiological mother (e.g., “Mommy and Amma”). The nonbiological mother’s last name is often hyphenated with the biological mother’s last name (e.g., Miller-Smith), included as a second last name (e.g., Miller Smith), included as a middle name (e.g., Jessica Smith Miller), or used as the child’s sole last name (e.g., Jessica Smith). Last names of the couple are a second naming practice used to symbolically assert authenticity. Shared last names are often adopted by females in committed same-sex relationships as a strategic means to secure external recognition and acceptance of family status by outsiders. Adoption of a shared last name manifests in a variety of naming forms, such as hyphenating the two women’s last names; both women adopting one of the women’s last names; or creating a novel, unique name to represent the couple. Unlike their heterosexual counterparts, name changing for same-sex couples is typically not associated with having a commitment ceremony. Rather, female–female dyads tend to ritualize name changing on other occasions special to the couple, such as the couple’s anniversary, one partner’s birthday, or during an intimate dinner among friends. Shared family names between comothers and their children function similarly. Despite the increased number and visibility of female–female comothered families in recent years, comothers continue to experience variant levels of disconfirmation of their familial identity when interacting with families of origin, social network members, and community institutions. Shared last names between comothers and their children are one primary symbolic means used to negotiate positive affirmation for the family’s identity. Given that a shared family name is a conventional symbol of

family, use of this symbol helps connote this traditional arrangement in the minds of outsiders. Moreover, a common last name helps redress the negative cultural assumption that female–female partnerships are short-lived by conveying a sense of permanency and commitment to the family unit. Finally, shared family names are used as a means to create a symbolic connection between nonbiological grandparents and their grandchildren in hopes that they will enact the role of grandparent despite the lack of biological connection between grandparent and grandchild. Elizabeth A. Suter See also Heteronormativity

Further Readings Bergen, K. M., Suter, E. A., & Daas, K. L. (2006). “About as solid as a fishnet”: Symbolic construction of a legitimate parental identity for nonbiological lesbian mothers. Journal of Family Communication, 6, 201–220. doi:10.1207/s15327698jfc0603_3 Suter, E. A., Daas, K. L., & Bergen, K. M. (2008). Negotiating lesbian family identity via symbols and rituals. Journal of Family Issues, 29, 26–47. doi:10.1177/0192513X07305752 Suter, E. A., & Oswald, R. F. (2003). Do lesbians change their last names in the context of a committed relationship? Journal of Lesbian Studies, 7, 71–83. doi:10.1300/J155v07n02_06 Suter, E. A., Seurer, L. M., Webb, S., Grewe, B., & Koenig Kellas, J. (2015). Motherhood as contested ideological terrain: Essentialist and queer discourses of motherhood at play in female–female co-mothers’ talk. Communication Monographs, 1–26. doi: 10.1080/03637751.2015.1024702

NATIONAL CENTER RIGHTS (NCLR)

FOR

LESBIAN

The National Center for Lesbian Rights (NCLR) is a national legal organization dedicated to achieving full civil and human rights for lesbian, gay,

National Center for Lesbian Rights (NCLR)

bisexual, and transgender (LGBT) people and their families through impact litigation, public policy work, direct legal services, and community and public education. Since its founding in 1977, NCLR has played a central role in securing equality for LGBTQ people in the United States and has been particularly influential in the family law arena, which includes issues such as relationship recognition, parenting, and marriage. NCLR is also the only national LGBTQ legal organization that centers on issues of concern to lesbians, while also serving the entire LGBTQ community. NCLR was founded in 1977 by Donna Hitchens as the Lesbian Rights Project of Equal Rights Advocates, a feminist legal organization in San Francisco. The organization broke ground early in the area of family law, helping LGBTQ and HIVpositive parents retain custody of their children, and promoting the concept of second-parent adoption. From this initial focus, NCLR’s program work has expanded, with a strategic approach to protecting the rights of those most vulnerable in LGBTQ communities. Roberta Achtenberg became NCLR’s second executive director in 1983, followed by Elizabeth Hendrickson in 1990, and Kate Kendell in 1995. Hitchens went on to become the first openly lesbian candidate elected to the California bench in 1990 and was appointed presiding judge of the San Francisco Superior Court in 2002. Achtenberg later served as the assistant secretary of the U.S. Department of Housing and Urban Development. She is currently a commissioner on the U.S. Commission on Civil Rights. NCLR’s legal directors have included Maria Gil de Lamadrid and Abby Abinanti, who was the first Native American woman appointed to the California bench and currently serves as the Chief Justice of the Yurok Tribal Court. The current legal director is Shannon Minter, a transgender man. NCLR bases its approach to legal and social change on feminist, antiracist, and progressive principles. The organization defines its constituency as “all those adversely affected by and/or committed to ending oppression based on gender and sexual orientation and/or gender identity.” As

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noted in its Board Policies, NCLR seeks to achieve the following broad ends: I. All Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) people marginalized by race, ethnicity, immigration status, class, gender identity, age, or disability live free from oppression; II. Lesbian identity and sexuality are embraced and valued as a cultural and social good; and III. Social and cultural institutions that enforce gender roles and conformity are transformed or dismantled. (NCLR website)

The organization defines its core values as follows: 1. What’s good for lesbians is good for humanity. 2. Collaboration with like-minded organizations is essential to achieving our End Goals. 3. The welfare of lesbians is inextricably tied to the welfare of all people regardless of race, ethnicity, immigration status, class, gender identity, religion, age, or disability. 4. The liberation of lesbians is inextricably tied to the liberation of all people marginalized by sexual orientation and gender expression. 5. We respect and honor individuals who live outside of couple-based relationship structures. (NCLR website)

NCLR has won a number of precedent-setting court cases, particularly in the area of family law. For example, NCLR litigated the first cases holding that states must apply their paternity laws equally to same-sex couples in Elisa B. v. Superior Court (California Supreme Court, 2005) and Chatterjee v. King (New Mexico Supreme Court, 2012). Other notable family victories include the first settlement requiring Adoption.com to stop discriminating against same-sex adoptive parents; a decision in Florida in Embry v. Ryan (2009) requiring Florida to recognize second-parent adoptions from other states; a decision in Cozen O’Connor, P.C. v. Tobits, et al. (2013) that a surviving same-sex spouse is entitled to survivor

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benefits from an employer plan; the first successful contested custody cases granting custody of a transgender child to a supportive parent; and numerous earlier decisions establishing the ability of same-sex parents to adopt in a number of states, allowing nonbiological and nonadoptive parents to seek custody, and prohibiting discrimination against LGBT parents in custody matters. In 2008, NCLR was lead counsel for several plaintiff couples in In re Marriage Cases, the California Supreme Court decision holding that samesex couples have a fundamental right to marry under the California Constitution. NCLR also successfully litigated marriage cases in Alabama, Idaho, New Mexico, South Dakota, Tennessee, and Wyoming, as well as Kitchen v. Herbert (2013), the first federal court of appeals decision striking down a state marriage ban. NCLR also represented plaintiff couples from Tennessee in Tanco v. Haslam, one of the marriage cases consolidated in 2015 before the U.S. Supreme Court. Other notable NCLR cases include Christian Legal Society v. Martinez, a 2010 decision by the U.S. Supreme Court holding that university student group nondiscrimination policies do not violate the First Amendment, and 2014 decisions by the Ninth Circuit and Third Circuits rejecting First Amendment challenges to state laws prohibiting therapists from performing conversion therapy on minors. Since its founding, NCLR has launched a number of innovative programs and campaigns to address emerging issues. In 1993, NCLR became the first national legal organization to create a project for LGBTQ youth. Originally focused on providing legal assistance to LGBTQ youth who are abused in the mental health system, NCLR’s Youth Project expanded to include youth in schools and in the child welfare and juvenile justice systems. In 2014, NCLR launched #BornPerfect, a campaign to stop the use of efforts to change sexual orientation or gender identity through socalled conversion therapy. In 2001, NCLR became the first national legal organization to tackle rampant homophobia, biphobia, and transphobia in sports. NCLR’s

Sports Project promotes equality through the legal system and on the playing field to ensure that LGBTQ athletes and coaches receive fair and equal treatment. Other NCLR programs and campaigns include the Family Protection Project, which partners with legal aid organizations across the country to provide resources and assistance to poor and lowincome LGBTQ parents and couples; the Immigration & Asylum Project, which provides direct services to LGBTQ immigrants, detainees, and asylum-seekers; and #RuralPride, a joint campaign with the U.S. Department of Agriculture to highlight the needs and issues of LGBT people in rural communities. NCLR is also actively involved in drafting and sponsoring local, state, and federal legislation, ranging from nondiscrimination laws to protections for LGBTQ parents, elders, and youth. Shannon Minter See also Criminal Legal System and LGBTQ People; Custody and Litigation, LGBQ Parents; Discrimination Against LGBTQ Elders; Legal Recognition of Nonmarital Same-Sex Relationships; Legal Rights of Nonbiological Parents; LGBTQ People of Color; LGBTQ-Parent Families With More Than Two Parents; Sexual Orientation Conversion Therapy

Further Readings National Center for Lesbian Rights (NCLR). http://www .nclrights.org NeJaime, D. (2014). Before marriage: The unexplored history of nonmarital recognition and its relationship to marriage. California Law Review, 102, 87–172.

NATIVE AMERICAN/FIRST NATIONS SEXUALITIES Native sexualities may be understood to refer to sexual behavior and expression as well as gender identities within Native American/First Nations cultures in the Western Hemisphere, specifically in

Native American/First Nations Sexualities

North and South America. Using “native” as a modifier for “sexualities” should be viewed with caution; the construction of the term itself presupposes a Western European approach to understanding sexuality and gender, which does not correspond in many ways with the variety of nonEuropean understandings of sexuality and gender identity found among native cultures. It is therefore necessary to set aside a number of Western European concepts related to sexuality and gender when speaking of native sexualities: The binary construction of gender. Many Native American/First Nations cultures do not see gender in binary terms of “male” and “female” and may have more than two genders identified within their cultural understanding and social practice. The division of sexuality into “heterosexual” or “straight” in contrast with “lesbian, gay, bisexual, transgender, queer,” and other related personal identities. Again, many Native American/First Nations cultures did not (and do not) link gender identities, sexual orientations, and sexual behavior in ways that correspond with these terms. Any “stigma” or negative social connotation connected to transgender or nonheteronormative behavior or identification. Among many—but not all— Native American/First Nations cultures, the social roles associated with what would otherwise be thought of as non–gender-conforming or nonheteronormative sexual behavior were viewed as having an important social and/or spiritual dimension, recognized as such by other tribal members.

It is worth noting that not all Native American/ First Nations cultures recognized these varied gender and sexual roles and identities equally, or even at all. Therefore, speaking about “native sexualities” requires a balance between finding meaningful common identities and understandings without overgeneralizing or engaging in other forms of misinterpretation due to unexamined cultural bias. This entry will address examples of native sexuality and gender identity, showing the variety of different native understandings of these issues. Attention is given to the historical context of Native American–European interaction, and the

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pattern of forced assimilation of native peoples into modern American society. Lastly, the emergence of “Two-Spirit” identity among contemporary native people, as well as the larger legacy of colonialism within Native American/First Nations culture is examined.

Examples of Native Sexuality and Gender Identity It is now generally understood that many if not most of the native tribes and cultures of North America and the Western Hemisphere have many different definitions of gender identity, gender roles, and social expectations around sexual behavior, and these do not correspond neatly to Western European definitions or ideas. Some examples include the following: • The Navaho culture possesses four different genders, recognizing the feminine woman or asdzaan, the masculine man or hastiin, the feminine man or nádleehi, and the masculine woman or dilbaa. The Yupik people of Alaska are also said to have four genders, but these do not correspond with those of the Navaho. • Among the Lakota Sioux, someone who was biologically male, but who took on nonmasculine gender roles and who could engage in homosexual as well as heterosexual behavior, was known as a winkte. Such a person was seen as having a special gift from Wakan Tanka or “Great Spirit” and was considered to be a medicine person. • The muxes of Oaxaca, Mexico, are seen as a “third sex”—people who are biologically male but who identify as female, or as a third gender, neither completely male nor female but partaking of both and possibly more. The muxes are recognized as a part of the indigenous Zapotec culture, and participate in socially accepted roles within modern Oaxacan society. • The Cree people of Northern Canada recognize a variety of different words related to gender, with six different terms for various gender expressions and at least three different gender identities.

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All of the above are similar to the identity of the mahu in Hawai’i and Polynesia, males who took on roles normally reserved for women, and who acted as shamans. What is important to note is that in many Native American/First Nations cultures, gender was seen as occurring along a continuum, rather than having a fixed dualistic construction. Similarly, sexuality was not viewed as a personal identity or orientation, but rather a range of behaviors that were interpreted through the social roles a person held within the larger society. Likewise, among some Native American/First Nations cultures, individuals who are gender-variant may have wives or husbands of different genders from their own, but this is not always the case; they may have sexual experiences and social bonds with other persons who may have the same or different genders from themselves. Thus, using terms such as “gay” or “lesbian” or “bisexual” or “transgender” may not accurately reflect the experiences and identities of native people, since these terms reflect Western European constructions of gender and sexuality.

Historical Context Early contacts between European explorers and settlers and Native American peoples reveal a clear difference between European understandings of gender and sexuality, and those of various native cultures. The historical accounts of European explorers, traders, and settlers provide examples of what were perceived to be native men acting as women, or women acting as men. In many cases, these persons were noted precisely for their seeming departure from “normal” gender roles and sexual behavior. A term used in some accounts was “berdash” or “bardash,” derived from berdache, a French term originally of Persian origin. The Persian word meant a kind of slave boy, while the French word was derogatory in character, referring to a kind of effeminate man. The term berdache was later adopted by anthropologists to refer to gender-nonconforming people in Native American/ First Nations cultures, who were recognized as such among their own people. The term is still

occasionally encountered, but is now considered to be obsolete and inaccurate. The life of We’Wha, a member of the Zuni tribe, provides an illustrative case. Born in 1849, We’Wha was recognized at an early age as being a Zuni Ihamana, having been born male but associating with girls and not dressing as a boy or man. After having been trained in the various domestic and religious roles of women, We’Wha became a farmer, supporting her family on lands originally held by the Zuni, and practicing both male and female religious and social leadership roles. In 1877, Christian missionaries arrived among the Zuni, and from them We’Wha learned to speak English and later took on various wage-earning tasks including laundering clothes for White soldiers and settlers in the immediate area. In 1879, We’Wha met the ethnologist Matilda Coxe Stevenson, and the two became close friends. Stevenson visited We’Wha several times between 1879 and 1896 as part of her anthropological work among the Zuni, documenting the important role played by We’Wha among their people and the strength of We’Wha’s character and personality. In 1886, hosted by Stevenson, We’Wha traveled to Washington, D.C., meeting President Grover Cleveland, as well as living with Stevenson for 6 months. Sometime during this period, We’Wha’s biological sex became known to Stevenson, who continued to refer to We’Wha using the feminine gender. We’Wha died in 1896, but We’Wha’s life was documented by Stevenson and later by Will Roscoe.

Forced Assimilation By the end of the 19th century, European colonization of the Western Hemisphere was largely complete. Native American/First Nations tribes were often restricted to reservations or other lands specifically set aside for them. In North America, a process of conversion to Christianity was officially sanctioned by the Grant Administration, and a longer-term project of assimilation to the dominant Western culture was initiated. Tribal spiritual traditions were sometimes set aside or forgotten,

Native American/First Nations Sexualities

and older cultural patterns were not always maintained or preserved. In particular, nonheteronormative behavior became stigmatized. In Canada, homosexuality and gender nonconformity were suppressed by the efforts of Christian missionaries and the actions of the Canadian government, and had largely disappeared by 1900. Due to the efforts of Christian missionaries and the Bureau of Indian Affairs, many Native Americans in the United States had adopted Western European gender roles and social expectations of heterosexuality by the 1920s and 1930s. Similar outcomes were observed in Central American and South American countries, due to the work of the Catholic Church, local and national governments, and cultural practices favoring the lighter-skinned aristocracy. All of these efforts must be placed in the larger context of cultural and social assimilation. Beginning in 1940 and continuing into the 1960s in the United States, federal and state governments passed laws and implemented policies intended to terminate tribal sovereignty and force Native Americans to assimilate completely into the dominant White culture. These attempts were of limited success, but did considerable damage while in effect. Both the Lyndon Johnson and Richard Nixon Administrations favored the policy of selfdetermination for Native American tribes, which largely ended assimilation efforts. By the 1960s, various Native American/First Nations political advocacy groups began to form, most notably the American Indian Movement (AIM) in Minneapolis, Minnesota, in 1968. But it wasn’t until the emergence of the HIV/AIDS crisis in the 1980s that work was undertaken within Native American/First Nations communities to confront the legacy of colonialism related to gender and sexuality. This was largely due to Native American organizations dedicated to dealing with HIV/ AIDS, such as the Minnesota American Indian AIDS Task Force (later the Indigenous Peoples Task Force), the American Indian Community House HIV/AIDS Project in New York, and (later) the Canadian Aboriginal AIDS Network and Healing Our Nations.

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Emergence of “Two-Spirit” Identity The post-Stonewall era of the 1970s was characterized by efforts aimed at recognizing nonheterosexual native sexualities, including the formation of groups like Gay American Indians, founded in 1975 in San Francisco. However, it wasn’t until 1990 that the term Two-Spirit was chosen at the Third Annual Intertribal Native American/First Nations Gay and Lesbian Gathering in Winnipeg, Manitoba, Canada. The term is a translation of the Anishinaabemowin (Ojibwe or Chippewa) niizh manidoowag, meaning “having two spirits.” The term was chosen as a pan-Indian gloss that would provide recognition of the range of gender identities and sexual orientations across Native American/ First Nations cultures, and as a much-needed replacement for the problematic term berdache, with all of its colonialist and anthropological baggage. It is important to recognize that “Two-Spirit” is as intentionally pan-Indian as a term such as “Native American/First Nations”; both are attempts to build greater solidarity among native peoples, and—regarding Two-Spirit—to provide greater recognition of both similarity with and differences from lesbian, gay, bisexual, and transgender identities. Yet that very pan-Indian character of the term “Two-Spirit” is also very modern in construction, lacking the specificity of distinct tribal terms of gender identification and sexual relation, and is thus only an approximation of the variety of native words describing people who are recognized as having a different gender identity or sexual orientation, as well as a different social role within their tribal communities, requiring greater examination for full understanding. One important distinction between Two-Spirit and terms such as lesbian, gay, bisexual, and transgender is the emphasis placed by many Two-Spirit native people on how it is not simply a label or passive identity marker; it also implies a way of life or ongoing self-presentation related to one’s place within the tribe or community. Such an emphasis is consistent with the original place of nonheteronormative and gender-variant people among Native American/First Nations cultures, and distinct from

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more recent constructions of gender identity and sexual orientation.

Legacy of Colonialism Despite considerable progress made by Two-Spirit native people toward recognition in their own communities and the larger society, discrimination and prejudice still exist as harmful influences within Native American/First Nations cultures. Bullying and violence directed at Two-Spirit people is not uncommon, and the rate of teenage suicide is significantly higher among LGBT and TwoSpirit native people. The case of Fred Martinez is telling: Martinez, a Diné (Navajo), was nádleehí, and identified as that or “gay” until being murdered in 2001 at the age of 16 at the hands of another teenager, with some evidence suggesting that the murder was a hate crime. Martinez’s life was documented in the 2011 PBS film Two Spirit¸ directed by Lydia Nibley, which garnered critical acclaim. The persistence of homophobia and transphobia within Native communities is made more problematic by questions of tradition and authenticity; some Native people do not want to accept the idea that their culture may have had greater variation in gender identity and sexuality in the past, preferring instead a more normative view consistent with a more recently acquired Christianity. Besides the issues surrounding the place and legitimacy of Two-Spirit people, it must be noted that Native American/First Nations people are themselves the target of sexual exoticization within the larger society. Native women are seen as being more sexualized, while native men are sometimes portrayed as lovers of considerable sexual prowess. Thus “native sexuality” itself is culturally appropriated, often within the mass media entertainment industry, to be both exoticized and eroticized.

Conclusion Native sexualities can thus be seen as a mosaic of different and varied understandings of sexuality and gender, based in and defined by Native

American/First Nations cultures and their relationship to the larger society in which they are located. The term itself is located within a specific contemporary context, distinct from such concepts as heterosexual, lesbian, gay, bisexual, or transgender—but clearly connected to all of them, and shaped by the historical legacy of relations between native people and the more recent Western European settlers and the cultural definitions of sexuality and gender they brought with them. Victor J. Raymond See also Asian American/Pacific Islander Sexualities; Heteronormativity; HIV/AIDS and Racial/Ethnic Disparities; LGBTQ People of Color; Nonbinary Genders; Religion/Spirituality and LGBTQ People; Sexual-Identity Labels; Transgender and GenderNonconforming Youth of Color

Further Readings Allen, P. G. (1992). The sacred hoop: Recovering the feminine in American Indian traditions. Boston, MA: Beacon Press. Brown, L. B. (Ed.). (1997). Two spirit people: American Indian lesbian women and gay men. New York, NY: Routledge. Driskill, Q., Finley, C., Gilley, B. J., & Morgensen, S. L. (Eds.). (2011). Queer indigenous studies: Critical interventions in theory, politics, and literature (First Peoples: New directions in indigenous studies). Tucson: University of Arizona Press. Gilley, B. J. (2006). Becoming two-spirit: Gay identity and social acceptance in Indian country. Lincoln: University of Nebraska Press. Jacobs, S., Thomas, W., & Lang, S. (Eds.). (1997). Twospirit people: Native American gender identity, sexuality, and spirituality. Chicago: University of Illinois Press. Rifkin, M. (2011). When did Indians become straight? Kinship, the history of sexuality, and native sovereignty. New York, NY: Oxford University Press. Roscoe, W. (1988). Living the spirit: A gay American Indian anthology. New York, NY: St. Martin’s Press. Roscoe, W. (2000). Changing ones: Third and fourth genders in Native North America. New York, NY: St. Martin’s Press.

No Promo Homo Policies Taylor, D. (2008). Me sexy: An exploration of Native American sexuality. Madeira Park, British Columbia, Canada: Douglas & McIntyre. Vernon, I. S. (2001). Killing us quietly: Native Americans and HIV/AIDS. Lincoln, NE: Bison Books. Williams, W. L. (1992). Spirit and the flesh: Sexual diversity in American Indian culture. Boston, MA: Beacon Press.

NEW FAMILY STRUCTURES SURVEY See Methodological Decisions by Researchers of LGBTQ Populations

NO PROMO HOMO POLICIES No promo homo is shorthand for laws and policies that prohibit the promotion of homosexuality and LGBTQ persons, standing for “no promotion of homosexuality.” No promo homo statutes and policies have taken two broad forms related to public schools: where schools and educators are prohibited from portraying LGBTQ identities and persons positively, and where educators are required to remain neutral and/or silent on LGBTQ issues and about LGBTQ persons. Both forms most commonly regulate the curricular content in sex and health education; filter the resources public schools may make available in their libraries; and limit the enumeration of specific classes of individuals for protection from harassment, intimidation, and bullying.

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straight identities exist or should be considered “normal”—because supporting queer identities and persons would be tantamount to state endorsement of “unacceptable” identities. In  addition, not promoting homosexuality has been suggested as a means for maintaining state-sponsored “neutrality” as to the religious perspectives of educators, students, and parents—often alluding to LGBTQ persons as harmful to the religious faiths of children. Presented this way, no promo homo policies frequently require the removal of LGBTQ issues from school curricula, resources, and policies. They also mandate that LGBTQ identities and persons be presented to students as either harmful to children or undesirable to society. The policies may require schools and educators to frame LGBTQ persons and identities as criminal within school curricula— often referencing unconstitutional sodomy laws. Curricula may also be required to include queerness only in the context of disease, allowing homosexuality to be discussed in connection with HIV/AIDS or other sexual ailments. Lastly, curricula may be required to assert that LGBTQ identities constitute a lifestyle that is generally unacceptable to society. Critics point out that such policies violate the First Amendment to the U.S. Constitution, which protects all speech/expression, including speech that makes adults uncomfortable. Furthermore, there is a growing body of research documenting  the roles no promo homo policies play in fueling school-level homophobia. Specifically, research suggests LGBTQ students under no promo homo laws/policies experience more harassment and violence than their queer peers in districts and states without no promo homo policies.

No Promo Homo Argumentation Proponents of no promo homo policies argue that state governments (and the institutions within states, like schools) should only support “good” lives, and acceptable identities and behavior. Heterosexual identities and dating/intimate behaviors are, they suggest, better and healthier than those taken up by LGBTQ persons. Therefore, states should only institute and enforce laws/policies that endorse heterosexuality and heteronormativity—the assumption that only

Examples of No Promo Homo Law and Policy No promo homo elements exist notably in both state law and district-level educational policy. Eight states presently have no promo homo laws: Alabama, Arizona, Louisiana, Mississippi, Oklahoma, South Carolina, Texas, and Utah. Two additional states, Missouri and South Dakota, have statutes prohibiting enumeration of protected

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Nonbinary Genders

classes of students, thereby requiring institutional neutrality with respect to student diversity and issues such as bullying due to sexual orientation or gender identity. One example of a state-level prohibition no promo homo policy can be found in two of Texas’s present sex education statutes, which stipulate that curricula must emphasize that “homosexual conduct is not an acceptable lifestyle and is a criminal offense under Section 21.06, Penal Code” (Tex. Health & Safety Code Ann. § 85.007) and that curricula must present “in a factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under Section 21.06, Penal Code” (Tex. Health & Safety Code Ann. § 163.002). Taken together, these statutes prohibit the positive portrayal of LGBTQ persons through requirements that homosexual identities be taught as a lifestyle, that said lifestyle must be taught as societally unacceptable, and that homosexual conduct be taught as illegal under a provision of the Texas Penal Code that was declared unconstitutional by the U.S. Supreme Court in 2003. School districts enacted no promo homo policies throughout the 1990s. The Anoka-Hennepin School District in Minnesota is notable for having both a prohibition and a neutrality no promo homo policy in place at different times. The district’s initial 1994 prohibition read, in part, that “homosexuality [is] not to be taught/addressed as a normal, valid lifestyle.” Schools within the district were prohibited from representing LGBTQ persons and identities positively and required to treat homosexuality as abnormal and socially unacceptable. Fifteen years later, the district revised its policy to emphasize that sexual orientation was not a part of its curriculum. The policy specified that, “staff, in the course of their professional duties, shall remain neutral on matters regarding sexual orientation including but not limited to student-led discussions” (Anoka-Hennepin District No. 11, 2009). This later policy required the absence of homosexuality from school curricula and, where this is not possible—such as when students raise LGBTQ issues—educators are required

to be neither explicitly supportive nor expressly critical. The district has since replaced this neutrality policy with a much more inclusive rule set, finally comporting with Minnesota state law.

Conclusion Clearly, while no promo homo policies are facially neutral, they can inflict great harm on LGBTQ students who attend public schools where such policies are in place. Given the threats to both LGBTQ students and First Amendment freedoms, many critics and observers have pointed out that no promo homo policies should not stand legal scrutiny—if challenged. Jason P. Murphy and Catherine A. Lugg See also Bullying, Legal Protections Against; Homophobia; Laws Banning Homosexuality and Sodomy; School Climate; Sexual Education Mandates for Inclusion; Sexualities at School

Further Readings Eskridge, W. N., Jr. (2000). No promo homo: The sedimentation of antigay discourse and the channeling effect of judicial review. New York University Law Review, 75, 1327–1411. Hoschall, L. (2013). Afraid of who you are: No promo homo laws in public school sex education. Texas Journal of Women and the Law, 22, 219–239. Lugg, C. A. (2006). Thinking about sodomy: Public schools, legal panopticons, and queers. Educational Policy, 20(1), 35–58. McGovern, A. E. (2012). When schools refuse to “say gay”: The constitutionality of anti-LGBTQ “no promo homo” public school policies in the United States. Cornell Journal of Law and Public Policy, 22, 465–490.

NONBINARY GENDERS The overwhelming majority of psychological studies have assumed that gender is binary, often to the point of focusing on a search for differences between men and women. The topic of

Nonbinary Genders

genders that fall outside of the common cultural binary of women and men has been underresearched in psychology to date, with only a small number of psychologists focusing on the area in any depth. This entry provides a history of psychological work that has taken account of gender experiences that fall outside of the binary, focusing on Sandra Bem’s classic research on androgyny and gender schema theory. It then summarizes the findings of the limited number of recent psychological studies that understand gender in a more diverse way and explore the experience of people who identify as nonbinary.

The History of Psychological Research on Nonbinary Genders In the early days of psychology, women’s experience was neglected and the focus was upon men’s psychology, with much research being conducted exclusively on men. In recent decades, there has been a turn toward a pervasive view of the (two) genders as different, or opposite, with research frequently seeking to explain why women differ from a perceived masculine norm. A small minority of researchers—such as Carol Gilligan—have challenged this by suggesting that women’s psychology may be superior to men’s in certain ways. Others have questioned the entire project of studying gender difference by pointing to meta-analyses that reveal that men and women are far more similar than they are different, and to the evidence that there are no psychological areas in which men and women are entirely different. There has been very little questioning, however, of the underlying assumption that gender is binary. This is exemplified by the way in which psychologists—and other researchers—ubiquitously ask participants whether they are a man or a woman on the demographics questions that are commonly included in surveys and experimental studies. Perhaps the first psychologist to conceptualize gender in a different way was Sandra Bem, who published work in this area from the 1970s through to the 1990s. Her Bem Sex Role Inventory

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(BSRI) was groundbreaking, as it was a validated instrument that included separate measures of masculinity and femininity, rather than following the prevailing view that masculinity and femininity were polar opposites on the same scale. On the BSRI, people were able to score as “sex-typed” (high on gender traits commonly associated with their birth-assigned sex and low on those of the “other sex”), but they could also score in a sexreversed way (the opposite of this), or they could score high or low on both masculinity and femininity simultaneously. Employing this inventory to collect data from people in the United States, Bem was able to challenge the popular view in the late 1960s and early 1970s that people were psychologically healthier when they conformed to the psychological characteristics most associated with their gender. On the contrary, across various arenas, Bem found that those who displayed both stereotypically feminine and masculine traits (whom she termed androgynous) were more flexible, adaptable, and psychologically healthy than sex-typed people. Bem’s later research moved away from the concept of androgyny because she realized that this perspective still maintained a notion that psychologically masculine and feminine traits existed, rather than being culturally and historically bound concepts. Her gender schema theory focused on  how children internalize cultural gender roles and the impact of this on their behavior. On the basis of this research, Bem suggested that gender was not a useful organizing category, and that psychology—and people more widely—should move away from the use of gender categories. Subsequently, she moved away from binary gender models altogether and argued for the value of a proliferation of different gender expressions. Overall, Bem’s research and theory suggested both that many people experience gender in ways that incorporate more than one gender, and that gender could be flexible and fluid rather than fixed from birth or early childhood. However, there were very few people in the United States during the time of her work who explicitly identified in a nonbinary way.

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Nonbinary Gender Identities Of course, there have always been cultures and communities around the world where gender has not been experienced or identified according to gender binaries. Such experiences and identities include the Hijra identity in India; the Tom, Dee, and Kathoey identities in Thailand; and the Bissu, Calabai, and Calalai identities in some communities in Indonesia. However, it is important not to view such experiences and identities through the lens of contemporary minority Western understandings of either binary or nonbinary genders, and more research is necessary that is fully embedded within such cultures and communities in order to avoid the ethnocentric perspectives that have tainted much previous work in these areas. Over the first decades of the new millennium there has been a burgeoning group of people in Western countries who have identified their gender in a nonbinary way. As with other recent sexual movements, such as the asexual movement of people who identify as not experiencing sexual attraction, the Internet has enabled individuals to find others who share their experiences, and has also enabled communities to form and people to begin to fight for various rights on the basis of nonbinary gender. A number of new terms have developed to capture different kinds of nonbinary identity or experience, including the following: • Being to some extent, but not completely, one gender (e.g., demi man/boy, demi woman/girl, fem man) • Incorporating aspects of both woman and man (e.g., androgynous, mixed gender) • Having no gender (e.g., gender-neutral, nongendered, genderless, agender, neutrois) • Being of a specific additional gender (either between man and woman or additional to those genders, e.g., third gender, sometimes pangender) • Moving between two genders (e.g., bigender, genderfluid) • Moving between multiple genders (e.g., trigender, sometimes pangender) • Disrupting the gender binary (e.g., genderqueer, genderfuck)

To date, there has been a limited amount of psychological research focusing on people who explicitly identify as nonbinary in terms of gender, although there has been work in both queer theory and queer activism on understanding and experiencing gender in nonbinary ways dating back to the early 1990s, which is useful to draw upon. The psychological research so far has particularly focused on determining the proportion of people who identify in this way, and on elucidating key aspects of their experience. Estimates of the proportion of people who identify as nonbinary vary depending on the population being studied. For example, between 10% and 25% of trans people identify as nonbinary gender in some way, whereas around 5% of LGBTQ youths identify as neither male nor female, and several studied concur that identifying in this way is more common among younger people.

Key Features of Nonbinary Experience A main finding from the research conducted so far is the importance of connecting with others for embracing a nonbinary gender identity. Many nonbinary people report struggling to express themselves, or to comprehend their experiences, until finding others who identified in such ways. Nonbinary people also often report that it is difficult to have a sense of authenticity without any acknowledgment of their identities from the people around them, a common experience as wider culture, and people within it, are often so embedded—and invested—in binary genders. Related to this is the trouble many nonbinary people experience in trying to find specific spaces or communities in which they fit. Many report not fitting into either cisgender or trans spaces, analogous to the common bisexual experience of not fitting into heterosexual or lesbian/gay spaces. Some endeavor to find a home within broader trans or LGBTQ communities, while others create spaces and communities for themselves as nonbinary people, often online, although this presents problems for those who are older and/or not Internet literate, who may not find such spaces to be inclusive.

Nonbinary Genders

Like both trans and bisexual people, people who identify as nonbinary experience higher rates of mental health problems than other gender- and sexual-identity groups, with over a third reporting they attempted suicide at some point. Experiences of discrimination and violence are also high, with a third reporting physical assault. Also highly common are everyday experiences of being misgendered; being the target of microaggressions relating to gender expression; and having to negotiate a hugely binary world in relation to public toilets, clothing choices, changing rooms, and the like. Most nonbinary people do not perceive either gender or sexuality as discrete, mutually exclusive categories but rather regard gender embodiment and expression as complex and diverse. Some report feeling a sense of responsibility to challenge the gender binary, even describing themselves as gender pioneers and feeling that they are engaged in culture-making.

Nonbinary Language and Expression A major area of research thus far is the language that nonbinary people are developing to express their identities and experiences. The impact of gendered language on experience is well documented in psychology, for example, in the research on the use of the generic “man” and other sexist language and its impact on women’s performance and experience, and on the impact of cisgenderist language on trans people’s sense of exclusion. Thus, it seems likely that binary language, and misgendering of nonbinary people, will have similar effects, although the research has yet to be conducted. In relation to terms used to capture diverse nonbinary experiences and identities, U.S.-based research has found genderqueer to be the most common gender-identity term used. Nonbinary people often relate to more than one gender term (either at the same time, or across time). Some gender terms used are specific to certain cultural traditions, for example, Two-Spirit (First Nations) and Mahuwahine (Hawai’ian); and some people devise their own unique gender terms or prefer not to use labels. Such diversification of terms reached popular attention in 2014 in the decision of the social

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media website Facebook to provide 58 possible gender terms for its users. Another key aspect of nonbinary terminology is pronoun usage. In English, the most common set of nonbinary gender pronouns are the existing terms they/their/them, also now adopted by Facebook. This is grammatically correct in the singular, and there are examples of such usage dating back to Chaucer and Shakespeare. However, some still do not like its association with plurality, and other popular pronoun sets that have been explicitly developed for nonbinary people include ze, zir, zem; xe/xyr/xem; Sie/hir/hir; and per/per/pers. In addition to pronouns, nonbinary people frequently struggle with the imposition of gendered titles (such as Mr./Ms.), with gendered address (such as Sir/Madam), and with family and friends who want to use birth names rather than chosen names. There is also a need to use nonbinary alternatives for relationship terms (e.g., partner instead of boyfriend/girlfriend, sibling instead of sister/ brother, offspring instead of son/daughter, parent instead of mother/father). While there is currently a good deal of diversification in relation to nonbinary gender, with many different experiences being embraced under that broad umbrella, there is also a tendency—as Sandra Bem herself pointed out—for the proliferation of possibilities to lead to further “straitjackets,” as people struggle to fit into new, narrowly defined identities. Perhaps this can be seen already in relation to appearance, with the vast majority of available images of nonbinary, androgynous, or genderqueer people being young, White, and slim. There were attempts in 2014 to challenge this on social media using the Twitter hashtag #whatgenderqueerlookslike. Trans activists such as Julia Serano have also pointed to a preference for masculine-of-center over feminine-of-center people in many LGBTQ, trans, and nonbinary spaces. Physical interventions may or may not be desired or required by nonbinary people. These include hormones; surgeries; and changes to aspects of appearance, clothing, gait, or voice. Research so far suggests there is diversity in the ways such possibilities are taken up, or not, by different nonbinary people.

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Nonbiological, Nongestational Mother

Finally, a small body of research suggests that far more people experiences themselves as nonbinary in some way than actually identify as nonbinary. One study on a general population found that over a third of people felt to some extent that they were the “other” gender, or both male and female, and/or neither. This highlights the importance of researching nonbinary experience in general populations rather than just among nonbinary communities or with those who explicitly identify in that way. Meg John Barker See also Bisexualities; Cisgenderism; Gender Binaries; Genderqueer; Queer; Queer Theory

Further Readings Bornstein, K., & Bergman, S. B. (Eds.). (2010). Gender outlaws: The next generation. New York, NY: Avalon. Fausto-Sterling, A. (2012). Sex/gender: Biology in a social world. New York, NY: Routledge. Joel, D., Tarrasch, R., Berman, Z., Mukamel, M., & Ziv, E. (2013). Queering gender: Studying gender identity in “normative” individuals. Psychology & Sexuality, 1–31. doi:10.1080/19419899.2013.830640 Nestle, J., & Wilchins, R. A. (2002). Genderqueer: Voices from beyond the sexual binary. New York, NY: Alyson Books. Richards, C., & Barker, M. (Eds.). (2013). Sexuality and gender for mental health professionals: A practical guide. London, England: Sage. Richards, C., & Barker, M. J. (Eds.). (2015). Handbook of the psychology of sexuality and gender. Basingstoke, England: Palgrave Macmillan. Richards, C., Bouman, W., Seal, L., & Barker, M. (in press). Non-binary gender. Basingstoke, England: Palgrave Macmillan.

NONBIOLOGICAL, NONGESTATIONAL MOTHER Nonbiological, nongestational mothers in lesbian couples have been given a variety of names, including “social mother,” “comother,” “mather,” or the

“other mother.” The meaning of these names has an emotional, social, and psychological impact upon the nonbiological, nongestational mother being labeled, as well as the entire family. These social labels have connotations toward the social valuation of the nonbiological, nongestational mother in the lesbian couple and in their broader social community. This entry will discuss the concept of “mother” within the lesbian couple and the associated relationship factors that have a significant impact on all involved. Being the nonbiological, nongestational mother in a lesbian couple may be both a personal challenge and a growth opportunity, as it relates to navigating the role of mother as a shared responsibility. The sharing of the “mother” role/duties can be an ongoing negotiation process, and the needs of the family change in response to the growing child. Positive and open communication between both parents in the lesbian couple is important to make this adaptive family process function well and keep everyone satisfied. It is important to acknowledge that the relationship of the lesbian couple is only one of many social “circles” of influence that can impact how a “nonbirth” lesbian mother regards her parenting role responsibilities and authority. The couple’s families and/or their extended social community may convey social messages regarding the degree to which the nonbiological, nongestational mother is regarded as a mother of “equal standing.” Who is acknowledged as being the primary caretaker of the children in the family can have meaningful implications for a range of issues, from how effective the nonbiological, nongestational mother feels in making parenting decisions to legal parental rights if the lesbian couple’s relationship dissolves through a divorce or breakup. Family therapists or other professionals working with lesbian couples need to understand the dynamic social and emotional issues connected with the rights and responsibilities of both mothers. There is a relative paucity of research regarding how lesbian couples work through the process of defining and implementing their shared parenting roles in a fair and equitable manner. Certainly education (aimed at the LGBTQ community) is

Nonbiological, Nongestational Mother

needed to assist in the successful navigation of this motherhood journey shared by both parents within the lesbian couple. One important aspect of this mother-related dynamic in lesbian families that warrants further discussion is the impact of this primary caregiving role upon the developing child. There is important socialization information conveyed to the child through the expressed attitudes and actions of the mothering partnership in the lesbian couple. In effect, the child internalizes an understanding of the role of a caretaker (i.e., “mother”), and this can shape the child’s own adult role as a parent and child caretaker. From a positive role-modeling perspective, it is important for the developing child to see a harmonious assumption of parenting duties and attitudes between the two lesbian mothers. Another part of the complex role for the nonbiological, nongestational mother is the voluntariness of her decision to become a parent. It might be the case that one partner in the couple decides to become a biological mother, and the other partner in the relationship goes along with the decision to keep the couple together and, thus, becomes a mother “by default.” In a different scenario, the non–birth mother may actually have wished to be pregnant, but different decision-making factors (e.g., physical health or age of each partner) may have led to the other partner becoming the birth mother. Which partner in the lesbian couple becomes the birth mother has a significant impact on the non–birth mother if her gender identity or self-esteem is tied to the desire to experience a pregnancy firsthand. The emotional and psychological needs of both partners in the relationship need to be acknowledged and accounted for throughout this decision-making process. In response to this significant life change, the couple may consult a family therapist to address the sensitive nature of this decision-making process and its associated impact upon both the lesbian couple’s relationship and their potential parenting response to the child that comes into their lives. This can be a personal growth opportunity for the non–birth mother to assume an unanticipated mothering role and benefit from the

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adaptation process in response to new caregiving role experiences and responsibilities. The varied social definition of a nonbiological, nongestational mother translates into an even more complex and inconsistent legal definition of this parental role on a state-by-state basis. In some U.S. states, lesbian parents may face legal uncertainty in the court system regarding who is awarded legal custody of the child if the couple does not remain together. The legal rights of the nonbiological, nongestational mother have social, psychological, physical, and emotional ramifications toward the care and well-being of the child, regardless of the relationship status of the couple. Public policy makers, legislators, and lawyers need to better address the legal custody rights of lesbian non– birth mothers to protect the welfare of all involved. Recognition of the important role of the nonbiological, nongestational lesbian mother within the family system is an important issue that needs to be discussed and reinforced at many levels of society. Certainly public policy legislation and community education are critically needed to determine the best ways to support the emotional, social, and psychological needs of both lesbian mothers and their offspring. A societal and legal valuation of both “mother” roles within the lesbian family are critical for a long-lasting relationship within the couple and a strong, loving parental bond with their offspring. The social labeling and the associated distinctions made between the biological and nonbiological, nongestational mothers in a lesbian couple should be eradicated through appropriate education and possible family counseling. There should be an equal societal valuation of the mothering role, regardless of her birth experience. A mutual understanding of the mothering role expectations, a mutual respect of role boundaries, and an equitable sharing of parental duties are all important factors for both the birth and non–birth mothers in the lesbian family. Lisa Hollis-Sawyer See also Children With LGBQ Parents, Psychological Outcomes; Coparenting; Couples Therapy; Families of Choice; LGB Parenting Styles and Values; Transition to Parenthood and Parental Roles

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Nondiscrimination Protections, State and Local

Further Readings Ben-Ari, A., & Livni, T. (2006). Motherhood is not a given thing: Experiences and constructed meanings of biological and nonbiological lesbian mothers. Sex Roles, 54, 521–531. doi:10.1007/s11199-006-9016-0 Brown, R., & Perlesz, A. (2007). Not the “other” mother: How language constructs lesbian co-parenting relationships. Journal of GLBT Family Studies, 3, 267–308. doi:10.1300/J461v03n02_10 Brown, R., & Perlesz, A. (2008). In search of a name for lesbians who mother their nonbiological children. Journal of GLBT Family Studies, 4, 453–467. doi:10.1080/15504280802191574 Gabb, J. (2005). Lesbian m/otherhood: Strategies of familial-linguistic management in lesbian parent families. Sociology, 39, 585–603. doi:10.1177/ 0038038505056025 Gartrell, N., Banks, A., Hamilton, J., Reed, N., Bishop, H., & Rodas, C. (1999). The national lesbian family study: 2. Interviews with mothers of toddlers. American Journal of Orthopsychiatry, 69, 362–369. doi:10.1037/h0080410 Padavic, I., & Butterfield, J. (2011). Mothers, fathers, and “mathers”: Negotiating a lesbian co-parent identity. Gender and Society, 25, 176–196. doi:10.1177/ 0891243211399278

NONDISCRIMINATION PROTECTIONS, STATE AND LOCAL This entry describes legal protections against discrimination for LGBTQ people at the state and local levels. It explains the types of discrimination experienced and the patchwork of laws passed to address that discrimination.

Prevalence of Discrimination Experienced by LGBTQ People The study of discrimination against LGBTQ people in the United States has disproportionately focused on employment. However, LGBTQ people also face bias in areas such as housing, public accommodations, credit, insurance, and education. This entry will focus on employment, housing, and

public accommodations, which are typically included simultaneously in state and local laws passed to address discrimination. More than 40% of LGBTQ people have experienced at least one type of employment discrimination—such as in hiring, promotion, or job retention—at some point in their lives as a result of their sexual orientation, according to the 2008 General Social Survey. The largest study of transgender people, Injustice at Every Turn, found that 47% of transgender people experienced a negative job outcome as a result of their gender identity, while 90% reported experiencing harassment, mistreatment, or discrimination on the job. Discrimination in employment leads not only to higher poverty levels but also to health-related problems. Housing discrimination against LGBTQ people occurs when an individual or family is charged higher rent, shown less desirable properties, or denied the ability to rent or purchase a property altogether. More than 10% of lesbian, gay, and bisexual people in a 2000 Kaiser Family Foundation Survey reported being discriminated against when renting an apartment or purchasing a home. Of those who had not experienced housing discrimination personally, 35% knew someone who had experience such discrimination based on his or her sexual orientation. The survey found that nearly 20% of transgender people have experienced housing discrimination. The definition of public accommodations varies from state to state. Generally, public accommodations laws cover anyplace an ordinary person would expect to be able to enter for the purpose of purchasing goods and services without express permission—restaurants, theaters, shops, bus stations, hotels, amusement parks, and salons. Recently, several high-profile lawsuits have been filed after same-sex couples experienced discrimination when attempting to purchase weddingrelated services and goods. Injustice at Every Turn reported that more than half of transgender people have experienced harassment in a place of public accommodation. Retail stores were the location of the most harassment and unequal treatment.

Nondiscrimination Protections, State and Local

Limitations on Nondiscrimination Laws Nondiscrimination laws are intended to create an equal playing field for groups who have historically been disfavored in the public marketplace. However, the laws do not prohibit the use of neutral criteria in making determinations on whom to hire or when people are eligible for services. Thus, an employer can take into consideration a job seeker’s education and previous experience as long as those factors are relevant to the job. A landlord or shopkeeper can legitimately take into account a person’s ability to pay.

Historical Background After decades of police raids and public harassment, in the summer of 1969 a group of lesbian, gay, bisexual, and transgender (LGBT) patrons took to the streets to protest a raid on the Stonewall Inn, a gay bar in New York City. The event galvanized the LGBTQ community and brought broader public attention to the discrimination faced by LGBTQ people. The city council in East Lansing, Michigan, passed the first ordinance (city law) prohibiting discrimination on the basis of sexual orientation in March of 1972. Initially, the ordinance only protected city employees from employment discrimination. A decade later, Wisconsin became the first state to pass a nondiscrimination law that made it illegal to discriminate against lesbian, gay, and bisexual people in employment, housing, and public accommodations. The state had long been a leader in prohibiting discrimination, also being the first state to make sex discrimination and disability discrimination illegal. In 1975, Minneapolis, Minnesota, became the first place in the United States to prohibit discrimination against transgender people. At the time, protections were given based on “affectional preference,” which was defined to include “having or projecting a self-image not associated with one’s biological maleness or one’s biological femaleness.” The state of Minnesota passed the first statewide nondiscrimination law to include gender identity in 1993. However, rather than passing it as

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a distinct category, the legislature defined sexual orientation to include language almost identical to the Minneapolis statute. Many following ordinances and state-level laws included protections for transgender people either in the definition of sexual orientation or in the definition of sex.

The Patchwork of State and Local Protections As of this writing, 17 states and the District of Columbia have laws prohibiting discrimination on the basis of sexual orientation and gender identity. The states are California, Colorado, Connecticut, Delaware, Hawai’i, Illinois, Iowa, Maine, Maryland, Massachusetts, New Jersey, New Mexico, Nevada, Oregon, Rhode Island, Vermont, and Washington. Each prohibits discrimination in employment, housing, and public accommodations with the exception of Massachusetts. There, the legislature did not cover public accommodations protections for transgender people. Three additional states—New Hampshire, New York, and Wisconsin—provide nondiscrimination protections in all employment, housing, and public accommodations only on the basis of sexual orientation. States that have chosen to pass nondiscrimination laws covering LGBTQ people tend to be clustered on the coasts or in the Midwest. No state in the South has adopted legislation to prohibit discrimination on the basis of sexual orientation or gender identity. When the state has failed to act, cities and counties often choose to pass nondiscrimination ordinances that include sexual orientation and gender identity as protected categories. More than 175 cities and counties have passed nondiscrimination ordinances in states that do not protect people from discrimination on the basis of sexual orientation or gender identity. Many more adopted these protections prior to passage of a statewide law. Cities such as Austin, Texas; Ann Arbor, Michigan; and St. Louis, Missouri, are places where most Americans would not be surprised to find protections for LGBTQ people. However, a

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Nonheterosexual Children of LGBTQ Parents

wide range of cities have chosen to protect their LGBTQ citizens, including more than a dozen in Utah and a half dozen in Idaho. Vicco, Kentucky, with a population of just over 300 people, adopted an LGBTQ-inclusive nondiscrimination ordinance in 2012.

Public Support A supermajority of Americans support laws prohibiting discrimination on the basis of sexual orientation and gender identity. According to the Public Religion Research Institute, 72% of Americans favor laws protecting gays and lesbians from discrimination in employment, including a majority of Republicans and a majority of every major religious denomination. A national survey of registered voters conducted by TargetPoint Consulting found that 68% support employment nondiscrimination laws that cover sexual orientation and gender identity. Sarah Warbelow See also Bullying, Legal Protections Against; Discrimination Against LGBTQ People in the Public Sector; Employment Non-Discrimination Act (ENDA); Housing, Protection Against Discrimination in

Further Readings Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Mezey, S. G. (2007). Queers in court: Gay rights law and public policy. New York, NY: Rowman & Littlefield. Pew Research Center. (2013, June 13). A survey of LGBT Americans: Attitudes, experiences and values in changing times. Washington, DC: Author. Retrieved November 29, 2015, from http://www .pewsocialtrends.org/2013/06/13/a-survey-oflgbt-americans/ Pizer, J. C., Sears, B., Mallory, C., & Hunter, N. D. (2012). Evidence of persistent and pervasive workplace discrimination against LGBT People: The

need for federal legislation prohibiting discrimination and providing for equal employment benefits. Loyola of Los Angeles Law Review, 45, 715–779.

NONHETEROSEXUAL CHILDREN OF LGBTQ PARENTS Although LGBTQ people have always been parents, it is only in the past few decades that they have been able to do so without fear of negative legal and social consequences. The children of LGBTQ people have been analyzed in social science research, and build their lives under the critical gaze of public opinion. LGBTQ parents experience pressure to ensure that their children are heterosexual and gender-normative, which have been presumed to be more optimal outcomes. This pressure has burdened these families to conform to societal heteronormative assumptions, and this has downplayed honest discourse regarding the complexity of children’s developing gender identity and sexual orientation living in LGBTQ families. Although most children growing up in LGBTQ-parent families are heterosexual and gender-conforming, some children in these families are not. There is scant research on the LGBTQ children of LGBTQ parents, but the extant research reveals some interesting information about these “second generation” children.

Historical Context Throughout most of modern history, LGBTQ people have lived closeted lives, and those who had children—generally produced while in heterosexual relationships—kept their sexual orientation and gender identities hidden. It was only with the rise of the lesbian and gay civil rights movement that same-sex–headed families were able to be publicly out. In the past few decades, increasing numbers of same-sex couples have consciously chosen to become parents after coming out, which has led to a rise in the social acceptance of lesbian and gay male–headed families.

Nonheterosexual Children of LGBTQ Parents

As the LGBTQ movement has grown, increasing numbers of transgender and queer parents have been able to claim their right publicly to build families. Transgender people—those whose gender identity or gender expression is different from their assigned sex at birth—can become parents before or after their transition. Queer, or genderqueer, is often used as an umbrella term for all people who step out of commonly expected and prescribed rules for gender expression and identity, including those who are lesbian, gay, bisexual, and transgender. Queer people are increasingly claiming their right to become parents, which is reshaping the modern definitions of family outside of a heteronormative context. Heteronormativity is an ideology that assumes everyone is heterosexual and should express traditional gender conventionality. It assumes that heterosexuality and genderconforming behavior are superior to other forms of sexual orientation or gender expression. All LGBTQ people are the recipients of institutionalized oppression due to their non-normative sexual orientation or gender expression, and these societal rules have historically limited LGBTQ ability to form families, as well as maintain custody of their children. Prior to the 1970s, the prevailing bias of the judicial system was that homosexuality and transsexualism were inherently damaging to children because of the lack of traditional sex roles modeled for children. The assumption was that these so-called alternative family structures would create children who were confused about normative male or female roles, and they would likely become LGBTQ themselves; having an LGBTQ child was considered a parental “failure,” and the courts were expected to assert social control to protect children. In the 1970s—in the midst of both the women’s and the gay and lesbian liberation movements— the question of whether LGBTQ parenting was inherently dangerous for children was challenged in the courts. Lesbian motherhood, and the right of lesbian mothers to retain custody of their children following a heterosexual divorce, became the focus of numerous legal cases, since it was believed that being reared in a home without a father was not

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“in the best interest of children.” In an era when women routinely won the right of full custody of their children following a divorce, lesbian mothers were losing every legal battle to retain custody of their children based solely on their sexual orientation. The lack of empirical evidence proving the supposedly negative effects on children of lesbian mothers became the impetus for a huge outpouring of social science research studies that eventually provided evidence-based support for the psychological stability of children reared by lesbian parents. These extensive court battles that lesbian mothers waged to retain custody of their children paved the way for other sexual-minority parents in the years that followed. Much of what is known empirically about LGBTQ parenting is derived from studies of lesbians and then generalized to gay male parents; few studies to date have focused on parenting by bisexual, transgender/transsexual, or queer people.

Research Findings and Controversies When the judicial system determined that lesbian parenting was not harmful to children, they based it on social science research that examined psychological adjustment, self-esteem, academic performance, and other issues of children reared in lesbian homes. The research unambiguously revealed that children of lesbian mothers do not show any signs of psychological problems; indeed, some results implied that many children reared in lesbian homes exhibit specific strengths compared with peers. This research has been instrumental in changing social policy for all LGBTQ people regarding child custody, access to reproductive technologies, and adoption and foster care placements, and has led to a “gayby” boom of LGBTQ parenting. A major focus of the research involved examining the development of gender identity and sexual orientation for children reared in same-sex homes. The concern was whether lesbian mothers (and, by  extension, other queer parents) would differ from heterosexual mothers in how they raised their children to social expectations regarding heterosexuality and gender-normative behavior.

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Nonheterosexual Children of LGBTQ Parents

The research unequivocally affirmed that children of lesbian parents express traditional gender roles and behaviors, and are almost always heterosexual. Same-sex parenting had been justified based on scientific affirmations of heteronormativity, and LGBTQ parents have been “allowed” to parent in part because the research affirmed heterosexual and gender-conforming outcomes. That is, the children of LGBTQ parents would maintain the status quo by heterosexually marrying, and by raising children according to acceptable gendered standards. This has placed tremendous pressure on LGBTQ parents to raise children who are heterosexual and gender-normative, as well as on their children to be “normal.” Given all that has rested on this research for LGBTQ parents, challenging these results has been politically complicated. Initially, the challenges came mostly from those who were opposed to LGBTQ parenting, based on their conservative values. More recently, meta-analyses and emerging research have continued to reexamine the initial questions of how having LGBTQ parents might influence child-rearing and identities of children reared outside of heteronormative presumptions. The assumption that healthy child development should be defined by heterosexual and gendernormative narratives is fraught with heteronormativity and based in false ideologies that being heterosexual, or demonstrating gender-conforming behavior, is a superior outcome. This assumption is being challenged by the increasing visibility of LGBTQ children of LGBTQ parents.

LGBTQ Children of LGBTQ Parents There is scant research on nonheterosexual children of LGBTQ parents, although the literature on LGBTQ youth reveals that some have LGBTQ parents, and the research on LGBTQ parents suggests that some of their offspring are LGBTQ themselves. They are an understudied minority group within a minority group. However, studying this population is complicated, since outside of the neutrality of academia, and given the heterosexism of the culture at large, the results of these studies

can negatively guide social policy and reverse the social acceptance of the diversity of family forms currently emerging. There is no evidence to suggest that LGBTQ parents encourage nonheterosexual or genderatypical behaviors in their children. Indeed, coming out may actually be more complicated for the LGBTQ children of LGBTQ parents. For example, LGBTQ parents may feel compelled to ensure that their children are heteronormative in the face of familial and social scrutiny. Same-sex parents who are raising gender-nonconforming children, or those that identify as transgender, may be as challenged as heterosexual parents. They may especially fear for their children due to their own traumatic history of being reared in far more homophobic times. They might also fear they will be blamed by their families and communities for their children’s queer identities. The children reared in these homes may worry they are disappointing their parents and may feel the need to protect their family from judgment and therefore repress their own emerging identities. Research suggests that not all LGBTQ children see that their parents are resources (even if their parents are loving and supportive), and LGBTQ youth with LGBTQ parents may hide their sexuality from their parents in similar ways as do many LGBTQ youth with heterosexual parents. Sexuality and gender expression as they emerge in youth are a private matter; few teens want to be “like” their parents, and it can be presumed that this is also true for the LGBTQ children of LGBTQ parents. If LGBTQ parents are able to step out of their own experiences and social pressures, they might serve as positive role models and protective buffers against societal heterosexism for their LGBTQ children. Perhaps, given their own experiences and the cultural influences in their lives, they might allow their children more freedom to “discover” their sexuality, outside of the heteronormative assumptions of much of society. They certainly are  knowledgeable about coming-out processes and have not only access to LGBTQ cultural communities but also a unique understanding about the challenges their children might face.

Nonheterosexual Children of LGBTQ Parents

However, LGBTQ parents commonly have their own legacy of psychological pain, which may cloud their ability to be responsive to their children; indeed, they may project their own histories of pain and internalized homophobia onto their child. The nature of homophobia and transphobia is such that it may be difficult for LGBTQ parents to celebrate having an LGBTQ child, although it seems that if “gay pride” has any meaning at all, it should be a natural reaction. There is enormous societal pressure on LGBTQ parents to produce heterosexual, gender-normative children and enormous expectations on their children to fulfill those social and parental expectations. Despite these challenges, LGBTQ children of LGBTQ parents— what some young people call “queerspawn”— exist, and nonbiased research into this emerging demographic is overdue. Arlene Istar Lev See also Adults With LGBQ Parents; Children With LGBQ Parents, Gender Development and Identity;

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Children with Transgender Parents, Psychosocial Outcomes; Custody Issues in Transgender Parenting; Heteronormativity; Therapy With Children of LGBTQ Parents

Further Readings Bigner, J. J., & Wetchler, J. L (Eds.). (2012). Handbook of LGBT-affirmative couple and family therapy (pp. 57–68). New York, NY: Routledge. Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Goldberg, A. E., & Allen, K. R. (2012). LGBT-parent families: Innovations in research and implications for practice. New York, NY: Springer. Lev, A. I. (2004). The complete lesbian and gay parenting guide. New York, NY: Berkley/Penguin. Riggs, D. W. (2007). Becoming parent: Lesbians, gay men, and family. Tenerife, Queensland, Australia: Post Pressed. Tasker, F. L., & Golombok, S. (1997). Growing up in a lesbian family: Effects on child development. New York, NY: Guilford.

O be utilized by researchers seeking to gain a large number of participants, whereas e-mail surveys are used to target smaller, more homogenous online groups. In what follows, the first section outlines the ways online surveys have been used to investigate LGBTQ lives. The subsequent section focuses on the advantages of Web surveys for LGBTQ research including the key issue of measuring sexuality and gender. The final section discusses the limitations of online surveys for understanding LGBTQ people’s experiences and lives.

ONLINE COMMUNICATIONS See LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook

ONLINE SURVEYS Surveys are a method of social research that provides a structured or systematic set of data from a number of cases. Surveys are used when researchers seek to construct descriptors of various attributes of larger populations. These descriptors can be related to attitudes, behaviors, or values and are developed by asking respondents open- and closedended questions. Survey research can be carried out in face-to-face or telephone interviews, or via postal or Web-based questionnaires. This entry focuses on self-completion online questionnaires, or online surveys (also referred to as Web surveys or Internet surveys). There has been considerable growth in the number and range of social surveys being administered online. Online surveys can be administered in one of two ways: via e-mail, where the questionnaire is sent to the respondent and the respondent completes the survey, attaching it to a reply e-mail; or via the Internet, where the respondent completes the survey on a website. It is more common for Web surveys to

Online Surveys and LGBTQ Research Online surveys have been used increasingly with LGBTQ populations. Various studies using this method have explored LGBTQ people’s experiences in and attitudes toward health, education, employment, politics, discrimination, harassment, violence, sex, crime, media, and religion, as well as many other aspects of life. One recent example of a large online survey included over 90,000 LGBTQ participants in Europe. Findings showed that many of the participants had experienced bias-motivated discrimination, violence, and harassment in various sectors of their lives, including employment, education, health care, housing, and other services. Most, however, did not report these incidents to relevant authorities or to police. This survey also revealed that many of the participants hid their 829

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identity or strategically avoided particular locations because of fear. Another series of online surveys was used in Australia over a number of years to examine the sexual health and well-being of LGBTQ young people. Using both forced-choice and open-ended questions, this survey gathered data from 14- to 21-year-olds who self-selected to participate online. Recruitment and promotion were undertaken both online and off-line, and over 3,000 young people participated. In addition to responding to demographic questions, they responded to questions about sexual feelings, identity, and behaviors; how others treated them; Internet use; disclosure of sexual orientation and gender identity and support; and school experiences and the multiple influences on their lives. This information provided a critical snapshot of the experiences of young LGBTQ people, with implications for policy and practice. Other online surveys have also been used in efforts to gather information about LGBTQ populations in order to address negative health outcomes, such as surveys about self-harm and suicidal feelings, mental health issues, drug use, sexual behaviors, and help-seeking.

Advantages of Online Surveys for LGBTQ Research Online surveys are often suitable within LGBTQ research, largely because of the discrimination that LGBTQ individuals and groups face in their dayto-day lives. This hostility, whether overt or more subtle, can result in LGBTQ people feeling less comfortable or motivated to participate in research, or to find out about or identify with the research at all. For these reasons, it can be difficult for researchers to locate LGBTQ participants to take part in research in nonvirtual settings. Equally, however, the fear of being judged, victimized, or excluded in nondigital settings may motivate LGBTQ people to seek help, information, and relationships or communities online. The perceived safety and anonymity of online spaces may therefore provide opportunities to recruit higher numbers of LGBTQ participants, particularly those who would not usually come forward in

face-to-face research methods. In the case of research with younger LGBTQ participants, recruitment initiatives generally revolve around membership in LGBTQ youth groups, which has important implications for the samples generated. Those recruited in these efforts tend to disproportionately consist of “out” and urban young people, and cisgender males who are receiving support. Significantly missing from the research on LGBTQ youth, therefore, are accounts of rural youth, female youth, or trans youth who may not have disclosed their sexuality or gender identity and are not seeking or not receiving support. Online surveys help to address these sampling difficulties by offering greater confidentiality and anonymity than other methods, particularly because of the ubiquity of technology. It is possible, particularly in the age of smart phones and tablets, for many people to take part in an online survey in a place and time of their choosing, without necessarily deviating from normal routine or practice. This means that participants who are uncomfortable revealing their identity are more likely to participate in this type of research, particularly if that research is investigating other sensitive themes such as violence, health outcomes, or substance use. LGBTQ people are able to access information on the Internet without feeling stigma, shame, or embarrassment due to feeling “invisible” and anonymous. This is theoretically similar to participating in anonymous online surveys. Another significant advantage of online survey research is that it can provide access to unique populations—groups that would otherwise be difficult if not impossible to reach through other methods. This is particularly the case as online communities continue to flourish, meeting in digital settings to discuss shared experiences, interests, or values. In terms of LGBTQ groups, the Internet provides an important setting for LGBTQ individuals to form communities, seek information, share experiences, and organize activities or movements. This means that researchers can find subgroups of the population—for example, young LGBTQ people living in particular geographical locations, or LGBTQ people from a particular religious or cultural background. Other examples

Online Surveys

include LGBTQ people living with HIV, or those engaging in self-harm or having suicidal feelings. Online spaces present opportunities to engage with these people, who are often hard to reach due to being stigmatized off-line. In this way, the Internet enables communication with people who, for a number of reasons, may be hesitant to communicate in less anonymous formats. Depending on the motivation of participants, Internet surveys are also advantageous in their ability to be shared among communities and communicated between friends and networks. If people see the benefit of the survey, then motivation, response rates, and “shares” of the survey (e.g., via e-mail or social networking sites) are likely to be increased, meaning that additional participants can be reached through unintended networks. Indeed, among newer social networking technologies, participants can use threads, status updates, posts, and hashtags to call attention to a large number of people.

Key Issue: The Measurement of Sexuality and Gender Identity An area of increasing methodological importance to using online surveys to investigate LGBTQ lives is how to ask questions about sexuality and gender that capture the complexity of sexuality and gender identity. If online surveys are to produce valid and reliable data that can increase our understanding of LGBTQ lives, they must use measures that make sense to the population under study; this means that all people must be able to understand the question and answer it in the correct way. Measuring sexual orientation is notoriously difficult, but it is generally agreed that questions for survey research must consider three dimensions of sexual orientation: sexual attraction, sexual behavior, and self-identification. There is evidence showing that different segments of the LGBTQ population (e.g., young people and those from minority ethnic backgrounds) do not answer questions on sexuality in the same way. For example, research demonstrates that if young people report same-sex activity, they do not automatically identify as lesbian, gay, or bisexual (LGB) and may still identify as heterosexual. Furthermore, research

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suggests that gender, ethnicity, and class are significant to the ways in which same-sex identities and behaviors are experienced and reported in surveys. For example, regarding gender, Australian, U.S., and UK research suggests that women display greater fluidity between sexual feelings, behaviors, and identities, whereas in men there is more congruence between same-sex attractions and behaviors. That is, in surveys, men are more likely than women to describe themselves as 100% homosexual. Regarding race/ethnicity, U.S. research consistently shows that people from Hispanic, Black, and Asian backgrounds tend to report similar levels of same-sex attraction and behavior as their White counterparts; however, lower-than-expected levels report that they identify with the categories of lesbian, gay, or bisexual. Similarly, regarding social class, research has found that those who report same-sex attractions or LGB identities in surveys are more likely to have a higher income. The measurement of gender identity is in its infancy. Official surveys have been reluctant to ask questions about trans status or gender identity, and we are only starting to develop appropriate ways of measuring gender identity. Many large-scale surveys only ask the question on “sex” with the options of male and female and do not recognize the possibility that a person’s gender identity may fall outside of the male–female binary. A common mistake on surveys that have attempted to include a question on trans identity is that they confound (or confuse) the issues of sex, gender, and sexual orientation in the question stems and response categories that have been suggested. For example, in a UK National Mental Health Survey, “transgender” is a possible response to a question asking for the respondent’s sexual orientation. The Equality and Human Rights Commission in the UK recommends a survey question that measures sex at birth (response options: male, female, intersex, I prefer not to say) and/or a gender identity question (response options: male, female, in another way). The combination of these two questions allows for transgender identity and history to be collected and therefore will include those people who have transitioned and identify themselves as their acquired gender. This measure may be criticized by

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some LGBTQ people because it does not capture those who may have a variable or fluid, nonbinary gender identity, use other terms such as genderqueer, or do not identify as any gender.

Limitations of Online Surveys for LGBTQ Research Although there are many advantages to the use of online surveys with LGBTQ people, there remain limitations and boundaries to their efficacy. In particular, the sample of participants that is available through this method is restricted. Online surveys are posited as advantageous when participant samples are spread over a large area, as their reach can theoretically be unrestricted in terms of geographical boundaries. This depends, however, on access and ease of participant use of technology. LGBTQ young people, for example, may be more likely to feel comfortable and confident completing an online survey than older LGBTQ people. Reaching a range of participants will also depend on their access to and use of the Internet. Online surveys are restricted to existing online populations, which will naturally exclude respondents from geographical and socioeconomic contexts with lower levels of Internet access. This may exacerbate the existing low levels of disadvantaged LGBTQ participants being represented in research. In addition, of particular relevance to LGBTQ populations are confidentiality and anonymity concerns. Although it is normal for researchers to indicate measures to ensure these outcomes, e-mail surveys that require the participant to reply from his or her e-mail address may mean that the participant has difficulty believing that the responses are confidential and anonymous. Web surveys that do not require “authentication” processes such as e-mail address verification or “sign-ups” can address this concern. There may also be issues related to reliability, as Web surveys have a potential risk of participants completing the survey more than once. Finally, it is important to note that online surveys must be designed to take into account the nuance and diversity present in the lives of LGBTQ people. Online surveys that may corral participants into particular responses

sacrifice validity and reliability. This may lead to the misrepresentation of a population that has previously been misrepresented in research settings. Elizabeth McDermott and Victoria Rawlings See also Ethical Research With Sexual and Gender Minorities; Intersections Between Sex, Gender, and Sexual Identity; LGBTQ Online Communications: Building Community Through Blogs, Vlogs, and Facebook; Psychological Approaches to Studying LGBTQ People; Quantitative Research; Sampling

Further Readings Browne, K., & Nash, C. J. (Eds.). (2010). Queer methods and methodologies: Intersecting queer theories and social science research. Farnham, England: Ashgate. Byles, J. E., Forder, P. M., Grulich, A., & Prestage, G. (2013). “It’s okay to ask.” Inclusion of sexual orientation questions is feasible in population health surveys. Australian and New Zealand Journal of Public Health, 37, 390–391. European Union Agency for Fundamental Rights. (2014). European Union lesbian, gay, bisexual and transgender survey: Main results. Luxembourg: Publications Office of the European Union. Hillier, L., Jones, T., Monagle, M., Overton, N., Gahan, L., Blackman, J., et al. (2010). Writing themselves in 3: The third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people. Melbourne: Australian Research Centre in Sex, Health & Society. Riggle, E. D. B., Rostosky, S. S., & Stuart, C. (2005). Online surveys for BGLT research: Issues and techniques. Journal of Homosexuality, 49(2), 1–21. Vrangalova, Z., & Savin-Williams, R. C. (2012). Mostly heterosexual and mostly gay/lesbian: Evidence for new sexual orientation identities. Archives of Sexual Behavior, 41, 85–101.

ORIGINS OF HETEROSEXUALITY NONHETEROSEXUALITY

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See Essentialist–Constructionist Debate on the Origins of Sexual Orientation

P postmodern sexuality, in an effort to further deconstruct ideas about sexual identity, sexual desire, and sexual activity. Bisexuality was also an early precursor to pansexuality in that the term bisexuality broke free from the strict heterosexual– homosexual dichotomy of earlier times. However, despite the move away from binary structures that bisexuality represented, some groups still considered bisexuality to be too limiting. The challenges to bisexuality came from several different communities. First and foremost, the rise of trans*1 movements, trans* identities, and trans* activism led to demands for the inclusion of trans* people in the realm of sexual-identity terms. Given that many trans* people did not fit neatly into the commonly understood confines of bisexuality (namely, the requirement to be attracted to men and women as defined by the traditional gender binary), there was a strong desire from trans* communities for a term that more accurately reflected both the desires of trans* people and the desires of people who were attracted to both trans* and cisgendered people. From this desire for a new and more inclusive term, both pomosexuality and pansexuality emerged, with pansexuality becoming the primary term for sexual identities that included trans* people through its avoidance of associations with the gender binary. However, writers such as Shiri Eisner have argued that bisexuality can also be understood in ways that are inclusive of trans* and nonbinary genders.

PANSEXUALITY Pansexuality is a sexual-identity term that allows for the inclusion of attraction, fantasy, sexual activities, and desires that extend to people across the gender spectrum. It also includes people who participate in non-normative sexual behavior. This includes practices including heterosexual pegging (anal penetration of a man by a woman) and all aspects of the leather/bondage, dominance/submission, sadism (BDSM)/kink communities. Although not included in the traditional LGBTQ acronym, pansexuality is a sexual-identity term that is vital for the study of sexual identities and concepts of sexuality. Pansexuality moves beyond the binary structures of gender and sexuality that can be implied by the term bisexual (if the bi- in bisexual is taken to mean attraction to “both” genders). Pansexuality is an attempt to create an identity term for those people who feel excluded by the male–female binary present in many common understandings of sexuality. It also moves to create freedom from the dichotomous spectrum of heterosexuality and homosexuality, within which bisexuality is also often situated. Pansexuality emerged in the early 1990s as a new sexual-identity or sexual orientation term that attempted to describe desires that already existed for many people. It was created alongside the now seldom-used term pomosexuality, or 833

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People who were active in communities of nonnormative sexual behavior also felt limited by the exiting labels and pushed for the creation of pansexuality. While there were many people who wished to retain the heterosexual label, despite their non-normative desires and activities, several key groups of people pushed for terminology that would allow them to more fully express both their traditional heterosexual attraction for what is traditionally called “the opposite sex” and their nontraditional desires for certain sexual activities. Some people in BDSM communities felt their attractions or actions laid beyond both the traditional definition of heterosexuality and the newer concept of bisexuality. Given the fluid gender identity of some participants and due to the complexities of identity that occur during certain BDSM activities, the definitions of man and woman used in both heterosexuality and, arguably, bisexuality did not seem sufficient to describe the actions and desires of certain members of BDSM communities. Thus, the adoption of pansexuality by some members of these communities began, since it allowed for attraction to a broader range of activities and people of varying gender and sexual identities. In addition to BDSM communities, groups of heterosexuals, sometimes called queer heterosexuals, also pushed for a sexual-identity term that would include their desires and attractions. These heterosexuals were attracted to sexual acts associated with homosexual communities, while wishing to perform those acts in a heterosexual context, and therefore felt they did not fit into the strict confines of heterosexuality. Many of these queer heterosexuals also found bisexuality to be too narrow or to be an inaccurate description of their desires. Pansexuality, however, allowed a greater number of sexual acts and desires to fall under its umbrella and therefore could be used by these groups of heterosexuals whose desires and activities were different than those traditionally associated with heterosexuality. Pansexuality is often seen as a fluid sexual identity. Although members of the pansexual community may maintain a constant set of attraction, people can also experience varying levels of attraction to people of various genders while still

maintaining the same sexual identity. The term also allows for fluidity of gender identity while still being part of the same sexual orientation. Thus, a trans* man or woman who transitioned could continue to identify as pansexual before and after transition. Furthermore, genderqueer, gender fluid, and genderfucking individuals are able to use the term pansexuality to describe their sexual identity as well. In some communities, the concept of queer sexuality overlaps with pansexuality to a large extent, whereas in other communities the two are seen as distinct terms and identities. One notable difference is that while queer can be used as a unifying term to encompass all other sexual-identity terms other than heterosexuality, pansexuality is not an umbrella term for all sexualities. Pansexuality is a distinct sexual identity that encompasses a broad range of sexual desires. Thus, while in some cases a lesbian may identify as queer, when the word is used as an umbrella term, lesbian is not part of the pansexual identity. In general, scholarship on pansexuality lags far behind its usage in communities. While the term is in popular use in many communities, its use has not been nearly as well documented as that of lesbian, gay, or even bisexual. Given the fluid nature of the term, the study of individuals identifying as pansexual often involves collecting data from numerous communities and being aware of the possible shifts in usage of the term in these communities. The inherently fluid nature of pansexuality means that its exact usage in communities varies by location, race, ethnicity, and gender identity and is influenced greatly by socioeconomic and political factors. The various uses of pansexuality in many of these communities are still an area that could benefit from further research. In particular, communities of color have various connections with the term pansexuality that have not been fully explored as yet in academic publications. Additionally, pansexuality as a term is considered to be first used in English-speaking U.S. contexts and therefore can be found more frequently in communities with ties to that geographic and linguistic area. However, the term pansexuality is in common use in many other parts of the world and seems to be in use in at least some

Parent Gender Transition and Intimate Relationship Changes

communities in most parts of the globe. Currently the use of pansexuality as a sexual identity around the world is being explored in a few studies. Of course, the absence of the term in some parts of the world does not necessitate the absence of people with similar desires to those who identify as pansexual; it merely indicates the existence of other constructions and terminology for these desires. Despite the importance of trans* people in the creation of pansexuality, there is no evidence to show that all, or even most, trans* people identify as pansexual. Furthermore, even though trans* communities pushed for a more inclusive term than bisexuality, many trans* people do not feel excluded by the term bisexual. Indeed, some trans* people identify as bisexual. While trans* activists were at the forefront of the creation of the term pansexuality, this by no means implies that all trans* people are pansexual or that the term is limited to use in trans* communities. Ultimately, pansexuality is a sexuality that attempts to move beyond traditional binaries associated with sexuality and gender and include people across, and beyond, the gender spectrum and people whose desired sexual activities exist beyond what has been traditionally considered heterosexual sex. Autumn Elizabeth See also Bisexualities; Bondage/Domination, Submission, Sadism/Masochism (BDSM); Polyamory; Queer; Sexual Orientation Among Transgender People; Transgender Identities; Transgender Sexualities

Note 1. The term trans* is a way to signify the entire scope of communities of transsexuals, transgendered, transvestites, some gender queer communities, and anyone who feels part of these communities.

Further Readings Eisner, S. (2013). Bi: Notes for a bisexual revolution. Berkeley, CA: Seal Press. Elizabeth, A. (2013). Challenging the binary: Sexual identity that is not duality. Journal of Bisexuality, 13(3), 329–337. Marinucci, M. (2010). Feminism is queer. New York, NY: Zed Books.

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Vassi, M. (1997). Beyond bisexuality. In C. Queen & L. Schimel (Eds.), PoMoSexuals: Challenging assumptions about gender and sexuality (pp. 70–75). San Francisco, CA: Cleis Press.

PARENT GENDER TRANSITION AND INTIMATE RELATIONSHIP CHANGES Gender transition impacts intimate relationships with partners and spouses, as well as relationships with children, often affecting relationship dynamics and family roles. A large national survey found that 41% of transgender (trans) participants were parents. Many trans parents transition after forming a family, while others have children after or even during transition. People over the age of 55 were much more likely to have children than were those who transitioned between the ages of 25 and 44 (82% vs. 38%, respectively, in the national survey). Trans women (male-to-female individuals, or MtF) are more likely to be married and to have children than are trans men. Indeed, it is becoming more common for people to transition “in place”—that is, with the goal of maintaining their families and careers. The trans person’s partner or spouse and children “transition with” the trans person as the family creates and adjusts to new roles. Social location, such as ethnicity, socioeconomic status, age at transition, and employment status, significantly influence the types of challenges that trans-parent families face. Having a higher income and greater education increases the likelihood that trans people have children. Contrary to stereotypes that divorce or separation is the inevitable result of partner transition, in the national survey, 45% of trans respondents maintained their partner and spousal relationships, and people who transitioned at a younger age were more likely to maintain (59%) partnerships than people who transitioned after 45 (36%). Immediate and extended family acceptance and support, or lack thereof, plays a highly significant role in the mental, physical, and practical outcomes following parental transition.

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Some trans parents experience partner rejection, anger, and parental alienation when they reveal their trans identity. Family rejection is associated with greatly increased rates of homelessness, health risks, substance abuse, and suicidality for trans persons. Others separate more amicably or work through their gender transition with their partners or spouses. The negotiation of transformed intimate relationships is complex as partners navigate name changes as well as bodily and gender presentation changes and then move beyond stereotyped gender roles. Evidence suggests that both partners often experience sexual identity and legal challenges as they adjust to real or perceived shifts in their sexual orientation. Non-trans partners report periods of identity exploration as they adjust to their partner’s transition and social perceptions that may not match their personal identities. Lesbian women with trans men partners may become situated in an (uncomfortable) heterosexual binary, and heterosexual wives of trans women face being situated as lesbian couples. In the United States, some trans people are legally married parents if they transitioned after forming a family. Their marriages’ posttransitions are recognized by various institutions and confer all the same rights and privileges that same-sex couples are, in some places, denied. However, this legal recognition is tenuous if the trans partner makes changes to legal identification documents, and social challenges (e.g., labels in their children’s school records) are abundant if they simply present as a same-sex couple. Data is limited on how transition affects sexual relationships in preserved partnerships. Predominantly qualitative reports suggest changes in sexual relationships ranging from increased interest in sex due to increased satisfaction or comfort with the transitioned body, to dissolution of the sexual part of the marital relationship. Generally, trans people, non-trans partners, and therapists agree that open communication about the degree and timing of transition, the partner and parenting relationship, and the pace of transition are important to maintaining and enhancing the relationship. Challenges may be significant; for example, the non-trans partner may prefer a slower transition,

while some trans people experience a “flood” period where they prefer to immerse themselves in their new identity and share their identity broadly. Decisions about pace and when and to whom to come out also depends on the children’s developmental level and the extent to which the parent presents as gender variant. Although children report experiencing periods of stress, evidence suggests younger children and children who have become empowered “trans experts” may have an easier time adapting and disclosing their trans parents’ status. In an empirical study, many trans parents reported limiting to whom they were out and pacing their transition (e.g., going at a “glacial” pace or delaying transition) according to the needs of their family. If a relationship is not salvageable, transknowledgeable therapists can help to reduce conflict and potential harm to the children from the acrimony between the parents. Many trans parents report irreconcilable differences with spouses and high levels of family conflict. In a transphobic culture, vindictive non-trans partners may succeed in preventing access to children or triggering trans discrimination in family court. Black (33%), multiracial (33%), MtF (34%), and female-to-male (FtM; 20%) individuals reported that ex-partners or spouses interfered with or limited their relationships with their children. Trans parents also face social stigma and systemic discrimination (e.g., transphobia, employment discrimination, inadequate access to health care). When compared to lesbian and gay parents, trans parents reported less support from their parents, extended family, and friends. Nevertheless, in a large sample, more than half of trans respondents (63% to 67%) reported that their family relationships gradually improved, with about half reporting that their family was currently as strong as it was prior to coming out as trans. Adult children of trans parents also characterized their parent–child relationship as at least as positive as it was prior to transition. Transgender parents destabilize gender roles in the family, and consequently reevaluating parenting roles is another important step for intimate partners. Trans men who bear children have attracted

Parent Relationship Quality

public attention as they reconciled masculinity with childbearing and breast-feeding. Although some trans people prefer to present as traditionally gender typed, the available evidence suggests that trans parents are likely to see gender roles as socially constructed and to challenge gender-stereotyped parenting roles. In one study, trans parents endorsed democratic and feminist styles of parenting and were fierce advocates for their children if the child experienced any bullying related to their trans status. Trans parents tended to choose lesbian, gay, bisexual, and transgender (LGBT)-friendly environments when possible as well as seek support for themselves, their partners, and their children through Web-based sources when support was not locally available. Trans parents attempt to balance their need to accept their own gender identity and to live authentically with their partners, with their desire for their children to thrive. Beth A. Haines and Alex Ajayi See also Transgender Parents and Well-Being; Transgender Sexualities

Further Readings Downing, J. B. (2013). Transgender-parent families. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 105–116). New York, NY: Springer. Grant, J. M., Mottet, L. A, Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality & National Gay & Lesbian Task Force. Haines, B. A., Ajayi, A. A., & Boyd, H. (2014). Making trans parents visible: Intersectionality of trans and parenting identities. Feminism & Psychology, 24(2), 238–247. Hines, S. (2006). Intimate transitions: Transgender practice of partnering and parenting. Sociology, 40, 353–371. Samons, S. L. (2009). Can this marriage be saved? Addressing male-to-female transgender issues in couples therapy. Sexual and Relationships Therapy, 24, 152–162.

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Veldorale-Griffin, A. (2014). Transgender parents and their adult children’s experiences of disclosure and transition. Journal of GLBT Family Studies, 10, 475–501.

PARENT RELATIONSHIP QUALITY Relationship quality for parents and nonparents alike has been defined in different ways in the research literature. Specifically, it has been defined in terms of relationship satisfaction, the stability of the relationship, level of commitment, sexual fidelity, and positive versus negative interactions between partners. Typically, relationship quality has been examined within heterosexual couples and gay and lesbian couples without children. Only recently have researchers begun to examine relationship quality within the context of LGBTQ couples with children. The quality of partner relationships can influence children’s well-being and overall functioning. Further, having children can be a barrier to relationship dissolution or divorce among LGBTQ partners. This entry will discuss overall relationship quality for LGBTQ parents, relationship quality during the transition to parenthood, how division of labor influences relationships, and the unique influence of minority stress on relationship quality.

Overview Currently, approximately 22% of gay male couples and 33% of lesbian couples are living with children under the age of 18 in the United States. There are multiple ways that LGBTQ couples bring children into the household, including adoption, children from previous relationships (including previous heterosexual relationships), surrogacy, and alternative insemination (using sperm from a known or unknown donor), among others. At the same time that same-sex marriage becomes legal throughout the United States and internationally, the incidence of children living with same-sex parents is also on the rise. Historically, one of the major issues facing LGBTQ-parent families is the lack of legal

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protections for partners, parents, and children. As legal protections for LGBTQ-parent families become more accessible, LGBTQ partners and their children are able to live more openly. The number of legal protections that facilitate family relationships and stability, including provision for marriage, divorce, and child custody, is increasing as state and federal laws become less restrictive. Gaining social acceptance, visibility, and basic rights for their families is an important step in legitimizing LGBTQ-parent families and enhancing family and couple relationship quality.

Relationship Quality Among LGBTQ Parents Many of the processes of relationship formation, maintenance, satisfaction, and functioning of LGBTQ couples are similar to those of heterosexual couples. There are certain characteristics that, when similar for both partners, can contribute to relationship satisfaction for couples with and without children, such as personality, attitudes, interests, and values. For example, research has found that when lesbian couples have similar levels of social involvement in the LGBTQ community, the partners were happier in their relationship. Additionally, having similar personality characteristics, such as similar levels of neuroticism, is related to relationship satisfaction. Early research on the relationship quality of lesbian couples with children and those without children found that lesbian couples with children had higher relationship satisfaction and higher sexual satisfaction than child-free lesbian couples. Stable and happy relationships have been found to exist for both types of couples. Recent research has found that younger maternal age, greater familial social support, less job-family role strain, and more positive sexual identity were related to greater selfreported relationship quality for lesbian women. Research on lesbian, gay, and heterosexual parents with adopted children found that couples, regardless of sexual orientation, tended to report long-term relationships, secure attachments, and high relationship satisfaction. Sexual satisfaction also did not differ based on sexual orientation.

Additionally, relationship satisfaction was positively related to sexual satisfaction, frequency of sexual relations, and greater attachment security. With the research on LGBTQ couples with children being somewhat limited, there is still more research conducted on lesbian mothers than on gay fathers. Existing work has primarily focused on relationship functioning among same-sex couples during the transition to parenthood and the year or so after children entered the family. There has also been work on division of labor and power among lesbian-parent couples, and—to some extent—gay male parent couples, as described next. Researchers are just beginning to document the experiences of relationship quality for transgender parents. When a partner transitions from one gender identity to another gender identity during an intimate relationship, the non-transgender partner may also experience an identity shift as they negotiate the changes. Even though it can be stressful on a relationship for a partner to transition, particularly in the context of being a parent, research has found evidence of resiliency and support in the relationship that eases the transition. Having social support and therapeutic support can aid in the transition for all parties involved.

Transition to Parenthood and Relationship Quality Most of the research on LGBTQ-parent relationship quality has focused on lesbians’ transition to parenthood. On average, lesbians’ love for their partners decreased across the transition to parenthood, and conflict within the couple increased. These trends are similar to heterosexual couples. This decrease in love for a partner may be due to less available time as a couple as well as the stress of the additional role and identity of being a parent. Further, personal and couple characteristics have been linked to change in relationship quality across the transition. Namely, lesbian women who reported higher levels of neuroticism reported lower feelings of love for their partner and more steep increases in conflict across the transition to parenthood. For mothers who were not related

Parent Relationship Quality

biologically or gestationally to the child (e.g., the nonbiological mother or social mother), those who had engaged in higher levels of relationship maintenance behavior prior to the birth of the child had higher levels of love for their partner across the transition. Also, among nonbiological mothers, those who were more satisfied with the division of labor in the relationship reported higher levels of love. There was an increased level of conflict between couples when the nonbiological mother’s expectation that the biological mother’s family would be supportive was not met. Whether a parent is biologically related to the child has other ramifications for the relationship and parenting roles. The gestational mother (typically the biological mother but not always so) tends to take on more of a caretaking role and develop closer ties to the child. This occurs even when LGBTQ parents seek to have egalitarian parenting roles and practices. The biological mother’s involvement in pregnancy and breastfeeding can lead to jealousy among some nonbiological mothers. It has also been shown that nonbiological lesbian mothers spend more time working outside the home within planned lesbianparent families. However, unlike heterosexual couples, child care is split fairly equally between the biological and the nonbiological mother. Research on female, male, and heterosexual couples who adopted their children found a decline in relationship quality during the first year of parenthood for individuals of all sexual orientations. This decline was particularly the case when parents had higher levels of depression, used more confrontational coping, and had higher levels of relationship maintenance behaviors. Relationship quality can decline as love decreases, as conflict increases, and ambivalence increases, on average, which is consistent with prior research on heterosexual biological parent couples. Research on gay men who became fathers via surrogacy has reported a general decline in time spent and intimacy between partners during the transition to parenthood. Although couples continued to consider their relationship romantic, there was some decline in romantic feelings

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compared to before having children. It is not fully clear how viewing the relationship as romantic translates to relationship satisfaction. One study did suggest that gay fathers were more satisfied with their relationships than heterosexual fathers.

Division of Labor Many LGBTQ couples desire to have egalitarian relationships, especially when polarizing gender roles in the couple are not at play. This intention often plays out in the household division of labor. Division of labor has been linked to relationship quality, particularly among lesbian couples, such that partners who perceive more equal division of labor tend to report higher-quality relationships and greater satisfaction with their relationships. On balance, research further suggests that when individuals are able to work fewer hours, they report more positive relationship interaction and less conflict between family life and work life. Research on coparenting and the division of labor research in the Netherlands found that nonbiological mothers in lesbian relationships indicated more satisfaction with the other parent than heterosexual fathers. Further, biological lesbian mothers were more satisfied with the other parent than heterosexual mothers were. This distinction could be due to lesbian couples sharing household and child care tasks more equitably—or at least feeling like they do. In another study, lesbian and gay couples reported sharing child care more so than heterosexual couples, and the partners tended to interact more equally during family time. In other studies, gay male couples were more equal coparents and coparented more compatibly than heterosexual couples. When gay men were satisfied with their partners and their parenting arrangements, the relationship satisfaction was higher.

Influence of Minority Stress Minority stress is the argument that members of stigmatized groups experience a unique form of stress due to their status as a member of the group. Further, minority stress can play out in

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physical, mental, or emotional strain. These strains are likely to influence relationship quality among LGBTQ parents given the fact that society is heteronormative. Relationships and families are shaped by heteronormative social structures and the intersecting expectations of extended families, friendships, and communities. However, being able to be more open about one’s same-sex romantic relationship has been found to aid in relationship quality for lesbian women. There are unique stresses, problems, and strengths for LGBTQ couples who parent, and it is important to recognize how their experiences might differ from, or be similar to, those of heterosexual parents. Erin S. Lavender-Stott and Katherine R. Allen See also Coparenting; Division of Labor in LGBTQParent Families; Marriage Equality, Effects on WellBeing and Relationships; Minority Stress; Nonbiological, Nongestational Mother; Sexual Desire and Relationship Quality

heterosexual couples’ relationship quality across the transition to adoptive parenthood. Journal of Family Psychology, 24, 221–232. doi:10.1037/a0019615 Koepke, L., Hare, J., & Moran, P. B. (1992). Relationship quality in a sample of lesbian couples with children and child-free lesbian couples. Family Relations, 41, 224–229. doi:10.2307/584837 Kurdek, L. A. (2001). Differences between heterosexualnonparent couples and gay, lesbian, and heterosexualparent couples. Journal of Family Issues, 22, 727–754. doi:10.1177/019251301022006004 Peplau, L. A., & Fingerhut, A. W. (2007). The close relationships of lesbians and gay men. Annual Review of Psychology, 58, 405–424. doi:10.1146/annurev. psych.58.110405.085701 Tornello, S. L., Johnson, S. M., & O’Connor, E. (2013). Relationship quality among lesbian mothers in planned families. Journal of GLBT Family Studies, 9, 346–363. doi:10.1080/1550428X.2013.801008

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Further Readings Bos, H. M. W., van Balen, F., & van den Boom, D. C. (2007). Child adjustment and parenting in planned lesbian-parent families. American Journal of Orthopsychiatry, 77, 38–48. doi:10.1037/00029432.77.1.38 Farr, R. H., Forssell, S. L., & Patterson, C. J. (2010). Gay, lesbian, and heterosexual adoptive parents: Couple and relationship issues. Journal of GLBT Family Studies, 6, 199–213. doi:10.1080/155042810037 05436 Goldberg, A. E. (2013). “Doing” and “undoing” gender: The meaning and division of housework in same-sex couples. Journal of Family Theory & Review, 5, 85–104. doi:10.1111/jftr.12009 Goldberg, A. E., & Allen, K. R. (Eds.). (2013). LGBTparent families: Innovations in research and implications for practice. New York, NY: Springer. Goldberg, A. E., & Sayer, A. (2006). Lesbian couples’ relationship quality across the transition to parenthood. Journal of Marriage and Family, 68, 87–100. doi:10.1111/j.1741-3737.2006.00235.x Goldberg, A. E., Smith, J. Z., & Kashy, D. A. (2010). Preadoptive factors predicting lesbian, gay, and

When lesbian mothers first became the focus of public attention in the 1970s, questions were raised about their psychological well-being. Indeed, the argument that lesbian mothers were likely to experience psychological problems was used to deny lesbian mothers custody of their children following their divorce. Since that time, the psychological well-being of lesbian mothers has been questioned in other contexts, particularly in relation to adoption and access to assisted reproduction. More recently, similar concerns have been expressed regarding gay men who wish to become fathers through adoption or surrogacy. This entry begins by examining the consequences of difficulties in parental psychological well-being for children generally, followed by a review of the research literature on the psychological well-being of lesbian mothers and gay fathers.

Well-Being in Heterosexual Parent Families There is a large body of research on heterosexual parent families showing that the psychological

Parental Well-Being

well-being of parents is associated with the psychological well-being of their children. Two aspects of parental well-being have been studied: (1) mental health and (2) parents’ relational well-being. Parents’ mental health can impact the psychological well-being of children. Among the many studies of the consequences for children of parents’ mental health problems, the influence of parental depression has received the greatest attention. Children of depressed parents have been found to show elevated rates of behavioral, social, and emotional problems. Studies that have diagnosed the presence or absence of psychiatric disorder in both children and their parents have shown that children whose parents are depressed are not only more likely to show a wide range of psychological problems but are also more likely to become depressed themselves. It is perhaps not surprising that depression in parents is associated with psychological problems in children. Of particular interest are the mechanisms involved in this association. One explanation is that depression reduces the ability to parent effectively. Depression is thought to interfere with parents’ control and discipline of their children, with depressed parents tending to be either very lenient or very authoritarian, and also with their emotional availability and sensitivity to them. When mothers are depressed, their babies are more withdrawn, less active, more irritable, and less smiley than are other babies. Moreover, studies that have directly examined the link between maternal depression and insecure attachment in children have established an association between the two. Another explanation is that the greater marital conflict in couples in which one partner is depressed is associated with the behavioral and emotional problems of the children of depressed parents. Furthermore, depression and marital conflict may each be caused by external factors, and these external factors may, in themselves, be implicated in children’s development of psychological problems. Children whose parents are dependent on alcohol or drugs are also at risk for psychological problems. Compared with other children, they are more likely to show conduct problems,

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including antisocial behavior and delinquency. Again, poor parenting has been implicated in the link between alcohol or drug dependence and the development of psychological problems in children. Studies of the association between marital conflict and negative outcomes for children have found a consistent link between the two. Children whose parents are in conflict have been found to be more aggressive, disobedient, and difficult to control; more likely to become involved in delinquent behavior and to perform poorly at school; and more likely to have difficulty getting on with peers compared with children whose parents are happily married. But just because parents are in conflict does not mean that their children will experience psychological problems. What seems to matter for children is not whether their parents fight but how they fight. Aspects that are harmful to children include frequent fighting, a belief that the fighting will lead to their parents’ separation, severe hostility (especially physical violence), being the subject of their parents’ disputes, and parents’ inability to make up. The process through which marital conflict affects children has been the subject of much debate. Whereas some believe that marital conflict is bad for children because of its indirect effects on parenting, in that conflict between parents may result in more negative relationships between parents and children, others think that exposure to parental conflict has a direct effect on children’s psychological well-being, in that seeing parents argue is, in itself, distressing. It is now generally agreed that marital conflict may have both indirect and direct effects on the psychological well-being of children as well as interfering with the relationships between the parents and the child, hostility between parents appears to be upsetting in its own right. Investigations of the impact of the quality of parents’ relationship on the development of their children have focused on the adverse effects of hostile relationships rather than the beneficial effects of harmonious relationships. However, there is growing evidence that the more favorable outcomes for children of happily married or cohabiting parents do not simply result from the

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absence of serious conflict but, instead, are associated with positive aspects of the relationship, such as open communication and the expression of affection.

Well-Being in Lesbian Mother and Gay Father Families Key questions regarding the psychological wellbeing of lesbian mothers are whether lesbian mothers differ from heterosexual parents in terms of mental health problems or relationship quality, and if so, what are the psychological consequences for their children? The early studies focused on families formed following the mother’s separation or divorce from the father of her children. One study was carried out in the United States in 1986 by Richard Green and colleagues, and another was conducted in the United Kingdom in 1983 by Susan Golombok and colleagues. These investigations adopted a similar design, comparing lesbian mothers with single heterosexual mothers. Both groups of mothers had experienced divorce or separation. It was important that the comparison group had also been through a divorce. Otherwise, any differences identified between family types may have been associated with divorce, rather than maternal sexual orientation. In the United States, in 1986, Richard Green and colleagues compared 50 lesbian mothers with a demographically matched group of 40 single heterosexual mothers. Around half of the lesbian mothers were cohabiting with their female partner. It was found that the lesbian mothers were more self-confident—and less likely to express feelings of inferiority—than were the heterosexual mothers. In 1983, in the United Kingdom, 27 lesbian mothers were compared with 27 single heterosexual mothers by Susan Golombok and colleagues. Around half of the lesbian mothers were cohabiting with their female partner and their relationships were generally harmonious, as measured by a well-validated assessment, with only two couples showing relationship difficulties. The lesbian mothers did not differ from the heterosexual mothers on any of the measures of

psychiatric disorder, which included a standardized measure of emotional problems and the use of tranquilizers or antidepressant medication in the year preceding the study. The growth of assisted reproductive technologies (ARTs) in the 1980s and 1990s resulted in donor insemination (DI) becoming a more accessible route to parenthood for lesbian women. As a result, lesbian couples began to plan their family together after coming out. A number of studies of the well-being of lesbian women who had become mothers through DI have since been carried out. In the United States, Raymond Chan and colleagues compared 55 lesbian mothers with 25 heterosexual mothers—some of whom had partners and others who were single parents. No differences in well-being were found between the lesbian and heterosexual mothers as assessed by standardized measures of stress associated with parenting, depression, self-esteem, as well as the couple’s relationship quality for two-parent families. Also in the United States, David Flaks and colleagues compared 15 lesbian couples with a demographically matched group of 15 heterosexual couples, all of whom had children conceived by DI. The lesbian and heterosexual parents were not found to differ from each other with respect to relationship quality, as assessed by a standardized questionnaire. Moreover, the lesbian couples’ scores did not differ from norms for married heterosexual couples on this measure. In Belgium, Anne Brewaeys and colleagues compared 30 lesbian couples with a child conceived by DI with 38 heterosexual couples with a child conceived by DI and 30 heterosexual couples with a naturally conceived child. The quality of the couple’s relationship was assessed by questionnaire and did not differ between the lesbian mother families and either of the heterosexual parent groups. In a study in the Netherlands by Henny Bos and colleagues, 100 two-parent lesbian mother families were compared with a demographically matched sample of 100 two-parent heterosexual families. No significant differences were identified between the lesbian biological mothers and the heterosexual mothers either in the extent to which they felt

Parental Well-Being

burdened by their child or in relationship satisfaction as assessed by a standardized measure. Neither was there a difference between biological and nonbiological lesbian mothers in the extent to which they felt burdened by the child. However, in comparison with heterosexual fathers, lesbian nonbiological mothers reported greater relationship satisfaction. In a study in the United Kingdom by Susan Golombok and colleagues, 30 lesbian couples were compared with 42 single heterosexual mothers and 41 heterosexual couples. The mean age of the children was 6 years. No differences were identified between the lesbian mothers and either the heterosexual mothers from single-parent families or the heterosexual mothers from two-parent families in anxiety, depression, or parenting stress. A qualitative longitudinal study, the U.S. National Longitudinal Lesbian Family Study, was initiated by Nanette Gartrell in 1986 to provide in-depth data on lesbian families with children conceived by DI. Eighty-four families were recruited to the study during insemination or pregnancy, of which 73 were headed by a couple and 11 were headed by a single mother at the time of the child’s birth. Subsequent data collection took place when the children were 2, 5, 10, and 17 years old, by which time 93% of the families were still participating in the study. Thus, the sample was not biased by the attrition of those who have not functioned well. Although the study does not include a comparison group, the majority of mothers reported good relationships with their wives or partners. In the early years of the children’s lives, the mothers reported concerns over challenges they, and their children, might face as a result of stigma against lesbian mother families parenting. However, while this concern over future stigma caused stress to mothers at the time, by later follow-up visits the rates of actual stigma were lower than they had anticipated. Due to the longitudinal nature of the study, the effect of parents’ relationship dissolution could also be examined. For mothers whose relationships had ended, acrimony and conflict with the previous partner were predictors of children’s ratings of family harmony postseparation. This finding is in keeping with the large

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body of literature on the effects of heterosexual divorce on parental well-being. In the 1990s, the first opportunities arose for studying representative samples of lesbian mother families recruited from the general population. One such investigation, conducted in the United Kingdom in collaboration with the Avon Longitudinal Study of Pregnancy and Childhood, focused on lesbian mothers with 7-year-old children. Thirty-nine lesbian mother families, 74 two-parent heterosexual families, and 60 single heterosexual mothers took part. There were no differences between lesbian and heterosexual mothers in anxiety, depression, or parenting stress as assessed by standardized measures. Neither were there differences in the prescription of anxiolytic or antidepressant medication since the birth of their children. However, a higher proportion of lesbian than heterosexual mothers had consulted a doctor for psychological problems since the birth of their children. For two-parent families, there was no difference in relationship satisfaction between lesbian and heterosexual mothers. The first controlled study of a systematic sample of gay father families was carried out in the United States by Rachel Farr and colleagues. Twenty-nine gay couples, 27 lesbian couples, and 50 heterosexual couples—all with adopted children aged between 1 and 6 years—participated in the research. The gay fathers did not differ from the lesbian mothers or heterosexual parents in terms of relationship satisfaction or stress associated with parenting. A study of adoptive gay father families was also carried out in the United Kingdom by Susan Golombok and colleagues. Fortyone gay father couples, 40 lesbian mother couples, and 49 heterosexual parent couples—all with children aged between 3 and 9 years—took part. Each parent completed questionnaire measures of anxiety, depression, and stress associated with parenting. The gay fathers showed lower levels of depression and lower levels of stress associated with parenting than did the heterosexual parents, with no differences in psychological well-being between the gay fathers and the lesbian mothers. The more positive well-being among the gay

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Parental Well-Being

fathers may have resulted from a more stringent screening process for gay couples who wish to adopt, resulting in even higher levels of psychological well-being among adoptive gay fathers than among adoptive heterosexual parents. Unlike the heterosexual couples and many of the lesbian couples in the study, it may also be relevant that the gay fathers had not experienced the stress of infertility and failed fertility treatments before adopting a child. Lesbian, gay, and heterosexual parents’ wellbeing and relationship satisfaction over the transition to adoptive parenthood has been studied extensively by Abbie Goldberg in the United States. In all family types, support from friends was shown to have a positive effect, whereas a history of infertility negatively impacted parental well-being. Abbie Goldberg has differentiated between factors that affect parental well-being regardless of sexual orientation and factors that are particularly or exclusively experienced by same-sex parents. For example, lesbian, gay, and heterosexual parents going through the adoption process reported the insecurity of the foster-toadopt situation to be similarly stressful regardless of parent sexual orientation. However, lesbian and gay parents additionally reported stress relating to their sexual-minority status and concerns about stigma within the child welfare system. One year following adoption, lesbian and gay parents’ wellbeing was shown to be negatively influenced by stigma and internalized homophobia, whereas residing in a state that acknowledged lesbian and gay parenting was associated with less internalized homophobia and higher levels of well-being. At two years postadoption, the majority of lesbian, gay, and heterosexual parents reported high levels of well-being. To assess the impact of changes in legislation on same-sex parenting, Goldberg studied changes in well-being before and after the lifting of a state ban on gay adoption in 2010. Parent well-being improved after the lifting of the ban, showing that changes in policy can affect the wellbeing of minority groups. Although few differences in psychological wellbeing have been identified between lesbian

mothers, gay fathers, and heterosexual parents, variation has been found within each family type, and this variation has been found to relate in meaningful ways to the psychological well-being of children. Several of the studies of lesbian mothers described previously have shown that the psychological well-being of parents, including the quality of the couple’s relationship, is associated with child adjustment. For example, Raymond Chan’s study of lesbian mother families with donor-conceived children found stress associated with parenting to be associated with children’s behavior problems. In addition, for the two-parent families, children were rated as better adjusted when their mothers reported greater relationship satisfaction, higher levels of love, and lower levels of conflict. Stigmatization has also been shown to be related to maternal well-being and child adjustment. The study by Bos of planned lesbian mother families in the Netherlands found that mothers who experienced ridicule, marginalization, or exclusion were more likely to report emotional and behavioral problems in their children. With respect to gay fathers, Farr found that parents who reported greater happiness with their partners and less parenting stress had children with higher levels of adjustment. Similarly, in the study by Golombok, higher levels of parenting stress were associated with higher levels of externalizing problems in children. An Internet survey of 230 adoptive gay fathers by Samantha Tornello and colleagues examined the factors associated with raised levels of parenting stress among gay men. It was found that gay adoptive fathers with less social support, older children, and children who had been adopted at older ages reported more parenting stress. An additional stressor for gay fathers was a less positive identity as a gay man, with fathers who were more sensitive to stigmatization reporting greater parenting stress.

Conclusion There is no evidence to suggest that either lesbian mothers or gay fathers show higher rates of psychological problems or relationship difficulties

Parent–Child Relationships

than comparison groups of heterosexual parents. As with heterosexual parents, lesbian mothers and gay fathers who show psychological problems or relationship difficulties are more likely to have children with adjustment problems. Little is known about the psychological well-being of bisexual, transsexual, or queer parents. Kate Ellis-Davies and Susan Golombok See also Adoption and Foster Care Discrimination; Nonbiological, Nongestational Mother; Parent Gender Transition and Intimate Relationship Changes; Parent– Child Relationships; Single-Parent Adoption; Stepfamily Family Functioning and Relationship Stability; Surrogacy; Transition to Parenthood and Parental Roles; Transition to Parenthood for LGBTQ People

Further Readings Bos, H. M. W., van Balen, F., & van den Boom, D. C. (2004). Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45(4), 755–764. Chan, R. W., Raboy, B., & Patterson, C. J. (1998). Psychosocial adjustment among children conceived via donor insemination by lesbian and heterosexual mothers. Child Development, 69(2), 443–457. Cummings, E. M., & Davies, P. T. (2010). Marital conflict and children: An emotional security perspective. New York, NY: Guilford Press. Farr, R., Forssell, S., & Patterson, C. (2010). Parenting and child development in adoptive families: Does parental sexual orientation matter? Applied Developmental Science, 14(3), 164–178. Gartrell, N., Banks, A., Hamilton, J., Reed, N., Bishop, H., & Rodas, C. (1999). The National Lesbian Family Study: 2. Interviews with mothers of toddlers. American Journal of Orthopsychiatry, 69(3), 362–369. Goldberg, A. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. Golombok, S. (2015). Modern families: Parents and children in new family forms. Cambridge, England: Cambridge University Press.

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PARENT–CHILD RELATIONSHIPS Despite the increasing number of families headed by LGBTQ individuals and couples, there is a dearth of research that examines the relationships between these parents and their children, especially relative to the number of studies that examine heterosexual parent–child relationships. Further, there is even less research emphasis on bisexual and transgender parents’ relationships with their children. This entry discusses what is known about LGBTQ parent–child relationships. First, a brief explanation of the ways in which LGBTQ individuals and couples pursue parenthood is presented. Then, the characteristics of the relationships between LGBTQ parents and their children are discussed, for intact and separated families.

Family Building in LGBTQ Families Sexual-minority individuals and couples pursue a variety of routes to parenthood. Some become parents in the context of heterosexual relationships or marriages. For example, these parents entered into a same-sex relationship after their child was born or adopted. Those who form families in the context of same-sex relationships do so via three most common methods: donor insemination (DI; for women), adoption, or surrogacy. An additional route to parenthood that is less common occurs when a female same-sex couple and gay male couple elect to parent together.

LGBTQ Parent–Child Relationships in Intact Families A small body of research has focused on parent– child relationships within LGBTQ-parent households. Existing data suggest more similarities than differences in bonding patterns and processes across parents of different sexual orientations. Parents have not been found to differ, on average, in parental warmth, emotional involvement, and quality of relationships with their children, regardless of family structure. Despite concerns that the sexual orientation of LGBTQ parents will

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Parent–Child Relationships

negatively affect children in both direct and indirect ways, research is consistent in indicating that sexuality is not relevant to adults’ mental health or parenting capacities. Specifically, studies that have compared lesbian, gay male, and heterosexual parents in terms of mental health (e.g., psychological distress, depression), perceived parenting stress, and parenting competence have found few differences based on family structure. Much of the research on LGBTQ parent–child relationships has been conducted on families formed through adoption and on lesbian- and gay male-headed households. Most parents in samesex relationships who have adopted describe a close bond to their children. However, both samesex and heterosexual adoptive parents may encounter certain challenges in regards to attaching to their children. These challenges are often in relation to the child’s characteristics. For example, adopting a child who is older has been associated with more difficulty bonding with the child as well as more behavioral and emotional challenges. Additional challenges to parent–child attachment include adopting a child with significant special needs. Furthermore, research has shown that challenges associated with the transition to adoptive parenthood in general (e.g., struggles with the process, lack of communication with agencies) can create a strain on the parent–child relationship early on. In addition, and similar to heterosexual parents, parents in same-sex couples sometimes experience the feeling that their child is more emotionally bonded to one parent than the other; this perceived or actual imbalance in bonding may cause tension within the couple. Parents in samesex relationships may feel an added layer of frustration when the child shows preference for one parent over the other because the child’s preference cannot be explained by gender difference or biological connection to the child. Despite their vulnerability to heterosexism (e.g., in relation to adoption agencies and their families of origin) and being more likely to experience legal complications related to parenthood, parent–child relationships in adoptive families with LGBTQ parents have been shown to be as satisfying as parent–child relationships in families with

heterosexual parents, from the child’s perspective as well as the parents’ perspective. Further, the existing research on children’s outcomes has demonstrated that overall, children’s relationships with their LGBTQ parents is positively associated with healthy child outcomes (e.g., life satisfaction). Children with LGBTQ parents have been shown to exhibit similar levels of self-esteem, quality of life, and social functioning compared to those with heterosexual parents.

LGBTQ Parent–Child Relationships in Separated Families Parent–child closeness and contact may be threatened when parents break up, an outcome similar to families with heterosexual parents who separate or divorce. Because of legal inequities and barriers for same-sex couples, there are additional challenges to custody when same-sex couples with children separate. Several studies have examined the consequences of sexual-minority parents’ relationship dissolution for parent–child relationships and closeness. Custody of the children in lesbian families, for example, is more likely to be shared if the nonbiological mothers had adopted the children prior to the separation. Adolescents report being close to both mothers more often in families in which their nonbiological mothers had adopted them; further, adolescents whose nonbiological mothers had adopted them spent more time with both of their mothers. These data suggest that legal parentage may have important implications for parent–child relationships postrelationship dissolution. Similarly, when parents in same-sex relationships decide to dissolve their unions, they are less likely than heterosexual parents to do so with legal intervention (e.g., lawyers, mediators). This lack of court involvement carries advantages and disadvantages for the parent–child relationship. For example, some youth in these families express appreciation for the fact that since their parents were never legally married, they did not get legally divorced, allowing their families to escape the bureaucracy of the legal system. Other youth, however, report disadvantages, especially when

Partners in (Gender) Transition

their nonbiological mother lacked legal ties to them (e.g., they were not able to or chose not to adopt the child). In this instance, it is possible that the nonbiological mother may move away or became less involved in her children’s lives once she separates from the biological parent. Thus, it is important to take into account the legal protections (or lack thereof) of parents’ unions when considering the parent–child relationship, in both intact and separated families.

Bisexual and Transgender Parent–Child Relationships There is a dearth of research that focuses specifically on the parenting experiences of parents who identify as bisexual as well as parents who identify as transgender. These parents may be excluded from studies or misidentified, given that their sexual orientation or gender may be assumed or incorrectly labeled by researchers. The research that has been conducted, however, has found that bisexual and transgender parents do not significantly differ in their relationships with their children, compared to parents who identify as lesbian, gay, or heterosexual and cisgender (individuals whose gender identity matches their biological sex) parents. Further research is needed to explore whether and how the invisibility of bisexual and transgender parents affects their experiences of bonding with their children. These parents certainly do not fit into the heterosexist norms of parenting but may encounter varying parenting experiences that have yet to be uncovered by researchers, related in part, to their identification as bisexual or transgender. In conclusion, the body of literature that has focused on LGBTQ parents and their relationships with their children demonstrates more similarities than differences between their experiences and heterosexual parents’ relationships with their children. In addition, children of LGBTQ parents fare similarly to their peers with heterosexual parents. Overall, LGBTQ parents’ relationships with their children are positively related to parents’ and children’s mental health and well-being outcomes. Further research is needed to continue to examine

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LBTQ parent–child relationships, especially the experiences of bisexual and transgender parents. April M. Moyer and Abbie E. Goldberg See also LGB Parenting Styles and Values; LGBQ Parents, Coming Out to Children; LGBQ Parents and the Health Care System

Further Readings Downing, J. B. (2013). Transgender-parent families. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 105–115). New York, NY: Springer. Goldberg, A. E., Moyer, A. M., & Kinkler, L. A. (2013). Lesbian, gay, and heterosexual adoptive parents’ perceptions of parental bonding during early parenthood. Couple and Family Psychology: Research and Practice, 2, 146–162. doi:10.1037/a0031834 Patterson, C. J. (2006). Children of lesbian and gay parents. Current Directions in Psychological Science, 15, 241–244. doi:10.1111/j.1467-8721.2006.00444.x Ross, L. E., & Dobinson, C. (2013). Where is the “B” in LGBT parenting? A call for research on bisexual parenting. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 105–115). New York, NY: Springer.

PARENTS AND FRIENDS LESBIANS AND GAYS

OF

See PFLAG

PARTNERS

IN

(GENDER) TRANSITION

Transitioning is the process that transgender (or trans) individuals go through in living as the gender with which they identify rather than the sex assigned to them at birth. Transitioning can entail complex personal, social, and medical changes, including changes in one’s name, preferred personal pronouns, and physical presentation as well

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Partners in (Gender) Transition

as hormone replacement therapies and sex reassignment surgeries for those who desire and can access such medical changes. Contrary to past assumptions regarding the inevitable dissolution of intimate relationships following the disclosure of a trans identity, research suggests that there are multiple personal, relational, and social changes that may occur within the context of one partner’s gender transition. Given the centrality of intimate partners in shaping the transition process as well as the impact that a gender transition has on an intimate relationship, gender transitions within intimate relationships can be conceptualized as involving a co-transition process for both partners. This entry highlights several central issues relevant to trans-partnered couples, including the timing and impact of transition, shifts in sexual orientation, and the implications for mental health on both partners. The entry focuses on couples in which only one partner in the dyad is trans.

Timing and Impact of Transitioning Historically, it was often assumed by clinicians and researchers that relationships formed prior to transitioning would lead to separation and divorce when one partner “came out” as transgender and began the transition process. Such assumptions were often supported by limited research that focused exclusively on male-to-female (MtF) individuals partnered with women, often in the context of previously heterosexual-identified marriages. Current empirical and clinically informed research has increasingly broadened its scope of focus to consider various gender identifications, including the experiences of female-tomale (FtM) individuals and their intimate partners. Across different kinds of couples it is clear that there is a diversity of relationship negotiations that couples may go through in navigating the impact of one partner’s gender transition, and relationship dissolution is only one possible response to a partner’s gender transition. The Timing of Transitioning

The timing of transitioning can have a significant impact on the co-transitioning experiences of

both partners. For instance, a relationship that is created prior to any knowledge of one partner’s transgender identification may endure particularly difficult feelings of hurt, anger, rejection, and confusion by the non-trans partner. Such relationships may differ significantly from relationships in which partners openly discuss gender issues and the possibility of transitioning throughout early stages of the relationship. Some research suggests that starting a relationship posttransition may more easily lead to a stable and long-lasting relationship compared to transitioning within the context of an already existing relationship. Nevertheless, it is increasingly clear that many couples do remain together throughout transitioning and couples develop diverse ways to navigate and embrace the co-transition process. The Impact of Transitioning

Although there are no definitive rates of relationship success versus dissolution following transgender disclosure within intimate relationships, current research suggests that many partners decide to work through transition-related challenges in order to maintain the relationship. Qualitative research on FtM men and their female partners has generally indicated that many female partners remain with their FtM partners throughout the transition. Some research has indicated that FtM partners and their female heterosexual partners may have similar rates of relationship satisfaction compared with heterosexual couples, thereby strongly challenging the notion that couples in which one partner is trans necessarily have lower levels of relationship satisfaction. FtM men partnered with women may also have more stable, enduring intimate relationships compared with MtF women and their partners. Researchers speculate that this may be a result of FtM men’s gender socialization as women prior to transition, which may allow for greater relational and affective capacity throughout the transition. Notably, relationship satisfaction throughout transitioning may have less to do with the specific gender identity of the trans partner and more to do with the centrality and rigidity of gender roles in the relationship. For instance, couples who have less rigid gender

Partners in (Gender) Transition

roles pretransition may be less likely to separate as a result of one partner’s gender transition. Moving beyond a focus on whether or not relationships can survive a partner’s gender transition, partners navigate various positive and negative changes in their relationships throughout the cotransition. Regardless of the trans partner’s gender identity, gender transitioning is typically a lengthy and ongoing process that can create significant stressors within the relationship. Partners may find themselves intensely involved in transition-related emotional and practical care. Depending on how far along the trans partner is in their transition when the relationship begins impacts how involved the non-trans partner is throughout the transition. The non-trans partner may be involved in such activities as supporting the trans partner through navigating barriers in accessing health care, recovering from surgeries, helping with the financial aspects of transitioning, and managing the impact of social and legal discrimination. This involvement by the non-trans partner may provide a much-needed and appreciated form of support, but it also may place a strain on the relationship as well as the personal lives of both partners. Furthermore, in navigating transition-related changes, some couples may shift away from an emphasis on the sexual relationship to a greater emphasis on the emotional aspects of the relationship. Such a shift may allow relationships to temporarily or permanently create new avenues for developing and maintaining intimacy. How couples negotiate the co-transition may depend a great deal on how stable the relationship was prior to transition. In relationships that were experienced as supportive and satisfying pretransition, the transition process may allow for a new realm in which partners can grow together in new and unexpected ways. The Role of Social Context

Social context can play a key role in supporting or challenging the co-transition process. For instance, depending on the social and geographical context in which the couple is living, there may be limited avenues for accessing social support. In rural areas, for example, there may be few if any

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trans-related support groups and limited available trans-related information within the community. Such a lack of tangible community supports may in turn negatively impact the couple’s experience of the transitioning process. Other aspects of one’s social positioning, such as one’s socioeconomic status, can greatly impact the extent to which transition-related medical care can be accessed. Trans partners who are unable to access adequate trans-related health care may have to endure particularly difficult challenges in transitioning, which in turn can exacerbate the healthy functioning of the relationship. Furthermore, although many trans people have supportive social networks, many trans people and their partners face disapproval and rejection from family members, friends, and coworkers, and diminished social support can add to the challenges that transitioning may already provoke within an intimate relationship.

Shifts in Sexual Identity and Orientation Transitioning in the context of an intimate relationship may entail changes in sexual identity and sexual orientation for both the trans partner and non-trans partner. For instance, a previously heterosexual-identified male may identify as a lesbian woman posttransition. This may give rise to challenges for a non-trans heterosexual female partner who may feel concerned about her new sexualminority status, even if her own personal identity as a heterosexual woman remains unchanged. Research suggests that heterosexual women partnered with MtF partners may continue to feel love toward their partners but find that they experience a decrease in sexual interest and desire for their trans partners. This difficulty may compound an additional struggle of losing their social status as a heterosexual couple and being repositioned as a sexual-minority couple. Couples in which one partner identifies as FtM and the other partner identifies as a lesbian woman may also experience unique concerns and challenges related to one partner’s transitioning and shifts in the sexual orientation status of the relationship. For instance, qualitative research has begun to shed light on some of the tensions that lesbian-identified female partners may face in

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Partners in (Gender) Transition

terms of their lack of visibility as a sexual minority when partnered with FtM men. While contending with a publicly appearing heterosexual relationship, some lesbian female partners may both benefit from and feel uncomfortable with accessing heterosexual privilege. Additionally, in such contexts, lesbian partners may have to contend with a lack of acceptance from the LGBTQ community as a result of being socially positioned within a heterosexual relationship. Similarly, FtM men who previously identified as lesbian women pretransition may find that they are no longer as welcomed or accepted within queer women’s spaces that they had been a part of prior to transitioning. Lastly, FtM men partnered with men may struggle with stereotypes that trans men only partner with women, and such FtM men may also feel alienated from the LGBTQ community at the same time that they are newly negotiating being perceived as a sexual minority. Although there has been a dearth of research regarding bisexual individuals’ experiences of partnering with a trans partner, limited research suggests that bisexual people may be uniquely positioned to manage the shifts in a partner’s gender identification. Sexual intimacy may also undergo changes throughout the transition process, with some couples taking a hiatus from sexual intimacy during transitioning while others may use intimacy as a realm in which to reaffirm and support the trans partner’s gender identity. Sexual practices may become more limited or more varied and flexible as the transition process progresses. Some couples may accommodate changes in the sexual intimacy of the relationship by transitioning to an open relationship in which partners may seek other sexual partners outside of the primary relationship. Other couples may find that the transitioning process positively impacts sexual intimacy as the trans partner feels increasingly comfortable physically and emotionally.

Intimate Relationships and Mental Health Trans people are at a disproportionate risk for physical and mental health issues compared with

the general population. Such disparities are further exacerbated by systemic discrimination and difficulties accessing adequate health care. Understanding the role of intimate relationships for trans people and their partners is therefore particularly important given that being in a relationship is an important protective factor that can positively impact self-esteem. More specifically, it is the quality of the relationship that is the relevant determinant impacting self-esteem and relationship satisfaction. Non-trans partners can play a key role in providing social support to trans partners through such behaviors as using correct pronouns, being emotionally and sexually intimate, and providing practical and emotional support during and after transition. Such behaviors can in turn help to bolster the trans partner’s gender identity and selfesteem throughout the transitioning process. Trans partners can similarly provide valuable support to non-trans partners by openly discussing and understanding some of the challenges that the non-trans partner may be experiencing, which can in turn positively impact the mental health of non-trans partners. Jordan B. Downing See also Transgender Geographies; Transgender Health Care; Transgender Identities; Transgender Inclusion in the LGBTQ Rights Movement; Transgender Sexualities

Further Readings Brown, N. R. (2009). “I’m in transition too”: Sexual identity renegotiation in sexual-minority women’s relationships with transsexual men. International Journal of Sexual Health, 21, 61–77. Brown, N. R. (2010). The sexual relationships of sexual-minority women partnered with trans men: A qualitative study. Archives of Sexual Behavior, 39, 561–572. Hines, S. (2006). Intimate transitions: Transgender practices of partnering and parenting. Sociology, 40, 353–371. Joslin-Roher, E., & Wheeler, D. P. (2009). Partners in transition. The transition experience of lesbian, bisexual, and queer identified partners of

PFLAG transgender men. Journal of Gay & Lesbian Social Services, 21, 30–48. Lev, A. I. (2003). Couples in transition: When one is trans and the other is not. In the Family, 8, 18–23. Lev, A. I. (2004). Transgender emergence: Therapeutic guidelines for working with gender-variant people and their families. Binghamton, NY: Haworth Press. Meier, S. C., Sharp, C., Michonski, J., Babcock, J. C., & Fitzgerald, K. (2013). Romantic relationships of female-to-male trans men: A descriptive study. International Journal of Transgenderism, 14, 75–85. Theron, L., & Collier, K. L. (2013). Experiences of female partners of masculine identifying trans persons. Culture Health & Sexuality, 15, 62–75.

PASSING See Strategic Disclosure

PFLAG National PFLAG is the nation’s largest support group for the lesbian, gay, bisexual, and transgender (LGBT) communities. It currently boasts some 200,000 members and has grown to more than 350 local chapters. Now more than 40 years old, PFLAG has evolved into a powerful engine of support, education, and advocacy relating to a broad range of issues, including discrimination against LGBTQ people; so-called reparative therapy that attempts to “cure” homosexuality; marriage equality for same-sex couples; human sexuality; and hate crimes law. The organization also supports the families and friends of the LGBTQ community. PFLAG grew out of the early 1970s activism that followed the Stonewall riots in New York City. Morty Manford, who had been at the Stonewall Inn in 1969 when the bar was raided by the New York City police, was subsequently attacked during a gay rights rally as the police stood by and watched. To show support for her son, his mother, Jeanne Manford, marched with him in a 1972 gay

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pride parade, carrying a sign that read “Parents of Gays Unite in Support of Our Children.” She was surprised at the number of marchers who asked her if she would speak to their parents, and the idea for PFLAG was born. The first meeting of what was originally called Parents of Gays (later, Parents FLAG) was held in New York City in March of 1973. Although about only 20 people attended, the strong emotions expressed during the gathering made clear the need for a family and friend support group for gays and lesbians. In 1976, a second chapter opened in Los Angeles, and from there, the idea of a grassroots organization spread to many other localities. The national organization known as PLFAG was launched in 1981, with Adele Starr as its first president. This was the same year that the organization first gathered widespread attention, when popular columnist “Dear Abby” mentioned PFLAG as a resource to a concerned parent. PFLAG opened its first national office in Los Angeles shortly after that, and in 1990, the organization relocated its headquarters to Washington, D.C., where it remains. Over the many years of its existence, PFLAG has become known for its efforts to gather support for an ever-expanding community of sexual minorities. In 1991, the group sought and received a statement of support from First Lady Barbara Bush. In 1993, bisexuals were added to the lists of those PFLAG supported, and in 1998, the national group officially added support of the transgender community to its mission. Although some have taken exception to the non-inclusion of the bisexual and transgender populations in the PFLAG name, the organization’s mission statement is quite clear about including them: “PFLAG promotes the health and well-being of gay, lesbian, bisexual and transgender persons, their families and friends. . . .” PFLAG advocacy and strong public presence have involved the organization in several highprofile controversies. In the 1980s, the organization pushed back against the efforts of antigay crusader Anita Bryant, by opposing her campaigns to block or roll back anti-discrimination laws. During that same period, PFLAG took the early

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lead in vocally opposing the military’s policy of excluding gays and lesbians because of their sexual identities. In 1996, the group became involved in a bitter legal dispute with evangelist Pat Robertson, who had made public statements demonizing gays and lesbians. Robertson threatened to sue the group over its Project Open Mind ad campaign. As part of that campaign, PFLAG quoted Robertson’s statement, from his 700 Club broadcast of January 21, 1993: “Homosexuality is an abomination. Many of those people involved with Adolf Hitler were Satanists, many of them homosexuals. The two things seem to go together.” The ad then juxtaposed this and other incendiary statements with images depicting the costs of homophobia, including an attempted suicide and a gay bashing. Robertson claimed that the ad depicted him in a false light, but no suit was ever filed. In recent years, PFLAG has been involved in many advocacy and educational efforts. Now officially named PFLAG National, the organization in 2007 launched the Straight for Equality initiative, enlisting allies who did not otherwise have a connection to the LGBTQ community. Straight for Equality has spun off several, more specific initiatives, including the following: Straight for Equality in the Workplace (2007), Straight for Equality in Healthcare (2009), Straight for Equality in Faith Communities (2012), and Straight for Equality Trans Allies (2014). PFLAG has also created the Our House to the Courthouse program and Our House to the Statehouse, which focus on judicial and legislative advocacy efforts designed to gain civil rights for the LGBTQ community. It sponsors national and local scholarship programs to support the education of the LGBTQ community. Each year, PFLAG hosts a gala that honors allies in three areas: entertainment, the workplace, and faith communities. By 2014, PFLAG had become firmly entrenched as a leading national and regional organization for LGBTQ issues, advocacy, and education. The organization now has a large national office and a staff with wide-ranging responsibilities, including development, policy, and operations. There are

also a national board of directors, regional directors, and a roster of corporate partners that in 2014 included KPMG, Johnson & Johnson, WilmerHale, and Wells Fargo. From a mother’s do-it-yourself approach to standing up for her gay son, PFLAG has grown into one of the nation’s largest and most influential LGBTQ advocacy organizations. During its more than 40 years of existence, PFLAG has continually expanded its mission, formed new alliances, and embraced new opportunities to support the LGBTQ community and their families, friends, and allies. John G. Culhane See also LGBQ Parents, Coming Out to Children; Parent–Child Relationships; Transgender Youth and Family Relationships; Violence and Victimization of Youth

Further Readings Bernstein, R. A. (2003). Straight parents, gay children. New York, NY: Thunder’s Mouth Press. Marcus, E. (2002). Making gay history: The half-century fight for lesbian and gay equal rights. New York, NY: HarperCollins. PFLAG. (n.d.). About PLFAG. Retrieved from http:// community.pflag.org/page.aspx?pid=191

PHYSICAL DISABILITIES The intersection between LGBTQ identities and physical disability, as defined by the social model of disability, is highly relevant to LGBTQ disabled people, who are often considered asexual and ungendered. LGBTQ disabled people experience a range of discrimination in multiple aspects of life, including social barriers to employment, housing, and health care. Furthermore, the issue of sex and relationships is especially important to consider because this is an area where LGBTQ disabled people’s lives significantly differ from non-LGBTQ disabled friends and colleagues.

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Models of Disability The dominant model of disability, used by medical and social policy makers, is the medical model. This model is a deficit model in that it considers disability to be the active limitations an impairment places on an individual to perform their daily functioning. For example, Sonya experiences pressure from nondeaf friends to wear a hearing aid to job interviews to “help” her. The alternate model of disability, used by disability rights organizations, is the social model. This model places the emphasis external to the person by considering disability to be the restrictions a person faces because of physical and social barriers. With this model, the disability is caused by the prejudice, discrimination, or lack of foresight of others. For example, Sonya expects that if the interview panel cannot themselves use sign language, they will at least provide an interpreter. If Sonya were to get the job, the two models suggest different ongoing considerations in terms of whether Sonya, or her new employer, made necessary changes to ensure she has a productive and enjoyable working life.

Discrimination Faced by LGBTQ Individuals It is unfortunately the case that disabled LGBTQ people face discrimination from multiple directions. As noted, a major myth about disability in general is that the disabled person is asexual and ungendered, in that they presumed to have no sexual desires, needs, or active fulfillment of these wishes. When a disabled person’s sexuality and gender are acknowledged, the default position is heterosexual and cisgendered. This position is routinely taken by professionals but also by families if an LGBTQ person has not “come out.” An LGBTQ disabled person may have grown up in a family where they are not only the sole disabled member but also the only LGBTQ identified member. The consequence of this may be a lack of understanding, acceptance, and support for either aspect of identity. In fact, forming a positive identity as either disabled or LGBTQ may be actively discouraged. People have reported receiving negative messages about their sexuality and gender identity

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from parents and witnessing their nondisabled, cisgendered, heterosexual siblings being treated differently. Disabilism, the discrimination against disabled people, together with sexual and trans prejudice, combine to produce a covert message to LGBTQ disabled people to appear as “normal” as possible—that is, in addition to not disclosing their sexual or trans identity, to hide their impairment as best they can. The mainstream medical-model message is one of shame and adaption. To resist the desire to “pass as normal” is to challenge prejudices that individuals may hold about themselves as well as those held in wider social contexts. However, there may be significant reasons why someone wishes to hide aspects of one’s identity, including the risk of violence, losing support, and increasing oppression. The intersectionality of an individual’s physicality, sexuality, gender, class, age, and race must be considered, and it is most likely that someone will be selective about how much and in which contexts they choose to disclose disabled or LGBTQ identities, choosing times that have the most personal and political significance. It is also the case that some people may not feel disabled “enough” to adopt a disabled identity, which is a flip side of a social expectation that disabled people should feel grateful or guilty about any concessions made to “accommodate” their impairment. When LGBTQ identities are recognized, they can be considered as a result of being disabled, as opposed to as a chosen affirmed identity. For example, a woman may be viewed as having a same-sex partner because she could not attract a man. It is unfortunately the case that mainstream disability movements can be sites of sexual and trans prejudice and LGBTQ organizations rife with disabilism. The myth of asexuality pervades both communities. For example, acceptance in LGBTQ spaces can come at the cost of one’s active sexual desires, in that acceptance may be on the level of politics or friendship but not as a potential sexual or romantic partner. It has been highlighted that the terms used within LGBTQ rights movement of “strength” and “voice” can be experienced as exclusionary by some (e.g., the statement on the

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Stonewall website: “The Stonewall Awards provide a much-needed platform to showcase the strength, confidence, visibility and talent of lesbian and gay people in this country”). The lack in civil rights movements of an intersectional perspective combining social diversity around gender, race, sexuality, and disability has been seen as having led to a silencing of LGBTQ and race issues within disability movements, of disability and race issues with LGBTQ movements, and LGBTQ and disability issues within race movements. Yet all these movements share similarities in their struggles against, and resistance of, discrimination and oppression, such as in campaigns and petitions to governments for policy change, with the potential for building on and learning from each other. However, while some authors suggest that people choose to seek support from different communities for different needs, others suggest that people find support from the community they have identified with for longest. An important example of where the intersection between sexuality and disability won over prejudice and overt discrimination is in the case of Sharon Kowalski, which took place in Minnesota, in the 1980s. Following a road traffic accident, Sharon was left hospitalized with impairment to her motor skills and communication. She indicated that she wished to return home to live with Karen, her partner, whose input at her bedside was applauded by the medical staff as significantly contributing to her progress. However, Sharon’s father had been awarded legal custody, and he forbade this and blocked Karen’s visits. On the back of Karen’s ardent national campaigning, a “National Committee to Free Sharon Kowalski” was formed, linking disability and lesbian, gay, and bisexual (LGB) activists who raised money for legal costs and supported the couple. Together, they won the legal battle: Legal guardianship was transferred to Karen, and Sharon returned home.

Sex and Romance in Adolescence and Adulthood During adolescence, disabled people have described feeling socially and sexually isolated, with some

experiencing prejudice and discrimination from the attitudes held by peers or accessibility of social venues, so that there are reduced opportunities to mix socially and create possibilities to start sexual liaisons. This is at a time when peers were learning how to flirt, date, and become sexually active. An individual who recognized their same-sex desires or trans identity at this time may find this particularly difficult in the context of living in a sexual and/or gender minority. Along with reduced opportunities for sexual experimentation or exposure to role models, individuals may be denied sex education and find it hard to find alternative examples of sex and sexuality than mainstream cisgendered able-bodied heterosexual information. Queer can take on particular significance as an identity label in rejecting norms imposed on sexual, gender, and body expectations. This lack of support, interest, and information is not only oppressive but also dangerous because it creates an unsafe culture where sexual abuse may remain hidden and unreported. Difficulties such as the lack of reporting, reports being discounted by those to whom they were made, or a lack of clear records of the disability status for victims of crime make it hard to estimate the prevalence of this abuse, but it has been suggested that disabled people are between 4 and 10 times more likely to experience some form of abuse than nondisabled people. Meeting romantic or sexual partners can be difficult if social venues present physical barriers to attendance, particularly relevant in smaller towns where there may only be one social or support group for LGBTQ people. The use of Internet sites and online dating is an alternative, although research shows that nondisclosure of a disabled identity correlates to more “hits.” If someone is single, whether disabled or not, this is rarely seen as a choice but rather that it is because this person has been unsuccessful in finding a partner. In a similar vein, a disabled person who chooses to date another disabled person can be considered to be doing so because they were unable to attract a nondisabled partner. What is actually the case is that disabled partners find strength and support together in facing a disablist society, and people

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may actively seek a disabled partner for this very reason, potentially using dating sites specifically created for this purpose (e.g., Disability Match or The Outsiders Trust). Nondisabled partners can have their choices questioned and scrutinized, or partners may be considered the disabled person’s caregiver rather than their romantic and sexual partner. If partners are involved in physical support of a disabled person, it can shift the dynamics of power within the relationship and potentially place it under strain. Examples of this might be the disabled person not wishing to upset their partner for fear of withdrawal of support or subtle retaliation (e.g., moving furniture in the home of someone who is blind). The disabled person may also fear being a burden and so hide tiredness or pain. Professionals rarely address the sexual needs of disabled people. With acquired disability (e.g., through accident or illness), previous sexual habits and patterns may have been disrupted or no longer possible, posing a challenge for the individual and/ or couple to find new ways to communicate about sex and be sexual. Within this context, the sexual needs of trans and sexual-minority disabled people are even more ignored or avoided, as professionals may feel unskilled, unknowledgeable, or embarrassed to have this conversation. While LGBTQ people have rejected the notion espoused in most sex education of sex equaling penises entering vaginas, the idea of sex cumulating in orgasm remains the dominant model of sexual satisfaction. The sexual response cycle notion of sex creates disability for those who do not fit neatly within its stages. This may result in feelings of inadequacy for those who have difficulties with arousal or orgasm and result in the person taking on the label of asexual when this might not be the case. For those with an acquired disability, they may compare the sex they are having now to a time before their acquired disability and feel lacking. Once people, whether LGBTQ or heterosexual or cisgendered, disabled or not, are able to move away from the constraining definitions of what sex can be, the world of sexual possibility opens up. For example, skin is the most erotic organ, rather than genitals.

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Many have argued that diverse forms of physicality can lead to heightened sexual pleasure and awareness. This can be because such variety invites one to engage the imagination and communicate clearly. One area of sexuality that has welcomed disabled people is the kink community. It has been suggested that this is because this community celebrates multiple aspects of the body, as well as pushing the boundaries between pleasure and pain. Disabled people have incorporated aids like wheelchairs into the sexual play, for example, getting a submissive to tow them. Another controversial area relating to sex and disability is that of sexual facilitators—caregivers (those employed to provide general care) who are present during sex to help (e.g., with positioning). This might be something caregivers are willing to offer, but they may not overtly advertise this. Further, it may be hard to raise this issue during an interview for a paid caregiver for a disabled person, particularly for LGBTQ people who may not wish to disclose their sexual orientation or trans identity at this early stage in the caring relationship. However, if not explicitly written into a contract, caregivers who do this would be acting outside of their legal obligations. There are alternative avenues for people who may wish to seek physical assistance during sex, such as the organization Tender Loving Care Trust, who link people to sex workers (those who sell sexual services) who have signed up to work with disabled people.

Conclusion The past few decades have seen a reassuring increase in the number of organizations, club nights, events, and publications that recognize and celebrate LGBTQ disabled identities. More recently, psychology and sociology have adopted the concept of intersectionality and begun to use it to advance theory and make recommendations for clinical practice. These emerging changes will set the stage for LGBTQ disabled people to expect recognition, acceptance, and high standards in the treatment they receive from professional services, to continue to challenge and

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debunk notions of normality and adaption that have prevailed for too long. Catherine Butler See also Cisgenderism; Coming Out, Disclosure, and Passing; Heterosexism; Homophobia; Intellectual Disabilities; Intersections Between Sex, Gender, and Sexual Identity; Kink; Queer; Strategic Disclosure; Transphobia

Further Readings Appleby, Y. (1994). Out in the margins. Disability and Society, 9, 19–32. doi:10.1080/09687599466780021 Ballan, M. S., Romanelli, M., & Harper, J. N. (2011). The social model: A lens for counseling transgender individuals with disabilities. Journal of Lesbian and Gay Mental Health, 15, 260–280. doi:10.1080/19359 705.2011.582073 Oliver, M. (1996). Understanding disability. London, England: Macmillan. Rubel, R., & Stassinopoulos, A. (2007). Playing with disabilities. Austin, TX: Nazca Plains. Shakespeare, T., Gillespie-Sells, K., & Davies, D. (1996). The sexual politics of disability: Untold desires. London, England: Cassell. Tepper, M. S. (2000). Sexuality and disability: The missing discourse of pleasure. Sexuality and Disability, 18, 283–290. doi:10.1023/A:1005698311392 Thompson, K., & Andrzeiewski, J. (1988). Why can’t Sharon Kowalski come home? San Francisco, CA: Spinsters/Aunt Lute.

PHYSICIANS Few studies have focused on the experiences of LGBTQ physicians. There are more studies of heterosexual physicians’ attitudes about LGBTQ patient care and LGBTQ patients’ experiences with health care providers than there are about LGBTQ physicians’ experiences. The unique position of LGBTQ physicians in often conservative and bureaucratic health care systems deserves more study. The available studies point to an increased burden of stress in an already stressful occupation. This entry addresses the experience of

LGBTQ physicians in medical school, residency, and practice and concludes with recommended resources for physicians.

Medical School Many colleges and universities have LGBTQ student groups or associations that are undergraduateoriented and not linked to health sciences professions. Liberal arts and social science departments have been quicker to adopt LGBTQ-welcoming policies and procedures, have LGBTQ-specific classes, and incorporate LGBTQ issues into “mainstream” classes than have medical schools. Some LGBTQ medical students may not disclose their sexual and gender identities for fear of discrimination and future repercussions. The stakes are so high to keep up one’s grades, get good faculty recommendations, and find a desirable residency placement that coming out as LGBTQ may be perceived as dangerous. Those who do come out must often constantly challenge the heterosexist and gender-normative medical school curriculum and assumptions of peers and faculty. Medical school curricula still contain little information about LGBTQ health care needs beyond HIV/ AIDS, and sometimes “out” LGBTQ students feel pressure to be the primary source of education for their peers. This is beneficial for their cohorts but does not lead to institutionalizing the information into the curriculum. On the other hand, a growing number of medical schools have LGBTQ student groups and openly LGBTQ faculty and staff for support. Changes in society have prompted more attention to LGBTQ issues in all aspects of life, including health care settings.

Residency Many medical students do not disclose their sexual orientation on residency applications. One study found that 95% did not reveal any information that might suggest they were LGBTQ. Whereas medical schools are generally part of universities, where there is greater acceptance and acknowledgment of LGBTQ issues, residency programs are in more varied and diverse locations. There are few published studies that focus on the experiences of

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LGBTQ residents in training. Some studies point to certain medical subspecialties such as psychiatry and family practice being more open and accepting of LGBTQ issues than other specialties, such as surgery, but these are generalizations. It takes only one highly negative faculty member to make the climate inhospitable for LGBTQ medical residents. Once in residency, LGBTQ physicians also have to worry more about patient’s reactions. Will patients be uncomfortable if they are out? Will this affect their future practice and livelihood? Residents form relationships that may lead to jobs, and these relationships may still be contained in “good old boy” networks that are not open to LGBTQ people; thus, there may be more challenges in finding jobs upon completion of the residency. One study found that many LGBT residents were uncomfortable talking about their partners or bringing partners to work events, and over half had witnessed homophobic remarks. The majority had concealed their sexuality for fear of rejection or poor evaluations, and of those who had been harassed, none had reported it.

Physicians in Practice Two national studies gathered information on LGBTQ physicians, separated by 15 years. In 1994, Ben Schatz and Kate O’Hanlan surveyed over 700 members of the first LGBT physician organization in the United States (now known as GLMA: Health Professionals Advancing LGBT Equality), finding that most LGBTQ physicians had experienced some form of harassment, discrimination, or social ostracization. The survey was repeated in 2008. The newer survey found only slight improvements in the work climate for physicians: 10% had been denied patient referrals, 15% had been harassed by colleagues, 22% felt socially ostracized, 65% had heard disparaging remarks about LGBTQ people, 34% had witnessed discrimination of LGBTQ patients, 36% had witnessed disrespect of same-sex partners, and 27% had witnessed discrimination against LGBTQ employees. Although there were improvements in the 15 years between surveys, many challenges still existed to full integration into the profession. On the positive side, many LGBTQ physicians were asked to help educate their peers and organizations

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about LGBTQ health issues. In addition to potential challenges with colleagues, some studies find that a significant number of patients would switch doctors or would have less confidence in their physician if they knew the person was LGBT.

Resources To deal with the stresses of the profession, three organizations may be helpful to LGBTQ physicians for support and advocacy work. These organizations work to increase integration of LGBTQ issues into medical school, residency, and continuing medical education as well as advocate for reducing health disparities experienced by LGBTQ patients and employees. GLMA: Health Professionals Advancing LGBT Equality LGBT Advisory Committee of the American Medical Association Human Rights Campaign (HRC): Health Equality Index

Supporting LGBT physicians to be out and visible will help change the climate of health care settings to be more inclusive of LGBT patients. Michele J. Eliason See also Education; Health Care Providers, Disclosure of Sexual Identity to; Health Care System

Further Readings Eliason, M. J., Dibble, S. D., & Robertson, P. (2011). Lesbian, gay, bisexual and transgender physician’s experiences in the workplace. Journal of Homosexuality, 58(10), 1355–1371. Lee, K., Kelz, R. R., Dube, B., & Morris, J. B. (2014). Attitude and perceptions of the other underrepresented minority in surgery. Journal of Surgical Education, doi. org/10/1016/j.surg.2014.05.008 Merchant, R., Jongco, A., & Woodward, L. (2005). Disclosure of sexual orientation by medical students and residency applicants. Academic Medicine, 80, 786. Oriel, K. A., Madlon-Kay, D. J., Govaker, D., & Mersy, D. J. (1996). Gay and lesbian physicians in training: Family practice programs directors’ attitudes

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and student perceptions of bias. Family Medicine, 28(10), 720–725. Schatz, B., & O’Hanlan, K. (1994). Anti-gay discrimination in medicine: Results of a national survey of lesbian, gay, and bisexual physicians. San Francisco, CA: American Association for Human Rights.

POLICE OFFICERS/LAW ENFORCEMENT OFFICIALS Police in the United States serve three primary purposes, which vary in priority from agency to agency, place to place, and time to time—namely (a) enforcing the criminal law; (b) maintaining order; and (c) providing miscellaneous services ranging from offering directions to tourists, to changing tires, and watching vacant homes while owners are vacationing. Broadly, this amounts to protecting, maintaining, and furthering the existing social order, respectively. Insofar as the existing social order is directed chiefly by straight, White, Christian males, the police, at times, have been unreceptive—or downright hostile—to anyone else. The police have traditionally been very conservative politically and have scored high on measures of right-wing authoritarianism. As American policing in particular and American society more broadly have evolved, however, the police have become more receptive to women, as well as sexual and religious minorities.

Evolution of American Policing The police as an institution in the United States initially were inextricably tied to politics until around 1840, when the professional era of policing, so called, saw efforts to detach policing from politics. Professional era reforms from the mid1800s until the late 1960s and early 1970s relied heavily on the implementation of policies and procedures to restrict the discretionary exercise of power by police in order to minimize political influence and opportunities for corruption. The goal was to establish and maintain a professional

distance between the police and the community. Fortunately—and unfortunately—it worked. With the approach of the 1970s, police agencies increasingly found themselves too detached from communities, who often experienced the police as more of an occupying army than an institution of service and protection. In the early 1970s, therefore, police agencies sought to reengage the community during what came to be known as the community, or problem-solving, era.

Police and the LGBTQ Community The Stonewall Inn Riots

American policing was in transition from the political to the professional or reform era in the summer of 1969 when a watershed event in the LGBTQ civil rights movement occurred at the Stonewall Inn, a gay tavern on Christopher Street in New York City’s Greenwich Village. What began as a “routine” raid of the club catering to the most marginalized members of the LGBTQ community spontaneously turned into riots lasting for days and became a defining moment in relations between the police and LGBTQ community. Although relations between the police and LGBTQ people would remain particularly strained, something changed forever when the patrons of the Stonewall Inn stood up to the police and against oppression. Engaging the Community

The Stonewall riots marked the end of an era in police–LGBTQ relations at a time when the police were already moving toward community-oriented policing more generally. Consistent with the overarching theme of the Supreme Court under Chief Justice Earl Warren, community policing is part of a reform movement to ensure that the police adequately reflect the communities they serve. After all, the police are perhaps the most conspicuous agents of a government that is supposed to be of the people, by the people, and for the people. Accordingly, the historically all-White, all-male, all-Christian, all-straight, conservative police departments began to include female and minority officers. In 2004,

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the International Association of Chiefs of Police conducted a workshop at its annual conference on lesbian, gay, bisexual, and transgender (LGBT) officers for the first time. Agencies have slowly opened their doors to lesbian, gay, and bisexual (LGB) officers and, more recently, have begun to accept transgender officers. Some agencies have even targeted the LGBTQ community in their recruiting efforts, albeit typically as part of damage-control efforts. The Stonewall Riots Redux?

An incident in Fort Worth, Texas, is illustrative of the kind of catalyst that prompts law enforcement agencies to actively recruit LGBTQ officers. In 2009, officers from the Fort Worth Police Department (FWPD) and agents from the Texas Alcoholic Beverage Commission (TABC) ventured out jointly to conduct routine bar checks. They had a number of clubs on their list to check one evening, one of which just happened to be a gay club, the Rainbow Lounge. The evening, coincidentally, was the 40th anniversary of the Stonewall riots. And, unbeknownst to the officers, many of the patrons had spent much of the evening watching a documentary on Stonewall. The bar check turned out to be anything but routine. Patrons made sexual comments toward the police, and some touched the officers in a sexually provocative manner. The feigned advances were not well received by the police. Arrests were made, and at least one patron had to be taken to the hospital for treatment of injuries sustained while he was in police custody. TABC made substantial personnel and policy changes in response to unfavorable coverage by the media and sustained protests. Moreover, the FWPD now actively recruits from the LGBTQ community.

LGBTQ Police Officers Actively recruiting LGBTQ officers is a huge step for police agencies. Research has shown that the police tend to subscribe to antiquated views of sexual orientation and be more punitive toward sexual minorities who commit crimes. Moreover, many

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workplaces treat LGBTQ workers as outsiders, and employment research has shown that openly gay men are especially likely to be discriminated against when seeking jobs, such as policing, that emphasize the importance of stereotypically male traits. Unsurprisingly, such negative attitudes and discriminatory behavior vary widely regionally. Equally unsurprising, in light of negative attitudes and discrimination, is that LGBTQ officers experience substantial pressure to keep their sexual orientation hidden. Doing so is made easier by the fact that agencies are increasingly avoiding exploration of sexuality and gender identity as part of the background investigation process. Although LGBTQ officers struggle with lack of acceptance by, and respect from, their peers, transitioning these officers into the agencies has not been as challenging as feared. Instead, officers become part of the new normal for the agencies. This is especially valuable to those agencies that subscribe to community policing, because LGBT officers typically endorse more humane approaches to policing and believe themselves to be especially qualified to work with people on the margins. Phillip M. Lyons See also Bias in the Criminal Justice System; Bullying, Rates and Effects of; Criminal Legal System and LGBTQ People; Incarceration; Laws Banning Homosexuality and Sodomy; Sexual Minorities and Violence; Stonewall; Transgender People and Violence

Further Readings Duberman, M. B. (1994). Stonewall: The riots that sparked the gay revolution. New York, NY: Plume.

POLICING MASCULINITIES AND FEMININITIES Western culture organizes gender through a binary framing, which posits masculinity and femininity as mutually exclusive categories. As culturally defined, the categories of masculinity

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and femininity correspond with anatomical sex. Masculinity, for instance, is the set of understandings, behaviors, bodily practices, and characteristics we associate with a biological state of maleness and femininity with femaleness. This definition frames masculinity and femininity as naturally extending from these biological states of maleness or femaleness; however, the meanings constituting each are actually culturally bound and change with time and culture. Because they are, in fact, not a natural set of behaviors or characteristics, masculinity and femininity require a great deal of cultural work for their maintenance. Much of this cultural work takes the form of “gender policing.” Gender policing is a term that identifies the ways in which individuals are socialized into culturally sanctioned gendered categories, enactments, characteristics, and bodily practices. While heterosexually identified as well as LGBT people are all subject to gender policing, this policing is often homophobic in nature. Because masculinity and femininity are “ideal types” or social norms that no one person can fully inhabit, gender requires constant social maintenance. These cultural values get internalized along the way and individuals police themselves as well. While much of this gender policing occurs in childhood, this sort of socialization is a lifelong process. Through formal and informal rewards and sanctions, society and individuals police gender at interactional and institutional levels. While gender policing restricts all individuals, even those it simultaneously privileges, transgender, gender queer, and gender-nonconforming individuals likely receive the most harsh and most frequent forms of gender policing. When individuals engage in gender-appropriate behavior they receive interactional and institutional rewards. These rewards take numerous forms. It may be in the form of a compliment, such as when a young girl sitting quietly is praised as a “beautiful young lady.” Other forms of rewards may be less visible. When individuals conform to normative gender expectations, for example, their behaviors and identities do not disrupt social interaction. Rather, a given social interaction proceeds as though gender were not present despite the fact

that it is likely a central organizing factor for the interaction. Individuals who conform to expected enactments of masculinity and femininity receive institutional rewards, such as legal protections and higher pay. Conversely, when individuals engage in enactments of femininity and masculinity that do not conform to cultural expectations, they are often sanctioned through gender policing. This policing takes many forms. A young woman wearing sweatpants with her legs spread wide apart may be shamed by hearing “that’s not ladylike.” When one’s gender is not immediately readable by others, it can render social interactions, at best, awkward, and at worst subject them to violence. Similarly, individuals who enact femininity or masculinity “improperly” receive lower wages, more limited employment opportunities, and possibly legal discrimination. Gender is one of the most fundamental and persistent forms of social organization, and existing outside its construction is impossible. This binary gender system cannot account for bodies and/or gender identities that fall “in the middle” or “outside” of the binary. As a result, people who do not conform to normative versions of masculinity and femininity exist in a culturally unintelligible space and are recipients of multiple forms of violence. Regardless of individual rebellions against gender normativity, individuals are perceived in relation to the gender binary by most of society’s members most of the time. Thus, understanding the ways in which masculinity and femininity are policed is critical to understanding all forms of gender violence. While normative gender expectations are promoted through a multitude of institutions and practices, we primarily police gender in our everyday lives through one of humanity’s defining features—language. Language about sexuality is one of the primary ways that masculinity and femininity are policed. In other words, heterosexuality and homophobia are two of the main concepts that are used to enforce particular meaning of masculinity and femininity, though how they matter varies by gender. Masculinity is often policed through what scholars call a

Policing Masculinities and Femininities

“fag discourse,” while femininity is often policed through what scholars call a “slut discourse.”

Masculinities In the West, masculinity is most commonly defined as that which is not feminine. Though masculinity is hard to define, in general it entails heterosexuality, strength, and competence. Masculinity is policed primarily by what scholars call a “fag discourse,” in which homophobic epithets are deployed to signal to someone that they are failing at masculine traits of heterosexuality, strength, or competence. While the deployment of the fag discourse does not necessarily entail a fear or dislike of same-sex desire, it does mean that the recipient is unmasculine, at least momentarily. Men can be subject to these sorts of epithets for a variety of transgressions. Perhaps the most obvious transgression that renders a man vulnerable to gender policing is a failure to signal heterosexuality in a culturally appropriate way. If a man displays too much emotion or too much romanticism or if he fails to engage in heterosexual sexual activity or to attract women, he may be labeled with homophobic epithets by others. The man being policed needs not actually engage in any homosexual behavior to be policed through sexual slurs. In an active–passive binary, gay men are equated with femininity. These men aren’t necessarily calling another man gay, but rather unmasculine, when they deploy these sorts of homophobic epithets. Similarly, when men in any way reveal weakness or incompetence they may render themselves vulnerable to gender policing. Men’s bodies are supposed to be big and strong, capable of athletic demands and violence as well as protecting women and children from other men’s violence. When men fail to be athletic or strong, they may be subjected to the fag discourse or feminized by being called a “girl” or “sissy.” Men’s bodies and behaviors are policed for anything understood as feminine. It is therefore no surprise that women’s bodies and negative stereotypical ideas of women are included in the language used to police masculinity.

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While the fag discourse does not necessarily entail a fear of homosexuality, it does create a climate of fear for the LGBTQ community. In conjunction with common phrases such as “that’s so gay” and “no promo homo,” the fag discourse makes clear that gay and queer identities are shameful. This has negative psychological repercussions for the LGBTQ community and is a critical feature in the hostile and homophobic culture that further threatens their safety. While this is the contemporary form that masculinity policing takes, the actual content that triggers this type of policing changes over time. For example, in the early 20th century, pinks and reds were the color of choice for boys and blue for girls. Reds and pinks were considered strong and masculine, whereas blue was considered more delicate and warm. Less than a century later, these meanings have been entirely reversed. The contemporary policing of men finds those who incorporate pink into their fashion and lifestyle are subjected to gendered and sexualized slurs such as sissy, faggot, and pussy. So while masculinity is policed, the actual meanings around which the policing happens may change according to time and place. In sum, the way in which masculinity is policed is primarily through feminized or sexualized insults. One is reminded what it means to be a man when one is called a feminine slur such as “sissy” or “girl” as well as when one is called a homophobic slur such as “faggot” or “queer.” Any slip by a man into unmasculine behavior—showing too much emotion, too much affection, wearing the wrong color, touching another man outside of a rule-bound environment (like sports), or engaging in inappropriate bodily practices—can render a man vulnerable to this sort of gender policing.

Femininities Policing femininities, like the policing of masculinities, entails sexualized meanings. However, the sexualized meanings that are deployed in socializing women into correct displays of femininity are not the same meanings deployed for men. Rather, femininity is policed through what scholars call a “slut discourse.” Like a fag discourse, a slut

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discourse involves messages about how to be properly feminine that have to do not just with sexuality but also with race and class. Slut, a discursive tool aligned with whore, is a powerfully controlling image, in part because it is used in a variety of circumstances. Women who explore their sexuality through casual sex, with numerous partners, and/or with emotional detachment from traditional notions of love are sanctioned as “sluts.” In fact, women need not engage in sex at all to be called sluts. Women who wear revealing clothes, who are empowered to speak of sexual matters publicly, who are successful in the corporate world, and who are single mothers—all of these women can be subjected to the controlling image of slut. The lack of clarity surrounding the term is what makes it such a powerful tool in the policing of femininity. The message involved in the slut discourse is that one needs to stay within the bounds of White, middle-class femininity. Women are in a double bind when it comes to gender policing—they get disciplined for both sexual availability and unavailability. Both render them vulnerable to the epithet of slut. Similarly, they are policed for same-sex sexual behavior but not when it is performed for the benefit of titillating heterosexual men. As with masculinity, bodies are a primary site for policing femininity. As evidenced through advertising, media, scientific textbooks, parents’ discussions with their daughters, and a host of other institutions and interactions, women’s bodies are supposed to be smaller than and less strong than men’s bodies. Unlike for men, “fat” is a powerful insult used to police femininity. Because masculinity and femininity are defined relationally, women are expected to work to keep their bodies smaller than men’s bodies. Similarly, they are supposed to be free from body hair. Thus, women’s body hair is a significant site for gender policing. While homophobic epithets are less frequently used to regulate femininity, when they are used they are frequently in reference to women’s hair— either bodily hair or particular hairstyles on one’s head. A woman who doesn’t groom her hair in accordance with contemporary expectations may

be subject to the epithet of dyke. In other words, though body hair and body size are thought to naturally express femininity in many ways, really both are examples of “body projects” in which women engage to demonstrate femininity and avoid gender policing. In sum, policing gender is an interactional way to socialize one another into culturally sanctioned behavior. While people of all sexual identities may be subject to gender policing, those who identify as trans*, gender queer, or gender variant may feel the weight of these cultural expectations most intensely. Indeed, these practices are often undergirded by threats (and enactments) of violence for transgressing particular definitions of masculinity and femininity.

Conclusion Gender policing can take many forms: bullying and joking as well as harassment, friendly banter, and play. However, these sorts of interactions are important ways to convey social value around masculinity and femininity and undergird and buttress inequalities embedded in other social structures. We currently live in a time where normative constructions of masculinity and femininity are both undergoing dramatic shifts. The lack of clarity surrounding socially acceptable displays of gender is part of what makes this current moment powerful. C. J. Pascoe and Lauren Charles Stewart See also Effeminacy; Gender Nonconformity, Youth; Hypermasculinity; Transgender Identities; Workplace Discrimination

Further Readings Armstrong, E. A., Hamilton, L. T., Armstrong, E. M., & Seeley, J. L. (2014). “Good girls”: Gender, social class, and slut discourse on campus. Social Psychology Quarterly, 77(2), 100–122. Pascoe, C. J. (2011). Dude, you’re a fag: Masculinity and sexuality in high school, with a new preface. Berkeley: University of California Press.

Polyamorous Parenting Schilt, K., & Westbrook, L. (2009). Doing gender, doing heteronormativity: “Gender normals,” transgender people, and the social maintenance of heterosexuality. Gender & Society, 23(4), 440–464. Thorne, B. (1993). Gender play: Girls and boys in school. New Brunswick, NJ: Rutgers University Press.

POLYAMOROUS PARENTING Polyamory is a relationship style in which adults have multiple, openly conducted romantic relationships simultaneously. Some polyamorous relationships include families with children, and others are composed of all adults. Polyamory differs from cheating in that all members are (ideally) aware of and consenting to the multiple relationships. Because some polyamorists remain unmarried and women in polyamorous relationships are also allowed to have multiple partners, it differs significantly from polygamy (which is usually practiced as polygyny where one man has multiple wives). With its emphasis on long-term relationships, polyamory is generally more emotionally intimate than swinging, which usually focuses on sexual variety with multiple partners but retains emotional exclusivity with one primary partner. Polyaffectivity is a type of chosen kinship popular in polyamorous families in which some members have emotionally intimate familial relationships that do not include sexuality—such as cospouses with siblinglike relationships who are not lovers themselves but share a lover or spouse in common. This entry provides a brief overview of polyamorous families, beginning by defining polyamory, then explaining family composition and addressing who children view as parental figures. Next, the entry discusses some of the benefits that polyamorous families experience, including shared resources, honesty, and emotional intimacy. Then, it details some issues facing poly families such as coming out, stigma, partners who leave, custody of children, and children’s concerns about too much adult supervision as well as the strategies that parents use to deal with these issues such as emotional

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protection, normalizing polyamory, and problematizing bigotry.

Family Composition The most common form of polyamorous family is the open couple, a relationship between two people (most often a heterosexual man and a bisexual or heterosexual woman) who also date other people outside of their dyad. In some cases, the core dyad is married—but not always. The members of the couple often consider each other primary partners, meaning that they usually make big decisions together, share finances, coreside, and (if they have children) coparent. Generally the people they date are their secondary partners, who may be emotional intimates but often have not been in a relationship as long as the primary partners, retain separate finances, do not live together, and do not have children together or coparent the primary dyad’s existing children. Less commonly, groups will raise children together with explicit coparenting arrangement in triads (three-person relationships), quads (four-person relationships), or moresomes (relationships with five or more adults).

Who Are the Parents? Because polyamorists are generally quite careful about exposing themselves to sexually transmitted infections (STIs), condom use is standard among polys, and accidental pregnancy is rare. Almost universally, poly families know which of the partners are the biological parents of the children, though some choose not to reveal that to others and simply identify themselves as parents regardless of biological relationship. Subsequently, children in poly families can identify their biological parents and differentiate between adults who qualify as polyaffective (social, not biologically or legally related) parents and other nonparental figures. Children in polyamorous families are unlikely to view their parents’ partners as parents unless the partner (a) is there from the child’s birth or joins the family when the child is quite young, (b) coresides with the family, and/or (c) remains in close contact with the family for many years. Children in

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poly families are more likely to think of parents’ partners as aunts or uncles or friends of the family and reserve parenthood status (polyaffective or biological) for a far more select group of adults.

children feel comfortable asking questions, and they try to provide the children with honest, ageappropriate answers.

Issues Facing Polyamorous Families Benefits to Polyamorous Families Shared Resources

The primary benefits for polyamorous families come from pooling individuals’ resources to benefit the group, because sharing resources provides more time, money, love, and assistance for everyone. Adults in families with children have more personal time to relax, exercise, work, study, and date because there are other adults caring for the children. Parents of infants value the sleep they get when they distribute baby care among multiple adults. Sharing income from multiple wagedworkers allows some families to support a parent to do the housework and child care full time. Children can get homework help from multiple adults and report that they are almost always able to get a ride from a family member who picks them up from sports practice or drops them off at the movie theater to meet their friends. Both adults and children have multiple role models for examples of ways to parent and approach life. By expanding notions of family to include chosen and polyaffective members, children and adults have a broader network of emotional, financial, and practical support.

Coming Out

How, when, and if parents come out as polyamorous to their children depends on a variety of factors. Parents of young children or children born into poly families often wait until the children ask questions and then provide truthful and ageappropriate answers. If children are already older when the polyamorous relationship begins, then the parents are more likely to have a coming out conversation with them and reveal information as it is relevant and age-appropriate. When parents are divorced from their child’s other parent and then become polyamorous, they are more likely to attempt to conceal their poly relationships from their children so that the children do not have to attempt to keep them secret from the other parent. These parents report fear of custody battles as a primary deterrent to coming out to their children as well as reluctance to put their children in a position where they would have to lie to the other parent about the poly parent’s relationship or jeopardize their ability to see the poly parent (or see them only during visits supervised by a courtappointed monitor). Stigma

Honesty and Emotional Intimacy

Generally, polys emphasize honesty and communication as keys to successful relationships, and that influences other family relationships as well. Literature indicates that polyamorous and polyaffective partners establish trust and emotional intimacy with each other using honesty, self-revelation, and communication as tools to (ideally) foster deep connections. Similarly, poly parents report using (age-appropriate) honesty in their attempts to build trust and intimacy with their children. By creating an environment rich in opportunities to communicate, poly parents hope to help their

On the one hand, polyamorous parents mirror other LGBTQ families because they face many of the same issues, such as the impact of stigma on their relationships, families, and children. On the other hand, polyamory is so little known that poly families can fairly easily pass as monogamists with good friends. This relative social invisibility can provide protection from stigma, at the cost of visibility and social recognition. When polys come out to their families of origin, they can experience a range of reactions from loving acceptance to horrified ostracism. Polyamorists experience the impacts of stigma on a variety of

Polyamorous Parenting

fronts, from losing their jobs when discovered to be violating a “morality clause” by engaging in (consensual) “adultery,” to losing friends who find polyamory upsetting. Partners Who Leave

Children in poly families sometimes become attached to parents’ partners and can experience feelings of loss if that partner leaves the children’s lives when their romantic relationship with the children’s parents ends. These children can feel abandoned and may not understand why a beloved adult has suddenly disappeared. Even though most children in poly families do not view their parents’ partners as parental figures, these children can still become emotionally attached to adults who routinely socialize with the family. Generally it makes no difference to the child if the adults are having a sexual or nonsexual relationship—what is germane in the children’s lives is that the person who used to be a source of fun, affection, and attention is gone, and the child had no control over that person leaving. It can happen with any friends of the family or other family members who leave, move away, have a falling out (fight and stop talking to each other), or pass away (die). It is possible that more partners will leave poly families than will leave monogamous or some serially monogamous families simply because poly parents are dating, and this is because there are more people are in the children’s lives. Because of this higher potential for turnover, poly families are more likely to have children experience the loss of someone their parent has been dating than are children in monogamous families. It is unclear at this point how poly parents who are dating compare with other single parents who are dating. Child Custody

For poly families, custody challenges usually come from three primary sources: (1) ex-spouses from former monogamous marriages who seek custody on moral grounds; (2) families of origin, especially grandparents, who worry about what others might think and the effects of the parents’

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poly relationships on children; and (3) Child Protective Services (CPS). In most cases involving the authorities, CPS will begin investigating the family for something more routine (such as a teenager running away) and become aware of the polyamory, at which point the poly family’s circumstances can seem more complicated than conventional families. CPS representatives are familiar with monogamous, serial-monogamous, or single people and generally do not encounter (openly) non-monogamous families. Lack of social and sexual conformity can come across as dangerous or immoral to CPS workers, especially if the CPS worker has religious beliefs that define non-monogamy as wrong. Too Much Supervision

While parents do not bemoan too much supervision as a disadvantage to poly families, children complain that their attempts to subvert parental control are frequently thwarted when multiple adults are in league with each other. Simply finding the privacy to break rules unobserved can be a challenge for children with multiple adults in the household because unsupervised time can be hard to get. Also, maintaining a coherent lie across multiple iterations to different adults who communicate with each other is particularly difficult. When adults can cross-check facts with each other, they are more likely to find out that an errant teenager was not at the library as they had initially reported but was in fact observed at or picked up from the skate park by another family member instead.

Parenting Strategies Emotional Protection

Parents in poly families report that they plan carefully to protect their children’s emotions by keeping their dating relationships separate from the children, waiting to introduce partners to children until the parents know that person well, keeping adult interactions friendly or nonsexual while children are still awake, and helping the children to distinguish between family members and other

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people who are not as close. Prior to defining a partner as a member of the family, parents often require that person to establish and maintain an independent relationship with the children, regardless of what happens with the adults. Those intentions sometimes work out well with collaborative coparenting, and other times the adults are not able or inclined to maintain contact with each other, even to help the children see the other adult(s). People leave—it is an inevitable part of everyone’s life that they will experience the loss of a loved one through a wide range of life circumstances or eventually through death. Poly parents try to use the fluidity of their relationships to help their children learn to deal with loss and accept change (including the end of relationships) as a natural part of life. By focusing on helping their children to learn emotional skills instead of shielding their children from possible sources of pain, these parents hope to foster emotional maturity and resilience in their children. Normalize Polyamory

Polyamorous parents attempt to “normalize” polyamory for their children by helping them to see it as a “normal” lifestyle in that it is just not a big deal. Socializing with other polyamorists and refusing to act ashamed of their families allows adults to demonstrate to children that it is okay to be polyamorous, and other people do it as well. Finding polyamorous communities online and then connecting with them in person at familyoriented events like campouts, hikes, potlucks, and movie nights allows children to make friends with other children in families like their own. Among peers from similar families, children can speak freely about the multiple adults in their lives without fearing negative reactions or having to explain themselves and their relationships. Problematize Bigotry

Parents and children alike often reject stigma from conventional society and instead cast bigotry and intolerance as a social problem that affects a

variety of unconventional families, including their own. This displaces shame and fear from the polyamorous family itself, allowing parents and children to direct it outward at the intolerance of conventional society rather than the lack of conformity within their own ranks.

Conclusion To date, almost all of the polyamorous parents who have participated in research have been White, middle- or upper-middle class, cisgendered people with high levels of education working in skilled professions like health care, education, or information technology. Research findings reflect respondents’ race and class privileges and indicate that polyamorous parents choose parenting strategies much like their White, middle-class, liberal peers— relying on time-outs instead of spanking, valuing free thought and verbal communication over obedience. Children in poly families benefit not only from their parents’ race and class privileges but also from the additional attention and increased resources they get when they have access to more caring adults upon whom the children can rely. Elisabeth Sheff See also Bisexualities; Children with LGBQ Parents, Stigmatization; Coming Out, Disclosure, and Passing; Coparenting; Custody and Litigation, LGBQ Parents; Divorce, Legal Issues in; Families of Choice; LGBTQParent Families With More Than Two Parents; Monogamy and Non-Monogamy

Further Readings Anapol, D. (2012). Polyamory in the 21st century. Lanham, MD: Rowman & Littlefield. Anderlini-D’Onofrio, S. (2009). Gaia and the new politics of love. Berkeley, CA: North Atlantic Books. Barker, M., & Langdridge, D. (Eds.). (2010). Understanding non-monogamies. New York, NY: Routledge. Burde, J. (2013). Polyamory and pregnancy. Retrieved from http://polyamoryonpurpose.com Pallotta-Chiarolli, M. (2010). Border sexualities, border families in schools. Lanham, MD: Rowman & Littlefield.

Polyamory Sheff, E. (2014). The polyamorists next door. Lanham, MD: Rowman & Littlefield. Sheff, E., & Hammers, C. (2011). The privilege of perversities: Race, class, and education among polyamorists and kinksters. Psychology & Sexuality, 2(3), 198–223. Taormino, T. (2008). Opening up. San Francisco, CA: Cleis Press.

POLYAMORY This entry presents polyamory as a stigmatized but viable relationship form and polyamorists as a stigmatized sexual minority. Starting with key terminology and definitions, the entry provides an overview of polyamory. This is followed by a discussion of polyamory as a contemporary, stigmatized relationship orientation and thus queer in relationship to heteronormativity. Finally, the entry discusses specific LGBTQ issues in regard to polyamory.

Language and Terminology Polyamory means “multiple loves” and refers to having, or desiring to have, emotionally and sometimes sexually intimate relationships with more than one person concurrently. Because monogamy is compulsory and the codified norm in Western societies, polyamorists, like LGBTQ individuals, experience stigma and social sanctions and are socially, politically, culturally, and sometimes economically disadvantaged by their relationship orientation. To the extent polyamory violates and challenges heteronormativity, it can be considered a queer relationship orientation. Because of poly invisibility and a lack of media representations, until recently there has been relatively little research on polyamory. Polyamorists (people who identify as polyamorous or practice polyamory) generally believe that emotional and sexual exclusivity are not necessary for deep emotional bonds and commitment, and they emphasize (1) mutual consent to emotional and/or sexual non-monogamy, (2) open communication,

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(3) gender egalitarianism, and (4) emotional bonds and commitment rather than casual sex. Polyamory is distinguished from infidelity or “cheating” in that all partners in polyamorous relationships are aware of and consent to intimate bonds with multiple others. It is also distinguished from polygamy (multiple marriage partners) in that polyamory is not associated with legal marriage and, because of the association of polygyny (one man, multiple wives) with male dominance and gender inequality. Because polyamorists are a marginalized sexualminority group as of yet, there are no studies to determine what percentage of the adult population is practicing consensual polyamory. However, there is a steadily growing “how-to” literature and conscious community building among polyamorists through blogging, podcasts, and local groups, where norms, language, and collective understandings of what polyamory is and how to successfully do polyamory are discussed, negotiated, and established. Polyamorists have developed their own language to describe their experiences. This reflects mononormativity (see further in this section) and the ways in which everyday language and practices are based on a presumption of monogamy. For example, polyamorists have developed the concepts of compersion (U.S. term) or frubbly (U.K. term), which means feeling joy over the pleasure one’s partner has with another person. Metamour is a partner’s partner, and terms like primary partner, secondary partner, or tertiary partner indicate different levels of involvement or relationship primacy, although many polyamorists reject these labels because they connote a hierarchy rather than difference in level of involvement.

Kinds of Relationships There are many different configurations for poly relationships, including versus where one person is involved with two people but those two people are not involved with each other. A triad, in contrast, refers to three people who are mutually involved with each other. A quad is a relationship between four people, often, but not always two couples

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who join together in a committed relationship with each other. Some poly relationships include more than four people and/or a poly network of many partners who are more or less part of each other’s lives. Polyamorous relationships can be internally monogamous, meaning that partners are sexually involved with only members of the relationship or partner network but do not have sex with others outside of the relationship. This is often called poly-fidelity. Poly relationships can also be open, in which case partners are permitted to develop emotional and/or sexual relationships with others outside of the group or the relationship network. Elisabeth Sheff defines polysexuality as having sexual relations with multiple people simultaneously or multiple lovers concurrently and poly affectivity as emotionally intimate and committed, polyamorous relationships that are not sexual. Schippers defines polyqueer as non-dyadic sex and/or relationships that, through plurality, open interactional or social structural space to alter or queer gender and/or sexuality.

Social Stigma, Compulsory Monogamy, and Mononormativity Social stigma is often a challenge for polyamorous people because of compulsory monogamy and mononormativity. Within a growing scholarly and popular literature on non-monogamies, researchers and activists build on the concept of compulsory heterosexuality to identify compulsory monogamy as the institutionalized arrangements that compel or force people into monogamous, dyadic relationships. Like the concept of heteronormativity, mononormativity refers to the institutionalized arrangements and cultural narratives that situate the monogamous dyad as the only legitimate, natural, or desirable relationship form, thereby systematically conferring privileges to those who are or appear to be in monogamous couples. In these discussions of mononormativity, the emphasis is not on sexual identities or practices but instead on relationship form or relationship orientation as variable and central to the operations of sexual stratification in a contemporary

U.S. context. Despite being disadvantaged by heteronormativity, monogamous gay and lesbian couples still benefit from mononormativity to the extent they are or are perceived to be in long-term monogamous couple relationships. Because of heteronormativity, however, heterosexual couples reap far more material, social, and cultural benefits than gay or lesbian couples by being monogamous and coupled. The point here is not to dispute heteronormativity or replace it with mononormativity but instead to consider mononormativity as central to the operations of sexual inequalities by highlighting how being in a long term, monogamous, couple relationship gets one closer to being “normal” regardless of gender or sexual orientation. Just as same-gender relationships challenge the idea that the only legitimate and moral way to establish intimate, familial relationships is within the context of heterosexuality, polyamorists are motivated to challenge the idea that “the monogamous couple” is the only legitimate relationship form. Compulsory monogamy and mononormativity are codified in law as a prohibition against polygamy or plural marriage. As is the case with samegender couples in jurisdictions that have historically prohibited same-sex marriage, people who have more than one partner are also denied the benefits of legal marriage, such as tax, health, and inheritance benefits for all partners. As is the case with legally vulnerable same-gender couples, child custody is a large issue, and vulnerability for poly families either in terms of the threat of losing custody of children because of their assumed sexual deviance or in terms of relationship dissolution and no legal protection for primary caretakers who are not legally defined as parents or guardians. In her extensive research on polyamorous families with children, Elisabeth Sheff found that there is no evidence that polyamory has a detrimental effect on children’s well-being. In fact, Sheff suggests that multiple parental figures and caretakers benefits children and, much like the children of lesbian, gay, and bisexual (LGB) parents, children in poly families are more open-minded about difference and develop resilience in the face of social

Polyamory

stigma. Sheff’s findings were consistent with the findings of other researchers, such as Alex Iantaffi and Maria Pollotta-Chirarolli.

LGBTQ Politics and Polyamory The vast majority of research on self-described polyamorists is based on samples of heterosexual (or sometimes bisexual), middle-class, White populations. This is largely due to snowball sampling, participation in community organizing, and the unwillingness of vulnerable or marginalized populations to be public about their relationship status. African Americans and other racial and ethnic minorities, for instance, are less likely than White polyamorists to be open and public about being polyamorous. For this reason, some have become critical of a resulting polynormativity, or the idea that White, middle class, nonkinky, and heterosexual polyamorists are the standard against all forms of non-monogamy and polyamory are judged and establish rules for how to be or identify as polyamorous and advocate their own definition of “normal” in order to gain power and acceptance while stigmatizing nonconforming polyamory or marginalized populations. Indeed, non-monogamy was a feature of gay men’s culture and relationships long before the term polyamory emerged. The gay liberation movement of the 1960s was critical of heteronormative family values, including monogamy, and advocated nonpossessive sexual and emotional bonds among men. Nonrepresentative samples of gay male populations show that gay men are more likely to be consensually non-monogamous than to be monogamous. However, most of this research suggests that, while many gay men are in sexually non-monogamous relationships, most are emotionally monogamous, meaning polyamory, or emotional commitment to multiple partners is prohibited and considered infidelity. There is less research or other written material on polyamory in lesbian relationships. Celeste West wrote about the radical potential for polyamory in lesbian relationships, and in an anthology titled The Lesbian Polyamory Reader: Open

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Relationships, Non-Monogamy, and Casual Sex, several authors describe polyamory in their own lives and articulate arguments for lesbian polyamory as a way to form feminist bonds between women. Research suggests that polyamorous bisexual men and women find that having multiple partners makes bisexuality more visible. Among self-identified polyamorists, there is an acceptance, if not expectation and celebration, for women to be bisexual. Although there has been some recent change, there is a fair amount of resistance to male bisexuality in poly communities and therefore bisexual, polyamorous men report feeling a need to be secretive about being bisexual. PallottaChirolli finds that polyamory is a common strategy for making mixed-orientation relationships (straight woman as well as bisexual or gay man) work. Similarly, asexual individuals sometimes find that polyamory can open up possibilities for mixed orientation (sexual–asexual) relationships in ways monogamy would not. For some transgender individuals, polyamory can open up possibilities to embody gender fluidity in relationship to others and, to the extent that we develop a sense of gendered and sexual self in relationship to others, polyamory and other forms of non-monogamy have the potential to break down sexual and gender dichotomies. While there has been a recent increase in research on polyamory and polyamorists, much of it is on small, nonrepresentative samples. As was the case until quite recently with research on LGBT populations, polyamory remains, in many ways, in the “closet.” Mononormativity is so pervasive that, for many researchers, the idea of polyamory is nonexistent or so new that large-scale study of representative samples remains elusive. However, as polyamory becomes more visible in the mainstream media and polyamorists are more vocal about their lives, polyamory will become a legitimate and common area of study and, like same-gender relationships, could become a socially sanctioned, viable option for how to do relationships and families. Mimi Schippers

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See also Bisexualities; Heteronormativity; MixedOrientation Marriages; Monogamy and NonMonogamy; Monosexism

Further Readings Barker, M., & Langdridge, D. (Eds.). (2010). Understanding non-monogamies. New York, NY: Routledge. Easton, D., & Hardy, J. W. (2009). The ethical slut: A practical guide to polyamory, open relationships, and other adventures (2nd ed.). Berkeley, CA: Celestial Arts. Munson, M., & Stelboum, J. P. (Eds.). (1999). The lesbian polyamory reader. New York, NY: Routledge. Sheff, E. (2013). The polyamorist next door: Inside multiple-partner relationships and families. New York, NY: Rowman & Littlefield. Taormino, T. (2008). Opening up: A guide to creating and sustaining open relationships. San Francisco, CA: Cleis Press. Veaux, F., & Rickert, E. (2014). More than two: A practical guide to polyamory. Portland, OR: Thorntree Press. West, C. (1995). Lesbian polyfidelity. San Francisco, CA: Booklegger Publishing.

POPULATION-BASED SURVEYS, COLLECTION OF DATA ON SEXUAL ORIENTATION AND GENDER IDENTITY Much of what we know about the U.S. population in terms of demographics, health, military service, economic status, labor force participation, and a variety of other characteristics comes from surveys of the U.S. population administered by the federal government. For instance, the U.S. Census Bureau conducts the decennial census and other surveys to understand the demographics and characteristics of the U.S. population. State governments also conduct surveys to find out how the residents of their state are faring. These surveys are designed in a way so we can understand aspects about the full population of interest based on a smaller sample from that population.

The types of surveys that use a sample of survey respondents to draw inferences about the full population are called population-based surveys. With the exception of a few cases, governmentadministered–population-based surveys do not collect data on the sexual orientation or gender identity (including transgender status) of survey respondents. This results in a lack of critical population-based data about sexual and gender minorities, such as LGBTQ people, in the United States. This entry discusses the importance of sexual orientation and gender identity data collection in population-based surveys, describes some of the challenges of collecting this type of data, and outlines best practices for asking survey questions to identity sexual and gender minorities. Population-based surveys provide vital information to state and federal policy makers by demonstrating where needs exist in the population, such as in terms of health or economic indicators. This information can help policy makers allocate resources to address problems that are identified. For instance, using data from the National Health Interview Survey (NHIS), researchers can show which demographic groups in the United States have disproportionately poor health. Policy makers can then create programs to improve health among these groups. In the landmark 2011 Institute of Medicine (IOM) report, The Health of Lesbian, Gay, Bisexual, and Transgender People, the IOM found that the gaps in our understanding of LGBTQ people’s health were vast and population-based surveys were needed to improve our knowledge about LGBTQ health. A lack of population-based data about sexual and gender minorities limits what we know about this population, including needs and disparities that should be addressed. One challenge when designing questions about sexual orientation and gender identity in surveys is that of crafting questions that will accurately classify respondents as sexual or gender minorities. Questions must be carefully crafted to reduce errors a survey respondent may make in their response. One example of an error would be a survey respondent indicating by mistake that they are gay when they are actually heterosexual, or a

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survey respondent indicating they are transgender when they are not transgender. This type of error is particularly a problem when trying to identify a population of people that is relatively small compared with the general population. It would only take a small percentage of people who are not sexual or gender minorities to mistakenly identify themselves as such on a survey to flood those categories with those who should not be included. This would make the resulting data less meaningful, since findings would not be based on data from only sexual or gender minorities, but also from people who are not sexual or gender minorities. In that case, any differences or disparities that would otherwise be found for sexual or gender minorities could be hidden by those who are mistakenly included in those categories. Another challenge is to craft questions that will be understood and accurately answered by the many groups of people who will take the survey, such as youth, older adults, people of various races and ethnicities, and people who do not speak English as their first language. For instance, if a survey includes youth, asking questions about sexual identity (i.e., gay, straight, bisexual, and lesbian) may be less desirable than asking questions about sexual attraction (i.e., attraction to girls, boys, or neither). People who do not speak English as a first language may not be familiar with sexual-identity terms. To ensure the accuracy of the data, questions should be designed keeping in mind the diversity and needs of those who will be asked to respond. The Williams Institute at the UCLA School of Law has led two multiyear projects to research and outline best practices for identifying sexual and gender minorities on population-based surveys. The Sexual Minority Assessment Research Team (SMART) found that three aspects of sexual orientation could be accurately measured: sexual identity, sexual attraction, and sexual behavior. The aspect of sexual orientation one would choose to measure may be driven by the purpose of the survey (e.g., assessing demographics or assessing health) and the target population of the survey (e.g., youth, adults, or both). The Gender Identity

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in U.S. Surveillance (GenIUSS) group found that gender minorities can be identified by assessing both a survey respondent’s sex assigned at birth (male or female) and gender identity at the time of the survey (i.e., the “two-step” method). The GenIUSS group also studied measures to assess transgender identity, gender expression (i.e., masculinity and femininity), and a combined measure of LGBT identity. Best practices reports from both SMART and the GenIUSS group are available and have been utilized by survey administrators and advocates to help increase population-based data collection about sexual and gender minorities in the United States. Jody L. Herman See also “Big Data” Bias in LGBTQ Research; Demographics and the LGBTQ Population; Online Surveys; Quantitative Research; Research, Use of Large Datasets in

Further Readings The GenIUSS Group. (2014). Best practices for asking questions to identify transgender and other gender minority respondents on population-based surveys. Los Angeles, CA: Williams Institute. Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press. Sexual Minority Assessment Research Team. (2009). Best practices for asking questions about sexual orientation on surveys. Los Angeles, CA: Williams Institute.

PORNOGRAPHY The majority of research on pornography, to date, examines the topic of pornography through a heterosexual lens, and as such, far less attention has been allocated to materials that target sexual or gender minorities (i.e., lesbian, gay, bisexual, and trans* [LGBT*]) or persons interested in sexually explicit representations of these groups. The limited scholarly work focusing on lesbian, gay, and

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trans* (LGT*) pornographies will be reviewed briefly in this entry. It should be noted that research concerning bisexual pornography has not been included because (1) we were unable to locate any published studies that focus specifically on this type of material; (2) much of the pornography labeled as bisexual seems designed for a (presumably) heterosexual male audience; and (3) bisexual pornography isn’t delineated as clearly as its LGT* counterparts (Is the defining feature of this material the involvement of a bisexual performer, sexual interactions among two men and one woman or two women and one man, etc.?).

Gay Male Pornography Gay male pornography (GMP) refers to material— written, spoken, or visual—that emphasizes the erogenous zones of men’s bodies (e.g., buttocks, penis) and is intended to elicit sexual arousal in an audience that is presumably male. Much of the early research in this area was ensnared in a simplistic debate about the salubrious and insalubrious “effects” of GMP. Those occupying an anti-GMP stance, for example, asserted that the medium (1) offers an unrealistic interpretation of gay sexuality and thus the potential to contaminate viewers’ perceptions of physical attractiveness and sexual proficiency; (2) plays an influential role in faulty sexual decision making by normalizing high-risk practices such as unprotected (condom-free) anal intercourse (UAI); and (3) codes performers as more or less masculine based on the sexual roles they assumed (i.e., top [engaged in penetrative anal intercourse] versus bottom [engaged in receptive anal intercourse]) and, thus, reinforced homonegativity and misogyny. In contrast, GMP proponents argued that GMP (1) validates gay male sexual desire (i.e., it remains one of the few media to depict man-withman sexual activity); (2) provides instruction about the “mechanics” of gay sex; and (3) challenges the power differentials that may be evident in heterosexual pornography because, given its reciprocal nature, sex between men is not reducible to a male–female dynamic. Recent scholarship has abandoned this binary, opting for a multifaceted view of GMP and its consumers.

As an illustrative example, in a study published in 2014, Simon Corneau and Emily van der Meulen (a Canadian sexologist and criminologist, respectively) argued that viewers of GMP do not regard it as a monolithic entity but, rather, as a variegated medium, with five distinct forms of pornography identified: mellow, commercial, raunch, amateur, and bareback. Mellow GMP featured relational, “normal,” and safer sex. “Commercial,” on the other hand, was perceived as artificial both in terms of the sexual activities engaged in by performers as well as their physical appearance. “Raunch” was the label applied to GMP that depicted less “mainstream” practices such as group sex and bondage. “Amateur” GMP was characterized as depicting “real” people who were highly relatable to viewers. This category also elucidates the paramount role that technology now plays in pornography—a role that serves to blur traditional boundaries between performer and consumer. The fifth category, “bareback,” was regarded as “kinky” because it depicted UAI. As another example of current work in the realm of GMP, CJ Bishop (a Canadian doctoral student in psychology) published a review article in 2015 that delineated several frameworks that may be used to categorize research on this medium. One of the most intriguing is the polymorphous framework, which avoids moralistic, judgmental, and didactic views of pornography opting for a less judgmental and myopic interpretive lens. A diverse assortment of studies may be situated in this framework including phenomenological accounts by consumers and performers that attempt to grapple with the complexities of GMP; analysis of elements unique to this medium such as being gay for pay, which refers to men identifying as heterosexual appearing in GMP; and the intersection of this medium and more mainstream, popular culture (e.g., “slash manips”: photographic remixes of media with images extracted from gay pornography).

Lesbian Pornography Lesbian pornography (LP) may be defined as written, spoken, or visual material that highlights the erogenous zones of women’s bodies (e.g., breasts, vagina) and is intended to stimulate sexual arousal

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in women; thus, material that is intended for a male audience (i.e., “girl-on-girl” pornography) is not of central concern for this review. To some scholars, the paucity of research on LP compared with heterosexual and GMP attests to the stereotype that lesbian women are asexual. Research that captures the spectrum of work on this medium will be reviewed briefly. In a study published in 2005, Todd G. Morrison (a Canadian psychologist), in conjunction with one of his students, Dani Tallack, conducted focus groups with lesbian and bisexual (LB) women whereby participants watched two pornographic film clips: girl-on-girl (i.e., “ersatz” LP) and another that was designed for female viewers (i.e., lesbiantargeted pornography). The analysis revealed four themes concerning the ersatz pornography: (1) performers’ bodies were youthful, feminine, and heterosexual-looking; (2) there was a lack of verisimilitude; (3) there was an absence of emotional connection and intimacy among performers; and (4) the erotic interests of male viewers were paramount, as evidenced by the absence of butch lesbian women and emphasis on penetration. For the lesbian-targeted pornography, three themes emerged: (1) bodies were more “natural”-looking; (2) there was an emphasis on intimacy and emotion; and (3) minimal attention was paid to the erotic interests of male viewers. However, the authors highlighted that findings on the lesbiantargeted pornography were not straightforward (nor was this film clip necessarily preferred over the ersatz material). Some participants found the intimacy and emotion in the lesbian-targeted pornography to be forced and stereotypical and, at times, humorous. The authors concluded that LP should be studied from a multifaceted perspective that enquires into reactions based on offense, indifference, excitement, and amusement. In three separate studies conducted by Dana Collins, Natalie Ingraham, and Valarie Webber, the researchers approached LP through one-on-one interviews with participants who were, in some way, associated with the queer porn business. To better understand the lesbian pornographic scene in San Francisco, in 1998, Dana Collins, an American sociologist, conducted nine interviews: six with individuals directly connected to the

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production of LP (e.g., worked with the wellknown lesbian pornographic magazine On Our Backs) and three who were tangentially involved (e.g., affiliated with the local lesbian S–M community). Those involved in the production of pornography emphasized that the radical sex they depicted stems from concrete practices and experiences rather than overt political agendas. In a paper published in 2013, Natalie Ingraham, an American doctoral student in sociology, sought to study the social world of queer porn by interviewing eight participants who identified as queer; thus, some were lesbian women while others were not. The key finding was that queer women’s involvement in pornography was not contingent upon financial gains; instead, the freedom of expression pornography offered was highly valued. Finally, in a paper appearing in 2013, Valarie Webber, a Canadian graduate student in medical anthropology, interviewed eight nonexclusively heterosexual women who performed in camera-mediated girl-on-girl pornography often in the service of male clientele. Since the participants were involved in Web-based pornography through livecam technology, the researcher’s core finding revolved around the fluidity between the pornographic sex acts conducted on and off set. To date, quantitative findings on LP are derived from larger studies conducted on sexually explicit material. Two Norwegian studies are particularly noteworthy. Using a random sample of 10,000 respondents, a group of Norwegian social scientists, Bente Træen, Toril Sørheim Nilsen, and Hein Stigum, published a study in 2006 that found LB women were more likely to report having seen all forms of pornography (i.e., magazines, film, and Internet) as well as more frequent use in relation to their heterosexual women counterparts. Recently, in 2013, Bente Træen and Kristian Daneback used data from a random sample of 12,000 Norwegians. Again, rates of exposure were higher for lesbian or bisexual women than for their heterosexual counterparts (92% versus 67%, respectively). The authors also noted that women’s (including LB) use of pornography was considered an additional benefit to a “well-functioning sexlife” (p. 7), whereas for men, it was considered a less satisfactory substitution.

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Finally, Dana Collins and Margaret Henderson textually analyzed lesbian pornographic materials. Collins, in a study published in 1998, offered an in-depth analysis of On Our Backs—including an examination of photographs, entries, and interviews. She found the images in On Our Backs tended to be of White, young, thin, femme women but included diverse sexual practices. In a paper published in 2013, Margaret Henderson, an Australian academic, reviewed Wicked Women and Slit articulating differences between these Australian magazines and the American-based On Our Backs (e.g., the Australian publications were deemed activist porn created within pro-sex lesbian subcultures).

Trans* Pornography Trans* (transgender or transsexual) pornography involves individuals who are representative of a gender minority and have undertaken hormonal and/or some form of surgical transition prior to their participation. Compared to more established forms of alternative pornographies (e.g., GMP), trans* pornography is a relatively new construct that has been gaining visibility over the past 10 years. The scant research that is available on this topic may be stratified into two mutually exclusive ideologies. The first ideology focuses strictly on the commercialization of trans* pornography and notes its growing popularity among self-identified heterosexual men. Here, trans* porn is explicated as a space that is only occupied by trans* women who have undergone hormone replacement but not had their penis surgically made into a vagina. In an article published in 2011, Jeffrey Escoffier, an American independent scholar, noted that many of the trans* women who enter pornography (and other elements of the sex trade) do so because it is lucrative and can fund an expensive sex reassignment surgery (SRS). However, once a trans* woman performer undergoes “bottom” surgery, she renders herself undesirable to those aroused by a woman who possesses a penis. As a result, some performers choose to forgo SRS to ensure they can maintain their status as a desirable (and subsequently high-earning) pornography performer.

The colloquial naming of such material has been met with controversy in that it relies upon politically incorrect terminology as marketing fodder (e.g., “tranny porn,” “chicks with dicks,” “shemale porn”). While prejudicial language is used to identify and promote the pornographic material described in this ideology, scholars have noted that this material is transgressive because it offers visibility to trans* women and problematizes heterosexual attraction. The second ideology does not focus exclusively on one type of gender-minority identity; instead, it focuses upon the struggle many trans* individuals experience in their attempt to achieve greater visibility (e.g., Buck Angel, a trans* man pornography performer). Literature within this ideology focuses on how there is a form of collective cognitive dissonance among trans* individuals when it comes to pornography. On the one hand, it provides a form of visibility both of their bodies and sexuality; on the other hand, there is concern that any gains made in the public spheres of medical access and tolerance may be eroded. Trans* pornography requires significant expansion in its research efforts within both ideologies. Within the first ideology, empirically based research involving consumers would provide evidence either for or against the speculative assertions made in the available literature. The consumption rates of other forms of trans* pornography (e.g., scenarios and situations involving trans* women) also requires empirical inquiry. The second ideology would benefit from qualitative data being collected from trans* individuals themselves to better understand their perceptions and opinions on the (potential) benefits and pitfalls of trans* representations in pornography. Todd G. Morrison, Elly-Jean Nielsen, and CJ Bishop See also Film; Kink; Media Representations of LGBTQ People; Visual Arts

Further Readings Bishop, CJ. (2015). ‘Cocked, locked, and ready to fuck?’: A synthesis and review of the gay male pornography literature [Special issue]. Psychology & Sexuality, 6(1), 5–27. doi:10.1080/19419899.2014.983739

Posttraumatic Stress Collins, D. (1998). Lesbian pornographic production: Creating social/cultural spaces for subverting representations of sexuality. Berkeley Journal of Sociology, 43, 31–62. Corneau, S., & Van Der Meulen, E. (2014). Some like it mellow: On gay men complicating pornography discourses. Journal of Homosexuality, 61, 491–510. Escoffier, J. (2011). Imagining the she/male: Pornography and the transsexualization of the heterosexual male. Studies in Gender and Sexuality, 12, 268–281. Morrison, T. G., & Tallack, D. (2005). Lesbian and bisexual women’s interpretations of lesbian and ersatz lesbian pornography. Sexuality & Culture, 9(2), 3–30. Phillips, J. (2005). Walking on the wild side: She/male Internet pornography. In L. Z. Sigel (Ed.) International exposure: Perspectives on modern European pornography (pp. 255–274). New Brunswick, NJ: Rutgers University Press. Traeen, B., & Daneback, K. (2013). The use of pornography and sexual behaviour among Norwegian men and women of differing sexual orientation. Sexologies, 22(2), 69–74.

POSTTRAUMATIC STRESS The mental health diagnosis of posttraumatic stress disorder (PTSD) disproportionately affects LGBTQ individuals, who experience elevated rates of trauma due to discrimination, victimization, and oppression. Despite the fact that relatively few research studies directly address PTSD and related conditions among LGBTQ populations, a number of specific stressors that may result in PTSD are discussed in this entry.

Defining Posttraumatic Stress The diagnostic category of PTSD is a relatively recent one in the psychiatric literature, having been first codified in 1980 with the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is a relatively unique diagnosis in that, in contrast to other well-known disorders such as depression, schizophrenia, or eating disorders, the proximal cause of

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the disorder (the trauma or traumas that have occurred) is known and is clearly defined in the diagnostic criteria. This aspect of the diagnosis has created controversy around what events, or types of events, should be included as meeting criteria for PTSD. Although earlier conceptualizations of PTSD focused almost exclusively on military combat trauma, natural disasters, or accidents (such as motor vehicle collisions), a growing body of literature has focused on interpersonal traumas that might lead to PTSD, such as rape and sexual assault. Of particular relevance to LGBTQ populations are events that stem from prejudice or discrimination that, while not necessarily meeting the most recent, fifth-edition (DSM–5) threshold of experiencing an event that involves actual or potential death, injury, or sexual assault, may still have a significant psychological impact upon the individual. Noted PTSD researcher Edna Foa has postulated that in the wake of a trauma, individuals with PTSD experience two primary changes in their thought patterns, or cognitions. These are the development of a belief that (1) the world is inherently dangerous, and (2) they are particularly vulnerable to experiencing such danger. In considering these cognitions within the context of Ilan H. Meyer’s minority stress model, which hypothesizes that sexual and gender minorities experience elevated rates of stress due to both proximal and distal stressors that are unique to the sexualminority experience, it seems plausible that LGBTQ individuals would have higher rates of PTSD than found in the general population.

Trauma Among LGBTQ Populations Rates of trauma exposure are indeed quite high among individuals who identify as LGBTQ and appear to be elevated in comparison with heterosexual individuals. In childhood, verbal victimization has been reported by as many as four fifths of sexual-minority individuals, along with elevated rates of physical and sexual victimization. Transgender and gender-nonconforming (TGNC) individuals also experience greater trauma exposure. Youth who report greater gender atypicality (i.e., their behavior and appearance do not conform to

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male–female gender roles) have even higher rates of victimization and associated psychological distress. It is possible that bullies target individuals on the basis of perceiving gender atypical behaviors, policing the gendered expressions and mannerisms of LGBTQ youth, and subsequently perpetrating traumas against them. The coming-out process is also a period in which LGBTQ individuals may experience traumas that could later lead to PTSD. Although there is considerable variation in the process from person to person, one way of conceptualizing the environment in which an LGBTQ individual comes out is through Uri Bronfenbrenner’s ecological systems theory. In this model, the individual is perceived as being influenced by a series of systems, from the individuals with whom one interacts directly (the microsystem) to the larger cultural context in which the person lives (the macrosystem), and all of the levels in between. When coming out, it is possible that a person’s immediate microsystem, such as parents or friends at school or at work, might respond relatively well to the revelation of a minority identity. However, this might occur in a broader context in which attitudes toward LGBTQ individuals are quite negative, represented by legislated inequalities and oppressive policies. Of course, the opposite may also be true—the negative impact of coming out to others who are less receptive may be buffered by living in a generally LGBTQfriendly environment. By adulthood, most sexual minorities have experienced at least one potentially traumatic event, and they more frequently endorse clinically significant symptoms of PTSD than the general population. Still higher rates of potentially traumatic events and PTSD symptoms have been reported by transgender adults. Despite these elevations, the preponderance of trauma research fails to collect comprehensive data on participants’ sexual orientation and gender identity, making it difficult to estimate differences in PTSD symptoms between sexual-minority and heterosexual populations. Unique stressors that are not captured by current definitions of PTSD, such as

microaggressions and experiences of marginalization, further complicate our understanding of trauma and resulting mental health concerns among LGBTQ individuals.

Comorbidity As with many other mental health conditions, PTSD often occurs in combination with other disorders, a phenomenon referred to as comorbidity, or co-occurring disorders. Frequently, comorbid conditions include other anxiety disorders, depression and related disorders, and substance use disorders. It is sometimes difficult to determine the reason for comorbidity (e.g., Did PTSD lead to the co-occuring disorder, or did PTSD indirectly contribute to the co-occurring disorder?). In some cases, for example, a person dealing with PTSD may ultimately also develop depression, perhaps as a result of having limited social interactions with others. Correspondingly, people with another mental health condition, such as a substance use disorder, may be exposed to violence that could lead to a subsequent PTSD diagnosis. For LGBTQ individuals who experience PTSD, the likelihood of another comorbid disorder is significant and further compounds the health disparities that sexual and gender minorities face. While sexual and gender minorities may experience the same types of traumatic events as nonLGBTQ individuals, they face additional threats of violence specific to their minority status. Depending on the individual, sexual and gender minorities may encounter intersecting homophobic, transphobic, sexist, and racist sentiments that pose a threat to their physical and mental well-being. Transwomen of color, in particular, report some of the highest rates of victimization among any marginalized group, most likely attributable to these mounting biases. Experiencing hate crimes and victimization due to one’s sexual orientation or gender identity may increase the likelihood of developing PTSD, depression, and a variety of other psychological disorders. In addition to the risk of direct victimization, LGBTQ individuals navigate cultural and media

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messages that report (and sometimes advocate for) violence against sexual and gender minorities. Cultural victimization refers to repeated exposure to these messages and their potential to result in cognitions mirroring those of PTSD. For example, learning about hate crimes experienced by an LGBTQ community in Texas may affect the psychological well-being and sense of safety of an LGBTQ person in New York. These current events are compounded by historical traumas, such as the criminalization of same-sex sexuality and publicized murders of sexual and gender minorities, which are entrenched in the LGBTQ narrative. Thus, it is possible that posttraumatic stress among sexual and gender minorities may be influenced by stressors not encapsulated by the DSM–5 PTSD criteria. The HIV pandemic is also relevant to LGBTQ people’s experiences of traumatic stress. In the early years of the pandemic, entire communities were devastated due to the high lethality of HIV infection. Finding out about one’s HIV-positive status has been frequently considered a traumatic event that might qualify as an impetus for PTSD. Additionally, navigating safe sex practices has led to a necessary hypervigilance for many individuals that has equated sexuality with potentially traumatic outcomes. Finally, the historical trauma experiences of those who witnessed the infection and often death of members of the LGBTQ community has led to, in many individuals, a sense of a foreshortened future—the feeling that being a sexual minority might lead to an inevitably shorter life span. Thus, whether affected directly or indirectly by the HIV pandemic, LGBTQ individuals are exposed to various levels of traumatic stress in the wake of the disease.

Conclusion While little research directly addresses the diagnosis of PTSD among LGBTQ individuals specifically, we do know a considerable amount about minority stress that disproportionately affects sexual and gender minorities. For example, the current version of the DSM notes that people

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diagnosed with PTSD typically have symptoms in four primary domains: intrusive symptoms, such as distressing nightmares or heightened reactivity to trauma-related stimuli; avoidance of reminders of the trauma; negative changes in thought patterns and mood; and hyperarousal or hyperreactivity. Because these reactions following a trauma are quite common, the DSM–5 denotes a marker of one month, after which symptoms are considered persistent enough to qualify for the diagnosis. However, PTSD research has rarely focused on LGBTQ populations, or even asked about LGBTQ identity; therefore, it is unclear whether or not reactions to sexual-minority–specific stressors would result in the same constellation of symptoms for LGBTQ individuals as it would for the general population. Future research in this area is needed to clarify how sexual and/or gender identity–related stressors may affect trauma exposure among LGBTQ populations. Bryan N. Cochran and Hillary A. Gleason See also Hate Crimes; Minority Stress; Sexual Minorities and Violence; Transgender People and Violence; Violence and Victimization of Youth

Further Readings D’Augelli, A. R., Grossman, A. H., & Starks, M. T. (2006). Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth. Journal of Interpersonal Violence, 21(11), 1462–1482. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. New York, NY: Guilford Press. Neisen, J. H. (1993). Healing from cultural victimization: Recovery from shame due to heterosexism. Journal of Gay & Lesbian Psychotherapy, 2(1), 49–63. Nemeroff, C. B., Bremmer, J. D., Foa, D. B., Mayberg, H. S., North, C. S., & Stein, M. B. (2006). Posttraumatic stress disorder: A state-of-the-science review. Journal of Psychiatric Research, 40(1), 1–21. Roberts, A. L., Austin, S. B., Corliss, H. L., Vandermorris, A. K., & Koenen, K. C. (2010). Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. American Journal of Public Health, 100(12), 2433–2441.

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Shipherd, J. C., Maguen, S., Skidmore, W. C., & Abramovitz, S. M. (2011). Potentially traumatic events in a transgender sample: Frequency and associated symptoms. Traumatology, 17(2), 56–67. Troiden, R. R. (1988). Homosexual identity development. Journal of Adolescent Health Care, 9(2), 105–113.

POVERTY This entry describes poverty in the LGBTQ population, including what we know about poverty rates, the factors that influence poverty in these populations, the ways that systemic inequalities shape inequality, recent research about LGBTQ people living in poverty, and LGBTQ poverty in the global context. Summarizing and explaining poverty in the LGBTQ population is challenging for two reasons. First, the term poverty carries different meanings depending on who is using it—for example, government agencies or researchers. Second, the LGBTQ population is not a homogeneous group. Gender and sexual-identity differences, as well as other characteristics such as age, race, ethnicity, ability status, family composition, citizenship status, and geographic location, are all connected to poverty and resources. Here, the term LGBTQ population is used when referencing general themes. When data collection or evidence is specific to one or more segments of the population, the entry uses more specific terms as they are used by researchers.

What Is Poverty? Estimates of how many people live in poverty and explanations of the causes of poverty depend on how poverty is defined. U.S. government statistics and state welfare agencies rely on an official measure of poverty based on family size and income. Official measures are intended to pinpoint a threshold income for subsistence living. Although useful for public policy, such thresholds have been criticized by social researchers who suggest that they are outdated and lead to underestimates of people living in poverty. It is important to know

that many people who live below the official poverty line may have incomes far below the line, while others may have incomes nearer to the line. Still, others may not be officially considered to be poor but have incomes that are only slightly above the official threshold. Thus, some researchers use alternative measures of poverty. Poverty literature also distinguishes between absolute poverty, when the lack of resources is life-threatening, and relative poverty, the lack of resources in relation to others who have more. In this entry, we most often rely on government thresholds to indicate poverty, but we also refer to other measures of income that suggest absolute poverty in some cases and relative poverty in other situations.

Poverty in the LGBTQ Population The heterogeneity of the LGBTQ population means that estimates of poverty differ by subgroup. Furthermore, the measurement of data about LGBTQ populations is uneven, and in some cases, nationally representative data are unavailable. Poverty rates that rely on U.S. Census statistics are based on “family poverty” and are only able to capture same-sex cohabiting couples, not poverty among LGBTQ people who are not cohabiting. Other nationally representative surveys rely on self-reported sexual orientation to capture poverty status for individuals, regardless of their relationship status. In a recent report written for the Williams Institute, authors M. V. Lee Badgett, Laura E. Durso, and Alyssa Schneebaum summarize what is known about the prevalence of poverty in the lesbian, gay, and bisexual (LGB) community. Data from the National Survey of Family Growth (2006–2010) suggest that LGB individuals are more likely to report being in poverty than heterosexuals. While 15.3% of heterosexual men report being at or below the poverty level, 20.5% of gay men and 25.9% of bisexual men are at or below the federal poverty line. Women are more likely than men to be in poverty. About 21% of heterosexually identified women are in poverty, versus 29.4% of bisexual women and 22.7% of lesbians.

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The Williams Institute report also includes poverty among same-sex couples based on 2010 American Community Survey (ACS) data. These statistics show that women in same-sex cohabiting couples are more likely to be in poverty than married women in opposite-sex couples (7.6% versus 5.7%). Lesbian couples are less likely to be poor than cohabiting heterosexual women who are not married, however (14.1% of whom live in poverty). The story is different for male same-sex couples, who are less likely to be in poverty than both married and cohabiting heterosexual couples (4.3% versus 5.7% and 14.1%, respectively). There is very little information on poverty rates for the transgender population. A 2011 report based on the National Transgender Discrimination Survey (NTDS) provides the most current national information about the economic vulnerability of the transgender and gender-nonconforming (TGNC) population in the United States. According to the NTDS, 15% of TGNC people surveyed had an annual household income under $10,000, compared to only 4% of the general population. Other social characteristics that make people more vulnerable to poverty also influence poverty in LGBTQ communities. Racial and ethnic minorities, women (particularly single mothers), children, and people with disabilities all face greater chances of poverty. Therefore, in addition to the differences between LGBTQ people, there are also differences within each group that are related to poverty. Race and ethnicity influence poverty in the LGBTQ population. For example, comparing all same-sex couples, poverty is most prevalent among African American lesbian couples. And although gay male couples generally have lower poverty rates than heterosexual couples, that does not hold true for African American gay male couples, who have much higher poverty rates than married heterosexual African American couples. Although national poverty statistics for transmen and transwomen are unavailable, the NTDS found very high unemployment among transgender people of color. In general, younger people report greater poverty than older people, and the same patterns hold in the lesbian and gay population. The highest

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rates of poverty are found among those who are under 25. According to the Williams Institute report, both lesbian and gay couples with children are more likely than heterosexual married couples with children to be poor, with 19.2% of male same-sex couples and 15.4% of female same-sex couples in poverty, compared to only 9.3% of married heterosexual couples. Having a functional disability is related to greater poverty among lesbian couples, but this is not the case among male same-sex couples.

Current Resources and Programs for Alleviating Poverty Many of the social resources and programs that are in place to eliminate or alleviate poverty in the United States were put into place as part of President Roosevelt’s New Deal and President Johnson’s War on Poverty. Because many of the antipoverty resources and programs have origins that reflect and support the traditional nuclear family, they are structured in a way that in some cases offers less support for LGBTQ population. Government programs and policies such as Social Security and family tax credits are all based on definitions of the family that exclude same-sex couples. Private charities intended to help those in poverty and the homeless may also privilege heterosexual and gender-conforming women and men. The Social Security system contains provisions that are intended to reduce old-age income insecurity but may differentially affect LBGTQ populations. Social Security guidelines include spousal benefits so that lower-earning spouses (or homemakers) can collect a portion of Social Security on the basis of their spouse’s earnings. Further, widows and widowers can collect survivor benefits of the full Social Security payments. Because these Social Security payments are based on federally recognized marriages only, lesbian and gay couples were not eligible for these federal benefits prior to the June 2015 Supreme Court ruling in Obergefell v. Hodges. Other federal policies intended to reduce poverty, such as the earned income tax credit, may

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help to prevent poverty among vulnerable workers. Such policies may be especially helpful for workers who are most disadvantaged, including lesbian and bisexual (LB) women, parents, racial or ethnic minorities, and disabled members of the LGBTQ population. In fact, some evidence suggests that the LGB population is in greater need of public assistance. Comparisons of same-sex and opposite-sex couples show that lesbian and gay couples are more likely to receive cash assistance and food stamps. Other policies and programs that may help to alleviate poverty that is rooted specifically in LGBTQ experience are discussed in further detail next. Such policies include anti-discrimination legislation, expansion of marital rights to include same-sex couples, better access to quality health care, affordable housing, and policies to expand educational access, such as anti-bullying efforts.

Obstacles to Overcoming Poverty The LGBTQ population confronts many obstacles to overcoming poverty. Activists point out that the pervasive stereotypes of LGBTQ people as affluent limits deeper investigations into the many economic challenges faced by members of LGBTQ communities. Indeed, the data about poverty in the LGBTQ contradict this stereotype. Although many of the factors that explain poverty in the general population operate similarly in the LBGTQ population, several factors uniquely contribute to the greater prevalence of poverty among some LGBTQ populations. Employment discrimination, restrictions on retirement and health insurance plans, disparities in health care, housing discrimination, and educational opportunities are all linked to poverty. In some cases, such factors have disproportionate effects on some segments of the LGBTQ population. For example, transwomen and transmen may be burdened by steep medical costs that cause financial strain. Access to paid employment is the cornerstone of escaping poverty. Federal law offers no protections against employment discrimination based on LGBTQ status. While 21 states do offer protection

based on sexual orientation, only 18 states prohibit discrimination on the basis of gender identity. Research indicates that employment discrimination based on sexual orientation and gender identity are related to lower earnings and greater unemployment. Reliable research on lesbians’ and gay men’s earnings supports the contention that gay men earn less than heterosexual men, although findings concerning lesbians’ earnings are less clear. TGNC individuals report high rates of workplace discrimination; nearly half of respondents on a recent survey reported discrimination because of their gender identity and unemployment rates much higher than the general U.S. population. Restrictions on retirement plans can have adverse economic consequences in old age. In addition to the structural constraints of Social Security mentioned previously, employer-provided and commercial retirement accounts can result in lower income in old age among same-sex couples. Although not directly about poverty, limited research suggests that lesbian couples, in particular, have lower retirement income than other couples. More data is needed to better understand poverty in old age in the LGBTQ community, particularly for transgendered people. Legal restrictions that do not recognize samesex couples have implications for access to health insurance, and a lack of affordable health insurance is connected to negative health outcomes. In general, those in poverty have worse health than others. Thus, the combination of greater chances of poverty combine with less access to health insurance coverage means that LGB populations may have worse health outcomes than others, although better information is needed to directly address health in the LGB population. The evidence from the TGNC population indicates problems with health care providers and worse health outcomes, particularly for those who are unemployed or working in the underground economy. According to the NTDS, nearly one fifth of TGNC people reported being refused medical care on the basis of their TGNC status. One persistent social problem related to poverty is homelessness. Evidence suggests high rates of

Poverty

homelessness in the LGBTQ population. A large proportion of homeless people identify as lesbian, gay, bisexual, and transgender (LGBT). In one survey on discrimination, nearly 20% of TGNC people had experienced homelessness at some point in their lives. While homelessness is a result of many factors, the lack of legal protection based on sexual orientation and gender identity in housing policies serves as an obstacle to reliable housing and economic stability. At the time of writing, only 18 U.S. states offer legal protections for discrimination based on sexual orientation and gender identity, and three more prohibit discrimination based on sexual orientation only. Reports by TGNC individuals of being refused a home or apartment and being evicted on the basis of their gender identity suggest that housing security is a significant issue for this population. Education level is directly related to earnings; thus, educational opportunities are important as a route out of poverty. Despite the fact that LGBT people have higher education levels on average than the population as a whole, two factors related to education have especially negative implications for LGBTQ populations. First, low educational levels have greater consequences for some LGBTQ populations. For example, members of lesbian couples with lower education are especially vulnerable to poverty; those with just some college experience and less are more likely than married opposite-sex couples and gay men to be in poverty. Second, LGBT youth experience a great deal of harassment and discrimination in schools from other students and from teachers. Such experiences can lead students to leave school and seek alternative routes to education, such as obtaining a GED rather than completing high school. Only 19 U.S. states legally protect LGBT students from harassment or bullying.

The Experience of Living in Poverty Living in poverty is always a challenge. For those people who face discrimination, harassment, and marginalization because of their sexual orientation or gender identity, economic need can compound

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the difficulties. The safety nets that many people in poverty draw on—governmental resources, private charity, and family—are not always readily available for those in the LGBTQ population. Official government criteria that privilege the non-LGBTQ population, biases of those working in private charities, and rejection by family members can make overcoming poverty in daily life especially difficult. Some problems related to living in poverty that may be greater in the LGBTQ population include a higher risk of homelessness and negative health outcomes.

LGBTQ Poverty Around the World The invisibility of LGBTQ poverty in poverty statistics in the United States is replicated throughout the world. Statistics about LGBTQ poverty are rare and difficult to find (and measure) in other industrialized nations as well as the poorer nations, sometimes referred to as the Global South. Some evidence suggests that poverty may be lower in Western industrialized nations and much greater in more economically disadvantaged parts of the world. Lower poverty rates in some industrialized nations, such as Sweden and Germany, combined with greater legal protections for LGBTQ populations, may result in less poverty for LGBTQ individuals in these nations. Yet in the United Kingdom, which offers the greatest legal protections for LBGT people in Europe, there is evidence to suggest the existence of material disadvantage based on sexual orientation and gender identity. Furthermore, some industrialized nations have far fewer protections for LBGTQ populations, and some, such as the Russian Federation, restrict public discourse about LGBTQ relationships. Such policies signify a lack of support for LGBTQ populations that is likely reflected in economic standing as well. When poverty is higher in poorer nations more generally, LGBTQ populations may be at an even larger disadvantage. Global inequality means that poorer nations are economically disadvantaged in part because of their status as former colonies. While there is a great deal of variation across nations,

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many nations offer few legal protections for LGBTQ people, and others criminalize same-sex relationships. For example, both Uganda and Nigeria have passed strict “anti-homosexuality” legislation that criminalizes same-sex relationships. In 10 nations, homosexuality may carry with it a death sentence: Iran, Iraq, Mauritania, Nigeria, Qatar, Saudi Arabia, Somalia, Sudan, the United Arab Emirates, and Yemen. Given the generally low economic resources of people in these nations, combined with hostile political climates, LGBTQ populations are especially vulnerable to poverty. For example, one 2012 report by the Global Men’s Health and Rights study indicates that in Uganda men who have sex with men (MSM) are especially prone to poverty and homelessness. More research is required in order to develop a complete picture of poverty among LGBTQ populations in international comparison. Until recently, it has been difficult to find reliable data on demographic characteristics of the LGBTQ population, and serious gaps in data collection still exist. As a result, making generalizable statements about poverty in the LGBTQ community is challenging. Nevertheless, researchers are building a foundation to better understand the prevalence and experiences of poverty in the LGBTQ communities. As mainstream research on poverty becomes more inclusive, large-scale survey research begins to ask more questions about sexual identity, and advocacy groups carry out more research, more will be known about these issues. Anastasia Prokos and Sela Harcey See also Demographics and the LGBTQ Population; Homelessness; Social Class; Workplace Discrimination

Further Readings Albelda, R., Badgett, M. V. L., Gates, G. J., & Schneebaum, A. (2009). Poverty in the lesbian, gay, and bisexual community. Los Angeles, CA: Williams Institute. American Psychological Association. (2014). Lesbian, gay, bisexual, and transgender persons & socioeconomic status. Retrieved September 2, 2014, from http://www .apa.org/pi/ses/resources/publications/factsheet-lgbt.pdf

Badgett, M. V. L., Durso, L.E., & Schneebaum, A. (2013). New patterns of poverty in the lesbian, gay, and bisexual community. Los Angeles, CA: Williams Institute. Goldberg, N. G. (2009). The impact of inequality for same-sex partners in employer-sponsored retirement plans. Los Angeles, CA: Williams Institute. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Human Rights Campaign. (2014). Maps of state laws and policies. Retrieved September 2, 2014, from http:// www.hrc.org/resources/entry/maps-of-state-lawspolicies Prokos, A. H., & Keene, J. R. (2010). Poverty among cohabiting gay and lesbian, and married and cohabiting heterosexual families. Journal of Family Issues, 31, 934–959. Uhrig, S. C. (2014). An examination of poverty and sexual orientation in the UK (ISER Working Paper Series. No. 2014–02). Colchester, England: Institute for Social & Economic Research.

POWERS

OF

ATTORNEY

A power of attorney is a legal document that delegates authority to make certain decisions from one person (the principal) to another person (the agent). It is typically, though not exclusively, used as an advanced planning tool to deal with the problem of incapacity. This is the situation in which the law has deemed an individual to lack the ability to make decisions on her own, creating the need for assistance from a substitute decision maker or supportive network. This entry discusses the different types of powers of attorney, the ways in which agent conduct is regulated by law, and the importance of this legal tool for LGBTQ populations. Powers of attorney are limited in time and scope. The principal may make the power of attorney effective at the time of execution or when a particular event occurs, such as the incapacity of the principal. The principal may also select whether

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the power of attorney is durable or not. Powers of attorney that are not durable expire when the principal loses capacity. The logic behind this version of the tool is that it should no longer be effective because the incapacitated principal can no longer monitor the activities of the agent for wrongdoing. Most powers of attorney, however, are durable and last past the point of incapacity of the principal. The authority granted in a power of attorney is often restricted to a particular decisional domain, and the two most common domains are property and health care. The former concerns powers of financial decision making, such as managing bank accounts, while the latter encompasses decision making around health care, such as selecting medical treatment options. Powers of attorney may provide the agent a general grant of authority, a specific grant of authority, or both. General grants of authority are simpler and give the agent the flexibility to deal with a variety of circumstances. With such broad powers, however, there is a risk that the agent may make certain types of decisions that the principal did not intend or that might not be in the principal’s best interests. Because of this possibility for abuse, some courts have been reluctant to enforce general powers of attorney in certain situations. For example, an agent acting under a general power of attorney for property may not be permitted to make large monetary gifts on behalf of the principal or change the beneficiary designation on the principal’s insurance policy without specifically being granted the power to do so. Thus, a general power of attorney may need to be supplemented with several specific grants of authority for controversial powers in order to be maximally effective. Alternatively, a principal may only want to delegate tailored powers to an agent in anticipation of a specific circumstance. Some decisions may be deemed too personal to delegate at all, such as the decision to divorce or to write a will. The enforceability of powers of attorney delegating such controversial decisions is uncertain, and there is significant debate over whether there should be a blanket prohibition on such delegation. Restricting an agent’s powers is one way of preventing exploitation, but fiduciary law also

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provides a check on agent misbehavior. Fiduciary law governs legal relationships of trust, and fiduciaries must adhere to certain duties, such as the duty of loyalty to the principal and the duty of care in making decisions. Once a principal lacks capacity, many states are not clear on whether an agent acting under a durable power of attorney must make decisions that she believes the principal would have made if the principal had capacity or whether an agent must make decisions that are in the best interests of the principal. If an agent is found guilty of misconduct, the remedies that fiduciary law provides are typically severe, including removing any benefits that might have accrued to the agent. Powers of attorney hold special importance for LGBTQ populations. To appreciate why, one must understand the default rules that govern surrogate decision making in the absence of powers of attorney, as well as the legal and social position of many LGBTQ individuals in society. In the health care domain, most states automatically empower a surrogate decision maker upon a finding of incapacity. Surrogates are selected from a hierarchical list, with the spouse typically at the top, followed by more distant familial relations. In the personal or financial realms, states require a guardianship in order to obtain legal decision-making authority. Courts sometimes rely on the same type of hierarchical list in selecting an appropriate guardian. Many LGBTQ individuals may be estranged from their biological relations because of their sexual orientation or gender identity; thus, those lists may not represent the best selection of potential decision makers. Powers of attorney can help remedy this problem by allowing LGBTQ individuals to select a decision maker who may not conform to default legal rules or societal expectations. It is also an alternative to guardianship, which can be a more public, cumbersome, and expensive legal process. This is not to say that powers of attorney are a panacea. The agent needs to have the document at the ready to convince the relevant entities, such as banks and hospitals, that she has the legal authority to make decisions on behalf of the principal. In addition, staff at financial or health care institutions may refuse to acknowledge the legal

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document’s effect due to prejudice based on sexual orientation or gender identity. Alexander A. Boni-Saenz See also Advance Health Care Planning; Legal Recognition of Nonmarital Same-Sex Relationships; Wills and Trusts

Further Readings Boni-Saenz, A. A. (2013). Personal delegations. Brooklyn Law Review, 78, 1231–1278. Boxx, K. E. (2001). The durable power of attorney’s place in the family of fiduciary relationships. Georgia Law Review, 36, 1–62. DuBois, M. (1999). Legal planning for gay, lesbian, and nontraditional elders. Albany Law Review, 63, 263–332. Whitton, L. S. (2007). Durable powers as an alternative to guardianship: Lessons we have learned. Stetson Law Review, 37, 7–52.

PRISON RAPE Prison rape is a type of sexual assault in which an individual, while incarcerated or working in a detention facility, is forced to engage in involuntary masturbation and/or anal, oral, or vaginal intercourse. Prison rape can be perpetrated by inmates, facility guards, or staff members. Individuals whom identify as LGBTQ are at a higher risk of sexual assault while incarcerated. Prison rape is highly underreported due to prisoner social codes and the lack of available reporting mechanisms. The public often lacks information about prison rape and relies on popular media to frame the issue.

History Before the 21st century, prison rape was rarely reported in the United States. Documentation consisted of memoirs, academic studies, and legal cases—most of which pertained to a select number of institutions. Many institutions lacked federal and state guidance about the problem, particularly for LGBTQ individuals, and often did not report

incidents of prison rape. Even though there is a lack of empirical data about both consensual and coerced sexual acts in prison, researchers began investigating prison rape partly because of an increase of HIV-positive inmates who had been HIV-negative prior to incarceration. In 2001, the Human Rights Watch conducted a study across several federal penitentiaries in the United States about sexual assault and prison rape. The report was the first of its kind to collect comprehensive data and highlight the scope of human rights violations occurring in the U.S. penal system. In 2003, President George W. Bush signed into legislation the Prison Rape Elimination Act (PREA), which instituted federal monitoring and the annual collection of prison rape statistics. The PREA provides standards for how to address, detect, and prevent sexual assault in detention centers, and it allows individuals to anonymously report an incident without fear of reprisal. In 2012, the Bureau of Justice reported that 4% of federally incarcerated individuals had been raped once or more during the previous year. However, the PREA collects data from only 10% of federal detention facilities each year; therefore, the number of incidents is still highly underreported.

Prison Rape and Gender or Sexuality In the prison system, rape can function as a method of ascribing gender and sex. Male individuals who are raped are sometimes identified with female names or pronouns. Individuals who position themselves as the penetrator (often the perpetrator of rape) are seen as male, and individuals who are penetrated are seen as female. The roles do not correspond with an individual’s avowed sexual or gender identity. Under the constant threat of rape, some individuals take on coerced sexual positions, such as accepting a “prison husband” or “daddy” (an individual who offers protection in exchange for sexual favors). On occasion, individuals are used as property by prison gangs whereby sexual acts are exchanged between various prison groups or individuals for the service of goods. Transgender individuals are at a higher risk of prison rape due to the prison classification system.

Prison Rape

Often, individuals are classified based on genitalia, or on gender assigned at birth, regardless of where they are in their gender identity and expression transition. Due to the concern of socialization and physical abuse, some institutions provide specific housing areas for LGBTQ individuals. Italy was the first country to provide a specific penitentiary for transgender-identified individuals. Furthermore, prison rape impairs the social, psychological, and physiological well-being of incarcerated LGBTQ people. Individuals who experience prison rape have higher levels of posttraumatic stress and are at a higher risk of committing suicide or obtaining a sexually transmitted infection (STI). Even though the PREA identifies individuals who have experienced prison rape, the number of individuals who obtain a STI through prison rape is undocumented.

The Prison Social Structure and Silence Prison rape is difficult to document because of the conflict and collusion between inmates and guards and the two social structures they produce. Both structures have social codes that are implicit and explicit and constrain individuals’ ability to report sexual abuse. Individuals who name their abusers are breaking social codes and can be labeled a “snitch.” Labels in prison can have life-threatening consequences, particularly if an individual is a threat to the social structure. Rape also functions as a method of maintaining the balance of power between the guards and inmates. Since the inmate social structure ensures that prison rape is highly underreported, some guards allow rape as an acceptable social practice. Guards or staff members enable prison rape by assisting inmates or by not protecting those individuals who are high risk. Penitentiaries that house females report the highest number of incidents committed by inmates, guards, and staff.

Prison Rape and Popular Media Rape and gender in prison are often framed through the cultural discourse found in popular media. Phrases such as “don’t drop the soap,”

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which is a reference to prison rape in the shower, is often used to make light of prison rape. Some forms of popular media rely on the cultural knowledge of prison rape in order to sell their products. In 2002, Dr Pepper/Seven Up, Inc. (now Dr Pepper Snapple Group), was forced to retract a 7UP commercial because it trivialized and commodified prison rape. However, the media constitute one of the few avenues of public discourse concerning human rights in the prison system. Television shows such as Orange Is the New Black and Oz have representations of LGBTQ individuals dealing with the implicit or explicit aspects of prison rape.

Conclusion A comprehensive overview of institutional practices and policies should be conducted to locate and address the inadequacies of the penal system. There are numerous studies that document an extensive amount of violence, emotional harm, and problems with prison acculturation that continue to perpetuate a cycle of recidivism. The majority of prisons in the United States lack mechanisms for protecting marginalized individuals; however, the acknowledgment of these disparities is the first step in making such institutions more accountable for the safety of their occupants. Additionally, institutions like Rikers Island in New York City acknowledge, at least in part, the alternative needs of LGBTQ individuals. In November 2014, Rikers Island opened a voluntary unit for transgendered individuals. Acts such as this are essential for supporting and acknowledging the needs of LGBTQ people while they are under the supervision of the state. However, it does not address the larger structural problems of violence and trauma committed against them while incarcerated. As many critics have noted, the prison system needs to find a better way to serve the public and those whom they detain. Cultural norms toward crime and imprisonment, in conjunction with the increase in private prisons, often influence legislative oversight and compounds problems of safety. Accordingly, the United States needs to reconceptualize the function and method of incarceration to ensure that all

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individuals—and primarily those at a higher risk— are adequately and humanely treated. A new orientation toward incarceration might solve some of the larger problems of our prison system and drastically reduce the sexual assaults committed against LGBTQ individuals. Christopher C. Collins See also Gangs; HIV/AIDS in Prison

Further Readings Beck, A., Berzofsky, M., Caspar, R., & Krebs, C. (2013, May 1). Sexual victimization in prisons and jails reported by inmates, 2011–12. Retrieved September 28, 2014, from http://www.bjs.gov Elsner, A. (2004). Gates of injustice: The crisis in America’s prisons. Upper Saddle River, NJ: Pearson. Prison Rape Elimination Act (Sexual Violence in Correctional Facilities). (2014, September 28). Retrieved September 28, 2014, from http://www .prearesourcecenter.org Struckman-Johnson, C., & Struckman-Johnson, D. (2000). Sexual coercion rates in seven midwestern prisons for men. The Prison Journal, 80(4), 379–390. Tomer, E. (2008). Homosexuality in prison. In Y. Jewkes & J. Bennet (Eds.), Dictionary of prisons and punishment. Portland, OR: Willan.

PROFESSIONAL ATHLETES Since 2010, LGBTQ inclusion in sports has received a sharp increase in attention. Prior to this time, only a handful of lesbian professional athletes had come out (i.e., openly disclosed their sexual identity), and not one gay male athlete was out in the major professional team sports. Over the past few years, however, high-profile professional athletes are coming out more frequently in a variety of sports. LGBTQ athletes like National Basketball Association (NBA) player Jason Collins; Canadian Football League (CFL) player Michael Sam; Women’s National Basketball Association (WNBA) player Brittney Griner; pro soccer players Abby Wambach, Megan Rapinoe,

and Robbie Rogers; and mixed martial arts (MMA) fighter Fallon Fox have come out publicly and all have received support and acceptance from fans and teammates. This increased visibility is prompting team owners, coaches, league officials, and fans to address LGBTQ issues in sports and react to increased media attention. Over the past few years, straight athletes, such as former NFL players Brendon Ayanbadejo and Chris Kluwe and NBA player Kenneth Faried, have also begun to speak out to support LGBTQ inclusion in sports and express the perspective that an LGBTQ teammate who can contribute to achieving team goals is welcome. These positive events are in contrast to prior predictions from male sports writers, fans, and some pro athletes that gay male athletes would never be accepted as teammates or that opponents would go out of their way to make their time in competition miserable.

History of Silence and Invisibility The increased visibility of professional athletes who are LGBTQ and the largely positive response from their straight teammates and fans are also in sharp contrast to the silence and invisibility that was typical of LGBTQ professional athletes in earlier times. LGBTQ athletes and coaches have always been a part of sports, but most of them hid their identities out of fear that they would not be accepted by teammates or fans and that they would lose commercial endorsements or the opportunity to play the sports they loved. Early LGBTQ athletes who publicly identified themselves while still actively playing their sports were the exception. Professional tennis players Billie Jean King and Martina Navratilova competed as openly lesbian athletes in the 1980s, and Renee Richards, a transgender woman, successfully sued the United States Tennis Association (USTA) in the 1970s for the right to play in women’s competitions. Major League Baseball (MLB) player Glenn Burke played for the Dodgers and the Athletics in the 1970s but left the game after experiencing open discrimination because he was gay. NFL player Dave Kopay wrote a book about his experiences as a closeted

Professional Athletes

football player in the 1970s. Although a few other professional athletes have come out since these early pioneers, such as MLB player Billy Bean, WNBA player Sheryl Swoopes, Ladies Professional Golf Association (LPGA) player Rosie Jones, and NFL player Esera Tuaolo, the majority of LGBTQ professional athletes, both male and female, have chosen to remain closeted. In this historical silence, stereotypes of LGBTQ athletes thrived. These stereotypes are often based in cultural gender expectations for women and men. The stereotype that gay men are too “soft” and feminine to successfully compete in highly macho team sports like football, basketball, baseball, or ice hockey has limited the acceptance of gay men in sport. In the macho world of professional men’s sports, gay men and all women have been treated like trespassers or oddities on traditionally masculine male turf. In 2014, Becky Hammon, a successful WNBA veteran, was the first woman to be hired to be on the coaching staff of an NBA team, the San Antonio Spurs. In contrast, several ex-NBA players have coached WNBA teams.

Stereotypes and Concerns About Openly Gay Athletes Some male athletes, team owners, or coaches have expressed the concern that, due to increased media attention, having an openly gay man on a pro sports team would be a “distraction” from the goal of winning championships. Some people speculate that Michael Sam’s failure to make the active roster of any NFL team in 2014 reflected this concern. Despite a stellar collegiate career at the University of Missouri competing in the tough Southeastern Conference, Sam was selected in the final round of the NFL draft by the St. Louis Rams. After an impressive preseason with the St. Louis Rams, Sam was cut from the squad and then selected by the Dallas Cowboys as a member of their practice squad but was again cut a few weeks into the season. Notably, NFL teams have not tended to express similar concern about distractions caused by players who have been arrested for assault, violence against women, or other felonies.

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Another stereotype of men’s sports in general is that a gay man would not be accepted in the locker room by other players. The presence of a gay man, it was often assumed, would disrupt the comfortable brotherhood of straight teammates. Recent interviews with many professional male athletes from the NFL, MLB, NBA, and NHL, however, indicate that most players are unconcerned about this and many players welcome gay teammates. It may be that team owners, coaches, and league officials are most concerned about the presence of openly gay athletes on teams. This generational difference reflects larger culture differences in the acceptance of and comfort with LGBTQ people. Recent national surveys, for example, indicate much greater support for same-sex marriage and LGBTQ rights in general among younger people than among their elders.

Stereotypes and Concerns About Openly Lesbian Athletes Stereotypes of lesbians in sports and women’s sports in general also reflect cultural gender expectations as well as important differences in how anti-LGBTQ prejudice and discrimination play out in men’s and women’s sports. Because women athletes, regardless of their sexual orientation, are competing in what has historically been a male domain, questions have always been raised about the femininity and sexuality of women athletes. The long-standing tradition in men’s sports of using female and gay labels or slurs to motivate, shame, or taunt male athletes is a reflection of this belief that women are not and should not be athletic. For example, “you throw like a girl” or “this team is playing like a bunch of faggots” are intended to insult male athletes by comparing them to women and gay men. The assumption that women athletes are lesbians is based on the stereotype that lesbians are masculine and athleticism is masculine. Moreover, the lesbian label has been used as a way to let women athletes know that they are stepping out of the bounds of appropriate feminine behavior by being too competitive, athletic, and strong, which

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is interpreted as masculine behavior. Calling women athletes “dykes” or “men” is intended to make women athletes uncomfortable with their athleticism and to highlight a perception that they are not acting like a woman should. The stereotype that women’s sports are dominated by lesbians is often used to marginalize women’s sports or to explain why women’s sports are not as popular with male fans. At the same time, the stereotype that all women athletes are lesbians can lead to the assumption that lesbian athletes are completely accepted in women’s sports and that the challenges to acceptance for gay or lesbian athletes is only an issue in men’s sports. Unfortunately, women in sport have often reacted defensively to the lesbian stereotype by accentuating their feminine appearance or highlighting their heterosexual relationships or feminine appearance as ways to deflect criticism and gain greater acceptance. Team owners and league executives in women’s sports, rather than creating a comfortable and inclusive climate for lesbian athletes, have attempted to combat lesbian stereotypes by highlighting heterosexual and feminine athletes in campaigns to promote their sport. In this context, lesbian athletes often choose to remain closeted or are pressured to remain closeted out of fear of jeopardizing the marketability of women’s sports. It wasn’t until 2014 that the WNBA officially embraced LGBTQ inclusion and encouraged each team to plan events to celebrate LGBTQ pride and inclusion.

Comparing the Experience of Gay and Lesbian Athletes It is informative to compare public and media reactions to lesbian and gay male athletes who come out publicly. When NBA player Jason Collins came out in 2013, the public and media reaction was overwhelmingly positive. Even President Obama contacted Jason Collins to express support. When WNBA player Brittney Griner came out the same year, the public and media largely ignored her revelation. This differential reaction in part reflects the difference in media coverage of

men’s and women’s sports in general. A recent study shows that women sports receive a mere 4% of the media coverage that men’s sports receive. A gay male professional basketball player coming out is considered more newsworthy because men’s sports get more media coverage in general than women’s sports do. In addition, a publicly out gay male athlete in one of the major team sports challenges cultural expectations that male athletes are heterosexual and that gay men are not athletic. A publicly out lesbian athlete in women’s basketball, in contrast, confirms cultural perceptions that women athletes are lesbians. In addition, Brittney Griner’s gender expression, unlike that of Jason Collins’s, challenges traditional gender expectations. She is tall, lean, has a deep voice, and she chooses to dress in a style that challenges traditional notions of femininity. Her comfort with both her sexual orientation and her gender expression are groundbreaking in her refusal to apologize for who she is or for her athleticism. As a result of the different stereotypes of women’s and men’s sports due to the combined effects of sexism and homophobia in sport, male athletes are more often judged on their athletic prowess while female athletes are judged on their physical attractiveness and sex appeal to men. Male athletes are assumed to be straight and women athletes are suspected to be lesbians. Fortunately, these stereotypes and prejudiced beliefs are changing. With the recent emergence of more openly LGBTQ athletes at all levels of sports and greater acceptance of LGBTQ people in all walks of life, it is evident that a generational change is taking place. Younger straight athletes and coaches are more likely to support LGBTQ teammates and colleagues and older coaches and team owners are learning that they must confront their prejudices to keep up with these changes.

Emergence of LGBTQ Sports Advocacy Organizations In addition to greater acceptance of LGBTQ people in the larger culture, one of the factors that has accelerated change in athletics is the emergence of

Professional Athletes

organizations that work at all levels of sports to promote inclusion, equality, and acceptance of LGBTQ people in sports. Such organizations as You Can Play, GO! Athletes, Br{ache the Silence, and Athlete Ally work with women’s and men’s professional sports leagues and college and high school sports to educate athletes, league personnel, and coaches about LGBTQ inclusion. Another indication of this change is that corporate sponsors, notably Nike, support LGBTQ inclusion in sports. Nike has initiated a #BETRUE campaign that provides financial support for a national coalition of LGBTQ sports organizations that are engaged in education and support for LGBTQ inclusion at all levels of sports from high school sports to professional sports. Nike has also provided corporate sponsorship to openly gay and lesbian athletes like Jason Collins and Brittney Griner. As a sign that times are changing for the better, professional sports leagues have increasingly endorsed events promoting the inclusion of LGBTQ athletes and fans. Several professional sports teams in the MLB, WBNA, NHL, and NBA have sponsored pride events at their games. The NFL and MLB recently announced programming to assist major league and minor league teams to address LGBTQ inclusion on teams. Whereas a few years ago professional athletes who used antiLGBTQ slurs in public were an accepted part of sports, now they are fined, suspended, or required to attend awareness training. In addition, recent polls indicate that sports fans are much more likely to welcome an openly LGBTQ member of their favorite teams.

Race and Sexual Orientation in Sports It is interesting to note that, with the exception of MLB player Glenn Burke and Esera Tuaolo of the NFL, most of the early LGBTQ professional athlete pioneers were White. However, over the past few years, many of the LGBTQ professional athletes coming out publicly are African American. This includes Jason Collins (NBA), Michael Sam (CFL), Brittney Griner (WNBA), Seimone Augustus (WNBA), and Fallon Fox (MMA), just to name

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a few. This increase in the visibility of Black LGBTQ athletes as well as the overwhelmingly positive responses of straight Black and White teammates challenge stereotypes that African American communities are less accepting of LGBTQ people. It certainly illustrates the fact that LGBTQ people include members of all races. Black LGBTQ athletes must also contend with racism in sports (and Black women must contend with sexism), but their courage in publicly coming out as LGBTQ provides role models for young LGBTQ athletes of color and challenges sports fans and professional sports to rethink stereotypes of Blacks and LGBTQ people.

Inclusion of Transgender Athletes The acceptance of transgender athletes in professional sports lags behind the acceptance of lesbian, gay, or bisexual athletes. Other than Renee Richards, who competed in professional women’s tennis in the 1970s, and Fallon Fox, who currently competes in mixed martial arts, there are no publicly out transgender athletes competing at the professional level. The issue of transgender women competing against cisgender women (women whose gender identity matches their gender assigned at birth) is particularly controversial. When transgender women are seen as men rather than as women, it can lead to the assumption that they have inherent physical advantages in competition with cisgender women. Such stereotypes and misinformation about transgender people in general and transgender athletes in particular often lead fans as well as competitors to reject transgender competitors or, in the case of team or league officials, to enact policies barring transgender athletes from competition.

Looking to the Future The increased attention to the visibility and inclusion of LGBTQ athletes in professional sports in the media and within sports leagues is an indication of how much has changed. Though we have a way to go before LGBTQ athletes are completely

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accepted in men’s and women’s sports, the visibility of openly LGBTQ professional athletes goes a long way toward breaking down stereotypes and increasing acceptance. Given these changes, we can look forward to a sports future in which athletes are appreciated for the skill they display in competition and for their character and integrity regardless of their sexual orientation or gender identity or expression. Pat Griffin See also College Athletes; Sports, Sexual-Minority Men in; Sports, Sexual-Minority Women in

Further Readings Anderson, E. (2005). In the game: Gay athletes and the cult of masculinity. Albany: State University of New York. Fagan, K. (2013). The reappearing act: Coming out as gay on a college basketball team led by born-again Christians. New York, NY: Skyhorse. Griffin, P. (1998). Strong women, deep closets: Lesbians and homophobia in sports. Champaign, IL: Human Kinetics. Griffin, P., & Carroll, H. (2011). NCAA inclusion of transgender student-athletes. Indianapolis, IN: NCAA Office of Inclusion. Hargreaves, J., & Anderson, E. (Eds.). (2014). Routledge handbook of sport, gender and sexuality. London, England: Routledge. Messner, M. (2002). Taking the field: Women and men in sports. Minneapolis: University of Minnesota. Sartore-Baldwin, M. (Ed.). (2013). Sexual minorities in sports: Prejudice at play. Boulder, CO: Lynne Rienner. Woog, D. (2002). Jocks2: Coming out to play. Los Angeles, CA: Alyson.

PSYCHOLOGICAL APPROACHES STUDYING LGBTQ PEOPLE

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The ways in which people think, feel, act, talk, imagine, and make meanings about the world, others, and self are constantly in flux. These shifts

change with new types of knowledge, the formation of new ideologies, and the telling and retelling of traditional and contemporary narratives over time. These temporal shifts take place because meanings about societies and their people do not remain permanently stable and predictable but allow for constant change. The instability of meanings leads to new ways of understanding the body and the psyche, the cultural and the structural, the political and the powerful. This instability also highlights the pace of transformation, especially when considered in relation to emerging global digitization and social media. The psychological study of LGBTQ people has also experienced these changes, and this entry will comment upon shifts in psychological approaches to studying LGBTQ people that have taken place in recent decades, adding to the circulation of knowledge and narratives about LGBTQ people.

Background Over the past 30 years, texts and articles, conferences, and social media have changed a great deal in the way that meanings about LGBTQ people have entered public discourse. Previously, the history of psychological interventions with regard to sexuality and gender were marked by ambivalence and dominant-culture rhetoric. The experiences of people who understand their experiences as nonheterosexual or non-normatively gendered have been shaped by varying degrees of social and personal insecurity, sometimes due to psychologists delivering powerful and often derisory discourse and ideology about LGBTQ people in the name of science or on behalf of government policy. Although these past actions may be fading in memory because of recent positive changes in policy toward LGBTQ people in some parts of the world (e.g., gay marriage in the United States, Canada, parts of Europe, Australia, and New Zealand), other countries (e.g., in parts of Africa and Asia) continue to oppress and cause fear, where being “gay” is a sin and warrants death. Is it going too far to expect those institutions partially responsible for allowing such acts of emotional brutality to show remorse

Psychological Approaches to Studying LGBTQ People

by using their organizational powers to fight for the citizenship rights of those who are LGBTQ in those parts of the world where psychology has influenced the oppression of LGBTQ people by highlighting their “dangerous” lifestyle (e.g., during the time of the criminalization of homosexuality in Britain and the rise of the American Psychiatric Association [APA] Diagnostic and Statistical Manual of Mental Disorders [DSM]) and problematic mental health? In the past, all American and Western European psychological organizations treated heterosexuality as the purest form of heteronormativity, as the preserve of psychological “normality,” thereby passing on a legacy of ignorance and prejudice about those who are not heterosexual. To date, no apology from any major international psychological organization has been forthcoming, and societal prejudice and hatred continue to affect those who are gender nonconforming. At the same time, the burden of minority stress and emotional labor—the way LGBTQ people have to manage their feelings in the face of prejudice— often goes unrecognized by the dominant culture.

The Psychological is Political The fact that LGBTQ people have had to mobilize politically has implications for the psychological impact of the political upon their lives. Everyday life experiences include the ongoing negotiation of societal and cultural metanarratives within the day-to-day micro interactions, behaviors, and conversations that influence the ways in which we feel and think. For example, it is still the case that people have to “come out” as LGBTQ. This requires assessing social mores, understanding prejudice and discrimination, holding conversations with those considered “safe,” and making sure that coming out affects both intimate and social relationships with others in the family and with friends, at work or school, and the like. Alongside the changes entailed in relation to finding one’s place within LGBTQ communities is the expectation that these individuals will help support their community in relation to changes in its relationship with the society at large. However, the

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psychological demands of this transitional and temporal shift on the LGBTQ population as a whole are rarely recognized by mainstream society, in which free access to the privileges of its heterosexual lifestyle is taken for granted. The politics of LGBTQ issues has its origins in the United States. Gay and lesbian politics had been mobilized effectively through the first homophile movement, the Mattachine Society, established by Harry Hay in April 1951, and the Daughters of Bilitis (DOB), established by four lesbian couples in 1955. Despite originally being Marxist and intent on civil rights, the Mattachine Society, and later the DOB, both had to face the interrogation of right-wing McCarthyism and the societal rejection of homosexuality and therefore their remit gradually moved from fighting for civil rights and facing ongoing hostility to one of trying to understand the “cause” and meaning of “homosexuality.” In effect, it would be only a matter of time before this would lead to a redefinition of homosexuality and a major shift away from the politics of rights and citizenship toward a politics of the personal and psychological. The shift to finding causal factors for homosexuality as well as the predictability of who would be homosexual coincided historically with the publication of the World Health Organization International Classification of Diseases (ICD), which classified homosexuality as a mental illness, and the DSM, which included homosexuality as a category. The latter publication was quietly enlarging the criteria for what constitutes “mental health problems,” and these would form the basis for diagnosis by the APA in the 1950s. Subsequently, and particularly in relation to homosexuality, the DSM has been seen by its critics as an arbitrary system with little truly scientific foundation. In order to allegedly cure society of social ills, the original DSM included homosexuality, then understood as a form of sexual deviance, and immediately converted a way of life into a mental illness. Many thousands of gay people were categorized as mentally ill because of the sexed and gendered body of the person with whom they shared their affectionate and/or sexual feelings. It is hard to imagine what it was like to

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wake up each day knowing that your identity, if not your very existence, was criminalized and/or considered mentally defective. Although LGBTQ people came together in the 1960s as a social movement, it was also a time when psychiatry and psychology seemed determined to experiment on lesbians and gay men to help rid them of the “illness” of homosexuality. Throughout the 1960s and into the 1970s, there was a move toward aversion, conversion, or reversion to heterosexuality. Therapies advocating this way were based on techniques to shock the brain back to heterosexuality. These techniques use electrical currents, or reward and punishment regimes, by behavior therapists who believed homosexuality was maladaptive and therefore aimed to use such treatments to convert gay men to heterosexuality. By the 1970s, the lesbian, gay, bisexual, and transgender (LGBT) social movement, citing findings that those who come out as LGBT are psychologically healthier than those who repress their feelings, began to demand the removal of homosexuality as a mental illness from the DSM. In 1973, under pressure from the LGBT social movement, the APA finally reached agreement to remove homosexuality from its manual, thereby highlighting the arbitrary manner in which mental illness can be both assigned and removed on the basis of committee agreement rather than evidence. In 1974, the APA also decided that homosexuality was not a form of personality disorder or mental breakdown.

Affirmative Research and Psychology This move gave rise to the emergence of affirmative lesbian and gay research, thus allowing a new approach to psychological health based on some of the research findings that were beginning to reposition the social and psychological roles of lesbians and gay men to a lifestyle perspective and away from a pathological perspective. At the same time, an affirmative therapy with lesbians and gay men began to emerge whereby issues were explored collaboratively with the client rather than beginning with the assumption that the client had a mental

health problem. Issues included coming out, identity, and internalized homophobia. From the 1970s for the following three decades, new approaches to research and a gay-affirmative form of therapy gradually edged their way onto the therapeutic agenda in North America and the United Kingdom. Publications on affirmative therapy appeared that allowed therapists to advocate a positive and considerate approach to their therapeutic work with LGBT clients. More importantly, it meant that sexual minorities could begin to speak openly about their feelings and experiences while the research agenda could also begin to question the role and meaning of heterosexuality for work with bisexuals, lesbians, and gay men. For example, some research questioned why some heterosexual men have aversion to depictions of the male body, and other research showed why civil rights and liberties needed to incorporate the LGBT communities. However, despite the development and contributions to a deeper understanding of LGBT issues, it appeared that in the mid-1990s, little had changed when considering the rate of adjustment toward attitudes about homosexuality. This latter point was emphasized from 1994 onward in research that found heterosexual therapists continue to struggle in forming an alliance at a therapeutic level with LGBT clients. The research showed that ignorance rather than prejudice was the central problem, simply because training failed to cover issues related not only to sexuality and gender but also to race, ethnicity, age, religion, disability, and social class. The question remains as to how therapists can possibly practice with clients effectively without a greater knowledge of the social world.

Queer Therapy The development of LGBT-affirmative approaches to therapy coincided over time with the rise of an increasing consumerism from the LGBT population. Therapy itself benefited from this new economic direction, with lesbian, gay, and bisexual (LGB) people (few trans people have been able to

Psychological Approaches to Studying LGBTQ People

access training) funding their training as therapists (a move that came about with homosexuality no longer being seen as a pathology and training opening its doors to LGB trainees) and beginning to work with the LGB communities. However, although LGB politics led to the rise of research and more positive therapeutic approaches, all was not well in the LGB movement as assimilation to heteronormative ideas and rules was seen as joining mainstream heterosexual practices. By the mid1990s, anti-assimilationist politics began to form under the banner of “queer” activism, a movement that began to question the foundation of “lesbian and gay” politics and approaches. Extending the remit to queer meant breaking with binary politics of homo or hetero, gay or straight, male or female and beginning to establish a new voice that moved beyond this dualistic way of understanding the taken-for-granted, everyday notion of normativity and instead presented a case for those who were no longer in or even out of the closet but had made it an open closet for everyone. As they said, “We’re here and we’re queer. Get over it.” However, a radical queer politics soon became labeled as extreme and as polar opposite to an extreme right-wing anti-homosexual politics, while the mainstream of LGB was seen as illustrating a centrist response to any radical perspectives that may be considered as far too exclusionary. These middle-ground politics remain a far cry from the early days of the early homophile movements of the 1950s and 1960s and the emergent Gay Liberation Front (GLF) formed in the United States after the Stonewall riots and leading to a similar activist stance in the United Kingdom based at the London School of Economics. Interestingly, these groups stood for anticapitalist, antiracist practices and politics by adopting a New Left discourse and would possibly be considered too left and too militant in the present political climate. However, it was the very act of seeking recognition for gay rights that gave impetus to the commercialization of the gay world and “big-city core-culture” in the United States, the European Union, Canada, Australia, and New Zealand. Predominantly White, Westernized countries developed their “pink

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power” (e.g., financial resources) while their centrist policies pushed for gay marriage and adoption rights, shifting the emphasis toward the idea of family and new forms of kinship. It is notable how the agenda has significantly altered over the decades. Originally, many LGBTQ people had little money, worked in the public sector, and lived in shared housing, fighting for the right to be treated equally and on their own terms. Today, support from LGBT people for those in the LGBT communities who are struggling to survive and are unemployed appears to be dwindling as more and more LGB people access well-paid jobs and are socially mobile.

The Emergence of Trans Emerging trans discourses have begun to have a major impact on ways of understanding bodies, sexualities, and genders as well as the meaning of these in relation to the formation of a trans life and inner experience. The trans communities include those who may want to define as transsexual, transgender, gender binary, nonbinary genderqueer, binary genderqueer, and transvestite— although not all those listed may want to associate or name themselves as trans. The importance of a trans political agenda has increased, in that it engages with societal change not by altering approaches to the trans community alone but through challenging the structures that underpin society and highlighting how they are limited when gender is questioned. Dean Spade, founder of the Sylvia Rivera Law Project (a nonprofit collective that provides free legal help to low-income people and people of color who are trans, intersex, and/or gender nonconforming and works to build trans resistance rooted in racial and economic justice), explained the following: Trans politics must contend with legal systems, since they violently enforce racialized gender norms and shorten trans people’s lives every day. However, there is a difference between law reform as our goal—assuming that we can get the law to say “good” things about us and that this will bring relief—and understanding that we

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need to use law reform as a tactic to dismantle systems of state violence. Instead of focusing on passing hate crime legislation and holding onto the fantasy of getting law enforcement to protect trans people, we need to launch campaigns to close prisons and jails, to decriminalize sex work and drugs, and to prioritize other strategic engagements aimed at disrupting the pathways to criminalization that are devouring trans populations. (Spade, 2011)

In effect, the trans communities are attempting to challenge the assimilation of LGB people into mainstream political discourse and offer a radical alternative embedded in activism and attempts to overhaul a neoliberal capitalist approach to sexuality and gender that underpins social as well and sexual and gender inequalities. Research and training could benefit from an approach that no longer lends itself to a dominant discourse and instead proposes a more socially just approach to gender and sexuality.

Conclusion Psychological approaches to studying LGBTQ people are immersed in social and political rhetoric. The idea that the psychological is apolitical remains unsubstantiated when LGBTQ meanings are considered within their social and cultural contexts. From the outset, it has been evident that social concerns for safety and mental health were paramount if heterosexuality was likely to be threatened while the introduction of sanctions to harness everyday life to “normality” was taken for granted. It is only over the past 60 years that major changes in social policy have shifted psychological discourse from discriminating against difference and diversity to championing the recognition of inclusion and moving toward equality of rights and the right to equal representation. Lyndsey Moon See also Affirmative Therapy; Health Disparities; Heteronormativity; LGBTQ Social Movements (Assimilation vs. Liberation); Sexual Orientation Conversion Therapy; Theories of Sexual Orientation; Therapists’ Biases Regarding LGBTQ People

Further Readings Adam, B. D. (2002). From liberation to transgression and beyond: Gay, lesbian and queer studies at the turn of the twenty-first century. In D. Richardson & S. Seidman (Eds.), Handbook of lesbian and gay studies (pp. 15–26). London, England: Sage. Blasius, M. (1994). Gay and lesbian politics and the emergence of a new ethic. Philadelphia, PA: Temple University Press. Davis, D., & Neal, C. (1996). Pink therapy: A guide for counselors and therapists working with lesbian, gay and bisexual clients. Berkshire, England: Open University Press. Engel, S. (2002). Making a minority: Understanding the formation of the gay and lesbian movement in the United States. In D. Richardson & S. Seidman (Eds.), Handbook of lesbian and gay studies (pp. 377–402). London, England: Sage. Greene, B., & Herek, G. M. (1994). Lesbian and gay psychology: Theory, research and clinical applications. London, England: Sage. Hochschild, A. (1983). The managed heart: Commercialization of human feeling. Chicago, IL: University of Chicago Press. Holmes, D., Jacob, J. D., & Perron, A. (2014). Power and the psychiatric apparatus: Repression, transformation and assistance. Surrey, England: Ashgate. Kirk, S. A., & Kutchins, H. (1992). The selling of DSM. The rhetoric of science in psychiatry. In D. Holmes, J. D. Jacob, & A. Perron (Eds.), Power and the psychiatric apparatus: Repression, transformation and assistance. Surrey, England: Ashgate. Mayes, R., & Horwitz, A. V. (2005). DSM-III and the revolution in the classification of mental illness. Journal of History of the Behavioural Sciences, 41, 249–267. Moon, L. T. (2011). The gentle violence of therapists: Misrecognition and dis-location of the other. Psychotherapy and Politics International, 9, 194–205. Plummer, K. (2003). Intimate citizenship: Private decisions and public dialogue. Seattle: University of Washington Press. Ritter, K. Y., & Tendrup, A. I. (2002). Handbook of affirmative psychotherapy with lesbians and gay men. New York, NY: Guilford Press. Spade, D. (2011). Normal life: Administrative violence, critical trans politics, and the limits of law. Brooklyn, NY: South End Press.

Q social attitudes. Instead, these qualitative studies are more aptly suited to advance understanding of individual and/or group experiences, situated in their social contexts. The specificity of findings is, therefore, the purpose of research rather than a limitation. The theoretical context and thus the driver for much early qualitative research design rests, in sociological terms, within Foucauldian ideas of power and the micropolitics of resistance that are exemplified in LGBTQ lives. Writing in the 1970s–1980s, Michel Foucault situated sexuality as the subject and product of discourse, with sexual identities being shaped through regulatory structures of governance that constituted personal understandings and articulations of sexuality. Disciplinary operations of power thus served to frame and often contain queer experience. The reflexive turn that followed is far more optimistic, arguably overly so. Anthony Giddens has been instrumental in this regard, suggesting that a recursive process of self-making characterizes the contemporary era of late modernity. His position is that through both the development of personal narratives and engagement with external narratives and expert systems, such as those evident in contemporary therapeutic cultures, individuals engage in reflexive self-identity. The resultant transformations of intimacy reflect a root and branch democratization of the interpersonal domain, fostered through a culture of self-fulfillment. Narratives of self and personal identities offer emancipatory, or

QUALITATIVE RESEARCH This entry provides an overview of qualitative LGBTQ research. It begins by mapping out the qualities and character of studies that use this approach with particular attention to psychosocial research. It then highlights how reflexivity, the iterative process of self-identity making, has informed qualitative research, influencing both understandings of sexualities and also the underlying methodologies and research methods used. Finally, it considers how “the everyday” and a practices approach have generated significant insight on the materialities (lived experiences) and emotionality in qualitative research on LGBTQ lives.

Approaches to Research Qualitative research is rich and illuminating, focusing attention on the micropolitics and personal dynamics of LGBTQ lives. It is, by its methodological nature, overridingly small scale and often structured around tightly defined cohorts characterized by age, parental status, relationship status, and sexual practice, for example. This focus in qualitative research thus generates significant understanding of how LGBTQ lives are lived but generalizability remains limited. Indeed, the design of small-scale empirical research does not have the capacity to speak to wider population trends or 895

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liberating, freedoms because they are neither predefined nor contained; transformations of intimacy and sexuality are constitutive of and constituted by personal and structural interactions. LGBTQ lifestyles are the exemplars of contemporary selfhood because they reside outside cultural registers, which regulate realms of possibility, determined through reproduction, for example. Lesbian and gay self-making identities thus not only epitomize sexual and queer potentialities; they also break down homo–hetero binaries. This theoretical context is foundational to understandings of much contemporary LGBTQ research. The postemancipatory politics in Giddens’s transformed sexual world open up queer ways of knowing but, as feminist critics such as Lynn Jamieson have so compellingly argued, this theoretically contained schema also obscures the materialities where enactments of power reside. Sexual freedoms, for example, are not uniform; class, education, ethnicity, and parenthood remain differentiating factors. LGBTQ studies have, in some instances, similarly invoked a universalizing narrative that subsumes difference under a queer sexual umbrella. Qualitative LGBTQ research that is attentive to the particularities of experience and the research–participant dynamic can, however, paint a far more nuanced picture. Research thus framed typically advances a feminist reflexive methodology that recognizes how researcher subjectivities and subject positions inform knowledge practices. Here, epistemological (theories of knowledge) and ontological (how we come to know) positions intersect to shape qualitative research design. Feminist researchers emphasize how dominant “malestream” methodologies reproduce existing power relations and, in Foucauldian terms, flows of power. Feminist LGBTQ qualitative research thus has an embedded political goal in that it seeks new ways of knowing that can empower those being studied. There is no object of study—only subjects. Knowledge generated is not “the truth” but a particular slice of life that is captured at a specific moment in time through researcher–participant interaction. This interaction is situated in sociocultural historical contexts and

the biographies of both parties, resulting in co-constituted qualitative research that is informed by those being researched and those who generate these data and advance analysis of findings. Qualitative research practice is therefore premised on reciprocity and often mutuality. Completing qualitative LGBTQ research is not ordinarily a dispassionate endeavor; it impacts upon the researcher. For the qualitative researcher, being “out in the field” combines personal and professional identities that bring together work and home lives: who we are and what we do.

Inside/Out Methodologies Qualitative queer research is designed to facilitate dialogue and interaction with LGBTQ individuals and communities. It comes from within: It is our lives that are being researched rather than theirs. This does not presuppose that a queer researcher will necessarily undertake queer research. Critical reflexivity can, however, be found at the methodological heart of most LGBTQ research. This practice calls into question the place of conventional research techniques, querying whether they can adequately examine the multiplicity, messiness, and fluidity of LGBTQ subjectivities and social lives. Surveys and quantitative research design ordinarily require particular variables to be fixed, often including categorical distinctions such as male–female, heterosexual–homosexual–bisexual sexual identity. Qualitative LGBTQ research often contests such sampling categories and is thus more readily able to incorporate nuanced non-normative understandings of gender and sexuality. The focus and design of LGBTQ research is, therefore, critical. It often places ideas of sexual or gender identities at its core, aiming to acknowledge and applaud the fluidity of identity categories. Sexual subjects and subjectivity are characterized as contingent, multiple, and constituted within historical, geographical, and sociocultural sets of relations. LGBTQ qualitative research thus works to simultaneously destabilize knowledge through its process of meaning-making alongside advances in understanding. Structure and power relations

Qualitative Research

are centrally positioned in the research dynamic resulting in queer methods and methodologies, which often applaud the messiness of findings. Queer theorizing, then, is troubled more than proven and disproven. Nuances and inflections caution truth claims. Queer theory, data, and method intersect; to separate them is antithetical to their design and purpose. There is arguably no such thing as queer qualitative research per se or qualitative methods that might be identified as queer. The ethos and practices that typify queer studies may, however, be said to characterize qualitative LGBTQ research. For example, the insider (emic)–outsider (etic) status is often crucial in qualitative LGBTQ research, with researchers grappling with their situated position, inside and outside the field of study. The research dynamic materializes “inside/out” queer theorizing, which has highlighted, among other points, the performativity of identities, or how ideas and displays of self are made, remade, and unmade through an iterative process that rejects any original or “natural” identity. This is not to romanticize familiar research or overstate its capabilities. The insider–outsider status has productively unsettled qualitative LGBTQ research, but the researcher does typically retain a privileged position, reinforced through their professional status in powerful, Western academic institutions. The researcher can wrestle with the profound tensions that such differences may invoke and any communicative dissonance that may follow, but this does not entirely close the gap. Differences remain. The multiplicity of identities and subject positions simultaneously match and separate researcher and participant. Insightful qualitative research has come from an acknowledgment of how such differences shape the narratives told. Research on queer families, for example, has shown how being a lesbian mother involves multiple subject positions that extend beyond both sexuality and the maternal. Experience is shaped through reproductive narratives, social location, and era to name but a few factors. The salient point here is the extent to which the researcher acknowledges, learns from, and capitalizes upon

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their insider–outsider status. As an insider, they have privileged knowledge. From the position of outsider, the qualitative researcher can draw on their “otherness” to sensitize them to configurations of experience that may be more difficult for established insiders to see. Otherness is thus a strategic position. Looking in, in ethnographic terms, otherness renders the familiar strange. Looking out, the LGBTQ qualitative researcher can use their research position to challenge heteronormative assumptions that construct traditional categories of being.

Qualitative Methods This strategic purpose, to unpack what is taken for granted, is rooted in the critical philosophies, such as phenomenology and social constructionism, which typically underpin qualitative research. Phenomenological research is guided by a belief that we can understand social structures and ways of being through the study of lived experience. Social constructionist perspectives contest any fixity of being, posing that how we live and understand our lives is culturally constituted and historically located. These critical perspectives facilitate more complex understandings of sexuality, which can represent the marginal and diverse perspectives of those being researched. The epistemological and methodological creativity that drives qualitative research in the field is further extended through the rich palette of qualitative methods that have been used to study LGBTQ lives. Sophisticated research designs aim to interrogate the complexity of sexuality and sexual identities. Multilayered dynamic methods resist both uniformity and conformity. Interviews operate alongside visual methods. Diary and memory work bring together past and present experience. Web-based methods mirror and work with online sexual communities. The richness and dynamism of these methods require similar analytical creativity. Case studies are combined with crosscutting thematic analysis of interviews. Oral histories and archival sources are read against the heteronormative grain. Firstperson reflexive accounts have been used to add

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another dimension to understandings alongside multimethod data from community workshops. Queer-affirmative perspectives challenge the pathologizing of sexual-minority experience as meanings are mined between the lines. This multimethod combination of approaches does not readily lend itself to neat interpretations that standardize complex stories and tie up loose methodological ends. In this sense, qualitative LGBTQ research typically—and intentionally— offers only partial answers. For example, accounts of identity “tell stories” that add to and shape the community pool of narratives rather than claim to represent and/or speak from a community standpoint. The creative interplay of different qualitative methods generate a dynamic account. Working across different datasets, these slivers of knowledge combine to shed light on the multidimensionality of LGBTQ lifestyles, identities, and sexual subjectivities. This section offers a flavor of some of the qualitative methods used in researching LGBTQ lives, focusing on empirical techniques based in the social sciences. Creative hands-on methods have emerged from recent trends in sociology and psychology where discourse and uniform understandings have given way to diverse and contested accounts of experience, materiality, emotion, and embodiment. While interviews (semistructured and open) are the most common in qualitative LGBTQ research, other methods are now routinely used to augment and sometimes supersede these oral narratives. “Draw and talk” qualitative techniques have a long-standing history in research with families and children, facilitating intergenerational research on sensitive topics such as sex and sexuality that may be otherwise hard to verbalize. Visual methods such as photo prompt interviews (also known as photo elicitation) have proven invaluable because they can enable the participant to represent their social and private worlds including their identity construction and relationship networks. In LGBTQ psychotherapy, nonverbal methods are routinely deployed, and participatory action methods have always been used in couple and family therapy. The most common visual method used in this

context is the genogram, or family map, tools that are designed to probe family processes and practices to facilitate clinical intervention. Other visual and action methods used in family therapy include enactments, sculpting, semantic polarities, and positioning. These methods rely on spatial metaphors and embodied techniques to engage the client or participant and facilitate personal insight. Visual methods in LGBTQ research draw on these traditions and techniques to further academic understandings. Photo elicitation and other visual methods such as collage creation, modeling, and sculpting techniques have been used to examine identity practices, experience, and personal interactions. The combination of multiple qualitative methods has proven particularly valuable in studying complex phenomena such as LGBTQ lives. Multisensory multiple methods research design generates richly textured data that can focus on different dimensions of experience and identity. For example, daily diaries can generate temporal data that shed light on routines and the sequencing of events alongside pictorial data that locate experience in their spatial contexts. Qualitative researchers working with multiple methods are not necessarily concerned with whether a study can be replicated. As such, they may devise new tools in response to particular research questions and contexts. For example, researchers have devised bespoke visual tools such as the emotion map to study intimacy and sexuality in families. The visual data generated locate interpersonal experience in context and thus facilitate examination of how sexuality and intimacy are materialized. This research method is now being extended for use in clinical practice. Indeed, an array of imaginative hands-on methods is often used to research nonheterosexualities and gender including body maps, sculpting, modeling, and collage work. These techniques have proven to be highly successful in provoking discussion on highly sensitive “private” experience. Visual methods such as those described previously take time to produce. Reflexivity is thus built into the method itself as participants design, produce, and talk about the experiences and

Qualitative Research

identities depicted. Events and roles that may be difficult to articulate can be visualized without recourse to narrativization, a linear process that can sometimes serve to package experience through dominant cultural discourses, such as the inclusion of a beginning, middle, and end. Exponents of visual methods in LGBTQ research claim that such techniques move beyond the standard scripts of sexuality and sexual identities. The lives thus presented can advance both academic knowledge and foster empathy and understanding between those included—or excluded—within LGBTQ communities. Typically advancing a phenomenological method of analysis, qualitative multiple methods research situates experience in context. This focus on the everyday facilitates understanding of how structures and processes of power operate and impact on the psychosocial dynamic of individual lived lives. Qualitative LGBTQ research thus often focuses on how sexuality is materialized. Where and how stories are told is crucial here. As sexual geographers have shown, familiar surroundings trigger memories. Material artifacts, such as photographs, keepsakes, and everyday objects, can feature centrally in the research narrative if they are close at hand. Memorabilia can also serve to facilitate recall of events and emotions that may have otherwise faded over the passage of time. Stories in these contexts are often steeped in emotion. The telling and experience are proximal. Time may have passed, but the “storyteller” remains immersed in the scenario through physical referents that surround them. Embodied narratives are thus located, in context, through emotional and tactile points of reference. A key fascination within LGBTQ research is the study of personal relationships in all their diverse forms. Relationships are interesting because they reflect, in their myriad shape and form, the situated intersections of different personal–biographical, political, and sociocultural contexts. LGBTQ relationships are thus often researched through everyday practices of relating. This attention to so-called mundanities in life is, in part, a materialist feminist response to high-profile social queer theorizing that heralded

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“the spectacular,” which typically focused on fateful moments and remarkable examples. Everyday practices have highlighted the extraordinary minutiae of LGBTQ lives—that is, how sexual identities are done and undone in the course of daily life. These are the shifting negotiations that are required as intersecting identities play out in bars, on the street, at home, and in the schoolyard. The research encompassed under this rubric is too rich and diverse to list. In contemporary studies of intimacy, sexuality, and personal relationships, especially in the United Kingdom, qualitative LGBTQ research has moved away from structure and social units of analysis onto the ways in which relationships become materialized and experienced through everyday practices. This “practices approach” focuses attention onto individual and relational behavior and the habituated routines that serve to reproduce preexisting ways of being and the diversity of relational experience. This practices approach shifts the research agenda away from dominant narratives that reify relationships into categorical types; it draws attention to the qualitative dimensions of interpersonal intimacies to recognize interpersonal relationships as reflexive sites that are shaped by, and in turn shape, public institutions.

Conclusion The focus on practices in LGBTQ research is not simply methodological preference or a by-product of technique. As this section has shown, it is also an intentional and political decision to keep the constitutive and iterative process of doing relationships at the forefront of the analytical lens while being attentive to the interdependent and dynamic elements that extend beyond specific moments of enactment. Qualitative research design is shaped around the recognition that experience is embodied, located, and configured over time. This focus on practices in LGBTQ qualitative research thus serves to unpick personal and social dimensions of intimate life and the ways that sexualities are lived and change, over time. Jacqui Gabb

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See also Focus Groups; Intersections Between Sex, Gender, and Sexual Identity; Methodological Decisions by Researchers of LGBTQ Populations; Quantitative Research; Queer Ethnographies/Autoethnographies

Further Readings Barker, M., Richards, C., & Bowes-Catton, H. (2010). Visualising experience: Using creative research methods with members of sexual communities. In K. Browne & C. J. Nash (Eds.), Queer methods and methodologies. Intersecting queer theories and social science research (pp. 57–79). Farnham, England: Ashgate. Gabb, J. (2012). Qualitative research on LGBT-parent families. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families. Innovations in research and implications for practice (pp. 324–342). New York, NY: Springer. Gabb, J., & Fink, J. (2015). Couple relationships in the 21st century. London, England: Palgrave Macmillan. Heaphy, B. (2008). The sociology of lesbian and gay reflexivity or reflexive sociology? Sociological Research Online, 13(1). Retrieved from http://www .socresonline.org.uk/13/1/9.html Lewin, E., & Leap, W. (Eds.). (1996). Out in the field: Reflections of lesbian and gay anthropologists. Urbana: University of Illinois Press. Phellas, C. N. (2012) Researching non-heterosexual sexualities. Farnham, England: Ashgate. Plummer, K. (1995). Telling sexual stories: Gender, change and social worlds. London, England: Routledge.

QUANTITATIVE RESEARCH Within the social sciences, quantitative research is frequently considered to be a systematic method in which observable data are collected and analyzed numerically. The focus is on the application of appropriate mathematical and statistical techniques to examine the relationship between variables of interest and hypothesis testing. Some researchers differentiate between qualitative and quantitative research methods and data collection,

such as surveys being associated with quantitative research and ethnographies with qualitative research. While this is often accurate, the greatest distinction between the two is sampling and generalizability of findings. For quantitative research, the findings must be generalizable from a specific sample to a greater population. This often involves large random sampling. Both quantitative and qualitative methods, along with the often-overlooked experimental methods, are necessary for the generation of knowledge within the social sciences. In sexualities and LGBTQ research, quantitative research has a short but dense history. To date, surveys are the most commonly employed method for quantitatively studying LGBTQ populations. This entry will address the historical background on the main studies framing current LGBTQ quantitative research approaches, followed by discussions of the central issues and primary barriers to the field—namely measurement and sampling. Next, attention is turned to what we know thus far including demographics, identities, practices, and perceptions related to the LGBTQ population. The entry concludes with a focus on future directions for study.

Background Alfred Kinsey (1894–1956) is often cited as having launched the modern history of sexualities studies, particularly in quantitative and LGBTQ research. Kinsey, originally trained in biology, set out to study human sexuality in the 1940s and 1950s the way biologists studied mating behaviors—in a systematic and empirical manner involving large and diverse (geographically and network-wise) samples. Kinsey designed a survey with over 350 items addressing sexual behavior and interviewed 5,300 White males and over 5,900 White females, mostly young adults with some college education. Prior to Kinsey, most research on sexuality from the turn of the century through the 1920s was limited to case studies of married or otherwise committed, stable couples, due primarily to cultural assumptions and norms regarding sex and sexuality. It was not until Kinsey’s work that sex and

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sexuality studies within the academy more closely reflected the cultural ideals of the time. This led the way for the better-known gender, LGBTQ, and sexual revolutions of the 1960s and for the scientific study of sexuality and LGBTQ studies. Kinsey is credited for increasing visibility of sexual minorities and deconstructing homosexuality—emphasizing behaviors rather than basing it on a condition or person type. Kinsey fought issues of censorship and set high standards for sexuality research that followed and contributed to the legitimation of the field. His work was not entirely accurate and perfect, but it taught us through his findings as well as his errors. Kinsey did not employ probability samples (which selects a subset of individuals from within a given population to estimate characteristics of the whole population); rather, he used a 100% sampling-ofgroups technique, whereby he would interview every individual in as many diverse groups as possible (whether it be a class of students, an office or union of workers, a ladies club, or some other club or organization). During this time, random probability sampling was also a fledgling field and one that many, including Kinsey, did not believe was possible—and particularly for the “invisible” LGBTQ population of which there was no prior enumeration. Nevertheless, his work has endured, and many of his original findings are consistent with what researchers find today. Specific to LGBTQ populations, Kinsey’s rates are consistent with current national probability samples. Most importantly, he helped establish sexuality studies as a serious discourse and opened doors for funding and more research—all of which deeply contributed to current research on the LGBTQ populations. The next major series of studies to quantitatively address sexuality and LGBT issues came in the late 1980s and 1990s. Edward O. Laumann, John H. Gagnon, Robert T. Michael, and Stuart Michaels’s Social Organization of Sexuality study is still one of the most comprehensive and representative surveys of sexual behavior. Laumann and colleagues performed 90-minute face-to-face interviews with a random sample of over 3,400

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American men and women between the ages of 18 and 59. Results were published in two books: The Social Organization of Sexuality: Sexual Practices in the United States (1994), which included extensive statistical analyses for academic readers, and Sex Practices in America: A Definitive Work (1994), intended for lay readership. The results of the survey supported many of Kinsey’s findings and led to a better understanding of how sexual behavior is organized in American society and its broadranging public policy implications. This work further contributed to the notion that sexuality is socially learned and is inherently social, as it tends to involve more than just the individual. Following the Kinsey studies and the Social Organization of Sexuality series, Robert T. Michael, John H. Gagnon, Edward O. Laumann, and Gina Kolata set out to design and conduct the Sex in America survey with special attention to the methodological critiques of prior surveys, most notably probability sampling, reliability, and validity. The researchers focused on prior criticisms of survey research: they accurately sampled the adult population; prepared a pretested questionnaire; trained their interviewers; and introduced several methods of checking the precision, or triangulation, of their responses. In line with Kinsey—and Laumann and his colleagues’ work—they found that 3% of men self-identified as homosexual, and 1.5% of women self-identified as lesbian. The survey also sought to examine variation across race, ethnicities, and religion. It further increased the validity of the discipline. While the Kinsey reports made waves in lay culture because of the shock factor, Sex in America actually did not gain any federal funding because conservative legislators expected that it would show a higher level of deviant behavior among Americans.

Measurement The central issue to quantitative research on LGBTQ populations is measurement. Most of the literature on homosexuality conceptualizes the phenomenon using two, or a combination of two, basic perspectives or approaches, referred to as

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essentialism and social constructionism. The essentialist view assumes there is an essential characteristic common to all homosexuals that is distinct and separate from heterosexuals. This common feature is often thought to be biologically or psychologically based and is a fundamental trait that establishes a person’s inclusion into one of two categories: homosexual or heterosexual. This view presumes that a person can be categorized as being or not being homosexual and makes a distinction between one who is homosexual and one who is not. Thus, the question is how to define and establish the categories. The essentialist conceptualization of homosexuality, which is founded in biology, served as the basis for biological, physiological, and psychological research, most notably that revolving around sexually transmitted infections (STIs) and HIV/AIDS, fertility, and mortality. The social constructionist view of homosexuality counters and critiques the essentialist perspective. Social constructionism argues against the notion of binary categories—that is, that one either is or is not a homosexual and thus may be categorized as homosexual or not. Instead, this approach suggests that there exists a continuum with varying degrees of homosexuality or heterosexuality. Social constructionists often point out that prevalence rates and visibility vary across time and setting. Moreover, they assert that the concepts, definitions, and practices of homosexuality vary across context and cultures. It is this social constructionist view that allows more room for self-identification—that is, for example, individuals may identify themselves as an orientation, which assumes certain sexual activities but also allows room for other cultural and social elements of the identity. Conceptually speaking, this view broadens the definitions of LGBTQ identities to include more than just particular sexual acts or incidents. With regard to empirical research, survey research is fairly essentialist and employs a clearcut and straightforward definition of what constitutes homosexuality in that moment of time, thus enabling quantification. However, the manner in which surveys measure and quantify homosexuality and sexual orientation can vary dramatically.

Sexual orientation may be defined in terms of sexual behavior, sexual desire (including fantasy), and self. In analyses based on data from national surveys, social scientists have drawn on one or more of the previously stated conceptualizations of sexual orientation but most often employ measures of self-identification and behavior. For example, the General Social Survey (GSS) uses a behavioral definition of homosexuality, such as whether a person’s sexual partners in the past 12 months, the past several years, or in one’s lifetime, have or have not been mainly or predominantly of the same sex as the respondent. The GSS does not include a question on the self-identification of the respondent’s sexual orientation. The National Health and Social Life Survey (NHSLS) conducted by Laumann and his associates in 1992 (see their The Social Organization of Sexuality: Sexual Practices in the United States [1994]), and the National Survey of Family Growth, include questions dealing with sexual behavior, self-identified sexual orientation, and sexual desire. There is also a fourth measure, of attribution (e.g., I have faced discrimination based on my sexual orientation), that is much less frequently employed in surveys. Researchers are able to speak to different qualities of sexual orientation depending on which measures are employed and how they are conceptualized. In this way, it has been argued that surveys can more closely conform to a social constructionist view than to an essentialist one. Measurement is further complicated for the transgender population and speaking to gender identity. While there is no common practice related to addressing gender identity, the most commonly recommended practices include adding a number of possible responses to the sexual orientation variable or gender variable as well as a two-step sex and gender question index (i.e., asking for the respondents’ sex and gender in two separate questions, allowing them to identify both), directly asking about trans identity, measuring gender conformity on a scale, and moving toward a more inclusive question addressing sexual-minority status in general (e.g., Do you identify as a sexual minority including but not limited to gay, lesbian,

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bisexual, transgender, two-spirited, and/or asexual?). In this case, the question can yield a dichotomous vague answer of true/false, yes/no, or ask/allow for specific identities to be identified such as follows: “Other, please specify: __________.”

Sampling The primary barrier to quantitative research on the LGBTQ population is attaining sufficiently large and representative samples—finding respondents. Very few administrative surveys, censuses, and government or national statistics and databases contain any measures of sexual orientation. Some do collect information on households or allow for “sensical” assumptions to be made in application to sexual orientation. This is the case with a number of censuses, including the U.S. Census, which collects information on the presence of same-sex households. It has been through administrative data collected for various other purposes that the greatest sources of secondary analysis have been generated regarding the gay and lesbian population to date. They have also demonstrated the need for more and improved measures related to sexual orientation. Overall, the scarce and sporadic literature that evaluates and reviews the conceptualization and measurement of sexual orientation suggests two major methodological limitations: the lack of common, consistent definitions in surveys and problems with obtaining sufficiently representative sample sizes or the lack of sexuality-related questions in large-scale data collections. Both limitations are attributed to the purported social stigma attached to sexual minorities. This stigma is believed to affect not only the way questionnaires are designed to address or measure sexual orientation but also the ways in which individuals will respond to survey questions about self-identification, behavior, and desire. For example, individuals may be reluctant to identify as LGBTQ or to report on stigmatized behavior. However, this may be changing as social tolerance rates increase. To date, it is technically impossible to generate a true random sample of the LGBTQ population; however,

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larger samples of all orientations can yield generalizable data on the LGBTQ populations.

The Demography of Sexual Orientation and Gender Identity Demographic research has dominated quantitative LGBTQ studies in recent decades. Census data have provided the greatest opportunity to examine gay and lesbian population as they allow for individual-level and household-level data. Census data have served as the backbone of LGBTQ research in a number of areas, such as fertility and family; geography and residential segregation; and urban and rural sociology. However, there are known complications using census data to speak beyond same-sex partnered individuals. For instance, census data neither directly employ any measures of sexual orientation or gender identity nor include single LGBTQ persons. Census data only capture individuals of the same sex who self-identify as living in a marriage-like relationship with one another in the same household. As with all surveys, there may also be variation between regions in the United States. Depending on where the survey is given, individuals who identify as same-sex partners may be more willing or less willing to disclose their relationship or living arrangements with their partners. On the contrary, studying the geography of LGBTQ individuals and families shows not only where these individuals choose to live but also sheds light on where individuals feel comfortable disclosing their identities. Demographic research in LGBTQ studies has focused primarily on gay and lesbian individuals, couples, and families, excluding issues of bisexuality and gender identity. Quantitative research on bisexuality and gender identity is even more limited—particularly when it comes to using nationally representative datasets such as the census. Similarly, the census and other large population-based datasets have not strayed from the male and female binary response options, limiting data and research on trans individuals. One of the most daunting challenges regarding studying bisexual and trans populations is how to define

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them: physical, social, political, temporal, and so forth. This makes it difficult to propose appropriate prompts or questions to elicit reliable, valid, and generalizable responses.

Identities, Practices, and Perceptions To date, there is overwhelming consensus regarding prevalence rates of gay men and lesbians. Generally, gay men and lesbians make up about 1% to 2.3% of the population in the United States with approximately 1.5% of the population indicating bisexuality. Surveys that offer a more general nonheterosexual option result in higher prevalence rates for LGBTQ individuals, closer to 5% of the population. The 2010 U.S. Census has released estimated counts of just under 650,000 same-sex partner households and families in the United States. Such estimates from the U.S. Census are conservative in counting LGBTQ families, given that they do not include single-parent families headed by gay men or lesbians and do not include couples who choose not to identify their relationship as a “same-sex partnership” on census surveys. Geographically, from census data we know lesbian and gay individuals exist across the nation but do have metro and regional variations. There is also diversity between the sexes. There is residential segregation between gay and lesbian households, with female same-sex households being less segregated from cross-sex households than their male counterparts. Also, male same-sex households tend to earn more than female same-sex households and are less likely to have children present. It has been inferred that they may have greater access to live in more expensive urban areas or the two sexes may seek out different amenities in making residential choices. Similar issues arise when looking at samesex households related to race and ethnicity. On the whole, we know that there is great diversity among gay and lesbian enclaves, and not all individuals have access to, or want, enclave living. It has been noted that geography also plays an important role in indicating not only where individuals choose to live but also where people choose to disclose their sexual identities.

LGBTQ adolescents are at particularly high risk for negative sexual outcomes, particularly STIs. A growing body of research in this area is now emphasizing positive sexual development in both straight and LGBTQ populations. This research includes sexual desire and identity, sexual-identity development, sexual practices and partnerships, and sexual behaviors and outcomes. With regards to LGBTQ adolescents in particular, studying positive and negative outcomes is important, as this population is more inclined to experience social exclusion and discrimination in response to samesex relationships. Availability of data in these areas of research is limited, since the topic is controversial on two fronts: sexuality and adolescence. The literature on aging LGBTQ individuals is even more scarce; however, we expect to see improvements and an increase in prevalence on this front as the “out” LGBTQ population grows and ages. Generally speaking, to study sexuality in older adults, the approach has been biopsychosocial, to examine biological, emotional, and social factors. Quantitative LGBTQ research across a number of fields shows that the LGBTQ population as a whole experiences discrimination and inequalities. For example, sexual-minority status serves as an important predictor of health and social outcomes, even taken out of the essentialist view and biological research. That is, as a demographic variable, LGBTQ status, over the course of one’s life, serves as a determinant for long-term effects of inequality. Another example is in the labor market. Legally, as of 2012, only 21 states and Washington, D.C., prohibited discrimination in employment based on sexual orientation. Discrimination in the workplace compounds effects of inequality with regard to income and socioeconomic status, education, sex and gender, and race. Research shows that lesbian and bisexual (LB) women are more likely to work in lower-paying crafts and services occupations than straight women or men. Gay and bisexual men are also more likely than their straight counterparts to work in professional, technical, and service occupations and within each field earn less than straight men. There has been a dramatic shift in American social tolerance rates. For the first time, there is

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majority support for same-sex marriage. Although public opinion on homosexual behavior is sharply divided, views are rapidly liberalizing. It is believed that the support of younger Americans, irrespective of race, religion, and politics, will continue to drive increasing rates of support not only for same-sex marriage but also for other legal rights applicable to LGBTQ families. This shift in attitudes is also recognized by LGBTQ adults who indicate that they feel more accepted by society now than in the past although they still experience discrimination— in everyday social encounters and at the macro level regarding rights and resources.

Conclusion The history, progression, and proliferation of quantitative LGBTQ research have reached a point in which studies often include LGBTQ identities and sexual-minority status as major demographic variables in considering intersectional power dynamics. For example, residential segregation research now has another demographic to consider as does family studies and so on. Alfred Kinsey had argued that it was impossible to enumerate how many gay men and lesbians are in the population. This assumption was due to the lack of data and the difficulty in counting a hidden and stigmatized population, such as sexual minorities. Although strides have been made, especially in the last decade, there is still no definitive count of the gay male and lesbian population, and researchers still grapple with the same theoretical and methodological issues. Available data are limited and prone to criticism. However, with the improved understanding of the data limitations and conceptual assumptions, reliable counts at the household level are increasingly becoming possible, allowing better access to same-sex partners and families. Further, survey and census data and estimates have been steadily improving. The future of LGBTQ quantitative research is bright, owing to clearer, comprehensive data and increasing visibility. D’Lane R. Compton and Isabelle Notter See also Demographics and the LGBTQ Population; Intersections Between Sex, Gender, and Sexual Identity; Research, Use of Large Datasets in; Sampling

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Further Readings Anderson, R., & Fetner, T. (2008). Cohort differences in tolerance of homosexuality: Attitudinal change in Canada and the United States, 1981–2000. The Public Opinion Quarterly, 72(3), 311–330. Badgett, M. V. L. (2001). Money, myths, and change: The economic lives of lesbian and gay men. Chicago, IL: University of Chicago Press. Baumle, A. K. (2009). The cost of parenthood: Unraveling the effects of sexual orientation and gender on income. Social Science Quarterly, 90, 983–1002. Baumle, A. K., Compton, D. R., & Poston, D. L., Jr. (2009). The demography of sexual orientation. Albany, NY: SUNY Press. Biblarz, T. J., & Savci, E. (2010). Lesbian, gay, bisexual, and transgender families. Journal of Marriage and Family, 72, 480–497. Bullough, V. L. (2005). Chapter 2: Alfred Kinsey. In J. K. Davidson, Sr. & N. B. Moore (Eds.), Speaking of sexuality . . . Interdisciplinary readings (pp. 14–22). Los Angeles, CA: Roxbury. Compton, D. R. (2013). The family and gay men and lesbians. In A. K. Baumle (Ed.), International handbook on the demography of sexuality (pp. 257–274). New York, NY: Springer. Gates, G. (2013, February). LGBT parenting in the United States. Los Angeles, CA: Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/ uploads/LGBT-Parenting.pdf Goldberg, A. E., Gartrell, N. K., & Gate, G. (2014). Research report on LGB-parent families. Los Angeles, CA: Williams Institute. Retrieved from http:// williamsinstitute.law.ucla.edu/wp-content/uploads/lgbparent-families-july-2014.pdf Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Philadelphia, PA: W. B. Saunders. Krivickas, K. M., & Lofquist, D. (2013). Demographics of same-sex couple households with children. Washington, DC: U.S. Bureau of the Census. Retrieved from http://www.census.gov/hhes/samesex/files/ Krivickas-Lofquist%20PAA%202011.pdf Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press. McCarthy, J. (2014, May 21). Same-sex marriage support reaches new high at 55%: Nearly eight in 10 young

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adults favor gay marriage. Omaha, NE: Gallup. Retrieved from http://www.gallup.com/poll/169640/ sex-marriage-support-reaches-new-high.aspx National Center for Health Statistics. (2010). National survey of family growth, Cycle 6, 2002. Hyattsville, MD: National Center for Health Statistics. Retrieved from http://www.cdc.gov/NCHS/nsfg/nsfg_2006_2008_ puf.htm O’Connell, M., & Feliz, S. (2011). Same-sex couple household statistics from the 2010 census. Washington, DC: U.S. Bureau of the Census. Retrieved from http://www.census.gov/newsroom/releases/ archives/2010_census/cb11-cn181.html Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. C. (2010). Counted out: Same-sex relations and Americans’ definitions of family. New York, NY: Russell Sage Foundation. Rust, P. C. R. (2000). Review of statistical findings about bisexual behavior, feelings, and identities. In P. C. R. Rust (Ed.), Bisexuality in the Unites States: A social science reader (pp. 129–184). New York, NY: Columbia University Press. Schilt, K., & Bratter, J. (2015). From multiracial to transgender? Assessing attitudes toward expanding gender options on the U.S. census. TSQ: Transgender Studies Quarterly, 2(1), 77–100.

QUEER Emerging in the early 1990s, queer theory is informed by and indebted to feminism, social constructionism, and poststructuralism. Feminist thought and social constructionism view the social realm, and thus “reality,” as not something “out there,” external to the individual. Rather, one’s reality—one’s own worldview and truths about the world—is determined by social norms and the dominant ideology. Under this view, gender is not natural but socially constructed, informed by the dominant “rules” and norms governing gender. Individuals internalize these rules and thus come to strongly believe in gender difference—the notion that “man” and “woman” are biologically (or naturally) different from one another. This sex or gender binary organizes society accordingly.

This binary preserves the status quo—the normative gender order, since subjects must fit into one of two social categories (man or woman), where man is positioned as the superior, dominant term. Queer theory seeks to challenge and dismantle notions of natural difference and difference itself, since difference is always “otherized”—that is, it marks something as inferior and less than. Queer theory aims to denaturalize gender difference by exposing how the sex or gender binary works. That is, a binary works through, and depends on, language and social categories (which again are socially constructed). A binary is itself a hierarchical relation, which means one term is always “on top”—one category is the norm, the default, standard term, upon which other categories are defined and measured against. For example, man and heterosexual are the norm, such that woman and homosexual are secondary terms, which deviate from the norm. Homosexuality has long been viewed as a pathological condition or perversion, since same-sex sexual orientation is thought to be unnatural. Queer theory attempts to deconstruct dichotomous thought by revealing social norms to be not “truths” but social fictions—arbitrary ideas that, as norms, become regulating devices. That is, societal norms and social identities (man–woman; heterosexual–homosexual) work to regulate and “discipline” subjects, as subjects must, in order to be recognized as “normal” (as opposed to deviant and perverse), or to be properly gendered subjects. In short and to reiterate, what is considered natural and normal are merely the dominant ideas, which reinforces gender inequality and heteronormativity. Understanding identities as “regulating” devices comes from poststructuralism, which challenges Enlightenment ideals regarding the subject. Enlightenment ideals emphasize rationality and reason above all, wherein the subject, as rational agent, is viewed as stable, unchanging, and free. The subject is, in other words, outside the social and cultural realm, able to transcend, and thus ultimately control his or her conditions. Queer seeks to show how this notion of the stable, unchanging subject (and thus the belief in the

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subject itself) is merely an effect of discourse. Put more simply, social norms and binary thought create the illusion of a stable subject, since it compels and forces subjects to regulate themselves and conform to preexisting social categories. For instance, if one identifies as a “woman,” then one’s gender identity must abide by the dictates and social expectations of a woman (such as being passive, more emotional, less rational), while excluding or concealing other (e.g., “masculine”) qualities. In contrast to claiming a “gay” or “lesbian” identity, queer defines itself as “anti-identity,” since one’s identity forecloses other possibilities, other aspects of self that do not align with one’s “true/core” self. But, according to queer theory, gender and sexuality (and thus the subject itself) are not stable, unchanging entities; rather, gender and sexuality are fluid, contingent, and constantly “in flux.” In sum, gender and sexuality are dynamic, indeterminate processes. This is also related to the reclaiming of queer queer—once a highly pejorative term—by queer activists and scholars to connote multiplicity and fluidity. Queer is antinormativity, since gender and sexuality do not abide by “regimes of the normal” (Warner, 1995, p. 27). Thus, queer signifies disobedience to the norm and has introduced terms such as genderfuck to highlight the radical potential in subverting gender normativity. Queer theory seeks to dismantle heteronormativity, the dominant system that privileges heterosexuality as the norm. Heterosexuality is thought to be natural, while homosexuality is understood as a perversion, an unnatural desire. Thus, homosexuality should either be persecuted and/or “corrected” through medicine and science, since, being unnatural, there must be an underlying (biological or psychological) cause for this deviation. But, here again, these “truths” about heterosexuality and homosexuality are dependent upon dichotomous thinking, both in terms of normative gender and the “normal” sexual subject. Heterosexuality is understood through binary, normative gender and gender difference, since to be “heterosexual” means to be attracted to the “opposite” sex. This assumes,

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for instance, that heterosexual men are always masculine and only attracted to feminine women. Thus, dominant understandings of sexuality depend on and assume essentialist, binary notions of sex or gender. This is a causal, linear model of sexuality, which suggests that biological sex determines gender, gender determines gender identity, and gender identity determines sexuality and desire. But queer theory seeks to reveal the discontinuities and “mismatches” between them, say, for example, between one’s biological sex and gender identity. These mismatches, queer scholars contend, reveal gender’s instability and incoherence. This indeterminancy works to potentially undermine and subvert heteronormativity itself, since there is no such thing as a pure, stable (read: “normal”) subject. In sum, queer theory’s radical potential lies in exposing discontinuities from within purportedly binary (stable) categories and, through this, highlighting the instability of gender (and the subject more generally). Judith Butler (1990) defines gender as a “stylized repetition of acts” (p. 191) and sees drag as one such deconstructive strategy, since drag “implicitly reveals the imitative structure of gender itself—as well as its contingency” (p. 187). In other words, if anyone can “do” any gender, than there is no “core” essential self, no “doer” behind the deed. Gender is, like sexuality, a “doing,” not a “being.” Queer celebrates and embraces non-normativity, both in terms of gender and in refusing to be “respectable” sexual citizens. Queer embraces the perverse, as such transgressions work to disrupt normativity. Given its investment in challenging normativity, its suspicion of identity categories as complicit in reinforcing inequality, and its stress on mobility and the fluidity of selves and identities, queer must itself remain elusive—that is, it must remain undefined. To define queer would, per its own logic, domesticate it, which would, as Butler (1994) contends, be its “sad finish” (p. 26). Corie Jo Hammers See also Heteronormativity; Homonormativity; Queer Politics; Queer Theory

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Further Readings Butler, J. (1990). Gender trouble. New York, NY: Routledge. Butler, J. (1994). Against proper objects. Differences: Journal of Feminist Cultural Studies, 6(2–3), 1–26. Warner, M. (1995). The trouble with normal. New York, NY: Harvard University Press.

QUEER ANTICAPITALISM For Marxists and anarchists involved in LGBTQ movements, it is imperative to understand the relationship between queer sexualities and capitalism, which has become the globally dominant economic system. This entry examines this relationship and its implications for LGBTQ individuals and communities.

Queer Anticapitalist Theory As the LGBTQ movement has gained visibility, spaces of commerce such as bars, restaurants, and retail stores, as well as queer media including magazines or TV shows, have provided spaces for the development of queer counterpublics—groups of people who come together to challenge the dominant heterosexual way of thinking about sexuality. These are venues for expressions of queer cultural, political, and personal lifestyles. These spaces, however, have resulted in the buying and selling of LGBTQ products and lifestyles, displacing diverse sexual desires onto costly objects and lifestyle choices. Sexuality, desire, and intimacy are thus commodified, or valued for their capacity to sell products within the capitalist system of exchange, sometimes even becoming products in their own right, such as through sex work. Queer anticapitalists have critiqued this way of building community, which requires people to spend money in order to participate, leaving more open or free spaces such as grassroots organizations, do-it-yourself (DIY) media, and community centers out of the community. Moreover, many individuals within the LGBTQ population are left out of these commercial spaces, or made invisible

in the queer counterpublic sphere for many reasons. For example, they live in poverty and cannot afford to pay entry fees or buy fashionable clothing; they do not fit the stereotypes of beauty such as thinness and muscularity; they are discriminated against because of their age, race, ethnicity, or disability; or they live in rural places where queer commercial spaces do not exist. Further, trans people and lesbians are often not included in commercialized spaces or media because they are not perceived to have, and statistically do not have, the buying power—referred to as “pink dollars”—of gay men. Queer anticapitalist theory has also been influenced by feminist intersectionality theory, which has found that not only social or economic class and sexuality but also identities such as race, gender, and disability are interrelated. These are not just personal identities but also interlocking systems of oppression. In other words, an individual’s sexual and social-class identities are connected, being affected by historical and institutional relations of oppression and privilege along different lines. For example, LGBTQ people of color may experience what is called a “double invisibility,” where they are excluded or marginalized by racism in the mainstream LGBTQ community and may simultaneously be excluded or remain closeted in their ethnic or cultural communities because of anti-LGBTQ sentiments there. Therefore in the early 2000s, queer anticapitalist theory started to put an emphasis on revealing and critiquing multiple forms of privilege and oppression in the queer community beyond heterosexuality and social class. Queer anticapitalist movements also started to explore new possibilities for diverse forms of intimacies, sexualities, and relationships that can account for various identities without reducing people to categories. Many queer anticapitalist theorists draw their thinking from, and participate in, grassroots social movements and activism.

Queer Anticapitalist Social Movements Queer anticapitalist social movements in the Western context have grown out of the confluence of the

Queer Ethnographies/Autoethnographies

LGBTQ mainstream movement and the anticapitalist contingent of the antiglobalization and anti– Iraq War movements of the 1990s and early 2000s. There have been many global gains for LGBTQ social movements in some countries or states, such as the legalization of same-sex marriage, and the inclusion of sexuality as prohibited grounds for discrimination in human rights codes. However, activist groups such as Queer Nation, the Pink Panthers, Gay Shame, and Queeruption continue to take action against the linking of LGBTQ politics to capitalism. Gay Shame, for example, organizes anti–gay pride parade events that are free for everyone to participate in. Gay Shame organizers reject the profit motive, and their events are therefore based on a barter or trade system, a gift economy, and a DIY ethos, where food, clothing, and art are homemade, found, or given away rather than bought or sold. Queer anticapitalist movements try to create safe spaces where people will not feel excluded due to social class or other bases of discrimination. Queeruption is an event that takes place in different global locations, which also focuses on sexual liberation in an anticapitalist context, creating “queer autonomous spaces,” that take over or occupy spaces independent of corporate, government, or other institutional ownership, funding, control, or hierarchies. In addition to creating free queer autonomous spaces, building on the militancy of the Stonewall riots, queer anticapitalists tend to engage in direct action. For example, the Pink Panthers used a “bash back” strategy where they would go out in large groups to fight back against gay bashing. The Montreal group Les Panthères roses engaged in a direct action against pink dollars by faux vomiting on the steps of capitalist establishments in the gay village. Such actions call into question the access that some people might have to shops and bars in the gay village, whereas others are excluded. Queer liberation direct actions do not favor assimilation into straight culture but instead use militant strategies to challenge the ways that sexualities, intimacies, and friendships are controlled or limited by gender, race, ethnicity, disability, and other social inequities. These actions explicitly challenge the

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way capitalism frames and claims queer identities in the context of commercial profits. Queer anticapitalists address these interlocking systemic oppressions through theory and direct action, thereby enlarging our understanding of who should be included in LGBTQ communities and building stronger, more diverse, and empowered communities for a much broader range of sexual identities and practices. Sandra Jeppesen See also Gender Binaries; Genderqueer; Homonormativity; LGBTQ Social Movements (Assimilation vs. Liberation); Queer; Queer Politics; Queer Theory; Transgender Sexualities

Further Readings Bernstein-Sycamore, M. (Ed.). (2008). That’s revolting! Queer strategies for resisting assimilation. Berkeley, CA: Soft Skull. Brown, G. (2007). Mutinous eruptions: Autonomous spaces of radical queer activism. Environment and Planning A, 39, 2685–2698. Daring, C. B., Rogue, J., Shannon, D., & Volcano, A. (Eds.). (2012). Queering anarchism: Addressing and undressing power and desire. Oakland, CA: AK Press. Heckert, J., & Cleminson, R. (Eds.). (2011). Anarchism and sexuality: Ethics, relationships and power. New York, NY: Routledge. Jeppesen, S. (2010). Queer anarchist autonomous zones and publics: Direct action vomiting against homonormative consumerism. Sexualities, 13, 463–478.

QUEER ETHNOGRAPHIES/ AUTOETHNOGRAPHIES Queer ethnographies and autoethnographies (also referred to as queer auto/ethnographies) link the methodological and representational practices of ethnography and autoethnography with queer theory’s critical framework for understanding difference, minority discourses, and identities. Queer auto/ethnographies offer researchers a strategy for

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creating just and humane scholarship that seeks to change people’s lives and worlds. Queer is a term with many definitions and uses. Queer can describe same-sex attraction or be used synonymously with gay or lesbian. Queer could describe any act or desire that goes against traditional, heterosexual—“heteronormative”—expectations of intimate relationships such as marriage, monogamy, and/or biological reproduction. There are practices of “queering” that involve acts that disrupt everyday, taken-for-granted routines with the intent to call attention to harmful norms and expectations in social life. There are also other contemporary uses of queer that describe feelings others might classify as uncomfortable, inappropriate, and maybe even disgusting—feelings such as failure, shame, melancholy, and/or grief. Queer theory is the broad area of study devoted to studying any of these ideas, desires, acts, and feelings. Ethnography is a research method used to understand, represent, and sometimes critique cultural life. Typically, an ethnographer engages in fieldwork and “participant observation”—techniques that allow the researcher to become an active and attentive member of the group under study. The purpose of participant observation is to describe and interpret group behaviors as they happen within “natural settings”—that is, contexts in which life would happen with or without the presence of the researcher. Autoethnography is a research method that combines these ethnographic techniques with the practices of autobiography, variously defined as personal experience, storytelling, memory or recollection, and literary devices such as character development and narrative voice in order to understand, represent, and sometimes critique cultural life. Auto/ethnography is both a methodological practice (e.g., “I do auto/ethnography”) and a product (e.g., “I wrote an auto/ethnography”). Queer auto/ethnography brings queer ideas, desires, and acts into contact and conversation with both the practices and the products of auto/ ethnography. For instance, queer auto/ethnographic practices may include determining ways to access, observe, and challenge the personal and

cultural experiences of same-sex attraction, heteronormative expectations, disruptive acts, moments of confusion, failure, melancholy, and grief; other acts others might classify as uncomfortable, inappropriate, and disgusting. Queer auto/ethnographic practice might also include research practices that, although productive to use in terms of knowledge, may counter traditionally understood research practices (e.g., being intimate with informants; foregrounding relational concerns over research concerns). For some researchers, the very use of personal experience in the research process could be considered a queer act. A queer auto/ethnography (product) might be a text that emphasizes the personal and cultural experiences of same-sex attraction, heteronormative expectations, disruptive acts, and other acts that others might classify as uncomfortable, inappropriate, and disgusting. In form, queer auto/ethnographic texts disrupt—that is, “queer,” traditional research representations and genres through the use of storytelling techniques (e.g., suspense; character development); poetry; fiction; and forms such as art, music, and dance, thereby “queering” more traditional genres. For some researchers, the very use of personal experience in a research report may be considered a queer act. Queer auto/ethnographic texts often also emphasize the accessibility of the research—as relevant and available to more than just academic audiences. Queer theory and auto/ethnography share purposes and practices. For example, queer theorists appropriate cultural beliefs, practices, texts, and bodies in novel ways; auto/ethnographers also revel in the particularities—those novel experiences—of personal–cultural life. Given the focus on particularities, auto/ethnographers conceive of personal–cultural experiences as uncertain, fluid, and open to interpretation; queer theorists also work against certain, stable, and rigid representations of personal–cultural experiences. Queer theorists advocate for social change by offering possibilities for using personal–cultural beliefs, practices, texts, and bodies as sites of ideological and discursive “trouble”—that is, they try to use

Queer Politics

these beliefs, practices, texts, and bodies to encourage people to question and create confusion around taken-for-granted assumptions about social life. For example, Judith Butler (1999) asked, “What best way to trouble gender categories that support gender hierarchy and compulsory heterosexuality?” (p. xxx). Many auto/ethnographers answer Butler’s call to make ideological and discursive trouble with their research representations by offering queer, honest-yet-graphic accounts of personal–cultural life. Queer theory and auto/ethnographic purposes and practices also complement each other. For example, while queer theory is sometimes conceived of as dense and abstract, not grounded in material circumstances, auto/ethnography aims to offer descriptive, grounded, and accessible accounts of lived, cultural experience. While auto/ethnography is sometimes criticized for being self-indulgent and too personal, queer theory is sometimes criticized for not being personal enough. And while queer theory is sometimes criticized for being elitist, Western, and White, auto/ethnographers use various media to represent personal–cultural experience, embrace reflexivity and multiple epistemologies (e.g., theories and ideas), and work hard to respect and maintain the relationships the researcher establishes with others. Given these shared and complementary purposes and practices, queer auto/ethnography is a powerful way to ignite cultural critique, expose queer stories, and do queer research. Tony E. Adams and Stacy Holman Jones See also Qualitative Research; Queer Politics; Queer Theory; Transgender Ethnographies

Further Readings Adams, T. E., & Holman Jones, S. (2011). Telling stories: Reflexivity, queer theory, and autoethnography. Cultural Studies Critical Methodologies, 11, 108–116. doi:10.1177/1532708611401329 Browne, K., & Nash, C. J. (2010). Queer methods and methodologies: Intersecting queer theories and social science research. Burlington, VT: Ashgate.

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Butler, J. (1999). Gender trouble: Feminism and the subversion of identity (2nd ed.). New York, NY: Routledge. Holman Jones, S., & Adams, T. E. (2014). Undoing the alphabet: A queer fugue on grief and forgiveness. Cultural Studies Critical Methodologies, 14, 102–110. doi:10.1177/1532708613512260 Holman Jones, S., & Adams, T. E. (in press). Queer autoethnography. Walnut Creek, CA: Left Coast Press.

QUEER POLITICS Queer politics are based on a reclaiming of the term queer from its original derogatory form, first recorded in the Los Angeles Times in 1914. This political reclamation of the term emerged through specific grassroots activist organizations emerging in the 1980s and 1990s in the United States, Canada, and Europe, such as ACT UP, OutRage, the Pink Panthers, Gay Shame, Queers Against Israeli Apartheid, Queer Nation, and Queeruption. Activists radicalized the predecessor lesbian and gay political movements in three theoretical ways. First, they deconstructed or destabilized the male– female gender binary, asserting a genderqueer identity, adopting gender-neutral pronouns such as they. Second, they deconstructed the heterosexual– homosexual binary, advocating a more fluid understanding of sexual diversities. Third, they critiqued the assimilationism of lesbians and gays who attempted to fit into mainstream heterosexual society by advocating for marriage, parenting, and economic rights. Early queer activists tended to favor liberationist politics, including coming out, pride, and queer visibility. They advocated for visibility of queers in public space and institutions, as emphasized in the slogan, “We’re here, we’re queer, get used to it.” They were more militant, using disruptive tactics to create queer visibility. They targeted not just homophobia but also heterosexism and heteronormativity, challenging violent attacks against the LGBTQ community as well as systemic oppression that creates heterosexual privilege through

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normative social assumptions, cultural norms, and institutional practices. They would go on to critique the homonormativity of LGBTQ movements, as evidenced by the White, middle-class, gay male domination of gay villages.

Queer Politics and Social Practices Michael Warner’s book Fear of a Queer Planet is important to queer politics in its arguments against heteronormativity and explorations of queer politics beyond queer theory. He links queer politics to social practices, challenging the heteronormative assumptions in society, including the assumption that queer politics are only about sexuality. Queer politics are connected to issues as disparate and widespread as family and kinship, public discourse and language, consumerism and advertising, desire and sensuality, nature, reproduction and parenting, race and ethnicity, nation-states, censorship and the arts, intimacy and friendship, terrorism, violence, racism, colonialism, disability, health and health care, elder care, cultural norms, TV and film programs, news media, the legal system, the military, schools and universities, the body in everyday life, and many others. Queer politics thus challenges the way that heteronormativity is embedded in every institution in society. Activists move past anti-homophobic politics, which define the sexual as the site of oppression, toward anti-heteronormative politics, which challenge the systemic oppression of queers in all social, cultural, political, and economic institutions and interactions. In other words, it is the social control that negates same-sex relationships that is itself called into question, the regulation of relationships to fit a heteronormative model of male– female reproductive monogamy. Rather than advocating for the acceptance of same-sex relationships that fit this model (gay marriage, middleclass values, conformity, etc.), queers militate against the placing of limits on sexual and intimate relations. Queer politics takes up this challenge in several ways, including through different forms of militant queer activism; queer counterpublics that provide

spaces for queer engagement against heterosexist social norms; queer world-making or the creation of spaces that are a kind of queer utopia in themselves; and queer intersectionality or anti-oppression politics where queer politics and identities are analyzed in relation to interconnected political subject-positions, identities and issues such as race, class, disability, mental health, police brutality, sex work, and so on.

AIDS Coalition to Unleash Power: ACT UP One of the first queer activist groups in the United States, ACT UP, was formed in 1987 as a response to the AIDS crisis, as feminists and gay men joined together to confront the intransigence of governments and health institutions in dealing with the crisis. Their slogan was “silence = death,” and they were vocal about achieving changes for gay visibility and health rights using militant actions including civil disobedience, die-ins, occupations, and other forms of protest, often including humor in their actions. They organized along anarchist lines as a grassroots horizontal direct democracy, forming committees to do specific work such as research on treatments, media work, or finances, and affinity groups to carry out direct actions. Two notable actions took place in 1989. The first involved several ACT UP members occupying the New York Stock Exchange to demand lower AIDS drug prices, which succeeded in reducing the price of the drug AZT from $10,000 to $6,400 annually. The second action mobilized several thousand protestors, some of whom entered St. Patrick’s Cathedral to protest the Catholic stance on safer sex, abortion, and condoms. These two actions demonstrate the queer political focus on systemic or institutional oppression: the first bringing attention to the economic impact of pharmaceutical pricing on queer health care and the second revealing the cultural impact of the Catholic Church on queer and women’s health. Both actions received media attention, with the intervention of queer bodies into public spaces resulting in the insertion of queer politics into public discourse.

Queer Politics

Understanding the importance of the media, ACT UP created a video activist collective called DIVA-TV, or Damned Interfering Video Activist TV, that produced hundreds of hours of video footage of ACT UP actions and protests, from short films screened at film festivals or on television, to feature-length documentaries such as the 2002 film Fight Back, Fight AIDS: 15 Years of ACT UP. Much of the footage is archived at the Humanities and Social Sciences Library within the New York Public Library. Self-produced media played a crucial role in raising awareness and creating public policy and legal changes on the AIDS crisis, particularly in the health care and pharmaceutical industries. It was also a factor in creating a queer counterpublic that generated public space for discourses on queer politics and activism of a much broader scope.

Queer Counterpublics: Queer Nation Queer Nation released its manifesto among ACT UP marchers in the 1990 New York City gay pride parade, calling for more militant actions and defending its right to undertake confrontational actions such as the St. Patrick’s Cathedral action, which had been widely criticized. Its premise was that queer survival and visibility is a revolutionary act. It advocated the tactic of “bashing back” or fighting back against antiqueer violence, including the right to express anger at queer bashing in all of its social manifestations from heterosexist bullying and physical violence against queers to the rise of queer teen suicide. The group was founded by four ACT UP members, Tom Blewitt, Alan Klein, Michelangelo Signorile, and Karl Soehnlein. Their first meeting was in March 1990, and the name Queer Nation was adopted in May 1990. The actions it became known for included “mall zaps” in which group members would go to a mall en masse to distribute flyers and show public displays of queer affection as well as “nights out,” where they would do the same thing only targeting popular straight bars. One of the group’s famous slogans was “Not gay as in happy, but queer as in fuck you!” which is

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emblematic of its confrontational approach toward public visibility. Queer scholars Lauren Berlant and Elizabeth Freeman have suggested that these actions reclaimed public space by using surprise interventions to counter the violence of normative heterosexuality, insisting on the freedom to be queer in public.

Queer World-Making: Queeruption Anticapitalist critiques of Queer Nation arose among activists who felt that their actions were too tied to consumerism and lacked awareness of social class. Social and cultural analyst Lisa Duggan argued that some of these actions came from a place of White, middle-class, gay male privilege, a subject position that did not represent all queers. Moreover, activists were critical of the consumerism of gay neighborhoods and pride parades, which were less interested in queer politics than in pink dollars. These critiques can be applied to TV shows such as Queer Eye for the Straight Guy, which not only rehearsed gay stereotypes but also focused on consumerism. Media and cultural theorist and activist Sandra Jeppesen has documented direct actions growing out of these critiques, such as the anticapitalist group Gay Shame, critiques of gay marriage as a heteronormative institution, and actions against the White, middleclass male homonormativity of the “gay village.” Queer theorist Michael Warner argues that the concept of queer community fails to deliver an effective challenge to the individualist ideology of contemporary American society because of its rootedness within late capitalism. These critiques from within the movement itself have led to an opening up of queer politics beyond visibility, pride, and coming out. Attempting to create a queer temporary autonomous zone, queer activists mobilized a global event called Queeruption, which started in London in 1998. This explicitly anticapitalist festival was a queer social weekend that took place in a squatted building, featuring homocore punk bands, cabaret performances, and dance parties; vegan food, doit-yourself (DIY) workshops, political discussions;

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and an anticapitalist, anticonsumerist, mutual aid, queer anarchist ethos. Since then, Queeruption has taken place in a range of cities such as New York, Berlin, San Francisco, Amsterdam, and Tel Aviv. It is an excellent example of what Gavin Brown calls “queer world-making.” Queeruption combined the festival atmosphere of pride day in its punk music and dance parties, with the political seriousness of ACT UP and Queer Nation in its workshops, DIY art and discussions of queer politics, adding anticonsumerist and antiracist perspectives, food politics, art, and other issues.

Intersectional Queer Politics As queer politics challenge the systems that oppress queer people beyond sexuality, queer politics move beyond identity politics to recognize interlocking systems of oppression, engaging issues of capitalism and social class, colonialism, race and ethnicity, gender, health, nation-state, borders, the law, and family, among others. A key queer intersectional subject–position emerges in queer politics in the form of queer people of color (QPOC). This manifests in several political strands or threads within queer politics. For critical race and gender theorist Marlon Ross, queer race politics play out in differential disclosure practices, where accepting an Americanized queer identity or lifestyle might be difficult despite the family perhaps being accepting of non-normative sexualities. Ross is critical of the presumed need to come out, and the presumed Western way to be queer, which might carry greater risks for QPOC. Anticolonial queer activists argue that queer is a Western concept that has colonizing impacts. For example, indigenous cultures use the term twospirited, which is complex and nonequivalent to European American concepts of queer or genderqueer. To take a second example, Queers Against Israeli Apartheid critique the colonizing discourse of Israel in its claims to be a safe place for queers in the Middle East while simultaneously colonizing the Palestinian people, some of whom of course are also queer.

Queer Nation advocates not just that queers have a place among the citizenry of the nation but that all people in some way are part of the queer planet or queer nation. Sexuality, according to Queer Nation, cannot be confined to gay versus straight; moreover, the boundaries between gay and straight or deviant and accepted sexual acts, relations, intimacies, and expressions need to be challenged at a deeper level, to eradicate sexual normativity altogether. Sandra Jeppesen See also Heteronormativity; LGBTQ People of Color; LGBTQ Social Movements (Assimilation vs. Liberation); Queer; Queer Anticapitalism; Queer Theory; Queering Heteromasculinities

Further Readings Berlant, L., & Freeman, L. (1992). Queer nationality. Boundary, 2(1), 149–180. Blasius, M. (Ed.). (2001). Sexual identities, queer politics. Princeton, NJ: Princeton University Press. Brown, G. (2007). Mutinous eruptions: Autonomous spaces of radical queer activism. Environment and Planning, 39(11), 2685–2698. Ingram, G. B., Bouthillette, A. M., & Retter, Y. (Eds.). (1997). Queers in space: Communities, public places, sites of resistance. Oakland, CA: Bay Press. Seidman, S. (2001). From identity to queer politics: Shifts in normative heterosexuality and the meaning of citizenship. Citizenship Studies, 5(3), 321–328. Shepard, B. R., & Hayduk, R. (Eds.). (2002). From ACT UP to the WTO: Urban protest and community building in the era of globalization. New York, NY: Verso. Warner, M. (Ed.). (1993). Fear of a queer planet: Queer politics and social theory. Minneapolis: University of Minnesota Press.

QUEER THEORY Queer theory grew out of a transdisciplinary intellectual movement that started in the late 1980s, when many scholars, especially those from

Queer Theory

humanities-oriented disciplines, began to theorize about sex, sexuality, and sexual identities in ways that especially challenged dominant scientific and cultural assumptions. Although scholars had used the term queer theory prior to 1990—especially Gloria Anzaldúa, who had used the term several times in the 1980s—many see the birth of queer theory as coinciding with the queer theory conference organized by theorist Teresa de Lauretis at the University of California, Santa Cruz, in 1990. That event was followed by a special issue of Differences: A Journal of Feminist Cultural Studies that de Lauretis edited from the conference proceedings. This work was quickly accepted and expanded upon by many academics, especially feminists who were eager to challenge notions of gender as part of an essential self, and scholars in gay and lesbian studies who were able to use queer theory as a fresh lens for examining the social constructions of what were widely considered to be normal sexual identities and natural sexual acts. Queer theory, despite its name, does not involve a singular theoretical view or a set of propositions related to gender and sexuality. Rather, it is a collective term that engages multiple, and sometimes conflicting, viewpoints about sex, gender, and sexuality. Queer theory, much like the word queer itself, is an often-contested term that is used in different ways by multiple scholars and activists. Although the lack of agreement about what queer theory means might be a limitation in some theoretical camps, it is often viewed as an advantage by queer theorists who see different viewpoints or perspectives as allowing for different insights about how gender and sexuality can be understood, analyzed, or enacted in cultures. Often queer theory is used as a tool to examine power and power relations, especially the political nature of sex, gender, and sexuality. Queer theorists also tend to explore gendered and sexualized practices that are constructed as deviant in cultures, including those that might be constructed as heterosexual in nature. Queer theorizing resists the categorization of people, even by objective– scientific means, into gendered or sexualized categories, especially binary categories such as

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man–woman or heterosexual–homosexual. Context is important, especially how geography, history, and cultural climate help to characterize or even constitute viewpoints.

Queer Theory’s Activist and Intellectual Backgrounds Many scholars point to the appeal of queer theory being that it is both an intellectual and an activist endeavor. Adding to this activist-intellectual synergy is the coterminous adaptation of the word queer by both academics and activist groups such as ACT UP or Queer Nation in the early 1990s. Queer Nation’s parade chant of “We’re here! We’re queer! Get used to it!” took a pejorative word that had been used for decades to abuse, shame, and even create notions of deviant sexual identity and behavior and reclaimed it as a tool for gaining awareness and questioning sexual and gender categorization. Similarly, queer theorists were using the word queer to disrupt the comfort others felt with the status quo of understanding sex and gender. These activist uses of queer faced opposition from people who claimed that using the word was nonproductive or that it conjured up painful memories of being bullied or abused. Still, the use and reuse of queer continued to find new purposes: to serve as a catch-all identity marker for those who are not heterosexual, as a commercialized term used to market or otherwise commodify sexual identities, and to name or rename departments or academic units. Queer theory is unique in the sense that—in both its street activist and scholarly forms—it relies less on building or protecting a specific identity label than on critiquing heteronormative values and assumptions. As that implies, most queer studies embrace poststructuralist theory, especially deconstruction, as well as ideological theories. Early pioneers in queer theory include Eve Kosofsky Sedgwick, Michael Warner, Judith Butler, Adrienne Rich, and David Halperin. Many of these scholars were influenced by the work of Michel Foucault, who is often considered a primary scholar for paving the way for queer theory. In 1993, Duke

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University Press started its Series Q line of books, indicating that queer theory was becoming legitimized as an academic field of inquiry. Annamarie Jagose developed a primer on queer theory that was published in 1996, further cementing queer theory’s role in academic studies. As queer theory gained traction, scholars such as E. Patrick Johnson noted that race and class were not addressed in queer critique and that this ignorance dismissed the implications of queer intersecting with racialized or classed identities. As a response, he developed quare studies to examine the experiences of QPOC. Other scholars, such as José Esteban Muñoz, examined what it meant to disidentify with different aspects of identities and even counteridentities—especially for those who came from different identities that are typically constructed as marginalized. Scholars also started to use queer theory to explore colonialism. For example, Scott Lauria Morgensen examined how White colonization of Native people in North America often involved the murder of two-spirited people, who were viewed by invaders as sexual and gender deviants, first. Queer theory continues to expand to critique social understandings of nationality, ability, religion, and other socially constructed identities.

Using Queer Theory Queer theory has been used in many ways by scholars, artists, and activists: as a tool for critique; to reexamine historical viewpoints; for coalition building and activism; to inspire art; and, more recently, as a form of social scientific inquiry.

or discourses. For example, Lee Edelman argued that queers are often socially pitted against children because people fear mortality (represented by the threat that queer people make to procreation) and crave a continuity of the self (represented by people’s offspring). To make his argument, he drew from news coverage of the case of Matthew Shepard, a young gay man who was murdered in 1998 in Wyoming; readings of films from Alfred Hitchcock; and psychoanalytic theory. Such a blend of texts and scholarly approaches is not unusual in queer theory. Challenging Historical Viewpoints

Queer theory is also used to examine archival materials, historical documents, and enduring cultural discourses to better understand how sexual and gender politics have seeped into historical understanding. Whereas lesbian, gay, bisexual, and transgender (LGBT) history typically seeks to understand queer people and their accomplishments or suppression over time, queer theoretical explorations tend to examine how history suppresses possibilities of queer pasts. Queer historical explorations often involve examining multiple cultures, especially when cultural assimilation is evident. Queer theory is also used to problematize notions of advancement for queer people, especially as queer cultures and practices are abandoned for heteronormative, often capitalist values. As that suggests, many historical feminist, gender, or sexual liberation movements have been analyzed through a lens of queer theory. Coalition Building and Activism

Queer Critique

Queer theory has primarily been used as an analytical tool for critiquing the creation of categories for sex, gender, and sexual identities. These critiques are often aimed at fictive texts including movies, television programs, or novels; cultural discourses about policies, actions, notable current events, and the people involved with them; and intellectual ideas, especially theories of gender or sexuality as they are developed by the sciences. Often queer critique can involve a number of texts

The term queer has been reclaimed and used as a unifying term to unite those marked as sexual deviants or gender outlaws, just as queer theory has been used to unite people in thinking about how they can find political power. This form of connection is one that is more about affinity than it is about essence. In its earliest forms, queer’s ability to create an affective stance of unity could be seen by “Queer Nation” appearing under the cover logo of gay–lesbian quarterly magazine Outlook, chants and rallying cries that invoked

Queer Theory

simultaneous celebration and defiance at rallies, and organizations using queer in their titles as a way of marking that they offer welcome to a wide variety of people and as a way of radically asserting their difference. The claiming of queer identity, paired with an academic movement, allowed a growing sense of coalition building that involved both thought and action. Sex workers, people with AIDS, health care professionals, people who identified as not being heterosexual, and their allies were coming together and are still coming together to think and act using the queer label and using aspects of queer theory. Art

Queer theory is also credited with the queering of method, where artistic and expressionistic forms of intellectual development are recognized as valid ways of knowing, thinking about, and experiencing queer worlds. Sometimes these works are directly influenced by queer scholarly writing, such as the science fiction novels of Octavia Butler that incorporate queer theory into fictive writing. In the early years of queer theory, a genre of film called New Queer Cinema emerged where artists including Gus Van Sant, Gregg Araki, and Rose Troche theorized about queerness via their films. Music genres ranging from queercore to queer hip-hop expand the range of genre forms. New media and the ability to create and distribute art more easily have allowed many artists to queer otherwise heteronormative art forms and to deconstruct heterosexuality in unique ways. For example, a genre of fan fiction known as slash allows the queering of characters from popular texts. This genre is queer not only because it destabilizes the heteronormative nature of most popular culture but also in that it embraces a sense of pleasure with the critique as popular characters find themselves in interpersonal and sexual relationships that defy gendered sexual expectations. Social Scientific Scholarship

Although it would seem that many social scientific studies are about classifying and identifying specific aspects of gender or sexuality, researchers

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have also used queer theory as a form of critique in interpretive or critical social scientific studies as well as a sensemaking mechanism for considering what data mean. Many guides or handbooks related to qualitative research methods include sections on queer theoretical approaches, as the fluid nature of queer theory matches up well with the iterative nature of qualitative research methods.

Queer Theory’s Ongoing Debates Although queer theory has gained much traction as a scholarly approach and as an interdisciplinary area of study, it is not without its ongoing debates. Many have questioned the utility of queer theory, contending that it relies too much on textual analysis and not enough on lived experiences and everyday realities. Arguments against this viewpoint suggest that texts capture some aspect of life and the language or images that create them are what constitute queer experience. Others have argued that queer theory turns its focus to two extremes, either examining the lives of privileged White people or focusing too much on unusual or obscure cases that will probably have little resonance with their audience. In response, queer theorists have continued to try and expand areas of inquiry to include a number of intersectional identities. Along those lines, others argue that queer theory will often focus on deconstructing gender or sexuality while reifying other social identities or categories, thus belying its own deconstructionist tendencies. Activists often note that when they try to embrace queer theory they are quickly lost in jargon and obscure writing, a problem also noted by many new students of queer theory. Academics in other disciplines have also critiqued queer theory, pointing out that it does not transfer well to application in other fields. In response, many queer theorists argue that this is one of the primary reasons for queer theory: It queers notions of conventional science and approaches academic inquiry from new perspectives. Still, many scholars reject the idea that queer theory is something new, instead contending it is an extension of literary or rhetorical criticism.

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Queering Heteromasculinities

In 2012, a public debate emerged about whether or not queer theory had died, including contributions from such notable queer theorists as Michael Warner and Jack Halberstam. Although some believe queer theory has moved past its ability to serve as a form of radical critique, others argued that the idea that it was even being debated shows there is a need for queer theory. Others pointed out that queer theory has been labeled as dead before but that it still continues to be a viable and valuable tool for scholarly inquiry. Jimmie Manning See also Intersections Between Sex, Gender, and Sexual Identity; Queer; Queer Politics; Sexual Norms and Practices; Sexual-Identity Labels

Further Readings Butler, J. (2011). Bodies that matter: On the discursive limits of sex. New York, NY: Taylor & Francis. Edelman, L. (2004). No future: Queer theory and the death drive. Durham, NC: Duke University. Lovaas, K. E., Elia, J. P., & Yep, G. A. (2006). Shifting ground(s): Surveying the contested terrain of LGBT studies and queer theory. Journal of Homosexuality, 52, 1–18. doi:10.1300/J082v52n01_01 Manning, J. (2009). Because the personal is the political: Politics and unpacking the rhetoric of (queer) relationships. In K. German & B. Dreshel (Eds.), Queer identities/political realities (pp. 1–12). Newcastle, England: Cambridge Scholars Publishing. Muñoz, J. E. (2009). Cruising utopia: The then and there of queer futurity. New York: New York University. Rand, E. J. (2014). Reclaiming queer: Activist and academic rhetorics of resistance. Tuscaloosa: University of Alabama Press. Sedgwick, E. K. (1990). Epistemology of the closet. Berkeley: University of California.

QUEERING HETEROMASCULINITIES Queer heteromasculinity is displayed by men who disrupt people’s ideas of how straight males are supposed to be. These are men who destabilize, or queer up, the binary gender categories. They

confuse people by having qualities associated with the feminine, or by supporting women’s rights and gay rights, even as they are clearly straight men. Their so-called feminine behaviors may be as simple as using their hands when they talk or saying that a shirt they see at the store is beautiful or pretty. Or they may appear typically male but have attitudes and beliefs not commonly expressed by heterosexual men, such as interrupting sexist, homophobic, biphobic, or transphobic jokes or bullying. They may also talk, even at a young age, about looking forward to being a father and have friends who are gay or bisexual. These are not what most people think about when they think about “masculine” men or how we expect straight guys to be. Consider the male high school student who studies dance, sings in his church choir, and loves to cook. Even though he plays a good game of basketball, he is clearly different. This same guy might have a close male friend with whom he shares a bed when they sleep over at each other’s house, and he might be open about giving him a hug when he sees him at school. His best male friend may be gay or bisexual. Such a guy is queering heterosexuality—what it means to be straight— and queering what it commonly means to be masculine. The behavior and relationships suggest he “must be gay.” But he isn’t. The term may seem odd—to put queer, heterosexual, and masculinity all in the same context. Yet naming a type of man as a “queer heterosexual” helps to get beyond what is thought of as the binary of sex and gender. The dominant gender and sexual binaries assume there is only one way to be masculine, and if a man does not perform by traditional expectations, then he is thought of as not being a real man, and thus, not likely to be heterosexual. In a binary system, one is either straight or gay, masculine or feminine. Queer heteromasculinity offers a more fluid option for straight men to embrace. Such men may be marginalized by traditional, gender conforming men and women because they disrupt the meaning of masculinity and upset the notion of heterosexuality. Yet queer heteromasculine men set new standards for how straight men can be.

Queering Heteromasculinities

In a patriarchal system, a system that bestows greater status on men than women, men have had to justify male domination over women. This has meant socializing men to fit into the heterodominant masculinity through a process of rewards and punishments. We socialize boys to make certain they do not grow up to be “like girls” and that they will do whatever it takes to keep others from thinking they are gay. The hierarchal gender binary insists that boys are by nature different from, and superior to, girls and that men by nature will be (or need to be) dominant over women. This story is told in patriarchal religions and in media, and is  reflected in government policy and corporate practices that have historically kept women out of leadership roles. Queer heterosexual men do not buy into these limited ways of being male. These men cross the line and join with women and with gay men in many of their behaviors and ways of thinking. How might one recognize them? Queer straight males may be “sissyboys”—those boys and men who are assumed gay because they have a number of qualities seen as feminine. Another type, socialjustice straight queers, may not display feminine qualities in their behaviors, but they are politically motivated to join with oppressed groups—women, gay men, lesbians, bisexual, and trans people—to work to bring changes in attitudes as well as public policies that discriminate. Some straight men simply prefer to engage at an equal level with sexual and gender minorities. Such men can be thought of as elective straight-queers—not necessarily political but comfortable in gay or female spaces. Other queer straight men may intentionally take steps that will lead others to assume that they are gay. They are committed to not being assumed straight, as a way to give themselves more freedom from restrictions imposed on straight masculinity. Many other heterosexual men are quiet in the ways they resist the sexism, misogyny, homophobia, biphobia, and transphobia that are associated with

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traditional masculinity. They live in the shadows of traditional masculinity, finding comfort in a quiet “queering” simply by not buying into the dominant messages about how to be a man. While they may not interrupt sexist, homophobic, biphobic, and transphobic bullying, they don’t like it and tend to stay out of masculine spaces where such behaviors are tolerated. Thus, queer heteromasculinities take a number of forms, but all represent the ways straight identified men can disrupt the assumptions we make about what it means to be male and heterosexual. These men legitimize alternative ways for all heterosexual men to experience masculinity. Robert B. Heasley and Betsy Crane See also Gender Binaries; Heteronormativity; Homophobia; Masculinities; Queer; Sissyboy Experience

Further Readings Bem, S. (1995). Dismantling gender polarization and compulsory heterosexuality: Should we turn the volume down or up? Journal of Sex Research, 32(4), 329–334. Butler, J. (1990). Gender trouble. New York, NY: Routledge. Crane, B., & Crane-Seeber, J. (2003). The four boxes of gendered sexuality: Good girl/bad girl & tough guy/ sweet guy. In R. Heasley & B. Crane (Eds.), Sexual lives: A reader on the theories and realities of human sexualities (pp. 196–217). New York, NY: McGraw-Hill. Heasley, R. (2010). But you’re so queer for a straight guy! Affirming complexities of gendered sexualities in men. In R. Plante & L. Maurer (Eds.), Doing gender diversity: Readings in theory and real world experience. Boulder, CO: Westview. Landreau, J., & Rodriguez, N. (2011). Queer masculinities: A critical reader in education. In J. L. Kincheloe (Series Ed.), Explorations of educational purpose. New York, NY: Springer.

The SAGE Encyclopedia of

LGBTQ Studies 3

Edited by Abbie E. Goldberg Clark University

R of a country, culture, or society. The term is used to explain the criteria for being the ideal man in a particular culture. Within a given culture, there are nondominant masculinities that are subordinate to hegemonic masculinity. In Western society, anatomical males are primarily associated with masculinity and anatomical females with femininity. Through social learning, boys and girls are taught by families and society how to think, act, and feel based on their anatomical sex. Masculinity ideology refers to beliefs about the importance of men adhering to these standards of male behavior as defined by a culture. Men who differ culturally from the majority may also differ in their masculinity ideology. Factors such as race, ethnicity, economic status, educational level, sexual orientation, and social context influence the kind of masculinity ideology that men learn and adhere to, or do not adhere to. Much of the research on masculinity ideology has focused on the negative aspects of what has been labeled “traditional masculinity,” which is the hegemonic masculinity of American men. Gay men are not included in hegemonic masculinity and, as such, often have to seek their own form of masculinity. Traditional masculinity, in these terms, not only restricts men from exhibiting signs of behavior or thought attributed to the female role but also entails a wide array of specific heteronormative behaviors and self-perceptions that men closely adhere to. For example, traditional masculinity entails such characteristics as competitiveness,

RACIALIZED MASCULINITY Racialized masculinity represents the interconnectedness of race and gender in the construction of masculinities and has relevance for understanding the lived experience of racial- or ethnic-minority gay men. In this entry, several masculinity constructs are defined: hegemonic masculinity, masculinity ideology, traditional masculinity, and racialized masculinity. An understanding of these terms leads to a discussion about racial- or ethnic-minority men and masculinity. Next, the concept of intersectionality with regard to racial identity and gender identity is offered to provide an understanding of racialized masculinity. Lastly, male identity theory provides an explanation for variations in masculinities among minority gay men. This entry focuses on cisgender men—that is, men whose gender identity agrees with the sex they were assigned at birth. The literature on racialized masculinity has not theorized on transgender men. However, we can presume that the concepts of racial identity and gender identity discussed in this entry apply to transgender men who identity as male.

Masculinity Ideology Masculinity is a sociocultural construction—that is, cultures create the prescriptions for, and characteristics of, being a man. Hegemonic masculinity is a concept that refers to the dominant masculinity 921

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Racialized Masculinity

physical violence, restricted emotionality, homonegativity, and restricted affectionate behavior between men. While most men do not embody all of these qualities, society supports hegemonic masculinity within all its institutions.

Racial- or Ethnic-Minority Men and Masculinity Racial- or ethnic-minority men have their own culture’s definitions of masculinity and gender role norms that they are taught through gender role socialization but must also negotiate the larger dominant culture’s male gender role norms. Additionally, the masculinities associated with minority men are subordinated masculinities and often require that they deal with stereotypes used to keep them and their masculinity subordinated or degraded. These circumstances can lead to “gender role strain”—that is, stress and strain associated with enacting the male role. First, gender role strain may be related to having to negotiate two potentially conflicting definitions of masculinity— those of one’s own ethnic culture and those of the dominant culture. Another possible source of strain may emerge when men are unable to fulfill the gender role norms and expectations of hegemonic masculinity due to racism or racial oppression. Third, gender role strain may be related to having to suppress one’s cultural expressions of masculinity in order to fit in or reap the benefits of the larger society. Some of the stereotypes that racial- or ethnicminority men must deal with include the following: Latino men are macho, hypersexual, lazy, drug addicts and dealers, undocumented, uneducated, and welfare recipients; Asian men are passive, shy, intelligent, computer geeks, kung fu masters, and video gamers; Black men are angry, violent, cool, athletic, unintelligent, and aggressive; American Indian men are spiritual, angry, savage, strong, and silent. For each minority male, competing with these stereotypes is hegemonic masculinity, the model for all men for how they “should” be. Hegemonic masculinity is associated with men of the dominant racial group, and subordinated

masculinities are associated with men of racial- or ethnic-minority groups. In this way, masculinity is racialized. Racialized masculinity represents the interconnectedness of race and gender in the construction of masculinities. By racializing masculinity, men and their gender expressions are placed within a hierarchy that is concomitant with their racial designation. From the point of view of hegemonic masculinity, racialized masculinities guarantee the dominant social position of White men and the subordinate social position of racial- or ethnicminority men. The hierarchy of masculinity is an aspirational system, in which almost no one achieves the masculine ideal but men strive for it nonetheless. Men who don’t achieve idealized masculinity in a significant way can bolster their sense of manhood through the subordinated masculinities below them. For example, White men who cannot achieve the masculine ideal can nevertheless feel superior in their sense of manhood to racial- or ethnic-minority men.

Intersectionality Intersectionality is a concept used to describe the ways in which oppressive institutions (e.g., racism, sexism, heterosexism) are interconnected and cannot be examined separately from one another. Intersectionality is also the term that is given to the complex interaction and coalition of identities related to one’s race or ethnicity, gender, sexual orientation, socioeconomic status, and so forth. Intersectionality acknowledges that one person’s identity can never be reduced to solely one characteristic, such as race or gender. Rather, each person’s identity is constructed of the various intersections of ways one might describe oneself. Racialized masculinity concerns the intersectionality of racial identity and gender identity. Sexual orientation identity intersects with these identity aspects, such that gay and bisexual men will have various identities that place their masculinity within the hierarchy of masculinities. For racial- or ethnic-minority gay and bisexual men, in particular, there will be the dual subordination of

Racialized Masculinity

their masculinity due to the intersection of race and sexual orientation.

Male Identity Human beings and sociocultural environments influence the creation and enactment of identities. The concept of the male reference group theoretically integrates the individual’s gender role selfconcept with the individual’s sociocultural setting. The sociocultural setting provides the messages, models, and/or objects of identification that become internalized and comprise the male identity. The concept of “reference group” is used to define any group with which an individual psychologically identifies himself or herself or aspires to relate himself or herself psychologically; and this identification can be through both real and vicarious relationships. The male reference group can serve as a source for a male’s gender role selfconcept—that is, one’s gender-related attributes, attitudes, and behaviors. During childhood and adolescence in particular, males will internalize images of males portrayed in sports, film, and popular music videos and imitate or try to become like cultural models in terms of dress, manner, language, attitudes, and values. Boys will internalize the masculinity they observe in boys and men because they identify with and want to be like those males—because of feelings of similarity and because such males are perceived as receiving valued social rewards. They will also define their maleness or masculinity based on other like males or their peer group, which would serve as the male reference group. Male identity in these terms provides an explanation for variation in masculinities among racialor ethnic-minority gay men. Some men will internalize the dominant masculinity associated with White American men, whereas other men will reject it and internalize the masculinity of their racial or ethnic group and socioeconomic status. For minority gay men, there will also be a gay masculinity that they may internalize that becomes part of their identity as a gay man, or they may reject gay masculinities altogether.

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Racialized masculinity, racism, and homonegativity can have an influence on male identity and gay identity or with regard to intersectionality. For example, if a young Latino gay man does not see any images of masculinity that he feels are congruent with who he is as a man because of negative stereotypes and the subordination of racialized and gay masculinities, he may experience feeling confused and alienated with regard to his gender role self-concept. He therefore will experience confusion related to male identity. He may ponder such questions as the following: What does it mean to be a man? Why am I different from other men?

Empirical Research Scholars and researchers have attempted to understand and describe those psychosocial factors that are particular to racial- or ethnic-minority men’s functioning given the structural contexts of their lives. This body of literature has tended to center on four themes: men’s constructions of manhood and masculinity, male or masculine identity, racial and ethnic identity, and the effects of traditional masculinity ideology. Authors have theorized how racial- or ethnic-minority men negotiate their masculine identity within the context of a sociopolitical environment that negates one’s manhood. Some constructions of masculinity have been viewed as dysfunctional and/or compensatory responses to racial oppression. Research on men and the intersectionality of racial and sexual identities has rarely been addressed. Researchers have tended to focus on racial-identity, ethnic-identity, or gay-identity development. The influence of “dual-identity” development has had sparse attention from scholars. Similarly, there is scarce research that has addressed “dual minority” status—that is, the lived experience of being part of two marginalized or oppressed minority groups. Additionally, racial stigma and prejudice play a role in gay America as they do in straight America. Research is needed on the topics of racial- or ethnic-minority gay men within their own communities, within the predominantly White gay community, as well as

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American society in general. In this way, we may come to understand and address the unique challenges facing racial- or ethnic-minority gay and bisexual men.

Conclusion Racialized masculinity guarantees the dominant social position of White men and the subordinate social position of racial- or ethnic-minority men. As a consequence, racial- or ethnic-minority men may experience stress and strain associated with enacting the male role and confusion related to male identity. The hegemonic standard of masculinity has been changing in recent times. Racialized, and to some extent gay, masculinities have slowly been gaining validity and acceptance. For the hegemony, this acceptance and change means an end to an exclusive control of systems of power. However, the changing definition of masculinity is not something that is easily accepted by all White or heterosexual men, or by all women and racialor ethnic-minority men. Jay C. Wade See also Hypermasculinity; Intersections Between Sex, Gender, and Sexual Identity; Masculinities; Masculinity Stereotypes; Minority Stress

Further Readings Connell, R. W., & Messerschmidt, J. W. (2005). Hegemonic masculinity: Rethinking the concept. Gender & Society, 19, 829–859. Kimmel, M. S. (2004). Masculinity as homophobia: Fear, shame and silence in the construction of gender identity. In P. F. Murphy (Ed.), Feminism & masculinities (pp. 182–199). New York, NY: Oxford University Press. Nardi, P. (Ed.). (2000). Gay masculinities. Thousand Oaks, CA: Sage. Pleck, J. H., Sonenstein, F. L., & Ku, L. C. (1993). Masculinity ideology and its correlates. In S. Oskamp & M. Costanzo (Eds.), Gender issues in contemporary society (pp. 85–110). Thousand Oaks, CA: Sage.

Sanchez, F. J., Greenberg, S. T., Liu, W. M., & Vilain, E. (2009). Reported effects of masculine ideals on gay men. Psychology of Men & Masculinity, 10, 73–87. Wade, J. C. (1998). Male reference group identity dependence: A theory of male identity. The Counseling Psychologist, 26, 349–383.

RELATIONSHIPS WITH FAMILIES WHO SHARE THE SAME DONOR This entry describes the growing phenomenon of contact among families who share the same sperm donor. Lesbian, bisexual, transgender, and queer (LBTQ) parents, as well as sperm donor-conceived children, adolescents, and adults, can use registries at donor insemination (DI) programs or independently established by parents to contact others who have the same sperm donor. The entry reviews research about experiences among people who share the same donor—who are “donor-linked”— and why they might want to contact each other. As research to date is primarily quantitative, this entry also includes more in-depth findings about one set of donor-linked families. These families’ experiences provide insight into the complexity of this new phenomenon and the difficulties with defining their relationships.

Building Family Through Sperm Donation One route to having children among LBTQ prospective parents is with the help of a sperm donor through assisted insemination. The donor can be known to a prospective parent or unknown, as in cases of DI through a fertility program or sperm bank. In DI programs, donors will help multiple families have children; this is rare among known donors. In the United States, unknown donors will assist anywhere from one to 40+, dependent on several variables but, most importantly, the DI program’s family limits. An unanticipated outcome of this type of family building, combined with parents being open about using donor conception, is that a DI family—parents and/or their children/

Relationships With Families Who Share the Same Donor

adolescents/adults—may be able to contact others who have the same donor. These “donor-linked” families share genetic links but do not have other features traditionally associated with family, such as shared lives and homes. (Families also exist who share the same known sperm donor or egg donor but are not discussed, as little is known about them.)

Finding Others Who Share Your Donor Most parents do not conceive their children with the intention of creating relationships with donorlinked families; until recently, most did not even know others existed. But once they become known, some seek contact with each other. How do families find each other? Why would they want contact? What kind of families would be interested? How many families are even interested in contacting other families to whom they are donorlinked? And how do they perceive their relationship(s) with one another? Quantitative, primarily survey-based, studies have begun to address these questions among single women (primarily heterosexual, with some bisexual- and lesbian-identified women), female same-sex couples, and heterosexual couples. Until recently, it was difficult to find donorlinked others (see, e.g., the 2001 documentary Offspring, by Barry Stevens). Only one small DI program, The Sperm Bank of California (TSBC), offered parents the opportunity for mutualconsent contact with others who shared their donor. The program’s “Family Contact List” was (and is) a registry of all TSBC parents and DI adults who register their interest in contact. When parents and/or DI adults from two or more families sign up, the registry shares their contact information and then leaves contact up to the families. Others, such as Voluntary Register of Victoria, Australia, work in much the same way and are now starting to link members. The largest registry is the Donor Sibling Registry (DSR; www.donor siblingregistry.com), created in 2000 by Wendy Kramer and her DI-conceived son. Unlike DI program-based registries, the DSR is open to anyone

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who is donor-linked—parents, donor-conceived individuals, and sperm, egg, and embryo donors. It is limited only by the ability to remember the donor’s number assigned by the program or other unique identifiers. The DSR has led the international explosion of people finding donor-linked others, usually parents and donor-conceived adults finding each other. The majority of research comes from this registry and is about people linked through an anonymous sperm donor. Estimates of interest in making contact among donor-linked people are difficult to obtain. Research among donor-linked families comes primarily from the United States, where the total number of donor-assisted births is unknown and renders estimates indeterminable. Approximate numbers of families are known, however, at the TSBC program, with about one quarter of all families signing up for donor-linked contact. DI adolescents and adults also express interest in contacting others who share their donor—sometimes as much interest as contacting the donor himself. For example, in 2005, Joanna Scheib and her colleagues found that in a small sample of TSBC adolescents who wanted their donor’s identity, almost 90% also expressed interest in others who shared their donor. In 2010, Vasanti Jadva and her colleagues found similar interest levels among DI adolescent and adult DSR members. While it is unclear whether this extends to the majority of donorlinked people, as of 2014, the DSR had almost 45,000 members with over 10,000 having matched to another parent, donor, or donor-conceived person. Clearly, a significant number of people want contact with donor-linked others.

Contact Interest by Family Type Based on DSR membership (the majority are parents) and the high proportion of “Single Mothers by Choice” members who join their linking registry, interest in donor-linked families appears greatest among DI single mothers. Membership in the TSBC matching registry also reflects this trend. In contrast, the majority of DI adolescent and adult (i.e., offspring) DSR members comes from

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heterosexual-couple parent families (not singlemother families) and the fewest from families with two mothers. Why there are so few individuals from two-mother families is unclear. One possibility is that there are simply fewer of them, as DI became available to female same-sex couples much later, only relatively recently. But it is also possible that interest differs by family type and by the importance attributed to genetic over social ties in determining who is family and in helping a person understand who they are—that is, their identity.

Why Do Donor-Linked People Want Contact? Based on registry research with parents of dependent children (of whom the most is known), parental curiosity appears to drive the interest in contacting donor-linked families. In addition, parents most often appear to seek contact to obtain (1) emotional and informational support for their children and/or themselves and (2) information about their children’s shared traits and sometimes medical problems. Differences have also emerged across family type, the most pronounced being that heterosexual-couple parents are least likely to even join a registry. In comparison to other family types, female-partnered parents more often nominate information-sharing as the reason for seeking contact, whereas single mothers explain interest in seeking support through knowing other DI, and thus nonheteronormative, families. Some parents hope to create extended family for their children, especially when they are single mothers or parentonly children (i.e., people with, on average, smaller families). Parents from all family types, however, report believing that finding other children who shared their child’s donor may ultimately give the children better insight into themselves. Single mothers may be more likely to desire and seek out donor-linked families for several reasons. They are in a unique position with only their children to consider when deciding whether or not to join a registry and whether a genetic link holds an opportunity for the benefits of family, such as support and strong relationships. In contrast,

partnered parents must balance the potential benefits of forming relationships with others based on shared genetics with the reality that one parent’s relationship is based on non-normative bonds of choices and experiences, rather than traditional genetic links. For heterosexual-couple parent families, which are traditionally defined (in part) by genetic links, forming relationships with others who share the link they will never have can be difficult to consider and act on, especially if the infertility and family’s donor origins are not known to others. For families with two mothers, there is the need to weigh the benefits of relationships with donor-linked others with the potential impact on the family, especially when the genetically unrelated mother’s legitimacy is challenged. Relationships with those who are genetically linked to her children, but not her, may be perceived as a risk not worth taking. Additionally, unlike heterosexual singles and couples for whom genetic links are perceived as powerfully defining features of important relationships, same-sex couples decrease the emphasis on genetic links as a basis for their families; instead, choices and affective ties are strongly defining features. It is possible, then, that sharing a genetic link holds less interest for and relevance to two-mother families. When DI adolescents and adults join linking registries, their motives for doing so appear similar to those of the parents. Curiosity seems to drive interest. Individuals raised by single mothers are, like their mothers, more likely to seek contact to find new family. Many adolescents and adults also seek contact for information about their shared genetic origins—medical but also shared looks, personality, experiences—based on the belief that this will give them a better understanding of themselves.

Relationships Little information is available about the ways in which DI people and their families view relationships with others who share their donor. Experiences seem positive enough that many families remain in contact after finding each other, but few studies have explored beyond this. Two sets of

Relationships With Families Who Share the Same Donor

study findings from the TSBC registry give insight. When parents were asked to describe their relationships, donor-linked families were most often described as friends, acquaintances, or connected through a unique relationship—in non-kin terms. But when asked to describe their children’s relationships, or how they perceived their children to view the relationships, they were most often described as kin. There was also a tendency for children of single mothers, more often than those of female-partnered mothers, to be described as perceiving the relationships in terms of immediate rather than extended kin. This further supports the idea that family is more rigidly defined by genetic ties among the single mothers, most of whom heterosexually identified, whereas definitions of family are more multiply determined among the lesbian families. But overall, being donor-linked to others is not an immediate, clear path to kinship. The next section illustrates the complexities and ambiguities of being donor-linked.

Experiences Among Donor-Linked Families A 2015 documentary, An Extended Family, helps fill the gap in understanding the experiences of donor-linked families. Seven donor-linked families were filmed by spouses Stephen Lee and Susan Czark—whose own family was included—to explore their coming to know each other over an 11-year period. Their experiences provide a glimpse into the complexity of this new phenomenon and the difficulties with applying labels to relationships among donor-linked families. More generally, terminology has been inconsistent, with, for example, “donor-sibling” being used more commonly than “donor-linked.” The latter, however, is less likely to imply familial relations—an important consideration for initial explorations of this phenomenon. Between 1996 and 1999, there were 12 families who selected the same TSBC donor for their children. The documentary includes most of these families. None of the families knew each other. Many of the families lived near TSBC, but others lived on the U.S. East Coast and dealt with the DI program by mail and phone. Over the next 15

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years, eight of those families also agreed to be part of the TSBC donor-linking registry. Lee and Czark’s family joined first, soon after their twins were born in 1998. Two more families joined in 2003; others joined sporadically over the next few years. The families in the group were diverse: one heterosexual-couple parent family, three singlemother families, and four two-mother families. Two of the same-sex couples had separated but continued to coparent together. Another of the two-mother families had separated, and the parents (and the children, both conceived with the same donor) no longer interacted. One of the single mothers was now female-partnered. The parents say they sought contact with other families to provide “context” for the children. One mother explained that her family joined the registry to give their son as broad an understanding of himself as possible. She added, “We weren’t looking for family—we had that.” The relationships between families developed over time but invariably followed the same steps. After receiving another family’s information, interactions between families begin tentatively with e-mails and photo exchanges. Phone calls follow, allowing the parents to share their personal stories and medical information. The families then progressed to meeting in person. The parents swapped stories, watched the teens interact, and pondered the connections. The parents observed that the children’s interactions resemble simultaneously those among siblings, cousins, and friends. The children (seven boys and two girls, ages 15 to 18 years) seemed almost magnetically drawn to each other. They roughhoused with one another—even the children who typically shied away from such activity. One of the mothers observed that all the children seemed drawn to touch their half-siblings, “almost like they are trying to put engrams of themselves on each other.” Another mother commented that the children also appeared to be more engaged and more forgiving of each other than they were with their other peers. She added wryly, “It’s almost like they’re related.” Like all social groupings, some people were closer to some individuals and families than

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others. One parent described an early meeting of the families as “we were like parents at our kids’ play date, but with more at stake.” Another parent described the relationship between the parents as “similar to in-laws, but without the negative connotations.” The adults also lacked a term that accurately described the parents’ relationships to each other. The children have had more workable language to describe their relationships. Initially, the teens usually described themselves as “half-siblings.” As the relationships matured, they now easily referred to each other as brother and sister. Several of the teens also commented that their relationships with their half-siblings differ from the relationships they have with friends, cousins, and their own siblings. One parent observed that the children had all the benefits of siblings, “without having to fight over resources.” The children in this group were genetically related, but what were the families to each other? In many ways they were friends, but many described their relationships as “more than friends.” Several parents described an underlying bond between the families that many of the parents noted is unique to this group. Was this group a family? The most accurate answer to this question might be, “It depends.” In certain situations, this group felt and behaved like family—in all the positive and negative connotations of the concept. Several of the parents spoke of the group as an “extended family,” but that also depended on one’s definition of family. As families have grown ever more blended and diverse, the meaning of family has grown far more permeable. One of the teens noted, “I think family is more about the people you want to be with than who you’re related to.” To paraphrase psychologist Madeline Feingold, genes make people, but what makes a family? Knowledge of donor-linked individuals forces DI families to consider whether or not genetic ties, in the absence of social interactions, are sufficient to merit contact, and even consider donor-linked others as kin. For those interested in contact, sharing the same donor, and thus genetic ties, may give

families, when initially strangers, leeway to behave as though their interactions will be long-term, so they may be more forgiving and quicker to connect. But like newer, chosen families, the decision to maintain active contact is likely based on mutually rewarding experiences and bonds—without these, parents may end contact, unless the children opt to continue later on their own, when they are old enough.

Conclusion Even though maintaining genetic ties is a central feature of DI family-building, this traditional criterion of defining family can be as easily rejected by parents as accepted by their children, when defining relationships among families who share the same donor. At this point in our understanding, whereas most relationships among DI children, teens, and adults appear kinlike, relationships among the parents, when they exist, may be best described as blurring the lines around friendships, sometimes to the extent of creating chosen, extended family. More research is needed to understand this new way of creating relationships and sometimes family, but clearly there is no one way of defining relationships among those who share the same donor. Joanna E. Scheib, Alice Ruby, and Stephen Lee See also Families of Choice; Heteronormativity; Nonbiological, Nongestational Mother; Sibling Relationships; Sperm Donor, Choosing a

Further Readings Blyth, E. (2012). Genes r us? Making sense of genetic and non-genetic relationships following anonymous donor insemination. Reproductive Biomedicine Online, 24, 719–726. DeGroot, J. (2010). Donor insemination guide. San Francisco, CA: COLAGE. Freeman, T., Jadva, V., Kramer, W., & Golombok, S. (2009). Gamete donation: Parents’ experiences of searching for their child’s donor siblings and donor. Human Reproduction, 24, 505–516.

Relationships With Former Spouses Goldberg, A., & Scheib, J. E. (in press). Conceiving kinship: Does sharing a sperm donor mean we’re family? Journal of Lesbian Studies. Hertz, R., & Mattes, J. (2011). Donor-shared siblings or genetic strangers. Journal of Family Issues, 32, 1129–1155. Jadva, V., Freeman, T., Kramer, W., & Golombok, S. (2010). Experiences of offspring searching for and contacting their donor siblings and donor. Reproductive Biomedicine Online, 20, 523–532. Kramer, W., & Cahn, N. (2013). Finding our families. New York, NY: Penguin. Lee, S., & Czark, S. (in press). An extended family [Motion picture]. Santa Clara, CA: First Pictures. Scheib, J. E., & Ruby, A. (2008). Contact among families who share the same sperm donor. Fertility & Sterility, 90, 33–43. Stevens, B. (2001). Offspring [Documentary]. Toronto, Ontario, Canada: Barner-Alper Productions.

RELATIONSHIPS WITH FORMER SPOUSES Many contemporary relationships end in separation or divorce. Former partners must uncouple their lives, and individuals must deal with the major life transition of lost love and emotional suffering, including guilt associated with feeling relief that one’s relationship is ending. Ending a marriage also involves dividing property, separating finances, creating new households, arranging for custody and support of children, and negotiating new relationships with family and friends that were once shared by the couple. In that sense, same-sex partners are like heterosexual couples in having to adjust and build new lives as single persons again. Separation and divorce are major life transitions that are affected by many circumstances, some of which are common across all couples and some of which are unique to same-sex couples by virtue of a history of legal discrimination and more restrictive social norms. This entry discusses relationships with former spouses in the context of LGBTQ individuals, beginning with dissolution of the relationships

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between same-sex spouses and partners and then considering former partners and spouses who were in a heterosexual relationship or marriage in which one of the partners transitions to a new LGBTQ identity. Also addressed are issues related to legal marriage, the care of children through the separation and divorce process, and implications for promoting productive and respectful relationships in the wake of relational dissolution (i.e., divorce, or divorcelike if the partners were not legally married) and family reconfiguration (i.e., new family structures such as forming a stepfamily).

Challenges Facing Same-Sex Partners in Divorce and Separation Compared to heterosexual couples who have always been able to marry legally, and thus have the legal right to divorce, there has been a historic lack of legal recognition of the family ties of samesex partners. Even in those states where there have been legal options available to same-sex couples, divorce and dissolution can be especially difficult because of the lack of social norms helping couples to negotiate the ending of their intimate relationship. One of the major challenges facing couples is the heteronormative belief that a same-sex relationship is not “real” and thus the couple is not going through a “real” divorce. It has been found that when their relationships end, sexual minorities are more likely to be treated as single individuals rather than as members of a couple. Gay men may face additional challenges in uncoupling, given that women are considered more emotionally attuned and better at communicating than men. Research has shown that despite a strong belief in and desire for marriage, same-sex couples have unique pressures that can lead to a greater number of breakups than in heterosexual relationships. Due to the lack of legal safeguards (until recent changes in marriage laws), societal recognition, or acceptance of same-sex partnerships, their relationships can be more fragile, even if the emotional ties are strong. Further, research on lesbian and gay couples in general has found that their

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relationships are more egalitarian and also allow partners to have more personal autonomy. These factors contribute to the greater likelihood of ending a committed relationship. Although there are no reliable data as yet to estimate the number of same-sex relationships that end, some evidence is now accumulating suggesting that even civil recognition and/or legal marriage are not always protective factors. For example, within one year after the legalization of civil unions in Vermont, 1% of the same-sex couples who had received civil unions had ended their relationships. Given that the acceptance of samesex relationships has only recently been increasing, the historic lack of uniformity in laws and the lack of social scripts for how to separate or get a legal divorce can make it challenging for LGBTQ individuals to navigate their postdissolution relationship.

Same-Sex Partners From Planned LGBTQ Families There are some differences among LGBTQ couples in terms of risk for divorce. It has been found that there is a higher risk of divorce or dissolution when partners are female, younger, have less education, and have a greater age discrepancy between the partners. One interesting finding is that many lesbian ex-partners continue to be friends postbreakup. Additionally, research has found that same-sex partners who have children present in their home are less likely to dissolve their relationships than couples without children. Children add a level of social pressure and emotional commitment that helps to maintain a spousal relationship. Having a formal tie to children helps to ease the transition in divorce and separation. For lesbian women who are parents living in states where same-sex marriage and/or second-parent adoption have not been available until recently, there is the chance for the mother who is not biologically related to the child to lose access to her children after her relationship with the biological mother ends. Researchers have found that nonbiological mothers and their children may become legal strangers to one another. On the other hand, many

lesbians retain good communication and positive relationships with former partners. In these circumstances, both parents can still share custody regardless of relationship status. There is some evidence that shows that it is easier to maintain positive relationships with the former spouse when the comother (or, social mother) had legally adopted the children. In the case of heterosexual divorce, however, former spouses can ease into new family roles with less difficulty than same-sex couples because the roles of former spouse, single parent, stepparent, and the like are more ritualized and institutionalized (i.e., taken for granted and supported by broader social institutions). Although same-sex relationships are becoming more accepted in society, there are few scripts for relationship dissolution in these couples. Former partners may feel that they are “making it up as they go along.” Due to the lack of ready-made roles to fall into, same-sex couples have to negotiate how they dissolve their relationships and share parenting responsibilities. Despite these difficulties, same-sex partners who break up may experience a unique source of support because they have previously established a strong network of friends and family outside the couple relationship. These chosen kin relationships, in which friends are converted into family, are more informal, flexible, and innovative than taken-for-granted kin relationships. Thus, there are both benefits and costs to living outside of the conventional social norms in society. On the one hand, the lack of formalized ties for LGBTQ couples can make it more difficult to transition to the roles of former spouses or members of stepfamilies. On the other hand, LGBTQ individuals, out of necessity and choice, may be open to more flexible definitions of who counts as family and have a broader array of social support available to them.

Issues Related to Children In many states, only biological or adoptive parents have legal ties to a child, thus excluding the social parent (e.g., comother or cofather). These challenges make the transition from being a member of a couple to a single person more difficult when

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there are children involved and when laws discriminate against same-sex families. Research has shown that children benefit when their parents (both residential and nonresidential) can communicate well and coordinate the care of the children. In a study of young adults with LGBTQ parents who have ended their partnerships, children fared better when custody was shared and their parents were cooperative and respective of one another than when there was ongoing conflict among parents or between children and their parents’ new partners. In this study, the most tenuous and difficult relationships were between children and their nonbiological parent’s new partner. A major issue remains as to whether LGBTQ stepparent and stepchild relationships would improve now that marriage and divorce are legal rather than informal, as has been the case until recently.

Different-Sex Partners From Formerly Heterosexual Marriages Researchers have studied relationships that end in divorce between formerly heterosexual partners to a greater degree than relationships that end in divorce between two LGBTQ individuals. This is especially the case for gay male relationships, which have received far less attention than lesbian relationships. In one study, approximately 33% to 50% of lesbian women and 14% to 35% of gay men had previously been in a heterosexual marriage. It was found that when one partner in a heterosexual relationship discloses a new sexual orientation identity to their spouse it often disrupts family relations. For wives, in particular, when their husbands come out as gay, they may react with shock, estrangement, confusion, and guilt, and they may feel a sense of stigma associated with their loss of a traditional marriage. When the partner who discloses a new sexual orientation identity leaves the relationship, the heterosexual partner may also react with acceptance of their spouse’s new identity. Some couples choose to remain in the marriage, typically for the sake of children, and thus have a mixed-orientation marriage where one spouse is heterosexual and the other spouse is not.

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Implications for Future Research and Practice Regardless of sexual orientation or legal status, divorce is a disruptive life transition that can be eased with social acceptance and support. Education is needed to inform family and community members, teachers, therapists, judges, lawyers, legislators, and other professionals about the unique challenges facing former LGBTQ spouses— especially when children are present. Because family law and social conventions are still based on heteronormative assumptions, it is especially important to acknowledge the legitimacy of samesex couple relationships and to utilize the creativity and flexibility of the LGBTQ community in establishing postdivorce family ties. Much more research is needed on the quality of relationships between LGBTQ individuals and their ex-partners. Mainly, more research is needed to understand the effect of LGBTQ legal marriage and legal divorce on how relationships end and how individuals relate to one another postdivorce. Key questions include the following: Are LGBTQ ex-partners different from heterosexual couples in the kinds of difficulties they must negotiate? Does the presence of children improve former spousal relationships, or does it make the breakup more strained and difficult? What kinds of chosen kinship relationships are most helpful in stabilizing and supporting relationships after they end? The answers to these questions can aid in understanding and strengthening the ties of former same-sex partners and their families.

Conclusion The study of same-sex relationship dissolution and its impact on the lives of former partners is increasing and improving. There are many ways in which both same-sex former partners and heterosexual former partners interact postdivorce, and these factors depend upon the length of the relationship, the ability to maintain positive communications, the presence of children, and the social support from family and friend kin networks. At the same time, same-sex former partners face unique challenges. In comparison to heterosexual

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divorcing couples, same-sex former partners have faced a previous lack of legal protection and a lack of knowledge about LGBTQ lives and communities, with the treatment of their relationships and their divorces not considered as real or intense as those of heterosexually married couples. Still, the flexibility and creativity found in the LGBTQ community, often born of necessity, can ease the transition from being coupled to being single or newly partnered and help all families regroup and thrive in the face of this major life transition. Katherine R. Allen and Erin S. Lavender-Stott See also Child Support After LGBQ Divorce/Separation; Divorce, Legal Issues in; Divorce and Relationship Dissolution, Psychological Experience of; Divorce and Separation, Historical Perspective on; Legal Recognition of Nonmarital Same-Sex Relationships; Legal Rights of Nonbiological Parents; Living Arrangements of Children After LGBQ Divorce/ Separation; Mixed-Orientation Marriages; Stepfamily Family Functioning and Relationship Stability

Further Readings Allen, K. R. (2007). Ambiguous loss after lesbian couples with children break up: A case for same-gender divorce. Family Relations, 56, 175–183. doi:10.1111/j .1741-3729.2007.00444.x Gartrell, N., Bos, H., Peyser, H., Deck, A., & Rodas, C. (2011). Family characteristics, custody arrangements, and adolescent psychological well-being after lesbian mothers break up. Family Relations, 60, 572–585. doi:10.1111/j.1741-3729.2011.00667.x Goldberg, A. E., & Allen, K. R. (2013). Same-sex relationship dissolution and LGB stepfamily formation: Perspectives of young adults with LGB parents. Family Relations, 62, 529–544. doi:10.1111/fare.12024 Hertz, F. (2012). Navigating same-sex divorce: Effective representation in a new legal landscape: Part I of II. American Journal of Family Law, 26, 164–175. Hertz, F. (2013). Navigating same-sex divorce: Effective representation in a new legal landscape: Part II of II. American Journal of Family Law, 26, 204–214. Kurdek, L. A. (1997). Adjustment to relationship dissolution in gay, lesbian, and heterosexual partners. Personal Relationships, 4, 145–161.

Oswald, R. F., & Clausell, E. (2006). Same-sex relationships and their dissolution. In M. A. Fine & J. H. Harvey (Eds.), Handbook of divorce and relationship dissolution (pp. 499–513). Mahwah, NJ: Lawrence Erlbaum. Van Eeden-Moorefield, B., Martell, C. R., Williams, M., & Preston, M. (2011). Same-sex relationships and dissolution: The connection between heteronormativity and homonormativity. Family Relations, 60, 562–571. doi:10.1111/j.1741-3729.2011.00669.x

RELATIONSHIPS WITH PARENTS, YOUTH This entry focuses on the relationships that lesbian, gay, and bisexual (LGB) youth have with their parents. Specific topics addressed include how gender nonconformity and sexual orientation can influence parent–child relationships before their parents are aware of their sexual orientation, how and why LGB youth reveal their sexual orientation to parents, how parents react to their child’s sexual orientation, how parents contribute to child health, and interventions to support parents. Although popular culture in the United States frequently depicts LGB youth as scorned by and cast off from their family of origin, parents react to discovering their child is LGB in a variety of ways. Research has begun to illuminate how parental reactions to their LGB child shape the health and well-being of these youth, and parents of LGB youth are critical to ensuring LGB youth have the opportunity to thrive throughout childhood and adolescence. The research literature on LGB youth’s relationships with their parents is still developing, and additional research is needed to more fully examine how LGB youth’s parents influence their health.

Before Coming Out—Gender Nonconformity and Initial Identification as LGB A child’s eventual identification as LGB can potentially influence relationships with their parents long before they reveal their sexual orientation, or “come out,” to their parents. Many LGB individuals report gender-nonconforming behaviors during

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childhood, meaning that they choose clothing, activities, or interests that do not conform to societal expectations of a child of their biological sex (e.g., a boy who desires to play with dolls). On average, LGB individuals report higher levels of gender-nonconforming behavior during childhood than heterosexual individuals, and increased gender nonconformity during childhood is associated with decreased relationship quality with parents. In addition, gender-nonconforming children are more likely to experience physical and psychological abuse at the hands of family members during childhood than children who are gender conforming. LGB youths’ relationships with their parents may be challenged in other ways prior to coming out to their parents. LGB youth typically selfidentify as LGB before revealing this to other individuals. Most LGB youth experience anxiety related to coming out to their parents and worry that their parents will reject them because of their sexual orientation. Suicide attempts by LGB youth are most common before they have revealed their sexual orientation to their parents, clearly indicating that this is a stressful time for youth. Some youth who have started to self-identify as LGB but have not revealed this to their parents begin to withdraw from their parents during this time. As a result, parent–adolescent relationships of LGB youth might be increasingly strained during this period of LGB youth development. Some parents even report feeling relief when their child reveals they are LGB, as parents now have clarity about why their child was behaving differently toward them, and they perceive their child’s coming out as an opportunity to reconnect.

Coming Out to Parents Not all LGB youth choose to reveal their sexual orientation to their parents during adolescence; some youth wait until a later time when they are less closely connected with and dependent on their parents. However, currently, most LGB youth do reveal their sexual orientation to their parents during adolescence, and many are coming out at increasingly younger ages. Although most LGB adolescents come out to their parents by telling

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them directly, other avenues of parents finding out this information exist, including parents asking their child or finding out through other means (e.g., finding romantic text messages to a same-sex classmate). LGB youth may deny they are LGB if parents inquire about their sexual orientation before the youth themselves are comfortable disclosing this information to others. Many parents of LGB children report suspecting that their child was LGB before the child came out to them, and parents often indicate that gender-nonconforming behaviors throughout childhood led them to suspect their child might be LGB. LGB youth’s decisions to reveal their sexual orientation to their parents—and how their parents react when they do find out—are shaped by both individual and family characteristics. LGB youth typically come out to their mothers before their fathers and are less likely to tell their fathers at all; and fathers of LGB youth are more likely than mothers to be rejecting of their child’s sexual orientation. Parents within highly religious families are less likely to be told that their child is LGB and are more likely to have rejecting reactions. LGB youth are more likely to come out to their parents if they have high-quality and supportive relationships with them and if they are securely attached to their parents (i.e., have a warm and trusting bond with them). Parental reactions to LGB youth when they come out are variable, ranging from celebration to outright rejection of the child and their sexual orientation. Parental rejection can occur in both subtle and overt ways following disclosure, and common rejecting parental behaviors include name-calling, attempting to change a child’s sexual orientation, denying that a child is “really gay,” encouraging a child to keep their sexual orientation a secret or to “tone down” behaviors that identify the child as LGB, and restricting access to LGB peers or resources. Even more serious forms of rejection, such as expelling LGB youth from their household or engaging in physical violence, do occur in some families but are relatively rare. Common accepting responses to LGB youth after parents discover they are LGB include affirming love for a child after they disclose their sexual orientation; assisting a child in coming out or

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finding resources; showing supportive interest in same-sex relationships and identity; supporting LGB rights publicly; and advocating for a child when family members, peers, or schools engage in homophobic behavior.

Parental Influences on the Health of LGB Youth Like all parents, parents of LGB youth have a profound influence on their children’s health and wellbeing. Caitlin Ryan and her colleagues found that LGB young adults who were rejected by their parents in adolescence reported dramatically higher rates of thoughts of suicide, suicide attempts, depression, substance use, and sexual risk taking, relative to LGB young adults who reported less parental rejection. LGB young adults who were accepted by their parents in adolescence reported more positive outcomes in adulthood, including greater self-esteem, higher social support from family and friends, and better general health. Researchers have also addressed how parent– child relationship quality influences LGB child health, separate from specific responses to a child’s sexual orientation. LGB youth who have generally supportive and caring relationships with their parents report lower levels of psychological distress, depression, thoughts of suicide, and suicide attempts. Few studies have examined how parents influence sexual behaviors among LGB youth, but some evidence indicates that youth whose parents express disapproval of them engaging in sexual behaviors will engage in fewer sexual risk behaviors. However, gay and bisexual male youth might not be protected against sexual risk behaviors via parental monitoring and parent–adolescent communication about sex in the same way that heterosexual youth appear to be protected by these factors. All adolescents experience stress, and adolescents are better able to cope with distress when their parents are a trusted source of support. LGB adolescents experience unique stressors, including discrimination and victimization because of their sexual orientation, and these stressors can

lead to compromised health. However, LGB youth who have strong, supportive relationships with their parents are less likely to report negative mental health outcomes when they experience discrimination. Almost all studies of families with an LGB child have examined how the LGB child is affected, but changes can occur throughout the entire family after a child comes out. Parents, siblings, and extended family members are all affected by this change within the family. Family dynamics that existed prior to the child coming out generally persist after the child reveals her sexual orientation, but preexisting family dynamics can momentarily shift following disclosure. For example, many parents report considerable personal distress and rumination after a child comes out. Moreover, conflict between parents could increase if parents do not agree about how to respond to their child, and relationship quality between parents could be compromised if one parent knows of her child’s sexual orientation but the other does not. On average, these difficulties appear to diminish gradually over time and in many instances result in families who report being stronger and closer as a result of a child coming out.

Interventions to Support Parents Given the challenges that parents face when they learn they have an LGB child, as well as the profound effect that parents have on their children’s health, many have recognized the need to provide support and guidance to parents with LGB children. The most well-known organization addressing this need is PFLAG, a national nonprofit organization with over 350 chapters across all 50 states. PFLAG chapters offer support to parents and families who might be struggling with the news that they have a lesbian, gay, bisexual, or transgender (LGBT) child (typically through group meetings). They also provide education about LGBT issues to families and communities more broadly and serve as a vehicle through which interested families and allies can engage in activism to promote LGBT rights. Other interventions for

Relationships With Siblings, Youth

parents that have been described in the published literature include narrative therapy to help parents to “reauthor” the stories about their expectations for their children, as well as an online film-based intervention titled Lead With Love that aims to make support, information, and behavioral guidance available to parents who have difficulty accessing other resources. Additionally, preliminary evidence has suggested that a modified version of attachment-based family therapy can be effective in reducing suicidality among LGB youth.

Limitations of Prior Research and Future Directions The methods that have historically been used to study LGB youth and their relationships with their parents have been limited. The vast majority of previous research has used cross-sectional methods where LGB youth are surveyed at just one time point. This method does not allow researchers to confidently make causal inferences within their studies about how family members reciprocally influence each other. Additionally, many previous studies have been retrospective, asking LGB adults to report on their experiences as adolescents. This method is subject to memory biases, as individuals may not be able to accurately report on events that occurred several years prior. Finally, parents of LGB youth have rarely been included in previous studies, and parental perspectives on LGB youth and coming out are imperative to discovering how parents can interact with LGB youth in a way that cultivates and maintains healthy developmental trajectories for youth and families. Brian C. Thoma and David M. Huebner See also Coming Out, Disclosure, and Passing; Developmental Aspects of Sexuality; Parent–Child Relationships; Relationships With Siblings, Youth; Transgender Youth and Family Relationships

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A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. Journal of Primary Prevention, 31(5–6), 273–309. doi:10.1007/s10935-010-0229-1 Diamond, L. M., Butterworth, M. R., Allen, K., Kerig, P., Schulz, M., & Hauser, S. (2012). Sexual-minority development in the family context. In P. K. Kerig, M. S. Schulz, & S. T. Hauser (Eds.), Adolescence and beyond: Family processes and development (pp. 249–267). New York, NY: Oxford University Press. Heatherington, L., & Lavner, J. A. (2008). Coming to terms with coming out: Review and recommendations for family systems-focused research. Journal of Family Psychology, 22(3), 329–343. doi:10.1037/0893-3200 .22.3.329 Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123(1), 346–352. doi:10.1542/peds.2007-3524 Savin-Williams, R. (2001). Mom, Dad. I’m gay: How families negotiate coming out. Washington, DC: American Psychological Association.

RELATIONSHIPS WITH SIBLINGS, YOUTH This entry describes the relationships between siblings during their youth. The definition of a sibling relationship (or sibship, as they are commonly referred to) and their importance is reviewed, followed by an overview of the various factors that can influence the quality of sibling relationships. The latter half of the entry examines LGBTQ youth and their sibling relationships, including their decision making in coming out to a sibling and the response of siblings to the coming-out process.

The Creation of Sibships Further Readings Bouris, A., Guilamo-Ramos, V., Pickard, A., Shiu, C., Loosier, P. S., Dittus, P., Waldmiller, J. M. (2010).

Most youth reside with a sibling at some point during their childhood. Sibling relationships are among the first social relationships a person

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acquires, and one of the longest-lasting familial relationships a person will have in their lifetime. What constitutes a sibship is more complex than at first glance. A sibship can be created (and in some cases, dissolved) through birth, adoption, cohabitation, marriage, divorce, and remarriage. They can also be self-selected, as is the case with fictive kin and “chosen families,” whereby sibships arise out of close relationships with people who are often seen as “like a brother/sister.” In addition to fictive, siblings can be thought of as full, half, quasi, step, or “in-laws.” Full siblings share the same biological mother and father, whereas halfsiblings share either the same biological mother or father. Quasi sibships occur when two families cohabitate, and stepsiblings are created through marriage, yet no biological connection is shared in either of these sibships. The marriage of a sibling can generate sisters- and brothers-in-law, a type of sibship commonly overlooked. Indeed, the fluidity inherent in the creation and definition of sibships reflects the diversity inherent in how society defines the meaning of family.

Youth and the Influence of Sibships Sibships remain an important familial relationship throughout many people’s lives, exercising a profound impact on social, emotional, and cognitive development. Many factors have been found to influence the quality of sibling relationships in childhood and adolescence, including (a) family size, (b) birth order and age spacing, (c) gender, (d) geographic proximity, and (e) parental influences. Family Size

Living in a postagricultural society has implications for family size, and many families include no more than two or three children, meaning that the majority of people may only ever have one or two siblings. A smaller number of siblings (typically a dyadic sibship) suggests a higher possibility of constant interaction—both positive and negative. In larger families comprising three or more siblings, conflict seems unavoidable, as siblings strive for

access to familial resources, including the attention of parents. However, larger families can provide a greater support system for its sibships, offering many opportunities for forming close sibling relationships among its members (known as sub-sibships). Birth Order and Age Spacing

Birth order positioning can have implications for availability of family resources; parental time, energy, and relationship quality; and the type of power and influence exerted over younger siblings. For example, younger siblings may model older siblings, and a greater age difference between siblings may yield stronger modeling behaviors. Given that older siblings can act as quasi-parents, teachers, and confidants, they wield a greater responsibility over the social, emotional, and cognitive development of their siblings, thus positively (and negatively) impacting their younger sibling. Moreover, when considering age spacing, de-identification processes may occur as a result of close age proximity. Particularly in late childhood and adolescence—when youth are attempting to forge unique identities apart from their families—siblings may consciously or subconsciously develop different personal qualities and define themselves as different from one another in order to reduce rivalry and competition. Gender

Perhaps one of the most significant predictors of sibling relationship influence and quality of relationship is the gender of the siblings. A typical familial socialization process directs women to be nurturers in and of the family—even from a young age. As a result, sibships that include a sister report a more intimate relationship across the life span. However, in late childhood and adolescence, sibling conflict peaks. As such, same-gender dyads (e.g., sister–sister, brother–brother) tend to engage in high levels of comparison, which can lead to jealousy, competition, and rivalry. Competition tends to be particularly highest among brothers, and sisters often report more jealousy. Overall, though, sisters report more affection, intimacy, and

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emotional closeness in their youth than do brothers. Siblings in mixed-gender dyads also report more emotional closeness than brothers, lending support for gendered socialization processes that guide women to disclose their feelings and develop rapport in an effort to bond and form close relationships. Geographic Proximity

Geographic proximity is a significant influencer of sibling relationships, especially during youth. During childhood and adolescence, siblings are more often than not sharing the same residence. While close proximity can create more bonding opportunities, it can also instigate confrontation— especially during adolescence when youth are seeking independence from their siblings and other family members. When youth experience the transition of a sibling moving out of the family home, the sibship enjoys a break in their relationship, as both siblings adjust to new roles—in the family (the sibling still residing at home) and in society (the sibling leaving home due to school, work, or romantic relationships). Parental and Caregiver Influences

A final influence on sibling relationships involves the perception of parental (or caregiver) behaviors and attitudes toward siblings. When youth perceive a discrepancy in parental affection, for example, the sibling relationship can be strained. Youth who believe they are being treated differently or unfairly in comparison to their siblings tend to be more jealous of their siblings than do siblings who perceive equal treatment by their parents. Conversely, if a parent, the parents’ relationship, or the family is experiencing a crisis, such as mental health concerns, divorce, or financial hardship, the sibling relationship may fortify in the presence of adversity.

LGBTQ Sibling Relationships While adolescence can create distance and strain in sibships, as youth enter young adulthood they may

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rediscover their relationships with one another from a fresh perspective. Pertinent to this encyclopedia entry, youth may rediscover their sibling relationship during the journey of gender and sexual identification and coming out. The process of self-discovery and formulating an identity, as well as navigating disclosures to family and managing family response, can be aided by a sibship. In reflecting on the process of coming out to family members (e.g., parents and siblings), some LGBTQ youth decide that the best domain in which to first come out is the sibship. In these circumstances, coming out becomes a pathway to fostering closeness—or perhaps discord—in the relationship. When individuals decide to discuss their sexual-minority (e.g., LGBTQ) status with a sibling first before any other member in the family, they are utilizing the egalitarian ties of the sibship. For example, a parent–child relationship is hierarchal, and the LGBTQ youth perceives more stress in disclosing their status with a parent as opposed to a sibling. Their parent may reject them, disown them, cut ties, and—if they are still residing at home—disallow them access to the family home. LGBTQ youth have more to lose, so to speak, when contemplating self-disclosure to parents. Therefore, given the perceived egalitarian nature of the sibship, it is inherently less threatening for an LGBTQ youth to first broach such a complex and sensitive topic with a sibling before doing so with parents or other caregivers. Assuming that LGBTQ persons have agency in revealing their sexual-minority status, whether a person chooses to discuss this with a sibling may rely on certain factors. For example, sibling closeness signifies a greater likelihood that a youth may talk to their sibling about their LGBTQ status, while research is mixed with regards to whether youth are more likely to come out first to a sister or a brother. A unique predictor, though, is the sexual-minority status of the sibling to which the youth is coming out. Emergent research suggests that if a youth has a sexual- or gender-minority sibling, they are more likely to discuss their own LGBTQ status with this sibling before anyone else, including friends and parents. A sense of mutual

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understanding and empathy is anticipated before initial disclosure, with the LGBTQ youth hoping that their LGBTQ sibling will be supportive and accepting. Upon coming out, both LGBTQ siblings are able to bond over a shared minority status and a deeper appreciation of one another. Considering the diversity in gender and sexualminority statuses, the reaction to disclosure of a lesbian or gay identity may vary from that of a bisexual or a transgender identity. Siblings—both heterosexual and LGBTQ—are generally initially accepting of a lesbian, gay, and bisexual (LGB) disclosure from a sibling. Understanding the complexity involved in identifying as transgender, though, presents more complication with initial acceptance. Some siblings feel confused and even ashamed of their sibling’s transgender identity, going so far as to dismiss their claims of a transgender identity. LGBQ siblings, though, are quite sympathetic when their transgender sibling discloses their status, recognizing the challenges they may face and offering unconditional support if and when transition occurs. Experiencing the coming out of a family member can present challenges for youth of LGBTQ siblings. Heterosexual youth who are the only family member aware of their sibling’s sexualminority status might be responsible for keeping what they know from other family members, causing discomfort and dissonance whenever interacting with other family members. Alternatively, siblings of LGBTQ youth may find themselves in a very important position, as their LGBTQ sibling may rely on them for support and to serve as a buffer during their coming out to parents and other family members. Further, youth with LGBTQ siblings must navigate their own coming-out process in which they continuously evaluate situations and people appropriate for disclosure of their siblings’ minority status. When a youth’s sibling discloses an LGBTQ status, they may reflect on their own values and belief system. Indeed, individuals with LGBTQ siblings report feeling more open to different people and different experiences, which can lead to a more open relationship with their sibling. Some

youth even decide to take up the cause of LGBTQ rights and engage in social activism, outreach, and educational programming, perhaps even alongside their LGBTQ sibling. Sibling relationships remain one of the most enduring familial relationships. They are defined in such a way as to reflect the complexity and flexibility of family and understood in relation to an array of personal, familial, and societal factors. The LGBTQ sibling relationship serves to illustrate the complexity of sibships, offering a nuanced perspective on gender, sexuality, and family relationships. Katie M. Barrow See also Coming Out, Disclosure, and Passing; Families of Origin, Relationships With; Relationships With Parents, Youth; Sibling Relationships

Further Readings Barrow, K. M. (2014). When a second child comes out as LGBT: Examining sibling relationships and family experiences. Unpublished doctoral dissertation, Virginia Tech, Blacksburg, VA. Factor, R. J., & Rothblum, E. D. (2007). A study of transgender adults and their non-transgender siblings on demographic characteristics: Social support and experiences of violence. Journal of LGBT Health Research, 3, 11–30. doi:10.1080/15574090802092879 Hilton, A., & Szymanski, D. (2011). Family dynamics and changes in sibling of origin relationship after lesbian and gay sexual orientation disclosure. Contemporary Family Therapy: An International Journal, 33, 291–309. doi:10.1007/s10591-011-9157-3 Jenkins, D. A. (2008). Changing family dynamics: A sibling comes out. Journal of GLBT Family Studies, 4, 1–16. doi:10.1080/15504280802084365 McHale, S. M., Updegraff, K. A., & Whiteman, S. D. (2012). Sibling relationships and influences in childhood and adolescence. Journal of Marriage and Family, 74, 913–930. doi:10.1111/j.1741-3737 .2012.01011.x Toomey, R. B., & Richardson, R. A. (2009). Perceived sibling relationships of sexual minority youth. Journal of Homosexuality, 56, 849–860. doi:10.1080/ 00918360903187812

Religion and Spirituality, Youth Walker, A. J., Allen, K. R., & Connidis, I. A. (2005). Theorizing and studying sibling ties in adulthood. In V. L. Bengtson, A. C. Acock, K. A. Allen, P. DilworthAnderson, & D. M. Klein (Eds.), Sourcebook of family theory & research (pp. 181–184). Thousand Oaks, CA: Sage.

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SPIRITUALITY, YOUTH

Just as with heterosexual youth, lesbian, gay, bisexual, and questioning (LGBQ) youth interact with religion and spirituality in their personal lives. This entry explains how contacts between LGBQ youth and religion and spirituality have historically been negative, punitive, shaming, and guiltridden experiences. This discussion includes an analysis of the efforts by some fundamentalist religious groups to use reparative and/or conversion therapy to change the sexual orientation of LGBQ youth to that of heterosexuality. This entry concludes with a discussion of how some of today’s LGBQ youth are experiencing a much more positive relationship with religion–spirituality than did previous generations of LGBQ youth.

Historical Interactions Between LGBQ and Religion and Spirituality Historically, heterosexuals have enacted homophobia to discriminate against LGBQ youth and youth perceived as LGBQ. Homophobic acts have included being physically violent, bullying in school and other settings, denying youth participation in community organizations, creating problems in the military, and rejecting such people from family activities. An example would be a heterosexual military person who refuses to shower with someone who is perceived as LGBQ, out of concern she or he will become an object of the other’s sexual gratification. Another term that is related to homophobia is heterosexism, which treats heterosexuality as the “normal” and therefore preferable sexual orientation. Heterosexist attitudes are found throughout local, state, and national policies, laws, and attitudes (e.g., consider states that refused to

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allow same-sex couples to marry until the Supreme Court, in June 2015, declared same-sex marriage legal in all 50 states). Another related term is sexual prejudice, a term coined in 2005 by psychologist Gregory Herek. Sexual prejudice is any adverse action toward someone based on their sexual orientation. However, in Western cultures this prejudice is most often directed to LGBQ people and rarely toward heterosexuals. It can be observed in the examples described previously related to homophobia and heterosexism. Religion and spirituality can be difficult to define and distinguish from each other. Many people find the term spirituality to be vague and imprecise. Indeed, spirituality is very personal and unique to each person. It involves a relationship between oneself and what is often referred to as a higher power or something in the universe that is greater than the power of an individual person. Spirituality is less structured than religion and can be practiced without the involvement of others. For example, one can discover one’s higher power through being in nature, as in a wilderness setting away from human settlement, and then use interacting with nature as a means of discovering meaning in life. Religion, on the other hand, provides laws and guidelines for how life should be lived and is usually experienced in a more formal setting such as a worship service that includes other people. It is important to note that one can be spiritual without being religious, religious without being spiritual, or one can incorporate both into one’s life at the same time.

Reparative and Conversion Therapy As mentioned previously, heterosexuals have used homophobia and religion to discriminate against LGBQ youth and youth perceived as such. Spirituality is rarely used in a similar manner. One illustration of the use of religion to discriminate against LGBQ youth is using the techniques of “ex-gay ministries,” officially known as reparative or conversion therapy. These treatments claim the ability to change a person’s sexual orientation from LGBQ to heterosexual. Such therapy has

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historically been employed by fundamentalist Christian churches, organizations, and/or counseling centers. All of the major professional associations whose members provided counseling and therapy to LGBQ persons have taken positions against reparative theory, describing them as dangerous and providing more harm than good. These organizations include the National Association of Social Workers (NASW), American Psychological Association (APA), and the American Association for Marriage and Family Therapy (AAMFT). These organizations have developed their positions based on a plethora of research studies examining the outcomes of reparative and conversion therapies—all of which have reached the same conclusion regarding the harm these therapeutic techniques have caused. An alternative focus would be on the strengths of individuals, as employed by the discipline of social work and other academic units, and gay-affirming techniques. For example, a 2011 research study by Lon Johnston and Chris Stewart, two social workers, found that the majority of respondents who participated in conversion or reparative therapy expressed their inability to experience a “normal” adolescence. As is widely accepted in American culture, adolescence is often known as a time of rebellion and self-discovery. Yet for participants in this study, acts of defiance and embracing their inner feelings were often curtailed during adolescence. Most participants indicated they rarely rebelled against their parents or other authority figures. Participants described intense pressure to guard the secret of their sexual orientation; one way to protect this secret was to always be in control of their behavior. Being in control meant rarely doing anything that could raise questions in their parent(s)’ and/or friends’ minds about what might be going on inside the adolescent’s mind. Many described feelings of regret related to their adolescence. Participants talked of knowing they were somehow different from their peers and believing something was wrong with them in most social situations, especially religious ones. This study, as well as numerous others, suggests that the development of a personal identity by LGBQ youth is impeded by internal conflicts

regarding one’s sexual orientation. Participants described organized religion as easily the most oppressive factor in the acceptance of their sexual orientation, as well as being responsible for much of the internalized heterosexism and homo prejudice carried by the participants. The LGBQ people in this study indicated they received the most negative messages about who they were from organized religion. Several of these messages included describing “homosexuals” as abominations, degenerates, sinners, threats to family life, and those who would destroy the moral fabric of America. Because of internalizing these heterosexist messages, participants felt guilt and shame and experienced low self-esteem. These feelings were a factor in some of the participants turning to the self-destructive activities, including drug and substance abuse, selfmutilation, promiscuity and other high-risk sexual behaviors, and suicidal thoughts and attempts to end their lives. In most instances, the participants were not even welcomed in their previous churches after their sexual orientation was known.

Rethinking Lesbian and Gay Adolescent Religion and Spirituality Some research studies and national reports indicate that many of today’s LGBQ adolescents and youth still experience the discrimination and oppression as described previously. However, there are many people advocating for changing the thinking about religion and spirituality in relationship to LGBQ adolescents and youth. As psychologist Ritch Savin-Williams notes in his book, The New Gay Teenager, some of today’s LGBQ adolescents and youth are having a different experience with religion and spirituality. He proposes a different perspective related to what it means to be a gay adolescent today. Specifically, he suggests that past notions must be shed. The experiences of previous generations of gay men and lesbians only act as suggestions for understanding, rather than firm milestones or expectations in the development— including religious and spiritual development—of an LGBQ young person. Johnston and Stewart’s research supports SavinWilliams’s position. For example Johnston and

Religion and Spirituality, Youth

Stewart found that only 25% of respondents reported leaving or changing their religious affiliation because of religious views toward their sexuality; only 13% actually changed their religious views or practices because of antigay religious teachings. While the vast majority of the adolescents surveyed do not seem to have trouble integrating religion, spirituality, and their sexual orientation, it may be that, for those in the minority, religion and religious dogma are still problematic. The catalyst for the positive changes of many LGBQ adolescents seen today is not entirely clear. However, the following suppositions are offered by social scientists and others working directly with LGBQ youth as reasons for today’s differences: • The support for same-sex marriage by the majority of Americans • The right for same-sex couples to marry in the majority of American states • The increase in the number of churches that ordain LGBQ as pastors, deacons, and elders • The rise in the number of youth groups sponsored by gay-affirming congregations such as the United Methodist Church, Disciples of Christ, American Baptist Churches, United Church of Christ, Universal Fellow of Metropolitan Churches, Reformed Catholic Church, some liberal Jewish groups, and independent, nondenominational assemblies • A spread in the number of community centers catering specifically to the needs and interests of LGBQ adolescents and youth • The visibility of LGBQ persons in local, state, and national government and the media who are open regarding their sexual orientation • The growth of the number of high schools allowing the Gay, Lesbian & Straight Education Network (GLSEN) and gay–straight alliances (GSAs) to form groups in their institutions • The increase in the number of university faculty who have been trained and participate in Safe Place programs to whom LGBQ students can turn for help • Nondiscrimination statements adopted as law by numbers of cities, counties, and states

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• The repeal of Don’t Ask, Don’t Tell (DADT) in the military • The right to serve openly as an LGBQ person in the military • The advocacy activities of organizations such as the Human Rights Campaign (HRC) • The media campaign known as “It Gets Better”

This list includes only a small number of the reasons offered as possibilities for more positive relationships LGBQ persons have with religion and spirituality. There are undoubtedly other possibilities that could be added to this list. Because of the many positive changes occurring in American society, it is incumbent for people to rethink former theories and ideas about LGBQ adolescent and youth and be open to the reality that past experiences are changing or have changed. There is a template of the progress that can be made with the treatment of LGBQ youth by looking at changing attitudes that came out of recent movements such as the ones for civil and women’s’ rights. Thus, it is important to rethink the experiences of LGBQ with religion and spirituality. Throughout history people of color and women experienced similar conflicts, and there are helpful lessons to be learned here. Lon B. Johnston See also Gay, Lesbian & Straight Education Network (GLSEN); Gay–Straight Alliances (GSAs); LGBTQ (In)Visibility Within College Contexts; LGBTQ Issues in K–12 Education Across Global Contexts; Religious Identity and Sexuality, Reconciliation of; Religious LGBTQ Youth; Sexual Orientation Discrimination as Sex Discrimination; Suicide, Risk Factors for and Prevention of

Further Readings Beam, G. L., & Savin-Williams, R. C. (2005). Reconciling Christianity and positive non-heterosexual identity in adolescence, with implications for psychological wellbeing. Journal of Gay & Lesbian Issues in Education, 2(3), 19–36. Dahl, A., & Galliher, R. V. (2012). The interplay of sexual and religious identity development in LGBTQ adolescents and young adults: A qualitative study.

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Religion/Spirituality and LGBTQ People

Identity: An International Journal of Theory and Research, 12, 217–246. Johnston, L. B., & Jenkins, D. (2004). Coming out in mid-adulthood: Building a new identity. Journal of Gay and Lesbian Social Services, 16(2), 19–42. Johnston, L. B., & Stewart, C. (2011). Rethinking GLBTQ adolescent spirituality: Implications for social workers in the 21st century. Journal of GLBT Family Studies, 7(4), 388–397. Kubicek, K., McDavitt, B., Carpineto, J., Weiss, G., Iverson, E. F., & Kipke, M. D. (2009). “God made me gay for a reason”: Young men who have sex with men’s resiliency in resolving internalized homophobia from religious sources. Journal of Adolescent Research, 24(5), 601–633. Lee, J. (2013). Torn: Rescuing the gospel from the gays-vs.-Christians debate. Nashville, TN: FaithWords. Savin-Williams, R. C. (2005). The new gay teenager. Cambridge, MA: Harvard University Press. Yarhouse, M. A., & Tan, E. S. N. (2005). Addressing religious conflicts in adolescents who experience sexual identity confusion. Professional Psychology: Research and Practice, 5, 530–536.

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Religion is one of the oldest forms of community organization across cultures—providing individuals with behavioral guides, rituals, and relational structures. While spirituality often accompanies religious experiences, it can stand alone as well as provide a personal sense of meaning within a larger universe. This distinction between religion and spirituality has become increasingly important within Western societies due to the redistribution of power from religious institutions to the individuals within them. This growing emphasis on the individual has brought to the foreground the debate regarding who has the right to interpret scripture and modify religious rituals for sexual (e.g., lesbian, gay, and bisexual [LGB]) and gender (e.g., transgender, gender queer) minorities seeking religious and/or spiritual experiences. In response to tensions between ancient scriptural

interpretations and contemporary contexts, many sexual and gender minorities are creating new religious and spiritual pathways. It is likely that this sustained religious–spiritual engagement amidst morality and being LGBTQ debates is motivated by religion serving as a form of identity and an avenue for reflection, social support, and familial connectedness. In addition, religion and spirituality may also minimize health risks among sexual and gender minorities (e.g., HIV risk reduction). Given the important role of religion and spirituality within the lives of many sexual and gender minorities, this entry briefly reviews the diverse pathways of their religious–spiritual negotiation and then explores the associated cultural contexts.

LGBTQ People’s Negotiation of Religion and Spirituality Research suggests that sexual and gender minorities address tensions between religion and sexuality in a variety of ways. While some suppress their sexual orientation or replace organized religion with personalized spirituality, others separate their religious and sexual identities or live with ongoing conflict. In fact, the Pew Research Center reports that more religious commitment is sometimes accompanied by greater levels of religious conflict for sexual minorities. Researchers have also reported that some sexual-minority individuals elect to address this conflict by disengaging from formal religious structures. However, it is important to note that the shift from religious member to spiritual nonbeliever is gaining momentum globally outside of sexual- and gender-minority contexts—with a reported 1.1 billion people now identifying as spiritual agnostics or atheists. Although sexual and gender minorities in America still report higher rates of religious nonaffiliation (48%) as compared with the general public (20%), researchers explain that this may be due to sexual and gender minorities feeling unwelcome due to a history of discriminatory religious traditions, contemporary homophobic practices within religious contexts as well as communal ignorance regarding sexual–gender minorities.

Religion/Spirituality and LGBTQ People

Despite the frequent association between religion and sexual-minority stress, Eric Rodriguez and Suzanne Ouellette’s landmark study of the Metropolitan Community Church of New York (MCCNY), a Christian denomination formed to specifically minister to sexual minorities, found that some LGBTQ individuals integrate their religious and sexual- or gender-minority identities without any reported conflict. Furthermore, there are reports of sexual and gender minorities from religious backgrounds continuing to utilize religious coping mechanisms even amidst faith and community challenges (e.g., God made me transgender or gay). In addition, both sexual and gender minorities have created change within their existing communities and/or formed new, LGBT-positive religious organizations such as Jewish Queer Youth (JQY, or JQYouth), Dignity American Catholic Church, Lutherans Concerned, Gay & Lesbian Vaishnava Association (GALVA), and Muslims for Progressive Values (MPV).

Cultural Variations of the LGBTQ Religious/ Spiritual Experience LGBTQ and religion scholars such as Andrew Yip note that integration pathways can vary tremendously across cultures and religions. For example, while there are a large number of Jewish and Christian gay-positive–gay-friendly resources, there are a limited number of integration structures within Muslim and Hindu communities. Researchers suggest that this may be due in part to the conflation of sexual–gender and immigration status—with many Muslims and Hindus in Western countries actively attempting to protect their cultural heritage by resisting assimilation and the “Western invention” of LGBTQ identity. Although, feminist scholars such as Ruth Vanita suggest that, while many fear that LGBTQ identities are a Western export, India’s long history of lesbian unions within rural communities unexposed to LGBTQ activism provides evidence that sexual- and gender-minority experiences are in fact a longstanding practice within Indian cultures. However, the bulk of religion and sexuality–gender research focuses

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on Jewish and Christian communities. Given this research gap, religious integration structures within Muslim, Hindu, and Buddhist communities are reviewed in depth below, followed by a discussion of within-group cultural variation illustrated by research regarding Christian and Jewish denominational differences. Islam and LGBTQ People

Despite a heritage of LGBTQ discrimination within Muslim communities, a number of sexual and gender minorities from Muslim backgrounds are attempting to create change within. Andrew Yip’s research regarding British LGBTQ negotiations of controversial Koranic texts regarding Lot and the story of Sodom and Gomorrah suggest that many LGBTQ Muslims creatively interpret the Koran to support their religious and spiritual integration efforts. Drawing on this platform of change, MPV was established in 2007 as the first (and only current) inclusive Muslim community rooted in the traditional Koranic ideals of human dignity and social justice. There are now four MPV Unity Mosques in North America, with Imam Daayiee Abdullah serving at the Light of Reform Mosque in Washington, D.C., as the first openly gay Muslim religious leader (imam) in North America. Abdullah is also the first (and only current) imam in North America marrying same sex couples and one of the few providing janazah (religious funeral services) to those who die of AIDS. While the size of this North American movement represents a fraction of the 1.6 billion Muslims in the world, their activism serves a pivotal role in providing a religious–spiritual reference point for LGBTQ individuals within Islam. Hinduism and LGBTQ People

Rusi Jaspal and Matthew Cinnirella report that LGBTQ Hindus are likely to encounter challenges due to their sexual- or gender-minority status. However, Jaspal also suggests that experiences may vary in relation to individuals’ specific cultural backgrounds and the supports available to them. For example, while some Hindu sects in

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Religion/Spirituality and LGBTQ People

North America reference religious (i.e., dharmic) texts as a foundation for the contemporary prohibition of LGBTQ acts or identity, GALVA and LGBT Hindu Satsang of Philadelphia provide alternative platforms for LGBTQ individuals. Alternatively, other Hindu sexual and gender minorities find support by joining third-gender sects that are traditionally comprised of individuals with both male and female characteristics. Although, some scholars question whether such sects are emancipating or undermining as thirdgender Hindu sects such as the South Asian Hijra and Jogappa are also associated with prostitution. Alternatively, the Aravani (Ali), a third-gender Hindu sect of Southern India, is estimated to have over 100,000 transgender members unassociated with prostitution. While Aravani’s membership is a tiny fraction of the 1 billion Hindus in the world, the cultural trend of sexual- and gender-minority inclusion has gained momentum in North America with the Hindu American Policy Brief on Hinduism and Homosexuality. The policy statement publicly recognizes the lack of explicit Hindu guidelines regarding homosexual sanctions and emphasizes the Hindu tradition of spiritual equality, highlighting the need to accept all on the journey to moksha (spiritual emancipation). However, psychologists caution that such North American shifts may not be reflective of contemporary LGBTQ experiences in non-Western cultures such as India. Buddhism and LGBTQ People

Buddhist attitudes regarding sexual and gender minorities also vary considerably across cultural groups. For example, while some LGBTQ Buddhists in China encounter views that homosexuality is a sin punishable in one of the nine hells, others in Burma reference affirming narratives of cross-gender acaults—men who present with female characteristics due to their possession by, and marriage to, the female spirit god Manguedon. Similarly, a growing number of Buddhist transgender advocates reference reincarnation and the Vinaya Pitaka’s (the monastic framework

presented in the first division of the Tipitaka/Pali canon) review of Buddha’s acceptance of transgender monks as scriptural support for transgender inclusion. In addition, LGBTQ-friendly Buddhist organizations, such as Queer Sangha in New York City and Gay Buddhist Sanga in San Francisco, offer sexual and gender minorities a safe and inclusive place to engage in Buddhist teachings and meditation. Researchers suggest that such LGBTQpositive communities are particularly necessary for American Buddhists as they are more likely to retain anti-LGBTQ attitudes than other religious groups in America (e.g., Christian), even after being primed with religious values of empathy and compassion. However, despite such findings, there is a growing sentiment among North American Buddhists that the third precept, advocating the awareness of the suffering caused by sexual misconduct, does not explicitly pertain to same-sex relationships. In addition, the Dalai Lama shifted his policy concerning homosexuality with his 2014 statement that consensual relationships between two people of the same gender are acceptable although, given the many sects within Buddhism and the Dalai Lama’s current exile, such perspectives are far from universal across the world’s 500 million Buddhists. Christian Diversity Regarding Sexual/Gender Minorities

In a similar vein, contemporary Christian denominations have voiced both inclusive and exclusionary attitudes regarding sexual and gender minorities. Researchers suggest that this wide range of attitudes reported by members of the same religious group may be related to religious leaders’ diverse and ambiguous attitudes on sexual- and gender-minority rights. For example, while Pope Francis stated in 2014 that it was not his role to judge homosexuals, he also did not change the Catholic Church’s policy against gay marriage. Similarly, the Church of Jesus Christ of Latter-day Saints (Mormons) issued statements in 2014 and 2015 against gay marriage while

Religion/Spirituality and LGBTQ People

simultaneously protesting LGBTQ housing discrimination. Within the Lutheran Church, the politically liberal-leaning Evangelical Lutheran Church in America (ELCA) has come out in support of gay marriage and LGBTQ inclusion and equality in church life, while the more conservative Lutheran Church Missouri Synod (LCMS) remains opposed. While many LGBTQ individuals reportedly struggle with such ambiguity, others report that the lack of clear and consistent religious policies has helped them feel comfortable forming and joining alternative Christian communities such as Dignity (Catholic), Welcoming and Affirming Baptists, Lutherans Concerned, and the nondenominational United Federation of Metropolitan Community Churches (UFMCC). Jewish Diversity Regarding Sexual or Gender Minorities

While Reconstructionist, Reform, and Conservative Jewish communities reinterpret scripture for the modern era, leading to varying levels of sexualor gender-minority acceptance, the majority of Orthodox Jewish communities maintain that both the Bible and the Oral Law (i.e., Talmud: 200–500 C.E.) remain contemporarily applicable—with same-sex sexual relations and gender-norm deviations viewed as a contemporary sin. However, attitudinal variations exist even within those orthodox parameters, with distinctions between Modern and ultra-Orthodox Jewish communities. For example, the Modern Orthodox Jewish community has attempted to pastorally acknowledge the spiritual needs of their sexual- or gender-minority members with a 2009 discussion panel at their flagship institution, Yeshiva University, and the Statement of Principles in 2010. Contrastingly, other ultra-Orthodox communities continue to maintain a culture of silence and/or active exclusion. Such debates have also taken on the global spotlight with Israel’s legal negotiations of LGBTQ issues. For example, Israel is one of the few countries in the Middle East recognizing same-sex residential unions and imported same-sex marriages; however, marriages outside of Orthodox religious

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ceremonies, including same-sex marriages, are not legal in Israel. However, despite these internal fragmentations, Israel is largely recognized as the Middle Eastern LGBTQ safe haven due to its awarding of political asylum to a gay Palestinian facing death threats. The Pew Research Center reports that 40% of Israelis support the acceptance of homosexuality as compared to significantly smaller percentages in traditionally Muslim countries such as Lebanon (18%), Turkey (9%), Palestinian territories (4%), Egypt (3%), Jordan (3%), and Tunisia (3%). Familial Contexts of LGBTQ Religion/Spirituality

Researchers suggest that while culture plays an important role in defining religious responses to sexual and gender minorities, family relationships also play a contributing role. Chana Etengoff suggests that religious family members’ responses are related to their ability to humanize their gay relative’s experience via empathic acts. Moreover, Etengoff and Colette Daiute suggest that religious family members who are unable to humanize their gay relative’s experience are more likely to use religion and God harmfully in their effort to win arguments (i.e., by stating that the other is a sinner). In light of such disparate uses of religion, it is likely that relational challenges are leading to family members’ negative uses of religion as opposed to religion being inherently problematic for LGBTQ people. Alternatively, some LGBTQ individuals from religious backgrounds respond to their birth family’s disapproval, and in some cases hostility, by developing a family of choice—an electively established social support network. Research suggests that sexual and gender minorities from religious backgrounds maintain successful family-of-choice networks online (e.g., MOHO [Mormon homosexual] Directory; transgender vlogs on YouTube); as well as via traditional in-person support groups (e.g., JQY, or JQYouth). As such, researchers report that families of choice may shield LGBTQ individuals from conflicts with their religious birth family, leading to lower levels of depression and anxiety.

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Research Limitations and Future Directions Generation Gaps and the Alphabet Soup Problem

Another contributing factor to the broad range of reported experiences may be researchers’ sampling of participants across a wide range of developmental periods without focusing on the possible differences between age groups (e.g., adolescents 12 to 18 years vs. emerging adults 18 to 29 years). This is particularly problematic as sexual- or gender-minority rights have evolved considerably in the past 50 years, leading to identifiable differences between age groups. In addition, religious experiences are largely acknowledged by researchers as a developmental experience evolving in conjunction with cognitive, emotional, personality, and relational changes. For example, emerging adults (18 to 29 years) are more likely to favor personalized spiritual experiences over organized religious institutions due to their generational emphasis on individuality. While the majority of sexual- and gender-minority scholars acknowledge this type of sampling as a limitation, sampling participants across a broad range of ages persists due to the general difficulty of recruiting LGBTQ participants. Similarly, due to recruitment challenges, researchers continue to simultaneously engage participants from sexual- and gender-minority groups without exploring the possible differences between groups—this has been identified by Y. Gavriel Ansara as the “LGBTQ Alphabet Soup Problem.” Essentially, many sexual and gender minorities feel as though a diverse range of communities and experiences are superficially joined together by the LGBTQ acronym—preventing researchers from accurately reporting their diverse experiences.

Conclusion Given the broad range of religious responses to issues of diversity, sexual- and gender-minority researchers have begun drawing upon sociocultural theory’s position that individuals can utilize religion to accomplish both harmful and helpful goals, neither of which is inherently dictated in absolute terms. While some sexual and gender minorities

have responded to such ambiguities by disregarding faith, practice and/or spirituality, others respond by creating safe religious–spiritual spaces. Researchers suggest that the tremendous variation in sexual and gender minorities’ religious responses may be related to familial and developmental variability as well as denominational and cultural diversity. Given the complexity of religious and spiritual experiences, further research is needed to ascertain the reasons for, and the impact of, this broad range of religious responses to LGBTQ individuals. Chana Etengoff and Eric M. Rodriguez See also Christian LGBTQ People; Jewish LGBTQ People; Muslim LGB People; Religious Identity and Sexuality, Reconciliation of; Religious LGBTQ Youth; Transgender People and Religion/Spirituality

Further Readings Ansara, Y. G. (2010). Beyond cisgenderism: Counselling people with non-assigned gender identities. In L. Moon (Ed.), Counseling ideologies: Queer challenges to heteronormativity. Farnham, England: Ashgate. Barrow, K. M., & Kuvalanka, K. A. (2011). To be Jewish and lesbian: An exploration of religion, sexual identity, and familial relationships. Journal of GLBT Family Studies, 7(5), 470–492. doi:10.1080/15504 28X.2011.623980 Etengoff, C. (in press). “You say your love me, but you don’t support me”: Coming out communications within religious family contexts. In L. Olson & M. Fine (Eds.), Examining the darkness of family communication: The harmful, the morally suspect, and the socially inappropriate. New York, NY: Peter Lang. Etengoff, C., & Daiute, C. (2014). Family members’ uses of religion in post–coming-out conflicts with their gay relative. Psychology of Religion and Spirituality, 6(1), 33. Etengoff, C., & Daiute, C. (2015). Clinicians’ perspectives of religious families’ and gay men’s negotiation of sexual orientation disclosure and prejudice. Journal of Homosexuality, 62(3), 394–426. doi:10.1080/00918369 .2014.977115 Halbertal, T. H., & Koren, I. (2006). Between “being” and “doing”: Conflict and coherence in the identity formation of gay and lesbian Orthodox Jews. In D. P. McAdams, R. Josselson, & A. Lieblich (Eds.),

Religious Freedoms and LGBTQ Rights Identity and story: Creating self in narrative (pp. 37–61). Washington, DC: American Psychological Association Press. Jaspal, R., & Cinnirella, M. (2010). Coping with potentially incompatible identities: Accounts of religious, ethnic, and sexual identities from British Pakistani men who identify as Muslim and gay. British Journal of Social Psychology, 49(4), 849–870. Pew Research Center Religion and Public Life. http:// www.pewforum.org Porter, K. E., Ronneberg, C. R., & Witten, T. M. (2013). Religious affiliation and successful aging among transgender older adults: Findings from the Trans MetLife Survey. Journal of Religion, Spirituality & Aging, 25(2), 112–138. Rodriguez, E. M., & Follins, L. D. (2012). Did God make me this way? Expanding psychological research on queer religiosity and spirituality to include intersex and transgender individuals. Psychology & Sexuality, 3(3), 214–225. Rodriguez, E. M., & Ouellette, S. C. (2000). Gay and lesbian Christians: Homosexual and religious identity integration in the members and participants of a gaypositive church. Journal for the Scientific Study of Religion, 39(3), 333–347. Vanita, R. (Ed.). (2001). Queering India: Same-sex love and eroticism in Indian culture and society. New York, NY: Routledge. Yarhouse, M. A., & Carrs, T. L. (2012). MTF transgender Christians’ experiences: A qualitative study. Journal of LGBT Issues in Counseling, 6(1), 18–33. Yip, A. K. (2005). Queering religious texts: An exploration of British non-heterosexual Christians’ and Muslims’ strategy of constructing sexualityaffirming hermeneutics. Sociology, 39(1), 47–65.

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More and more jurisdictions are outlawing discrimination on the basis of sexual orientation. Protection based on gender identity is not quite as extensive but is also making strides. States and municipalities have banned discrimination against LGBTQ people in employment, housing, parenting,

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education, and public accommodations. At the federal level, the Supreme Court struck down the Defense of Marriage Act (DOMA) provision that denied federal marital benefits to same-sex married couples and in June 2015 declared that all samesex marriage bans are unconstitutional. While Congress has failed to act, presidents have by executive order (EO) forbidden discrimination on the basis of sexual orientation and gender identity in federal employment and by federal contractors. Full protection is still in the future, as roughly half the states have not yet implemented any kind of antidiscrimination measures for LGBTQ people. But the overwhelming trend is toward greater equality. There is one potential caveat to this picture of every increasing protection. The rise of anti-discrimination laws has been accompanied by a rise in religious liberty complaints by those whose religion condemns homosexuality. For example, as more states have welcomed same-sex marriage, people and companies involved in the wedding industry have claimed that it violates their religious beliefs to participate in any way in those marriages. To do so, they argue, would make them complicit in sin. Some wedding photographers do not want to take pictures of same-sex unions, some bakers and florists do not want to bake cakes or arrange flowers for same-sex ceremonies, and some bridal shop owners do not want to sell dresses to same-sex brides. These vendors argue that they should be entitled to exemptions from public accommodations laws that would otherwise require them to serve any member of the public, regardless of their sexual orientation. Nor are they alone in seeking exemptions from various anti-discrimination protections. Current religion jurisprudence offers three possible paths to a religious accommodation: the Free Exercise Clause of the U.S. Constitution, the Religious Freedom Restoration Act of 1993 (RFRA; or a state counterpart), or a specific statutory exemption.1

Free Exercise Clause and Constitutional Exemptions Religious protesters are unlikely to obtain an exemption under the U.S. Constitution. The Free

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Exercise Clause of the First Amendment states the following: “Congress shall make no law . . . prohibiting the free exercise [of religion].” After the landmark Supreme Court case Employment Division v. Smith, the Free Exercise Clause only prohibits the government from singling out religion for unfavorable treatment.2 A neutral and generally applicable law does not violate the Free Exercise Clause even if the law imposes significant burdens on religious practice. Smith itself upheld a law that banned all uses of peyote, including its sacramental use. Given that the Free Exercise Clause only protects against intentional religious discrimination, it is unlikely to support a free exercise exemption from anti-discrimination laws.3 Anti-discrimination laws tend to be neutral and generally applicable. Their aim is to prevent discrimination, not penalize religion, and they usually apply across the board, not just to religious entities. Accordingly, when religious photographers who would not take pictures of a same-sex ceremony challenged their state’s public accommodation law, the Supreme Court of New Mexico held that “the [New Mexico Human Rights Act] is a neutral law of general applicability, and as such it does not offend the Free Exercise Clause of the First Amendment.”4 For similar reasons, the Supreme Court of California rejected a free exercise challenge to California’s public accommodation law by fertility doctors who refused to treat a lesbian patient.5 Different rules, however, apply to churches. In Hosanna-Tabor Evangelical Lutheran Church & School v. EEOC, the Supreme Court held that the religion clauses require a “ministerial exemption.”6 The ministerial exemption essentially immunizes churches from discrimination suits brought by “ministerial employees.” The Supreme Court argued that the government may not intrude on internal church governance and interfere with “a church’s ability to select its own ministers.”7 Who counts as a “ministerial employee” remains uncertain. Hosanna-Tabor involved a religious school and a religious-school teacher, so it is not limited to houses of worship and ordained clergy. It is also not clear whether the ministerial exemption is limited to the employment context or reaches other areas of internal church governance. What is

certain, however, is that religious organizations are exempt from anti-discrimination laws when it comes to their “ministerial employees.”

Religious Freedom Restoration Act and General Statutory Exemptions Religious objectors might have a better chance at success under the RFRA. The RFRA represents Congress’s attempt to undo Employment Division v. Smith. RFRA restored as a matter of statutory law the pre-Smith rule for religious exemptions: Unless a federal law passes strict scrutiny, “[g]overnment shall not substantially burden a person’s exercise of religion even if the burden results from a rule of general applicability.”8 Although the Supreme Court struck down RFRA as applied to state laws,9 RFRA is valid as applied to federal laws. Meanwhile, many states have passed their own version of RFRA that governs their laws.10 In order to obtain an RFRA exemption, religious objectors must first establish that the law substantially burdens their religious conscience. Even then, no exemption will be granted if the law survives strict scrutiny. That is, the challenged law will stand if it advances a compelling state interest and the law is narrowly tailored to achieve that interest. Arguably, the Supreme Court’s 2014 decision in Burwell v. Hobby Lobby Stores, Inc.,11 has made it easier to qualify for an RFRA exemption. First, the Hobby Lobby Court held that forprofit corporations may seek religious exemptions under RFRA. This was a novel development in religious liberty jurisprudence. Never before had a billion-dollar company like Hobby Lobby Stores, Inc., been considered a religious rights-holder entitled to religious exemptions. Indeed, the circuit courts had been split as to whether a for-profit business could even be said to have a religious conscience or practice religion. Nonetheless, the Supreme Court held that RFRA covered closely held for-profit corporations. State courts, to the extent the language is ambiguous, are free to interpret their state RFRA differently.12 Second, the Supreme Court took an expansive view of the kinds of burdens on religion that should lead to an exemption. In particular, the

Religious Freedoms and LGBTQ Rights

Supreme Court accepted the attenuated claim that the owners’ religious opposition to abortion was substantially burdened by the contraception mandate because facilitating other people’s sinful abortions was itself a sin. This claim parallels the ones made by those hostile to same-sex marriage who argue that facilitating other people’s same-sex union by providing a cake, or flowers, or a dress, makes them complicit in the sin of homosexuality. The fact that the plaintiffs themselves are not forced to take medicine or marry someone of the same sex will not preclude a claim under RFRA. Again, state courts may construe their state RFRA differently. Third, the strict scrutiny standard has become stricter. While the pre-Smith test (after which RFRA was modeled) might have called for strict scrutiny of laws that imposed substantial religious burdens, it was never “strict in theory and fatal in fact.” More plaintiffs lost than won their Free Exercise Clause challenges. In Hobby Lobby, however, the Court applied a more demanding level of review, arguing, rather unpersuasively, that RFRA had meant to break with previous free exercise doctrine rather than reinstate it.13 Nonetheless, anti-discrimination laws have a good chance of surviving even this newly invigorated strict scrutiny. Whatever earlier cases may have held,14 recent religious exemption decisions have found that laws banning sexual orientation discrimination do pass strict scrutiny.15 However, the case law is still developing.

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have given rise to much litigation, the scope of these exemptions is uncertain. In particular, it is too early to know whether any of these exemptions will be interpreted to reach businesses. Anticipating more widespread protection for the LGBTQ community, some states that do not ban sexual orientation or gender identity discrimination have attempted—with little success—to preemptively implement religious exemptions. One proposed bill would have allowed businesses to refuse to recognize as valid same-sex marriages and to refuse any services or employment “related to” same-sex marriages if such action contravened a sincerely held religious belief.21 Another plainly stated that businesses cannot be compelled to serve or employ based on sexual orientation.22 Whether future efforts will succeed remains to be seen.

Conclusion Because anti-discrimination laws are neutral and generally applicable, Free Exercise Clause exemptions are unlikely. And because there is strong argument that anti-discrimination laws pass strict scrutiny, state and federal RFRA exemptions may also be unavailable, Hobby Lobby notwithstanding. In fact, courts have so far rebuffed attempts by businesses to evade LGBTQ protective laws on religious grounds.23 However, state legislatures, especially in states hostile to LGBTQ rights, may enact specific exemptions. Caroline Mala Corbin

Specific Statutory Exemptions The third type of exemption is a specific one provided by the legislature. These exemptions are often built into or accompany anti-discrimination law. For example, many public accommodation laws do not cover churches16 or religious schools,17 while LGBTQ-protective employment laws usually exclude religious organizations from their coverage.18 Several states that have legalized same-sex marriage give religious organizations the right to refuse to provide services related to the solemnization or celebration of a marriage if it would violate their religious beliefs.19 Other exemptions are more expansive.20 Because they are too new to

See also Christian LGBTQ People; Jewish LGBTQ People; Muslim LGB People; Religion/Spirituality and LGBTQ People; Religious Identity and Sexuality, Reconciliation of

Notes 1. Another avenue, the Free Speech Clause, is outside the scope of this entry. 2. Employment Division v. Smith, 494 U.S. 872 (1990). 3. In theory, religious objectors seeking exemptions from state laws could also bring claims under their state constitution’s counterpart to the Free Exercise Clause. In fact, the vast majority of these religious liberty provisions are coextensive with the federal Free Exercise Clause and therefore provide no additional protection. Of the state

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courts that have explicitly rejected the Smith rule for their own constitutions, only a handful have insisted on a pre-Smith level of protection. 4. Elane Photography, LLC v. Willock, 309 P.3d 53, 75 (N.M. 2013), cert. denied, 134 S. Ct. 1787 (2014). 5. N. Coast Women’s Care Med. Grp., Inc. v. San Diego Cnty. Superior Court, 189 P.3d 959 (Cal. 2008). 6. Hosanna-Tabor Evangelical Lutheran Church & Sch. v. E.E.O.C., 132 S. Ct. 694, 704 (2012). 7. Hosanna-Tabor Evangelical Lutheran Church & Sch. v. E.E.O.C., 132 S. Ct. 694, 704, 706 (2012). 8. Religious Freedom Restoration Act, 42 U.S.C. § 2000bb-1(a) (2013). 9. City of Boerne v. Flores, 521 U.S. 507 (1997). 10. States with religious freedom restoration acts include Arizona (1999), Connecticut (1993), Florida (1998), Idaho (2000), Illinois (1998), Kansas (2013), Kentucky (2013), Louisiana (2010), Mississippi (2014), Missouri (2003), New Mexico (2000), Oklahoma (2000), Pennsylvania (2002), Rhode Island (1993), South Carolina (1999), Tennessee (2009), Texas (1999), Utah (2008), and Virginia (2007). One state—Alabama—amended its constitution. Alabama Religious Freedom Amendment of 1998, Ala. Const. art. I, § 3.01. 11. Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014). 12. Like their federal model, most state RFRAs do not explicitly include or exclude for-profit corporations from their coverage. A few, however, do. While Arizona’s attempt to amend its existing RFRA in 2014 to reach forprofit businesses ultimately failed, Kansas’s Preservation of Religious Freedom Act of 2013 defined “person” to include “any legal person or entity.” In contrast, Louisiana and Pennsylvania RFRAs limit “persons” to individuals and 501(c)(3) or (d) tax-exempt (i.e., nonprofit) religious organizations. 13. Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751, 2791-92 (2014) (Ginsburg, J., dissenting) (describing as “not plausible” the majority’s characterization of RFRA as “a bold initiative departing from, rather than restoring, pre-Smith jurisprudence”). 14. Cf. Hurley v. Irish-American Gay, Lesbian, & Bisexual Group of Boston, 515 U.S. 557 (1995) (finding public accommodation law banning discrimination on basis of sexual orientation violated Free Speech Clause as applied to a parade). 15. See, for example, N. Coast Women’s Care Med. Grp., Inc. v. San Diego Cnty. Superior Court, 189 P.3d 959, 968 (Cal. 2008) (finding that California’s public accommodations law “furthers California’s compelling interest in ensuring full and equal access to medical treatment irrespective of sexual orientation, and there are no less restrictive means for the state to achieve that goal”); cf. Bernstein v. Ocean Grove Camp Meeting Ass’n, No. PN34XB-03008 (N.J. Div. on Civ. Rights Dec. 29, 2008) (finding New Jersey Law Against Discrimination would pass strict scrutiny).

16. See, for example, Colo. Rev. Stat. § 24-34-601 (2012) (“‘Place of public accommodation’ shall not include a church, synagogue, mosque, or other place that is principally used for religious purposes.”). 17. See, for example, Ill. Comp. Stat. Ann. Ch. 775 §5-101(A)(11) (West 2010) (defining place of public accommodation as limited to “nonsectarian” schools). 18. See, for example, Del. Code Ann. tit. 19 § 710(6) (West 2014) (“The term employer with respect to discriminatory practices based upon sexual orientation or gender identity does not include religious corporations, associations, or societies.”). 19. These states include Connecticut, Minnesota, New Hampshire, New York, Rhode Island, Vermont, and Washington as well as Washington, D.C. 20. In Rhode Island, religious organizations may decline to provide “any social or religious program or service” if they believe it “promotes” same-sex marriage. R.I. Gen. Laws Ann. § 15-3-6.1(c)(2) (West 2014). In Minnesota, nonprofit religious organizations and schools may “in matters relating to sexual orientation, tak[e] any action with respect to education, employment, housing, or use of facilities.” Minn. Stat. § 363A.26 (2) (2013). 21. South Dakota’s Senate Bill 128 was quashed in February 2014 by the State Senate Judiciary Committee. 22. Kansas House Bill No. 2453 passed the State House but died in the state senate in February 2014. 23. Elane Photography, LLC v. Willock, 309 P.3d 53, 75 (N.M. 2013), cert. denied, 134 S. Ct. 1787 (2014) (denying religious exemption to wedding photographer); N. Coast Women’s Care Med. Grp., Inc. v. San Diego Cnty. Superior Court, 189 P.3d 959 (Cal. 2008) (denying religious exemption to fertility doctor); Cervelli v. Aloha Bed & Breakfast, Civ. No. 11-1-3103-12 ECN (Haw. Circ. Court 1st Cir. Apr. 15, 2013) (denying religious exemption to bed and breakfast); Charlie Craig and David Mullins v. Masterpiece Cakeshop, Inc. and Jack Phillips, CR 2013-0008 (Admin. Ct. Colo., Dec. 6, 2013) (denying religious exemption to baker); See also Bernstein v. Ocean Grove Camp Meeting Ass’n, No. PN34XB-03008 (N.J. Div. on Civ. Rights Dec. 29, 2008) (denying religious exemption to nonprofit organization that rented out a boardwalk pavilion).

Further Readings Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014). Case, M.-A. (2015). Why “live-and-let-live” is not a viable solution to the difficult problems of religious accommodation in the age of sexual civil rights. Southern California Law Review, 88, 463–492. Employment Division v. Smith, 494 U.S. 872 (1990). Hamilton, M. (2005). God vs. the gavel: Religion and the rule of law. New York, NY: Cambridge University Press.

Religious Identity and Sexuality, Reconciliation of Hosanna-Tabor Evangelical Lutheran Church & Sch. v. E.E.O.C., 132 S. Ct. 694 (2012). Luchenitser, A. J. (2015). A new era of inequality? Hobby Lobby and religious exemptions from antidiscrimination laws. Harvard Law & Policy Review, 9, 63–88. Lupu, I. C. (2015). Hobby Lobby and the dubious enterprise of religious exemptions. Harvard Journal of Law & Gender, 38, 35–101. Marshall, W. P. (1991). In defense of Smith and free exercise revisionism. The University of Chicago Law Review, 58(1), 308–328. Melling, L. (2015). Religious refusals to public accommodations laws: Four reasons to say no. Harvard Journal of Law & Gender, 38, 177–192. Religious Freedom Restoration Act of 1993. Underkuffler, L. S. (2011). Odious discrimination and the religious exemption question. Cardozo Law Review, 32(5), 2069, 2087.

RELIGIOUS IDENTITY RECONCILIATION OF

AND

SEXUALITY,

Historically, in the social scientific literature, sexual minorities (i.e., lesbian, gay, bisexual, and queer individuals [LGBQ]) have been placed in opposition to religious others. Researchers have tended to focus on the attitudes of religious individuals and institutions toward same-sex sexual behavior. Specifically, the focus has been on how religiosity informs such attitudes, the attitudes that sexual minorities have toward established religions, and even the social and personal impact of religious authoritarianism and prejudice on sexual-minority lives. Despite themes of homophobia, intolerance, and prejudice found in most monotheistic religions (e.g., Christianity, Islam, and Judaism), many sexual minorities manage to retain a strong sense of faith alongside an equally strong desire to be “out” as a member of the LGBQ community. In effect, many sexual-minority individuals are able to integrate their religious– spiritual identities with their sexual identities, rather than maintaining them as separate and incompatible.

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Many LGBQ individuals, however, are regularly exposed to religiously based messages that samesex attraction, behavior, and relationships are unnatural, sinful, perverse, and an abomination in the eyes of God. These messages can make difficult the process of combining one’s sexual orientation with one’s religious beliefs; this process is often fraught with both personal and social conflict. Such conflict typically takes one of two forms: intrinsic or extrinsic. Intrinsic conflict is within a person and may include an overwhelming belief regarding the incompatibility of one’s religious beliefs and sexual identity, or a fear of divine retribution. Extrinsic conflict comes from outside of the person and may include exposure to antiqueer religious doctrine, or personal experience with religiously based antiqueer prejudice and discrimination. How do some LGBQ individuals manage to not only live with two identities that are perceived by so many (religious, agnostic, or atheist; bi, straight, or gay) as being completely irreconcilable but manage to flourish while embracing and combining them both? After a brief discussion of denominational differences, what follows is a discussion of the social scientific theories (predominantly from the fields of psychology and sociology) that provide a current understanding of the concept of identity integration between one’s sexual orientation and their religious and spiritual beliefs.

Religious Identity Some religions are more accepting and tolerant than others of sexual-minority issues and concerns. According to the Pew Research Center’s Religion and Public Life Project, while some religions (e.g., mainstream Protestant denominations and Reform and Conservative Judaism) have become more accepting and tolerant of same-sex relationships, the majority of monotheistic religions today (including Islam, the Catholic Church, the Church of Jesus Christ of Latter-day Saints, Orthodox/ ultra-Orthodox Judaism and Evangelical/Fundamentalist Christian churches) are not accepting and are still viewed as being overwhelmingly unfriendly to LGBQ individuals. On the other

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hand, most nonmonotheistic religions (e.g., Buddhism, Hinduism, Taoism, Wicca) are generally believed not to hold strong positions regarding sexual minorities. In his ongoing research on religion and spirituality in sexual-minority lives, Eric Rodriguez has pointed out that an LGBQ individual’s potential personal experience of conflict between their sexual orientation and their religious beliefs is not just being born into, or growing up in, a religiously conservative family. Instead, he argues that political viewpoint (on the conservative to moderate to liberal spectrum) combined with early childhood religious beliefs determines the level of religious and/or spiritual acceptance that sexual minorities will typically experience during the course of their lives.

Identity Integration According to social and personality psychology researchers Eric Rodriguez and Suzanne Ouellette, the process of integrating one’s sexual orientation and religious–spiritual beliefs follows four different pathways: (1) eliminate the religious identity; (2) eliminate the sexual identity; (3) compartmentalize or maintain the two identities as completely separate from each other; and (4) integrate the two identities, creating a new and positive whole. To eliminate the religious identity is a very common way for sexual minorities to help them deal with the conflict they experience between their sexual orientation and religious beliefs. For many, the conflict arises based on the need or desire to minimize the multitude of negative messages they are confronted with regarding their sexual orientation. As a result, they often leave or disavow their childhood religions and religious identities. This rejection can be accomplished through a number of means. Some reject any and all organized religions by becoming atheist or agnostic. Others, while still privately believing, may simply stop attending worship services or no longer pray or refer to God or any higher power—in effect, allowing their religion to disappear from their lives. Each of these options are attempts to help LGBQ individuals feel better about themselves by

eliminating a major source of identity conflict from their lives. Another pathway is to eliminate the sexual identity. This is the path often taken by those seeking sexual orientation conversion therapy. Ex-gay or reparative therapy movements, such as the former Exodus International, claim to be able to change homosexual urges and impulses into heterosexual ones, thus removing the sin of homosexuality from one’s life. Such approaches have been repudiated by both psychological and psychiatric professional organizations throughout the world that have stated unequivocally that such treatments are not only countertherapeutic but are potentially harmful. Another means of rejecting one’s homosexual identity could also be accomplished by abstaining from same-sex sexual behavior. For some conservative religious denominations that follow a “love the sinner, hate the sin” approach toward sexual-minority individuals, this meets the mandate because if one does not engage in sexual contact with others of the same biological sex then one cannot be found guilty of the sin of homosexuality. The third pathway, to compartmentalize, is a compromise between conflicting identities. According to Roy Baumeister, Jeremy Shapiro, and Dianne Tice, by keeping the two conflicting identities separate, one can resolve the inherent conflict. LGBQ people of faith are able to maintain this stance by keeping religion out of the homosexual parts of their lives and keeping homosexuality out of the religious part of their lives. This requires isolating and maintaining the separateness of one’s sexualminority identity and one’s religious identity. Thus, a gay or bisexual man could go out to a bathhouse and have sex with multiple men one night and then the next day go to church, mosque, or synagogue as though nothing had happened. To be fair, compartmentalization is not just the providence of sexual minorities, as research indicates that heterosexuals also rely on this mechanism to manage the conflicts between their sexuality and their religious identity. The fourth and final pathway is to integrate. According to Eric Rodriguez and Suzanne Ouellette,

Religious Identity and Sexuality, Reconciliation of

integrating one’s religious beliefs and one’s homosexuality into a new, workable whole is a means of eliminating identity conflict. The result of successful integration is having a positive gay identity, a positive religious identity, and a lack of conflict between the two. Integration differs from compartmentalization in that LGBQ individuals combine these two identities, rather than keeping them isolated from each other. Integration would, in theory, allow for a new, compound identity: LGBQ person of faith. Integration can be accomplished by becoming involved in gay-positive (i.e., ministers directly to the LGBQ community) or gay-friendly (i.e., welcomes sexual minorities to participate but doesn’t specifically minister to them) religious denominations that are supportive of both religion and the rights of sexual minorities to love whomever they like as God made them.

Spiritual Journeys David Shallenberger has referred to the term spiritual journey (or faith journey) as the path many LGBQ individuals undertake toward finding identity integration between their own religious–spiritual identities and their sexual orientation. Shallenberger identifies five steps that apply to the spiritual journeys of LGBQ individuals: (1) “coming out of the closet,” (2) distinguishing between religion and spirituality, (3)  questioning, (4) going through reintegration, and (5) reclaiming. According to Shallenberger, the results of the coming-out process form the basis of conflict between one’s sexual orientation and religious beliefs. From a religious perspective, coming out relates not only to when one begins to grapple with the conflict between their religious and homosexual identities but when the individual acknowledges the inherent discrepancies between their sexual orientation while remaining actively involved in organized religion. Coming out, therefore, is akin to the beginning of the integration process and is central to Shallenberger’s concept of a spiritual journey as it pertains to sexual minorities. The next

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step for LGBQ individuals is making a distinction between religion (i.e., religiousness or religiosity) and spirituality. In the social scientific study of religion, the term religion relates specifically to behavior (e.g., worship service attendance, involvement in religious activities and ministries) versus spirituality, which refers to issues of belief and faith (e.g., belief in God or a higher power, personal morality and ethics). In this stage, many LGBQ individuals thus begin to claim that they are “spiritual” but not “religious.” Questioning relates to the individuals’ ongoing conversation with themselves and others as they explore and make sense of their own religious beliefs as they relate to their experiences as LGBQ individuals. Reintegration is the process by which LGBQ individuals attempt to bring into accord their religious identity with their sexual-minority identity. This can occur through reading literature about others who have successfully accomplished the task, talking and meeting with other LGBQs who have grappled with similar issues, and talking openly with their families and loved ones about both their faith and their sexuality. During the fifth step, reclaiming, individuals may begin to seek out safe spaces and institutions where they can connect, or reconnect, with their LGBQ identity and their religious identity amongst similar, like-minded, and supportive individuals.

Other Theoretical Perspectives Identity theory is but one perspective in exploring the relationship between sexual and religious identities. Kimberly Mahaffey, Richard Pitt, and Scott Thumma have considered this connection from the perspective of cognitive dissonance—the idea that two conflicting thoughts make a person uncomfortable and that they will work actively to eliminate this discomfort and thus remove the dissonance and thereby resolve the conflict (i.e., achieving cognitive consonance). Andrew Yip, on the other hand, has relied heavily on stigma management theory in his research on gay Christian and Muslim men. Yip theorizes that one can counter and undermine the religious argument that homosexuality is

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a sin and an abomination by attacking the stigma of homosexuality, attacking the stigmatizer (i.e., the religious institutions themselves), relying upon positive personal experiences of homosexuality, and using the ontogenetic argument, which states that since all sexual orientations were made by God, they are all therefore blessed by God. This is accomplished by critiquing the traditional interpretation of specific antigay passages within religious texts, critiquing the interpretative authority of religious structures and figures, as well as recasting religious texts in more positive, and less pejorative, terms. Other theories that consider the intersection of sexual and religious identities include the community psychology theory of empowerment and the positive psychological theories of stress-related growth (SRG) and coming-out growth (COG). Operating on three distinct levels—individual, organizational, and community—empowerment refers to a mechanism where LGBQ people of faith take back control over key aspects of their lives. While SRG is defined as experiences of personal progression attributed to stressful like events, COG is understood to be a type of individual growth specifically related to sexual-minority identity development processes.

Assumption of Conflict Although support for LGBQ rights is growing in many regions of the world, including the current trend toward acceptance of gay marriage, not all LGBQ individuals are successful at reconciling the conflict between their sexual and religious identities. One may also consider that integration of the two identities can be achieved without having to experience conflict between them. In fact, due to recent cultural and societal shifts regarding gay rights, many do not face the task of reconciling what were once disparate, conflicting identities. Eric Rodriguez argues that not all LGBQ people of faith report experiencing conflict between their sexual orientation and their religious beliefs and that the desire to merge one’s sexual and religious identities does not always follow a period of conflict between the two. This is in contrast to other current psychological literature on the religious

lives of sexual minorities, which relies on the underlying assumption that all LGBQ people of faith have experienced conflict between their sexual identity and religious beliefs at some point in their lives. Some of the reasons provided by LGBQ people of faith for a lack of conflict between their homosexual or bisexual and religious identities include (1) never encountering antigay religious rhetoric, (2) encountering antigay rhetoric but never internalizing it, (3) devaluing religious teachings, (4) coming out at a late age, (5) attending seminary, and (6) God’s all-encompassing love. For some, society has progressed to the point that such conflict becomes moot because they have never experienced any negative messages that denigrate, or interfere with, the compatibility between their religious beliefs and their sexual orientation. Other LGBQ people of faith are able to counteract the impact of negative messages through consciously negating the intent of the words and messages or learning about their religions on a deeper educational level, thereby gaining a better understanding of how their religion and religious texts positively impact their sexual identity. Others, through the maturity of coming out later in life, are better able to utilize their life experiences to make peace with the conflicts they faced throughout their lives while still others rely on their fundamental belief that God loves everyone equally, regardless of their sexual identities and practices. These are just some of the ways that LGBQ individuals of faith are able to live full, positive lives, incorporating their sexual, religious, and spiritual identities into an integrated and sustaining whole. Eric M. Rodriguez, Chana Etengoff, and David L. Shmerler See also Christian LGBTQ People; Closet, The; Coming Out, Disclosure and Passing; Jewish LGBTQ People; Muslim LGB People; Religion/Spirituality and LGBTQ People; Sexual Orientation Conversion Therapy

Further Readings Baumeister, R. F., Shapiro, J. P., & Tice, D. M. (1985). Two kinds of identity crisis. Journal of Personality, 53(3), 407–424.

Religious LGBTQ Youth Mahaffy, K. A. (1996). Cognitive dissonance and its resolution: A study of lesbian Christians. Journal for the Scientific Study of Religion, 35(4), 392–402. Perkins, D. D., & Zimmerman, M. A. (1995). Empowerment theory, research, and application. American Journal of Community Psychology, 23(5), 569–579. Pitt, R. N. (2010). “Still looking for my Jonathan”: Gay Black men’s management of religious and sexual identity conflicts. Journal of Homosexuality, 57(1), 5–38. Rodriguez, E. M. (2010). At the intersection of church and gay: A review of the psychological research on gay and lesbian Christians. Journal of Homosexuality, 57(1), 39–53. Rodriguez, E. M., & Ouellette, S. C. (2000). Gay and lesbian Christians: Homosexual and religious identity integration in the members and participants of a gaypositive church. Journal for the Scientific Study of Religion, 39(3), 333–347. Rodriguez, E. M., & Vaughan, M. D. (2013). Stressrelated growth in the lives of lesbian and gay people of faith. In J. Sinnott (Ed.), Positive psychology: Advances in understanding adult motivation (pp. 291–307). New York, NY: Springer. Shallenberger, D. (1998). Reclaiming the spirit: Gay men and lesbians come to terms with religion. New Brunswick, NJ: Rutgers University Press. Thumma, S. (1991). Negotiating a religious identity: The case of the gay evangelical. Sociological Analysis, 52(4), 333–347. Yip, A. K. T. (1997). Attacking the attacker: Gay Christians talk back. British Journal of Sociology, 48(1), 113–127. Yip, A. K. T. (2005). Queering religious texts: An exploration of British non-heterosexual Christians’ and Muslims’ strategy of constructing sexualityaffirming hermeneutics. Sociology, 39(1), 47–65.

RELIGIOUS LGBTQ YOUTH Both religious and secular spaces inhabited by queer religious youth, such as church spaces; lesbian, gay, bisexual, and transgender (LGBT) “scene” spaces; and everyday spaces of home, education, and employment may be positioned apart from and at odds with one another. Indeed, the

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three categories—youth, religious, queer—do not normally sit side by side. Religion, sexuality, and youth would seem to strike many as contradictory, or would seem to inevitably represent sites of trouble and struggle, insomuch as widely held perceptions have often cast religion as automatically negative or harmful to the realization of LGBTQ identities. In a particular time of vigorous debate on interfaith and secular stances on homosexuality, there has been interdisciplinary dialogues and even disconnects—on the place of religion in everyday contemporary intimate lives. Same-sex marriage rights, as well as international equalities legislation more generally, such as the protected status of religion and belief, alongside sex and sexual orientation, highlight the continued significance of religion as interfacing with sexual citizenship. Some sociological studies into queer religious identities have unpacked the experiences of those wrestling with sexual–religious “contradictions,” noting too that Christian denominations, and indeed interfaith positions, can officially hold a variety of perspectives toward homosexuality, from wholesale acceptance, to grudging tolerance, to condemnation. But often religious queers are not officially welcomed or legitimized in institutionalized religious spaces, as audiences, listeners, or leaders. An overemphasis on secularizing trends arguably obscures the influence of religion upon the complex convergence and intersection of personal, political, familial, and institutional realms. At the same time, a metanarrative of secularity may mask a range of diverse experiences and relationships, and cultural formations and social practices of praise. Paul Heelas and Linda Woodhead’s subjectivization thesis posits a decrease of participation in and adherence to “life-as” religions—understood as subordinating to and conforming of individual life to divine life—and an increased interest in holistic “subjective-life” spiritualities. The latter involves living in tune with individual subjectivities as a legitimate form of spiritual living. Current empirical studies among LGBT Christians support the latter position, with U.K. sociologist Andrew Yip suggesting that nonheterosexual

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Christians utilizing aspects of de-traditionalization and individualism, whereby senses of “self” function as a clear reference point in the individual’s life courses. Such privatization is seen to characterize religious faith today more than do external authority structures. There are, however, enduring tensions between “self-cultivation” in religious subjectivization and life-as demand, whereby gendered and sexualized scripts recirculate certain sources of authority. Despite these debates, young people’s voices are particularly marginalized within writings on religion and inclusion—often positioned as obvious absences, given the assumed dichotomy and mutual disinterest between “youth” and “religion.” Queeridentified youth are further negated within the sweep of citizenship rights and policy debates that imagine and center an older, adult citizen (as domestic partner, homeowner, employee, consumer), and as such, their (dis)comforts and (dis)investments are mostly absent. Much research on youth transitions has focused on the educationaland employment-related aspects of young people’s transitions to adulthood with other facets of their lives—such as religion—largely ignored. One exception to this is Making Space for Queer Religious Youth, a U.K.-based research project that charts young people’s “understanding of religion” and their everyday practices and transitions, investigating the experiences, choices, and identities of queer (lesbian, gay, and bisexual [LGB]) young people involved in inclusive churches in the United Kingdom. It explores the relevance of religion, and Christianity in particular, in the lives of LGBT youth. As an empirical example of “lived religion,” this research has found the role of new social media in terms of religious–sexual lives to be significant. There has been a growing interest in the use of digital technologies in the lives of young people, with social media sites and online networking such as Facebook and Twitter becoming central to the identities and connections of young people in their everyday lives. Religious-themed iPhone and Android applications are becoming increasingly popular amongst the young and IT

savvy, such as digital Bibles through Youversion or the Carry Your Faith app, which rebroadcasts morning Mass throughout the day. Young people have creatively claimed space online, in social media forums and through using digital technologies, “coming out” as queer and religious. Rather than online technologies creating difficulties and unwelcome exposure, many young people use these spaces to actively negotiate, question, and shape sexual–religious identification. Such engagements often act as interactive resources, through which young participants regain control over their identity profiling (e.g., on Facebook pages), and provides a “virtual space” to be both religious and queer, against the restriction of off-line spaces (“I just said it on Facebook, typed in ‘I’m gay’ and I hit Enter.”). One interviewee, for example, mentioned the “picking up” of personal–public information as replacing a face-to-face coming-out moment: “[Her brother] probably picked it up, like I’m on Twitter and I think that’s part of my description, so he’d be a bit dim if he hadn’t picked it up by now but he just hasn’t mentioned it.” When much has been mentioned about the disconnect between religion, sexuality, and youth, from policy formation to media reporting, and academic “wrestling,” the project hopes to continue to consider the coexistence and lived-in realties of queer and religious identities. Beyond this study, there has been a growing interest in the experiences of Christian students living out their religious identities at college. This research has tended to focus on the navigation of faith when there is a shift from precollege home life to entering into the realm of higher education and its associated pedagogies and sociality and has provided a closer assessment of students’ religious and spiritual qualities. Sonya Sharma and Mathew Guest note that while this transitional process can often destabilize existing religious identities, for Christian students at U.K. universities enactments of faith can enable a smoother transition; familiar cultures of faith can help comfort students and forge relationships with others. Such studies point

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toward the rise of a more “Christian higher education”; the global resurrection of Christian universities highlights that the principles of Christianity, religion, and higher education are deeply intertwined. While the “question of homosexuality” has been a central concern for many religious intuitions and practices, the variety of positions have arguably been collapsed into a presumed discontinuity and disjuncture between sexual identity and religious identity. To date, there has been little literature on the multiple intersections involved in the enactment, refusal, and approval of these as interconnected identities. Yet while the three categories—youth, religious, queer—do not always sit comfortably with one another, they clearly have policy, disciplinary, and empirical relevance, suggesting a need to more deeply consider their intersections, as identities, practices, and categories of rights-based demands and citizenship. It is important to consider “religious LGBT youth” from international and multifaith perspectives as well as beyond the examples of Christian LGBT youth provided here. Yvette Taylor See also Christian LGBTQ People; Defense of Marriage Act (DOMA); Families of Choice; Jewish LGBTQ People; Religion and Spirituality, Youth; Religious Freedoms and LGBTQ Rights

Further Readings Taylor, Y., Falconer, E., & Snowdon, R. (2014). Queer youth, Facebook, and faith: Facebook methodologies and online identities. New Media and Society, 16, 1138–1153. Taylor, Y., Falconer, E., & Snowdon, R. (2014). Sounding religious, sounding queer. Journal of Ecclesial Practices, 1, 229–249. Taylor, Y., & Snowdon, R. (2014). Making space for young lesbians in church? Journal of Lesbian Studies, 18, 393–414. Taylor, Y., & Snowdon, R. (Eds.). (2014). Queering religion, religious queers. New York, NY: Routledge.

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REPRODUCTIVE OUTSOURCING See International Surrogacy/Reproductive Outsourcing

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This entry examines the growing use of large datasets in LGBTQ research. LGBTQ researchers are increasingly involved in the creation of large datasets, through their own data collection or through advocating the inclusion of sexual and gender identity measures in existing large-scale data collection projects or mechanisms. Primary analyses (analyses conducted by those who collected the data) are increasingly being complemented by secondary analyses (analyses conducted by researchers not involved in the original data collection) as a greater number of large datasets relevant to a diverse and broad range of LGBTQ research inquiries become available. This entry describes the creation of large datasets for LGBTQ research and the challenges in defining and measuring LGBTQ status. The entry also provides recommendations on how to approach large datasets for secondary analyses, and it concludes with the benefits and challenges inherent in using large datasets.

Sampling Strategies for LGBTQ Research LGBTQ individuals represent a hard-to-reach population, comprising only a small percentage of the general population. Specific subpopulations, such as those who identify as transgender or intersex, are particularly small in number. Apart from the issue of population size, recruiting LGBTQ participants in large numbers can be additionally challenging because of sexual and gender identity stigma, which can result in some LGBTQ people not wanting to reveal their sexual or gender identity publicly or to researchers. Despite these issues,

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various sampling strategies have been used to create large datasets with information about LGBTQ respondents. In this section, we focus on two common approaches with very different pros and cons: convenience sampling and representative systematic sampling. Convenience Sampling

With LGBTQ populations being difficult to reach on a large scale, research often relies on purposive or convenience sampling of self-identified LGBTQ respondents. Examples of convenience samples include attendees of an LGBTQ community event or pride march, patrons of an LGBTQ bar or club, or the contact lists of LGBTQ community organizations. Convenience sampling can be a cost effective way to amass enough respondents for a meaningful analysis. However, it introduces substantial generalizability difficulties. Such samples omit those who do not actively identify as LGBTQ or who are not connected to the visible LGBTQ groups and activities likely to be targeted by such a sampling approach, making external validity questionable. Representative Systematic Sampling

Representative sampling techniques (e.g., census, random sampling strategies) have strong advantages in terms of generalizability. Availability of such data is rapidly increasing as researchers continue to successfully advocate for the addition of sexual-identity questions to general population studies across the globe. Probability sampling uses the element of randomization so each person in the population has a known chance of being selected for the study. This characteristic allows generalization to a larger population (the sampling frame). Randomized chance of selection also provides a statistical test validity that is absent from all studies lacking randomization features. Often, today’s large datasets involve complex probability sampling designs (multistage sampling for layers of strata and clusters) that require weights as well as special statistical techniques and software to calculate appropriate error terms and population estimates representative of the sampling frame.

However, representative sampling can be expensive and may not result in enough respondents with rare specific characteristics of interest, such as transgender identity.

Data Collection Strategies for LGBTQ Research Large-scale data collection may use the mail service, telephones, in-person interviews, or the Internet. The quality of the data often depends on selecting data collection strategies that allow LGBTQ people to feel comfortable participating in research and answering sensitive questions. This entry highlights three data collection issues of growing importance in LGBTQ research: missing data, online data collection, and longitudinal data collection. Nonresponse and Missing Data

Situational factors, such as the respondent’s perception of privacy, confidentiality, and social desirability, may aggravate self-disclosure bias in LGBTQ research. Researchers are constantly working on strategies to improve privacy and increase reporting on sensitive topics. For example, audio computer-assisted self-interviewing (audioCASI) uses laptop computers to allow respondents to listen over headphones to digitally recorded questions that they can answer directly into the computer. This approach increases confidentiality but can be costly. Even with such practices in place, missing data can still be a problem. Furthermore, missing data on sexual identity is unlikely to be randomly distributed with regard to the true answers, complicating any theoretical case for imputation. Extensive missing data may indicate data quality problems that make the dataset unsuitable for the desired analysis. Online Data Collection

In recent years, online data collection has become an important approach for generating large datasets in LGBTQ research and offers a range of tools for improving participant privacy and confidentiality. Online surveys are especially

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common, which may be completed anonymously on computers, smartphones, or tablets. Collecting data online is highly cost-effective and has made it substantially easier for researchers to achieve large samples of LGBTQ people by covering wide geographic areas, such as national and multinational surveys. Often, recruitment for these studies is also conducted online, with targeted advertising on websites and social media that attract large numbers of LGBTQ individuals such as the websites of LGBTQ community organizations, online forums, and dating sites. One limitation of online studies is that anyone without Internet access is excluded. Other concerns expressed about online data collection include the possibility of multiple survey completions by a single participant or the survey being completed by people outside the target population. Results published from online LGBTQ research suggest that the numbers of such cases are typically low, especially when compared with the overall size of samples collected, and researchers will often use screening questions and techniques for identifying multiple survey completions, such as logging IP addresses, requiring usernames and passwords, or generating unique participant codes from demographic information. Collecting a large sample further minimizes the statistical impact of any sampling error. Although not without some limitations, techniques for collecting data online have allowed substantial breakthroughs for obtaining large samples of LGBTQ people, and the data obtained are often judged to be of sufficient quality for publication in leading peer-reviewed journals. Longitudinal Data Collection

Longitudinal data collection (collecting data from the same group of people at multiple time points) can be an expensive endeavor, especially if the follow-up period is quite long. However, the ability to monitor change over time is critical for tracking issues such as progress in easing LGBTQ disparities or understanding the impact of new policies and programs. It can also provide an important developmental perspective as we further our understanding of LGBTQ identity and

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experiences through the life course. Losing participants over time is one challenge with longitudinal research. Collecting a large baseline sample is often necessary to allow for loss to follow-up. Finding ways to keep participants engaged and interested in the study can also help to reduce loss to followup and therefore improve the quality of longitudinal data collection.

Identifying and Defining LGBTQ in Large Datasets Defining sexual orientation for research purposes can be a complicated process. Cultural pressures, respondent confusion about questions, and stigma can make measurement difficult in the field. Perhaps the most commonly used operationalization is self-labeled sexual orientation identities, but other methods have included same-sex sexual behavior, same-sex nonroommate cohabitation, or same-sex sexual desire as a way to identify sexualminority respondents. Research indicates that these measures often do not map well onto each other, so each of these indicators may result in different groups of people being classified as LGBTQ. If “orientation” is measured only on the basis of attraction, or relationships, or self-labeling, then crucial subsets of the sexual-minority population may be missed. There is a growing consensus that to fully understand sexual-minority status, researchers must include multiple dimensions in their measures, such as attraction, behavior, and self-labeling, but the availability of multiple measures in large datasets is still rare. It can also be hard for large datasets to keep up with the many diverse and newly emerging identities. Keep in mind that how LGBTQ participants are identified will likely affect both population estimates as well as the strength of associations between LGBTQ status and other variables of interest.

Approaching Large LGBTQ Datasets for Secondary Analyses In LGBTQ studies, the use of large datasets is just emerging, due to increasing recent availability.

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Secondary data analysis (using existing data to address new research questions) can open opportunities for researchers to access much larger sample sizes and sometimes more representative samples over broader geographic areas than they could hope to gather alone—and at a much lower cost. As with other research endeavors, it is critical to begin secondary analysis with a strong conceptual model and a comprehensive literature review. Only then should researchers proceed to an intensive review of large datasets to determine whether data relevant to the research question already exists. When researchers find one or more possible datasets, they should delve deeper into its appropriateness for their project, carefully examining the study documentation, codebooks, and previous publications. While research questions may be modified to map better onto available data, researchers should be sure that the uniqueness and clinical significance of the original questions are not lost in the process. An appropriate dataset must have the variables of interest measured in a valid manner. It must also have a large enough number of respondents from the LGBTQ groups of interest to support an analysis with adequate statistical power to detect hypothesized effects. The dataset should not have high nonresponse or extensive missing data of interest. Once researchers have identified an appropriate dataset and finalized their questions, the sometimes arduous task of data management begins. Missing data and complex skip patterns must be dealt with during data cleaning and preparation. Operationalizing variables using measures someone else designed can involve important judgment calls and an ongoing awareness of threats to validity and reliability. Overall, secondary analyses involve less control over sampling, measures, data entry, data quality, and study documentation, which all have implications for data management and analysis. Some researchers are disappointed at the possibly unexpected time commitment of data management during their first foray into secondary analyses. The standards for statistical sophistication in secondary analyses tend to be higher—partly

because the large dataset often allows researchers to investigate more complex conceptual models with a broader range of variables. In addition, the researcher must often handle issues such as complex sampling designs, multilevel models, and longitudinal data. For these reasons, employing a statistical consultant is recommended. However, the primary researcher should remember that ultimately they are responsible for the quality and thoroughness of the analyses. Although it may be tempting to assign data management and analysis entirely to a statistician or graduate student, such an approach can backfire as the statistical decisions are further removed from the original conceptualization and purpose of work. If the primary investigator does assign data analysis to someone else, the quality of that analysis will still partly depend on that investigator’s ability to understand data management decisions, to follow and proof any statistical programming, to instigate appropriate statistical tests and models, to account for sampling design, and to interpret all of the output correctly.

Conclusion Large datasets in LGBTQ research hold both challenges and great opportunities. Despite LGBTQ individuals being a hard-to-reach population, researchers have devised sampling and data collection strategies to achieve large datasets. Such datasets are now more common due to online data collection and a growing trend toward including questions on sexual identity in large general population studies. In many countries, LGBTQ individuals have disproportionately high rates of mental health and other health problems, sexual health problems, and drug and alcohol use. Large datasets can achieve the statistical power needed for identifying factors that underpin these issues and to target analyses on subpopulations, such as those who identify as transgender or bisexual. Whether researchers are collecting their own data or conducting secondary analyses, it is important to be aware of issues of validity and reliability, such as sample representativeness, participant

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disclosure, and measuring LGBTQ status, as well as other sampling, data collection, and data analysis issues described in this entry. Christine Elizabeth Kaestle and Anthony Lyons See also Demographics and the LGBTQ Population; Methodological Decisions by Researchers of LGBTQ Populations; Online Surveys; Quantitative Research; Sexual-Identity Labels

Further Readings Black, D., Gates, G., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography, 37(2), 139–154. Brogan, D., Frank, E., Elon, L., & O’Hanlan, K. A. (2001). Methodologic concerns in defining lesbian for health research. Epidemiology, 12(1), 109–113. Diamond, L. M. (2000). Sexual identity, attractions, and behavior among young sexual-minority women over a 2-year period. Developmental Psychology, 36, 241–250. Russell, S. T., Everett, B. G., Rosario, M., & Birkett, M. (2014). Indicators of victimization and sexual orientation among adolescents: Analyses from Youth Risk Behavior Surveys. American Journal of Public Health, 104(2), 255–261. Russell, S. T., & Toomey, R. B. (2013). Risk and protective factors for suicidal thoughts among sexual minority youth: Evidence from the Add Health Study. Journal of Gay & Lesbian Mental Health, 17(2), 132–149. Saewyc, E. M., Bauer, G. R., Skay, C. L., Bearinger, L. H., Resnick, M. D., Reis, E., & Murphy, A. (2004). Measuring sexual orientation in adolescent health surveys: Evaluation of eight school-based surveys. Journal of Adolescent Health, 35, 345–346. Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36, 385–394. Trzesniewski, K. H., Donnellan, M., & Lucas, R. E. (2011). Secondary data analysis: An introduction for psychologists. Washington, DC: American Psychological Association.

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RESILIENCE AND PROTECTIVE FACTORS, YOUTH The purpose of this entry is to describe research that investigates how protective factors and resiliencies are associated with the health of sexualminority youth (SMY; including people under age 18 who self-identify as lesbian, gay, and bisexual [LGB] or have same-sex attractions or behaviors). This entry focuses on four positive health outcomes: reduced mental health problems (e.g., depressive symptoms, self-harm), lower substance use (i.e., licit and illicit drug use), less victimization, and lower risk of HIV and sexually transmitted infections (STIs). Protective factors are generally defined as attributes associated with positive outcomes, while resilience is a process in which factors help youth overcome adversity, thereby promoting healthy adaptation. Both concepts focus on how assets and resources assist youth in achieving and maintaining positive health outcomes. This entry examines protective factors and resiliencies found at each level of the socioecological model, beginning with the macrosystems and ending with the individual.

Macrosystem The macrosystem describes the societal context in which youth live, including laws, policies, and norms. Rigorous research on this topic is starting to emerge, principally in relation to how greater sexual-minority inclusivity is associated with better health for SMY. Social stressors contribute to greater psychological distress and the adoption and maintenance of negative health risk behaviors. SMY living in states with less structural stigma (i.e., greater density of same-sex couples, sexual-minority–inclusive policies, and sexual-minority–supportive public opinion) are less likely to exhibit psychiatric disorders and to engage in health risk behaviors, such as cigarette smoking and alcohol abuse. SMY living in counties with positive social environments (based on the proportions of same-sex couples,

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registered Democrats, schools with gay–straight alliances (GSAs), schools with sexual orientation nondiscrimination policies, and schools with antibullying policies protecting SMY) are less likely to attempt suicide than those living in negative environments. Although decreases in structural stigma may not be protective for heterosexual youth, evidence suggests that it is for SMY—suggesting the specificity of structural stigma for cigarette smoking in SMY. Similarly, social stressors related to sexual-minority acceptance within established institutions (e.g., religious institutions) may affect the well-being of SMY. For example, SMY living in counties with more sexual-minority–supportive religious climates (defined as having greater than the median proportion of the population belonging to religions classified as supportive of sexualminority orientations) are less likely to report alcohol abuse symptoms than SMY living in sexual-minority–unsupportive religious counties; this finding is significant after controlling for known community- and individual-level risk factors. Furthermore, the interaction between religious climate and sexual orientation is significant in its relation to alcohol abuse symptoms—that is, the relation between religious climate and alcohol abuse is stronger for SMY than heterosexual.

Mesosystem This section focuses primarily on school characteristics, since this is the most researched mesosystem. School is where youth spend a large proportion of their week, and school environments can impact the relationships SMY have with peers and adults. Thus, school characteristics are tremendously important in the lives of SMY. Living in jurisdictions with more protective school climates (e.g., greater percentages of schools with GSAs, sexual-minority–inclusive curricula, school anti-bullying policies enumerating sexual orientation, sexual-minority trainings for teachers) is associated with reduced risk of suicidal ideation among SMY. Among lesbian and gay youth, the risk for suicide attempts is lowest in counties with the greatest proportion of school districts with sexual-minority–inclusive

anti-bullying policies; however, this relation is not true for bisexual youth. Also, simply having an anti-bullying policy without enumerating sexual orientation as a protected class is not associated with lower suicide risk among SMY. Overall, there is good evidence for the associational relation between anti-bullying policies and better mental health among SMY. Although anti-bullying policies reduce suicide risk among SMY, schools with anti-bullying policies do not reduce risk for victimization among SMY. However, SMY at schools with greater sexual-minority–inclusive policies are less likely to hear homophobic remarks and more likely to have staff intervene over such remarks, implying that comprehensive nondiscrimination policies enumerating sexual orientation may reduce victimization. SMY at schools with a GSA have greater perceptions of school safety than those without a GSA. Additionally, SMY in schools with GSAs are less than half as likely as those in schools without GSAs to report dating violence, being threatened or injured at school, or missing school due to fear. SMY at schools with GSAs are also less likely to hear homophobic remarks or experience victimization as compared to SMY at schools without GSAs. With regards to mental health and substance use, compared to SMY without GSAs in their school, SMY with GSAs are less likely to report suicidal ideation or attempts; are less likely to report making multiple past-year suicide attempts; have lower depressive symptoms and general psychological distress; and have lower alcohol use dependence and consumption. Among schools with non-GSA peer-support groups, evidence suggests that SMY who have access to nonacademic counseling, student court or other student judiciary system, staff training on sexual harassment, and peer-tutoring systems have better mental health outcomes and less victimization than SMY at schools without these features. Furthermore, health-promoting social norms among SMY are associated with less HIV and STI risk among sexual-minority boys. For example, perceiving peer norms that are supportive of safer sex is associated with less instances of unprotected anal intercourse (UAI) for sexual-minority boys.

Resilience and Protective Factors, Youth

SMY who believe there is a school staff member they could talk to about a problem are less likely than their unsupported sexual-minority counterparts to be threatened or injured with a weapon at school; feel unsafe; have depressive symptoms; report suicidal ideation or attempts; and use alcohol, marijuana, or other illicit drugs. However, after controlling for known risk factors (e.g., bullying) and potential protective factors (e.g., family support), having adult support at school is not associated with self-injury or suicide attempts, which suggests adult support at school may be less protective than other protective factors. School attachment or connectedness is often conceptualized as how students feel about school and are treated by people at school. SMY who report suicidal ideation have lower levels of school connectedness than non-ideating SMY and all heterosexual youth. Higher school attachment is also associated with lower depression and suicidality as well as lower alcohol and marijuana use among SMY and heterosexuals. One strategy to promote school connectedness is to include teaching curricula that is supportive, affirming, and sensitive to the unique issues of SMY. SMY students who are taught curriculum with positive representations of sexual-minority people in history heard fewer homophobic remarks, felt less unsafe, and reported a greater sense of school connectedness than students who are not instructed with inclusive curriculum. Additionally, SMY in schools with sexual-minority–sensitive sexual health instruction report fewer sexual partners, less recent sex, less substance use before sex, and a lower likelihood of becoming or getting someone pregnant than did SMY in schools without sexual-minority–sensitive sexual health instruction. Furthermore, sexualminority–specific HIV instruction decreases the risk of suicidal ideation and having property damaged or stolen for SMY. These findings suggest that inclusive curricula have protective effects for SMY across multiple health domains.

Microsystem Researchers have investigated the relationships SMY have within their social networks, which

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comprise the microsystem. Familial and peer support, in particular, appear to be of great import for the well-being of SMY. The relationship between parental support and health among SMY has been studied extensively. While familial rejection is associated with myriad negative health outcomes, the relations between familial support and positive health outcomes are more complex. For mental health, family support is robustly associated with positive outcomes. Among SMY, perceived parental caring is negatively associated with depression, and parental connectedness is associated with reduced suicidal ideation and suicidal attempts. Even after controlling for common risk factors, family support is associated with lower risk of psychological distress. Greater depressive symptoms among sexualminority girls are partially mediated by having less familial support, parental involvement, and parental closeness compared to heterosexual girls. Additionally, mothers’ positive attitudes toward their child’s sexual orientation are associated with lower depression, anxiety, and hostility among youth, but fathers’ positive attitudes are not associated with their child’s mental health. There are mixed results for the relations between familial support and substance use. Perceived family support is associated with decreased alcohol use over time for sexual-minority boys and girls. Sexual orientation disparities in alcohol use are partially mediated by familial support and parental closeness, and higher drug use among sexualminority girls is mediated by familial support but not by parental closeness; however, familial factors did not mediate these relations among boys. Additionally, similar to the mental health findings, mothers’ positive reactions to their child’s sexual orientation are negatively associated with illegal drug use, while the fathers’ reactions are not at all associated with their child’s substance use. Because parental support contains, in general, a positive response from parents about a child’s sexual orientation, it is not surprising that the findings for the relation between parental support and at-home victimization are consistently negatively correlated with each other. However, parental support has mixed associations with HIV/STI risks for

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SMY. Family connectedness among young sexualminority boys is negatively associated with being HIV positive, but is not associated with having unprotected sex. Peers also influence the well-being of SMY. Having peer support has positive associations with better mental health outcomes for SMY. Increased peer support among SMY is associated with less psychological distress and has stronger effects on mental health than victimization or family support for SMY, suggesting peer support is an incredibly important factor in the lives of SMY. Having sexuality-related support provided by heterosexual and sexual-minority friends is important because it correlates with decreased emotional distress among SMY, and because SMY are much more likely to receive this type of support from peers as opposed to parents. Having support from, and being close to, straight friends is associated with less psychological distress for SMY, while having support from sexual-minority friends is only marginally related to lower psychological distress. Research on drug use suggests that drug use is negatively correlated with increased contact to straight friends but not with contact with sexual-minority friends. Current evidence suggests no association between drug use and closeness or support from either type of friend. While most studies investigate social support from specific people (e.g., family members, peers), some studies combine perceived family and peer support and do not report on their separate protective effects. Having any social support over time is protective against suicidal ideation; however, social support did not predict less self-harm among SMY. Youth who perceive having support from family or friends report higher scores of psychological wellbeing, including positive relations with others, life purpose, personal growth, autonomy, and selfacceptance. Additionally, having someone to talk to about HIV or sex is associated with a greater likelihood of having ever been HIV tested among sexual-minority boys.

Individual The individual attitudes, beliefs, and behaviors of SMY are also pertinent to their health and

well-being. While most research focuses on risky sexual behavior among sexual-minority boys only, some studies examine the relations between individual-level factors and health for both sexualminority boys and girls. How SMY think and feel about sexual-minority orientations, including their own, is an important individual-level factor associated with various health outcomes. SMY with more positive beliefs about sexual-minority orientations versus those with more negative beliefs have higher self-esteem and lower anxiety. Having negative beliefs about one’s own sexual orientation is called internalized homophobia. The combination of having low internalized homophobia (or more positive beliefs about one’s own sexual orientation) with having family support buffers the effects of victimization on negative mental health outcomes. Altogether, more positive beliefs and attitudes toward minority sexual orientations are associated with better mental health outcomes for SMY. Specifically for sexual-minority boys, having more positive attitudes toward their own sexualminority orientation is associated with reduced risky sexual behavior, including UAI. Other individual-level characteristics are also associated with reduced risky sexual behaviors for sexual-minority boys. For example, greater condom self-efficacy (i.e., one’s ability to use a condom effectively), greater perceived self-control in sexual situations (i.e., ability to carefully plan or stop sexual activity), and more positive safer sex attitudes are all associated with less risky sexual behaviors. Another individual-level factor is religiosity, which encompasses religious beliefs, activities, and dedication. SMY who identify as Christian, as opposed to nonreligious, are less likely to report self-injury; however, the more religious guidance they receive, the greater their risk for self-injury. Furthermore, religiosity is protective against alcohol use for boys regardless of sexual orientation but has different effects for girls based on sexual orientation. For heterosexual girls, religiosity is protective against alcohol use and binge drinking, while for lesbians there is no relation between religiosity and alcohol use. On the other hand, religiosity is harmful for bisexual girls: If they are religious, they are more likely to use alcohol and

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drink heavily. Regarding sexual risk for sexualminority boys, the combination of faithfulness (i.e., thinking religion is at least fairly important) and attendance at formal religious services once a month or more is associated with lower risk of unprotected receptive anal sex than either factor alone. Overall, these findings show that religiosity is associated with both positive and negative health outcomes.

Conclusion Though SMY experience great health inequities in mental health, substance use, victimization, and sexual health, many factors at multiple socioecological levels are associated with demonstrable positive health outcomes for SMY. Some factors are associated with improvements in multiple health domains, while others have more complex relations with health outcomes. Finding ways to increase the potency, prevalence, and quantity of protective factors and resiliencies for SMY is an avenue that will likely assist sexual-minority people in achieving healthy adaptation during the important development stages of childhood and adolescence. Robert W. S. Coulter, Ryan T. Ricarte, and Amy L. Herrick See also Campus Climate; Depression; Gay–Straight Alliances (GSAs); Health Disparities; HIV and Treatment; Sexual Minorities and Violence; Sexual Risk-Taking; Substance Abuse and LGBTQ People; Suicide, Risk Factors for and Prevention of

Further Readings Bouris, A., Guilamo-Ramos, V., Pickard, A., Shiu, C., Loosier, P. S., Dittus, P., . . . Michael Waldmiller, J. (2010). A systematic review of parental influences on the health and well-being of lesbian, gay, and bisexual youth: Time for a new public health research and practice agenda. Journal of Primary Prevention, 31(5–6), 273–309. Eisenberg, M. E., & Resnick, M. D. (2006). Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health, 39(5), 662–668. Fergus, S., & Zimmerman, M. A. (2005). Adolescent resilience: A framework for understanding healthy

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development in the face of risk. Annual Review of Public Health, 26, 399–419. Hatzenbuehler, M. L., Jun, H.-J., Corliss, H. L., & Austin, S. B. (2014). Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth. Annals of Behavioral Medicine, 47(1), 48–56. Herrick, A. L., Egan, J. E., Coulter, R. W. S., Friedman, M. R., & Stall, R. (2014). Raising sexual minority youths’ health levels by incorporating resiliencies into health promotion efforts. American Journal of Public Health, 104(2), 206–210. Herrick, A. L., Lim, S. H., Wei, C., Smith, H., Guadamuz, T., Friedman, M. S., & Stall, R. (2011). Resilience as an untapped resource in behavioral intervention design for gay men. AIDS and Behavior, 15(1), 25–29. Herrick, A. L., Stall, R., Goldhammer, H., Egan, J. E., & Mayer, K. H. (2013). Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: Theory and evidence. AIDS and Behavior, 1–9. Longo, J., Walls, N. E., & Wisneski, H. (2013). Religion and religiosity: Protective or harmful factors for sexual minority youth? Mental Health, Religion & Culture, 16(3), 273–290. Luthar, S. S., Cicchetti, D., & Becker, B. (2003). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. Masten, A. S. (2013). Risk and resilience in development. In P. D. Zelazo (Ed.), The Oxford handbook of developmental psychology (Vol. 2). New York, NY: Oxford University Press. Mustanski, B. S., Newcomb, M. E., Du Bois, S. N., Garcia, S. C., & Grov, C. (2011). HIV in young men who have sex with men: A review of epidemiology, risk and protective factors, and interventions. Journal of Sex Research, 48(2–3), 218–253. Mustanski, B., Newcomb, M., & Garofalo, R. (2011). Mental health of lesbian, gay, and bisexual youth: A developmental resiliency perspective. Journal of Gay & Lesbian Social Services, 23(2), 204–225. Newcomb, M. E., Heinz, A. J., & Mustanski, B. (2012). Examining risk and protective factors for alcohol use in lesbian, gay, bisexual, and transgender youth: A longitudinal multilevel analysis. Journal of Studies on Alcohol and Drugs, 73(5), 783–793. Reisner, S. L., Biello, K., Perry, N. S., Gamarel, K. E., & Mimiaga, M. J. (2014). A compensatory model of risk

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and resilience applied to adolescent sexual orientation disparities in nonsuicidal self-injury and suicide attempts. American Journal of Orthopsychiatry, 84(5), 545–546.

RETIREMENT The degree of societal marginalization experienced by the current cohort of retired LGBTQ older adults influences their health and well-being. Historical differences among cohorts of older adult LGBTQ people have implications for successful aging and retirement. For example, lesbian, gay, bisexual, and queer (LGBQ) adolescents, along with those identified as transgender, who realized their same-sex attractions or expressed gender identity before the Stonewall riots of 1969 (often referred to as the beginning of the gay civil rights movement), experienced more discrimination and oppression than those who have identified as LGBTQ in the years that followed. These differences in age cohorts have important implications for retirement. Successful aging and retirement for the current cohort of older adults who have experienced lifetime marginalization is often tied to the effects of psychosocial stressors associated with stigma, discrimination, and internalized homophobia, which affect three important factors needed for successful aging and retirement. These factors include having formal and informal social supports, access and utilization of health and social services, and adequate financial security to maintain physical and mental health and well-being.

Importance of Social Supports Successful aging in retirement for older LGBTQ adults in part relies on the existence of quality formal and informal support networks. It has been found that the social networks of many older adults provide a resource for health encouragement, advice, and information. Not having developed social networks can result in a decrease in overall health and well-being. Changes in health as one grows older can result in stressful events such as increased cost when

income has become fixed and negotiating activities of daily living (ADLs) become more difficult. However, social supports can buffer the impact of such stressors. Many LGBTQ individuals rely upon networks made up of non-kin friendships, often referred to as family of choice, whereas heterosexual peers rely chiefly on biological family. Older LGBTQ adults who receive most of their support from partners and friends (i.e., family of choice) have better overall mental health and less internalized homophobia than those who receive their primary support from biological family. As older LGBTQ individuals age into retirement, many have reduced social supports. This comes at a time when they often are less likely to be open with their sexual orientation and identity to outside mainstream supports due to the fear of discrimination and perceived and experienced homophobia. There is the risk of losing their spouse or partner to death while their own health is deteriorating. Isolation, or the lack of social support, is a vulnerability for some older LGBTQ individuals. The results can be poor physical and mental health outcomes, lack of financial stability, and a decrease in knowing of available community resources that are accepting and welcoming. While there are LGBTQ-specific formal support agencies available, their access and programs are limited, especially in more rural areas. Currently many states lack protections for LGBTQ people faced with needing access to nursing homes, housing, and public accommodations. Many older LGBTQ individuals are forced back into the closet to conceal their identities out of the fear of discrimination and homophobia when utilizing these services. Many mainstream support agencies such as local community organizations and agencies serving older adults have been found to lack the knowledge and awareness of the unique challenges faced by older LGBTQ adults. While this is changing with education and programs designed to increase awareness and understanding, gaps in knowledge and awareness still exist.

Sustaining Health and Well-Being There are documented and specific physical and mental health risk factors associated with LGBTQ

Retirement

individuals, which need to be further understood by health care professionals. Sean Cahill and his colleagues detail the specific health risk factors associated with delaying seeking health and social services. LGBTQ individuals usually access health and social service care far less than their heterosexual counterparts. This creates delays in seeking out services for acute health needs and chronic conditions usually worsen. Possessing a comfort level to utilize health care and social service when needed results in optimal health well into retirement. There are several structural barriers directly affecting health care service utilization. These barriers include health care service providers who are unfamiliar with LGBTQ-specific health needs, which contributes to the lack of culturally competent practice. There is also the lack of recognition of partners in health care decisions, exclusion of sexual orientation and relationship status on health care forms, and the fear of breach of confidentiality. These discriminatory factors decrease LGBTQ older adults’ sense of security when they do not know that treatment will be provided with respect and with confidentiality by insurance companies, practitioners, and service providers. Furthermore, these barriers interfere with complete and appropriate communications with the health care provider. When LGBTQ individuals do not have personal coping skills needed to counter discrimination and other biased interactions with providers, they have been found to avoid health care services altogether. Resiliency in older age increases personal health coping skills. It is believed that many older LGBTQ adults possess a heightened ability to handle crisis situations (i.e., crisis competency skills) because of the ongoing negotiation of the stigma, discrimination, and homophobia experienced throughout their lives. However, there is a counterbelief that these psychosocial stressors reduce personal coping skills and overall resiliency. Resiliency skills transfer to healthier behaviors that promote positive impacts on successful aging and retirement for this population. When developed, these skills create positive effects on self-acceptance and translate to better self-esteem including seeking health care. If personal resiliency and coping skills are not

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developed, LGBTQ people will encounter greater threats to their overall health and well-being as they move into retirement. Individual resiliency is enhanced not only by having adequate formal and informal social supports but also by having adequate financial resources in retirement.

Adequate Financial Resources for Retirement Financially, the landscape for older LGBTQ adults has been changing rapidly. The passing of the Defense of Marriage Act (DOMA) prohibited lesbian, gay, bisexual, and transgender (LGBT) individuals’ access to some 1,100 federal laws that provide personal protections based on recognition of marital status. The Supreme Court’s decision in 2013 to strike down Section 3 of DOMA was the catalyst for rapid changes with marriage equality and was followed by its June 2015 ruling that state prohibitions on same-sex marriage violate the Constitution. These changes will have a tremendous positive financial impact for all LGBTQ individuals. However, for many who are from the older age cohorts, the effects of not having time on their side to influence savings and investments and not having been recognized in their relationships are still impactful. Older LGBTQ adults who have resided in states where same-sex marriage has not been recognized as legal may have been at risk for further negative physical and mental health problems and overall decreased well-being in retirement as a result of limited access to financial resources. For older LGBTQ Americans who now face retirement, certain federal and state benefits are essential for successful aging. Particularly important for this population is access to Social Security benefits, Medicare, Medicaid, Family and Medical Leave Act (FMLA) as well as the ability to file federal taxes as a married couple. Individuals who are recognized by their state of residence as married receive Social Security benefits. Same-sex married couples who have not been recognized by their state are considered strangers to each other. This has created a hardship for many current retired LGBTQ individuals. One of the benefits of Social Security is spousal survivor

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benefits. When a recipient dies, the spouse is eligible to receive a death benefit and receive benefits on the deceased worker’s Social Security benefit, often increasing their individual monthly benefit. Medicare provides for those 65 and older and follows the same guidelines as Social Security for benefit determination. Therefore, those states that have not recognized same-sex married couples have not had the spousal-based benefits for Medicare purposes. This has resulted in same-sex couples having to pay a premium for Medicare Part A. For Medicare Part B enrollment, if a person does not enroll when turning 65, there is a 10% lifetime penalty every year they are not enrolled. This penalty is deferred for those who are on their own health plan or are on a spouse’s health plan. Thus, prior to the Supreme Court’s ruling, without having been recognized by the state of residence as a married couple, many individuals in same-sex marriages were not protected and will now enjoy these benefits, greatly increasing their ability for better well-being and active aging. Previously, states that recognized same-sex marriage included Medicaid benefits to same-sex couples, and this recognition will now widen to all states. An individual who has a same-sex spouse receiving long-term care has the protection of being allowed to stay in the shared home as well as other protections of assets when Medicaid is used, which had not been offered to those living in states that did not recognize same-sex marriage. FMLA for working adults is an important benefit that provides for taking leave (up to 12 weeks with no pay) to care for an ailing spouse. The legal and political landscape is rapidly changing with regards to financial protections for LGBT individuals. More recently, the law looked to the employee’s state of domicile in order to determine eligibility for FMLA benefits. However, in February 2015, the U.S. Department of Labor revised its standing, changing from the “state of residency” rule determination to the “place of celebration” for qualification of this benefit. Previously, many older LGBT workers who lived in states where their marriage was not recognized were not included. Many lacked social supports and other financial abilities to care for an ailing spouse as they neared retirement. The consequences for past LGBT

individuals have included increased stress finding ways to care for their loved one, along with having their financial standing jeopardized while preparing to move into retirement. The new qualifying definition gives the current and future LGBT samesex married couples equal footing when caring for an ailing spouse. Therefore, their future retirement goals are less likely to be negatively affected. Same-sex married couples, no matter where they were married or where they reside, are now able to file their federal tax returns jointly, benefiting those nearing retirement. Other important tax incentives for being recognized as a married couple include favorable treatment of gift taxes, exclusions on the gains from a sale of a principal residence, and the earned income tax credit. Prior to the June 2015 Supreme Court ruling, in states that did not recognize same-sex marriages, state tax benefits were denied. Other effects of nonrecognition included financial concerns regarding unfavorable pension laws and saving and investment accounts not set up properly to protect same-sex married couples. The primary considerations for successful aging and retirement for older LGBTQ adults in retirement include having received adequate formal supports, active informal social supports, access and utilization of health care and social services, and adequate financial security. Many older LGBT adults have developed resiliency skills that help them cope and plan for these important and fundamental aspects to successful aging in retirement. However, it has been found that not all from this population are as resilient, resulting in shortcomings as one moves into retirement. Shawn D. King See also Advance Health Care Planning; Aging, Social Relationships, and Support; Aging and Gay Men; Aging and Lesbian Women; Discrimination Against LGBTQ Elders; Health Care System; Marriage, Reasons for and Against; Marriage Equality, Effects on Well-Being and Relationships; Services and Advocacy for GLBT Elders (SAGE); Wills and Trusts

Further Readings Butler, S. (2004). Gay, lesbian, bisexual and transgender (GLBT) elders: The challenges and resilience of this

Romantic Friendships marginalized group. Journal of Human Behavior in the Social Environment, 9(4), 25–44. Cahill, S. R., & South, K. (2002). Policy issues affecting lesbian, gay, bisexual, and transgender people in retirement. Generations, 26, 49–54. Dean, L., Meyer, I. H., Robinson, K., Sell, R. L., Sember, R., Silenzio, V., . . . Xavier, J. (2000). Lesbian, gay, bisexual, and transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association, 4, 102–151. Friend, R. A. (1990). Older lesbian and gay people: A theory of successful aging. Journal of Homosexuality, 20, 99–118. Godfrey, D. (2012). Three legs on the ground: Retirement income essentials for LGBT adults. Generations, 36(2), 81–87. Grant, J. M. (2009). Outing age 2010. Washington, DC: National Gay and Lesbian Task Force Policy Institute. Grossman, A. H., D’Augelli, A. R., & Hershberger, S. L. (2000). Social support networks of lesbian, gay and bisexual adults 60 years of age and older. Journal of Gerontology, Psychological Sciences, 55(3), 171–179. LGBT Movement Advancement Project, & SAGE. (2010). Improving the lives of LGBT older adults. New York, NY: Authors. Retrieved from http://sageusa.org/ uploads/Advancing%20Equality%20for%20LGBT% 20Elders%20[FINAL%20COMPRESSED].pdf Masini, B. E., & Barrett, H. A. (2008). Social support as a predictor of psychological and physical well-being and lifestyle in lesbian, gay, and bisexual adults aged 50 and over. Gay and Lesbian Social Services, 20, 91–110. MetLife Study. (2010). Still out, still aging: The MetLife study of lesbian, gay, bisexual, and transgender baby boomers. Retrieved from https://www.metlife.com/ assets/cao/mmi/publications/studies/2010/mmi-stillout-still-aging.pdf Meyer, I. H., Schwartz, S., & Frost, D. M. (2008). Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67, 368–379.

ROMANTIC FRIENDSHIPS Romantic friendships are relationships that constitute a break from modern views of intimacy behaviors in same-sex friendships. Romantic friendship is a contemporary term used by

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historians and literary critics and applied to the interpretation and analysis of intimate samesex relationship characteristics through time— particularly the 18th and 19th centuries in England and New England. Scholars researching romantic friendship do so through literary and historical analysis of literature along with personal journals and correspondences. The term romantic friendship became widely used after the publication of Lillian Faderman’s book, Surpassing the Love of Men: Romantic Friendship and Love Between Women From the Renaissance to the Present. The work that has followed in this vein has characterized romantic friendship as intimate; passionate; emotional; and, at times, sexual. The historical and literary naming, interpretation, and analysis of romantic friendship has much significance to LGBTQ studies.

Characteristics of Romantic Friendships Romantic friendships share behavior patterns similar to that of contemporary intimate couples. Although romantic friendships may have involved sexual activity, the activity remained private. Yet, the friends often displayed qualities that appear more similar to contemporary romantic couples than to purely platonic friends. For example, romantic friends often spent the majority of their time together, expressed passionate devotion to each other, expressed physical affection, and viewed one another as priorities. For some, the distinction between a romantic friendship and a sexual relationship is the difference between love and eroticism. While a romantic friendship contains high degrees of love of the friends for each other, it does not necessitate feelings of eroticism. While modern society may view the characteristics of a romantic friendship as peculiar, the behaviors displayed were not seen as odd during the late 18th and early 19th centuries. Rather than characterizing a romantic friendship as a friendship crossing too close into the territory of a sexual relationship, people from the periods where romantic friendships were commonplace may have characterized the relationships as merely ones of heightened warmth. The friends exhibited an immense level of care for each other and often

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proclaimed a love for one another greater than that for family members or lovers. Typical behaviors included passionate expressions of affection between the friends. When separated after spending an extended period together, friends often expressed their longing for one another in romantic letters. Today, these letters might be read as love letters. However, at the time, the letters were viewed as expressions of intense and devoted friendship. Such forms of romantic talk between friends were common enough during this period that they even appeared in the artistic works of popular writers, poets, and playwrights during the 19th century. For instance, the intense friendship between Ishmael and Queequeg, two characters in Herman Melville’s (1851) novel Moby Dick, has been interpreted as the type of romantic friendship that was typical of the historical period during which the novel was written.

Romantic Friendships Between Women Romantic friendships were relatively commonplace among White, middle- and upper-class women in Western culture (e.g., New England, Western Europe) until the late 19th and early 20th centuries. Intimate relationships between women were generally viewed as consistent with women’s heterosexual roles, given that such friendships were perceived as “safe” contexts for women’s emotional investments. Historians and literary critics have most closely studied romantic friendships among women in the 18th and 19th centuries in Britain and New England. Historians have interpreted examples of English women eloping in the late 18th century, such as Eleanor Butler and Sarah Ponsonby, as evidence of a general lack of concern for the relationships between women during that time. Because these relationships did not involve men, they were seen as generally harmless and incapable of impropriety. The social norms that forbade unmarried women from intimately interacting with men contributed to these attitudes and made it appear understandable that women would form intimate emotional relationships with each other. Their intimate closeness in communication may have also been understood as beneficial

to women eventually entering into relationships with men. Intimate friendships between women were socially encouraged because they ultimately fulfilled the needs of men. From the perspective of men writing at this time, romantic friendships between women were permissible and nonthreatening for a wide variety of reasons ranging from the belief that women were not capable of having authentic relationships with each other to the belief that such relationships served as preparation for the eventual emotional commitment of heterosexual marriage. However, the writing of women from that time period suggests that these relationships were often far more important and intimate than outsiders may have suspected. Stories such as Sarah Scott’s (1792) A Description of Millennium Hall depicted romantic friendships as involving long-term commitments between women, devoid of reliance upon men, and characterized by devoted interdependence upon one other. Such themes of female friendship were popular in the writing of the time because female readers could associate with the characters in the story—either through their own adult friendships with women or their memories of close childhood friendships. By the second half of the 19th century, many women endeavored to become a part of a world that was built by men for men. Many women turned to their female friends to provide the support and intimacy they could not obtain from men, and their female friendships became increasingly significant. Responding to these changes, early feminists, such as Margaret Fuller, argued that the love between two women (or two men) was actually superior to the love of a man and a woman. In late-19th-century New England, long-term relationships between two unmarried and financially independent women were dubbed Boston marriages. Characterized by strong emotional commitments to each other, the women of Boston marriages often grounded their lives in efforts to socially and culturally advance the lives of women. In contemporary times, some may look back on these women and view them as “19th-century lesbians,” but historians have argued that such a characterization is inaccurate, given that the relationships were

Romantic Friendships

more romantic than sexual. Yet as the 20th century progressed, sexologists increasingly discussed same-sex love as taboo and pathological and began coining terms and categories—such as lesbian—to describe this phenomenon. This had the effect of stigmatizing romantic friendships between women and subsuming them into the category of lesbianism.

Romantic Friendships Between Men From as early as the writings of Plato to the novels of Melville, romantic friendships between men have been illustrated in popular written works for hundreds of years. Although these friendships possessed qualities that deviated from modern norms of masculinity, they did not suffer from the same degree of scrutiny in past centuries that they might be subjected to today. There were multiple reasons why men formed close bonds with other men, such as long periods of close proximity, separation from members of the opposite sex, educational camaraderie, and work-related bonding. Many men formed intimate, lifelong bonds in the context of professional mentorships. Such relationships also arose in situations where men worked closely alongside each other toward common goals, often developing deep levels of trust. When these bonds were formed, men often displayed behaviors that modern viewers might associate with sexual attraction, such as sharing beds, kissing each other on the lips, holding hands, professing undying love for one another, exchanging love letters, and cuddling. For example, Abraham Lincoln, as a young lawyer, often shared a bed with another practicing lawyer for financial reasons. Lincoln spoke openly about sharing a bed with other men when referring to his beginning days as a lawyer because this behavior was not considered unusual or inappropriate. Romantic friendships between men may have involved sexual attraction and even sexual activity, but they were not primarily defined by such acts. Rather, it was the deep emotional connection between the friends that constituted their primary characteristic. From a modern perspective, the intimacy between such friends is often construed as

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homoerotic, but it is important to note that such relationships were not necessarily sexual. There is no way for historians to know just how many romantic friendships between men contained sexual activity, but it is clear that although behaviors such as sharing beds and holding hands were acceptable during this time period, sexual activity between men was clearly unacceptable. For that reason, men who were sexually intimate with their romantic friends would have engaged in such intimacies in secrecy. By the end of the 19th century, the increased awareness of homosexuality would have made it increasingly difficult for men to share any level of intimacy with one another. Karl-Maria Kertbeny, an Austrian-born Hungarian journalist, coined the terms homosexual and heterosexual in the 1860s. Before this construction of distinct sexual-identity categories, same-sex sexual acts were viewed as unacceptable, but they were not considered to be indicative of any sort of enduring personality trait. Yet with the new categorizations, individuals came to be categorized as homosexual or heterosexual, and the focus shifted from same-sex acts to homosexual individuals. Sexual stigma surrounded the identity of homosexual individuals, and any behaviors that were seen as departures from the traditional norms for masculine behavior became vilified. Kissing other men on the lips or sharing a bed with a male friend were now more dangerous because they were potential indicators of homosexuality. Accordingly, the behaviors that used to be typical within men’s romantic friendships became taboo. In cases where erotic desires were present, men’s behaviors became even more secretive. In others, where no erotic desires existed, behaviors shifted to avoid violating expectations of masculinity and to fit within social roles.

Significance for LGBTQ Studies Romantic friendships are important to LGBTQ studies for a variety of reasons. First, they illustrate the entanglements of semantic contagion. That is, when looking back, it is critical to resist the temptation of labeling these relationships as merely homosexual, gay, or lesbian because to do so

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would be essentializing and reductionary. Second, they underscore the importance of understanding the social construction of norms regulating intimate relationships. Changing historical views of romantic friendships reveal histories of norms governing modes of relating as they have changed markedly over different time periods. In this way, the study of romantic friendships supports the efforts of LGBTQ scholars to critically investigate the social, cultural, and political construction of sexuality, gender, and intimate relationships. Derek M. Bolen and John Marc Cuellar See also Essentialist–Constructionist Debate on the Origins of Sexual Orientation; Friendships; Masculinity Stereotypes; Morality and Respectability; Naming Practices; Sexual Norms and Practices; Sexual-Identity Labels; Social Class

Further Readings Crain, C. (2001). American sympathy: Men, friendship, and literature in the new nation. New Haven, CT: Yale University Press. Faderman, L. (1981). Surpassing the love of men: Romantic friendship and love between women from the renaissance to the present. New York, NY: Quill. Nissen, A. (2003). Romantic friendship reader: Love stories between men in Victorian America. Boston, MA: Northeastern University Press. Nissen, A. (2009). Manly love: Romantic friendship in American fiction. Chicago, IL: University of Chicago Press. Rothblum, E. D., & Brehony, K. A. (Eds.). (1993). Boston marriages: Romantic but asexual relationships among contemporary lesbians. Amherst: University of Massachusetts Press. Smith-Rosenberg, C. (1975). The female world of love and ritual: Relations between women in nineteenthcentury America. Signs: Journal of Women in Culture and Society, 1(1), 1–29.

RURAL

AND

URBAN COMMUNITIES

This entry describes how LGBTQ individuals in rural areas have different experiences from those

of LGBTQ individuals in urban areas. It outlines how understandings about cities and small towns have been intertwined with understandings about LGBTQ identities as well as what current demographic data show with regard to where LGBTQ people live in the United States. Then the entry details LGBTQ identities and communities in urban contexts. It ends by describing LGBTQ identities and communities in rural contexts. Throughout, attention is paid to the diversity of experiences within each context.

Geography and LGBTQ Identities and Communities LGBTQ identities have been associated with urban spaces. Early work in LGBTQ studies focused exclusively on individuals and communities in cities and documented how subcultures developed in places such as New York and San Francisco. It is assumed that such urban areas continue to afford individuals the freedom to express lesbian, gay, bisexual, and queer (LGBQ) sexualities and transgender gender identities. Embedded in this assumption is that the opposite is true in rural areas. LGBTQ individuals in small towns are assumed to hide their sexual or gender identity or to face hostility if they do express it. It is assumed, therefore, that rural LGBTQ people will migrate to a city. Certainly for some LGBTQ individuals, these assumptions match their experiences. Scholarship has demonstrated the migration of LGBTQ people from rural to urban locales and the importance of neighborhoods in cities that are home to a large number of LGBTQ people (or visible gay neighborhoods). Yet demographic data suggest that LGBTQ people are now living in a range of contexts—not only in visible gay neighborhoods in cities. In fact, LGBTQ individuals live in 99% of U.S. counties. The number of same-sex couples in rural areas has increased. Likewise, the concentration of same-sex couples in urban neighborhoods traditionally home to a large number of LGBTQ people has declined. These patterns are attributed to a number of factors, including gentrification processes in cities whereby many LGBTQ people can no longer afford to live in urban areas. These patterns also

Rural and Urban Communities

reflect the increasing societal acceptance of LGBTQ people. Rather than needing to seek out certain urban neighborhoods, LGBTQ people may increasingly feel comfortable in nonurban communities.

Urban Communities Starting in the early 20th century, individuals have found that urban spaces allowed them freedom to express LGBTQ genders and sexualities. Bars in particular were important for identity and community development. Bars allowed people to meet each other, to develop certain aesthetics in terms of expressing identity such as drag, and to organize politically. Research on contemporary urban communities indicates that visible gay neighborhoods exist in many cities. These neighborhoods are home to business and community organizations that cater to LGBTQ individuals. These neighborhoods are often visibly marked by rainbow flags flying on streets, for instance, and are sites where gay pride events occur. Along with the existence of such visible urban gay neighborhoods, research also indicates that there is diversity within cities with regard to how LGBTQ identities are expressed and how LGBTQ communities are experienced. First, there is diversity among urban LGBTQ people’s experiences insofar as not all LGBTQ people live in visible gay neighborhoods. For instance, Black LGBTQ people in Los Angeles and New York City are more likely to live in predominantly Black neighborhoods as opposed to gay neighborhoods. For some, their social lives and communities are thus more organized around friendship networks and private house parties, for instance, rather than through visible institutions like bars in gay neighborhoods, which are predominantly White. Additionally, Black and Latina/o LGBTQ individuals develop their own subcultures distinct from those of White LGBTQ individuals in many cities. Further, there are divisions along race, class, and gender lines in urban LGBTQ communities, despite the assumption that the city is the place to find and build a community around a shared marginalized sexual or gender identity. Those most likely to be living in urban visible gay neighborhoods are often

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White, middle- and upper-class, gay cisgender (cisgender, meaning not transgender) men. Transgender individuals and sexual minorities who are bisexual, racial minorities, women, or people of lower socioeconomic class may be less likely to live in or feel a sense of belonging in visible gay neighborhoods. The demographic makeup of visible gay neighborhoods has been exacerbated by gentrification. As working-class neighborhoods transition to middle- and upper-class neighborhoods, poorer LGBTQ individuals, including women, people of color, and transgender people, can no longer afford to live in visible gay neighborhoods. Such realities mean that the experience of urban spaces are raced, classed, and gendered. The assumption that cities are utopic for LGBTQ people ignores the violence that LGBTQ people can experience in urban locales. Nonetheless, visible gay neighborhoods continue to be important spaces for many LGBTQ individuals, even if they are not actually residents of these neighborhoods.

Rural Communities Increasingly, scholars in LGBTQ studies are focusing on rural areas. With this focus, scholars not only remedy the bias of prior literature that solely focused on urban areas and show that people with diverse sexualities and genders have always lived in rural areas but also address the increasing geographical diversity of LGBTQ individuals. Some historical work underscores that just as urban sexual subcultures were emerging in the early 20th century, similar processes were occurring in rural contexts. Likewise, LGBTQ activism in the mid- to late 20th century, including radical faerie groups and the lesbian land movement, sought to create welcoming spaces for LGBTQ people in rural contexts. For such groups, a rural environment was imagined as an escape from an urban lifestyle and as a place to more freely express non-normative genders and sexualities. Further, there are some small towns such as Ithaca, New York, or Northampton, Massachusetts, that have a reputation for being LGBTQ-friendly and have a large LGBTQ population. Thus, despite

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assumptions that all rural areas are alike and anti-LGBTQ, this is not the case. Yet not all LGBTQ individuals living in rural areas are connected to such intentional or LGBTQfriendly communities. The experiences of these individuals are diverse. Some may experience samesex desires or have same-sex sexual experiences but not adopt a lesbian, gay, bisexual, or queer (LGBQ) identity. Others may adopt an LGBQ identity and find that although there are many elements they enjoy about rural life, including a slower pace, a connection to the outdoors, and close relationships with family and friends, they also face barriers with regard to being isolated, not feeling comfortable expressing their gender or sexual identity, and not feeling connected to an LGBTQ community. These barriers can be exacerbated for individuals living in certain areas where religious teachings that oppose LGBTQ sexualities and genders are central to the community. Alternatively, others may adopt an LGBTQ identity and report being out, visible, and accepted in small towns. In fact, compared to their urban counterparts, sexual minorities in small towns are not more likely to be closeted and report higher levels of well-being. Some LGBQ individuals in small towns understand their sexual identity to be uniquely rural and to be distinct from urban LGBQ identities. For instance, their understandings about what it means to be out and visible are predicated on their characterization of small towns as exuding a close-knit, everybody-knows-everybody atmosphere. This atmosphere sustains their sense of being visible by being seen around town with a same-sex partner or their sense of being out in the community, since knowledge of their sexuality travels fast around town given how interconnected people are. They see this way of expressing LGBQ identities to be distinct from what they imagine happens in cities, where people might be active in LGBQ communities, or fly rainbow flags, or go to LGBQ bars and pride parades. Yet other LGBQ individuals, particularly young ones, do not see such expressions to be incompatible with rural life and, for instance, as Mary Gray shows, are active in local pride groups or do drag shows at the local Walmart.

Further, LGBTQ people’s experiences of rural communities also differ by race and class. Being accepted as an LGBTQ individual is predicated on having ties to the community and embracing small-town ways of life. Who is able to be seen as legitimately belonging in a small town is racialized insofar as rural and White are conflated and urban and racial diversity are conflated; namely it is White LGBTQ individuals who are seen as belonging. In terms of class, rural (in contrast to urban) is understood as inhabited by poor or lower-class people in popular imaginations. Some rural LGBTQ people distance themselves from urban people, whom they see as higher-class and whom they in turn devalue, including urban LGBTQ people. Likewise, some rural LGBTQ people live in poverty. Yet class differences also exist within rural communities, such that LGBTQ people with class privilege meet greater acceptance and tolerance with regard to their LGBTQ identity. In sum, LGBTQ studies scholars have unearthed a rich history of communities where LGBTQ genders and sexualities flourish in both urban and rural communities. Whereas small towns and LGBTQ identities were once assumed to be incompatible, emerging work illustrates how many LGBTQ individuals are out and accepted in rural areas. Importantly, scholars also address the diversity of experiences for LGBTQ individuals in both urban and rural contexts. Emily Kazyak See also Community Climate; Demographics and the LGBTQ Population; Gay Gentrification; Gayborhoods; Intersections Between Sex, Gender, and Sexual Identity

Further Readings Abelson, M. (2015). Gendered violence and intersectionality in the everyday experiences of transgender men. In C. M. Renzetti & R. KennedyBergen (Eds.), Understanding of diversity (pp. 53–64). Upper Saddle River, NJ: Pearson Education. Bailey, M. (2013). Butch queens in pumps: Gender, performance and ballroom culture in Detroit. Ann Arbor: University of Michigan Press.

Rural and Urban Communities Barton, B. (2012). Pray the gay away. New York: New York University Press. Chauncey, G. (1994). Gay New York: Gender, urban culture, and the making of the gay male underworld 1890–1940. New York, NY: Basic Books. Ghaziani, A. (2014). There goes the gayborhood? Princeton, NJ: Princeton University Press. Gray, M. L. (2009). Out in the country: Youth, media, and queer visibility in rural America. New York: New York University Press. Greene, T. (2014). Gay neighborhoods and the rights of the vicarious citizen. City & Community, 13, 99–118. Halberstam, J. (2005). In a queer time and place: Transgender bodies, subcultural lives. New York: New York University Press. Johnson, C. R. (2013). Just queer folks: Gender and sexuality in rural America. Philadephia, PA: Temple University Press. Johnson, P. E. (2008). Sweet tea: Black gay men of the South. Chapel Hill: University of North Carolina Press. Kazyak, E. (2011). Disrupting cultural selves: Constructing gay and lesbian identities in rural locales. Qualitative Sociology, 34, 561–581.

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Kazyak, E. (2012). Midwest or lesbian? Gender, rurality, and sexuality. Gender & Society, 26, 825–848. Kennedy, E. L. & Davis, M. (1993). Boots of leather, slippers of gold: The history of a lesbian community. New York, NY: Penguin Books. Moore, M. (2010). Black and gay in L.A.: The relationships Black lesbians and gay men have with their racial and religious communities. In D. Hunt & A. Ramon (Eds.), Black Los Angeles: American dreams and racial realities (pp. 188–212). New York: New York University Press. Oswald, R. F., & Culton, L. (2003). Under the rainbow: Rural gay life and its relevance for family providers. Family Relations, 52, 72–81. Rupp, L., & Taylor, V. (2003). Drag queens at the 801 Cabaret. Chicago, IL: University of Chicago Press. Swank, E., Frost, D., & Fahs, B. (2012). Rural location and exposure to minority stress among sexual minorities. Psychology & Sexuality, 3, 226–243. Weston, K. (1995). Get thee to a big city: Sexual imaginary and the great gay migration. GLQ, 2, 253–277. Wienke, C., & Hill, G. (2013). Does place of residence matter? Rural-urban differences and the wellbeing of gay men and lesbians. Journal of Homosexuality, 60, 1256–1279.

S same-sex couples (particularly those in long-term relationships who could not marry for years because it was illegal) would rush out to marry, but this is not necessarily the case. Younger couples are more likely than older couples to see it as an expected future transition in their lives. Older couples in long-term relationships may first have to deal with ambivalence they feel toward the institution of marriage, given that they had been denied access to it for so long. Due to internalized heterosexism, they may still see it as only for straight couples. They may also see it as something that younger gay couples will do but not necessarily something that they themselves will do. Already being in committed and long-term relationships, with various private ways of recognizing and celebrating their families, as well as legal protections likely in place, can also contribute to questioning whether legal marriage makes a difference in their lives. Ultimately, the step can be taken for personal reasons (e.g., wanting to acknowledge one’s love for a partner through this additional step) and/or political reasons (e.g., wanting to make a statement or gain additional legal protections). Thus, life course experiences (e.g., the age at which a person marries, how long they have been with their partner, and how long they have understood and accepted marriage to be a reality for them) can influence whether or not a same-sex couple moves toward marriage and how quickly they do so.

SAME-SEX WEDDINGS Rituals associated with life course transitions are important for families’ well-being. They help families make sense of changing family membership, create identity, and encourage positive emotional bonds. Rituals also provide an important opportunity for others to emotionally and legally recognize and affirm families. A small number of countries (e.g., Belgium, Canada, and South Africa) have legalized same-sex marriage, and in June 2015, the U.S. Supreme Court ruled that existing state-level restrictions were unconstitutional. Thus, weddings are now a ritual more available to same-sex couples than in the past. However, given the heteronormative (promotion of a “correct” way to live through family tradition, gender conventionality, and heterosexuality) nature of weddings and marriage, questions arise about what kind of weddings same-sex couples have, whether their experiences are different from heterosexual couples, and how the wedding industry is responding to these societal changes. This entry addresses the process of deciding to marry for same-sex couples, wedding characteristics, wedding planning, and the samesex wedding industry.

Deciding to Marry One might think that as soon as same-sex marriage becomes legal in a country or region, most 977

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Same-Sex Weddings

Wedding Characteristics Same-sex weddings are sometimes described as “scriptless,” as they do not have the same heteronormative influences that heterosexual couples experience. In some ways, they may closely resemble heterosexual weddings, but they will feel differently to those participating in them. The mood is not only celebratory but also jubilant, and there may be “political” undertones (e.g., statements made about marriage equality in the vows or mentioned at a reception, or showing photos documenting the committed nature of a decades-long relationship). Their weddings are typically different from heterosexual couples’ weddings in ways such as having smaller weddings, smaller wedding parties, being less likely to be married by a religious officiant or in a religious location, walking into the ceremony together rather than separately, and not having mothers of the brides highly involved. Intentionality may be present in ways that reflect the nonheterosexual nature of their weddings, such as through the incorporation of LGBTQ symbols like a rainbow flag and being mindful of who to invite (not only those who are supportive of their decision to marry but also unsupportive family members whom the couple hopes may change their mind over time). Intentionality may also be demonstrated through wanting to put on a good show for guests—being aware that some guests may be attending their first (or potentially only) gay wedding and so wanting to represent same-sex marriages in a positive and/or somehow revised manner (e.g., only briefly kissing their partner even though they would prefer to do otherwise or having a short ceremony so that guests do not become impatient). According to Jen Bacon, representations of same-sex weddings tend to be one of three images. The first image shows photographs of couples marrying in a civil ceremony at a city hall, amidst all the legal paraphernalia, the American flag, and supportive crowds of people behind them. This image highlights the political nature of marrying. The second image involves photographs of couples in typical wedding outfits and poses (e.g., two

women in wedding gowns cutting a cake) that give heterosexual viewers the reassuring image that gay people are “just like us.” This sanitized view promotes heteronormativity through the perpetuation of the “respectable same-sex couple” ideal (e.g., as long as gay couples are like heterosexual couples, it is acceptable for them to marry). A third image involves nonphotographic images showing “cookie-cutter brides” (in wedding gowns) and “cookie-cutter grooms” (in tuxedos). Whether in wedding gowns or tuxedos, the key point is that both individuals are identical to each other in these images. Bacon argues that although these illustrations seem innocent, they actually reinforce gender. The presentation of two male-looking characters in matching tuxedos, for example, is meant to bring up the image of two gay men in tuxedos, rather than two lesbians in tuxedos. Same-sex couples’ weddings, however, are as varied as the couples who marry: They can be political in tone, minimalist, secular, religious or spiritual in nature, or very public or demonstrative. Moreover, there are many subcultures in LGBTQ communities that can be reflected in couples’ wedding (e.g., leather bears having a “bear” theme at their wedding or high femmes having a very feminine-focused celebration1). As same-sex weddings become more common and accepted, it may be that greater representation is seen in the media and wedding industry. Websites such as The Knot (www.theknot.com) now show same-sex couples in a variety of contexts and outfits, such as two brides dressed informally or one or both dressed in a pantsuit (over 60% of female samesex weddings involve at least one woman wearing a suit). There may also be generational differences. Younger couples are much less likely to tolerate heterosexism (whether accidental or not), and they may have more support from their parents. They may also worry less about what others will think of any public displays of love between them. Moreover, those whose relationships develop after same-sex marriage is legalized may have different types of weddings and spend different amounts of money on their weddings. Currently engaged

Same-Sex Weddings

same-sex couples report plans to spend more money on their weddings than those who are already married have reported spending on their weddings.

Wedding Planning Planning a wedding involves negotiations with many people, regardless of one’s sexual orientation or gender identity. Wedding planning involves some combination of one’s own wishes, a partner’s aspirations, any political intentions or tones, the realities of one’s situation (e.g., how much can be spent versus what one wants, available community resources), and sensitivity to family dynamics. However, same-sex weddings involve other considerations that make them different from heterosexual weddings. For example, publicly announcing one’s same-sex wedding can raise resistance from others. In some cases, adult children who have been out to their (presumed) supportive parents for years may be unaware that their parents’ support is “conditional.” That is, the parents had come to terms with their child being gay but drew the line at the idea of their child actually marrying. Thus, such support is, in essence, a truce rather than unconditional acceptance, and a wedding may bring this dissonance to the surface. It also places a family at risk of heteronormative assessment and can out the future bride or groom and their partner to many people for the first time. If family dynamics are complicated, wedding planning may, too, be complicated. Only about two thirds of same-sex couples report that they have support from both sets of parents for marrying. Over time, however, parents, other family members, and friends can move from resistance to full acceptance of their child’s marriage.

Wedding Industry The economic impact of same-sex marriage is estimated to be 3 times as much as that of civil unions or domestic partnerships, as those who marry are more likely to have a reception and to invite more people. It is estimated that the legalization of

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same-sex marriage in New York in 2011 resulted in $249 million worth of business in the year that followed. Historically, in the United States, it is not just states in which same-sex marriage has been legal that have financially benefited, though. Many couples have traveled to a different state to marry and then returned to their home state to have a party or reception. Thus, all states have benefited financially from same-sex weddings, including those states that did not support them. The wedding industry is slowly responding to this economic treasure chest, considering how they can market themselves and work with these couples in ways that promote further business and referrals. Bernadette Coveney Smith, an expert on samesex weddings and the wedding industry, notes that wedding professionals and employees need to be careful with the language and terminology they use, not rely on stereotypes of LGBTQ individuals, and understand that there will be differences among LGBTQ couples. Some couples want “the big gay wedding,” whereas other do not. Asking open-ended questions is important, as well as being flexible and sensitive (e.g., shopping for a dress could be both emotional and challenging for a transgender bride). Gender differences exist; women are more likely than men to follow traditions such as buying an engagement ring or having a first dance, and they also wear a greater variety of outfits. Additionally, most same-sex couples do not use conventional wedding resources (e.g., bridal magazines). Instead, they turn to LGBTQspecific online blogs and resources (e.g., gayweddings.com). Gay consumers are known to be brand loyal and to rely on referrals, particularly with regard to weddings. Three in four couples say they want to work with businesses that are gayfriendly and have experience with planning samesex weddings. Thus, treating same-sex couples respectfully and not being heterosexist or homophobic is extremely good for businesses. Nevertheless, according to a 2013 study of same-sex weddings by Community Marketing and Insight, approximately one quarter of same-sex couples experience either discrimination or

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Sampling

heterosexism in the planning of their weddings (this percentage might have been higher if they had not been engaging in peer referral). Wedding industry workers need to look carefully at the language they use—not only verbally but also in how they communicate nonverbally to couples and their guests as well as the language found in documents. As unacceptable as it is to have one’s business turned down by a company because they state that they will not work with two gay men, it is also unacceptable and disheartening for a male photographer to comment while taking pictures that he’s “turned on” by watching a lesbian couple kiss or for two grooms to fill in a marriage certificate that requests only the “bride’s name” and the “groom’s name.” Alternatives to “bride” and “groom” can be “bride/groom” for both options. Although the wedding industry has adjusted to same-sex marriage in some ways, it is clear that much more change is still needed. Áine M. Humble See also Bear Community; Commitment Ceremonies; Defense of Marriage Act (DOMA); Heteronormativity; Heterosexism; Long-Term Same-Sex Couples; Marriage, Reasons for and Against

Note 1. Leather bears typically refer to gay or bisexual men who are rugged and masculine looking, have facial and body hair, and like to wear leather. High femmes refer to individuals who are highly feminine—wearing full makeup, having hair and nails done at all times, wearing tight dresses and jewelry, and so on.

Further Readings Bacon, J. (2009). Lesbian weddings and the revenge of the clones. Journal of Lesbian Studies, 13, 4–14. Clarke, V., Burgoyne, C., & Burns, M. (2013). Unscripted and improvised: Public and private celebrations of same-sex relationships. Journal of GLBT Family Studies, 9, 393–418. Humble, A. M. (2013). Moving from ambivalence to certainty: Older same-sex couples marry in Canada. Canadian Journal on Aging, 32, 131–144. Lannuti, P. J. (2008). Attractions and obstacles while considering legally recognized same-sex marriage. Journal of GLBT Family Studies, 4, 245–264.

Smart, C. (2008). “Can I be bridesmaid?” Combining the personal and political in same-sex weddings. Sexualities, 11, 761–776. Smith, B. C. (2013). The business of gay weddings. San Bernardino, CA: Goodnow Flow Publishing. Valverde, M. (2006). A new entity in the history of sexuality: The respectable same-sex couple. Feminist Studies, 32, 155–162.

SAMPLING The LGBTQ population has been underrepresented or absent from empirical research in the social, behavioral, and health sciences until relatively recently. While there are many explanations for why this has been the case, a primary culprit has been the stigmatization of LGBTQ people as well as research about them. LGBTQ people have been a “hidden” population, posing a challenge for recruiting samples for participation in research. More specifically, given the diversity among LGBTQ people, sampling methods that are effective for recruiting from one population may not be effective for recruiting from another. Understanding sampling is important because researchers and consumers of research alike must critically examine the degree to which results from empirical studies are relevant for understanding the populations that may be of interest to them. For example, different sampling strategies are required, and results differ, if a study focuses on gay-identified men, men who have sex with men (MSM), or all men who could be understood as part of the broad LGBTQ population. The following sections begin with an introductory discussion of sampling, including attention to issues of representation (the degree to which a sample represents the larger population that a given study is designed to understand). Sampling methods are then discussed within historical context, including early research on human sexuality and the slow emergence of research designed to include LGBTQ individuals. Finally, persistent challenges of obtaining samples that adequately

Sampling

represent the experiences of this diverse population are considered.

Sampling LGBTQ Most studies that include individual human subjects rely on some form of sample because data from the entire population is unavailable and infeasible to obtain. In the case of LGBTQ research, it is unrealistic and impractical to include every individual who identifies as LGBTQ in a study; thus, research depends on collecting information from a smaller subgroup or “sample.” In social, behavioral, and health sciences (often using quantitative methods), typically the goal is to derive estimates from a sample that should reflect patterns in, or that can be generalized to, the broader population. In cultural studies or in fields of humanistic inquiry (often using qualitative methods), the goals for sample selection may not include generalizability but rather to understand the meaning of, and gain rich knowledge about, a social or cultural phenomenon. In both cases, the nature and character of a sample is important because the composition of a sample will shape either the degree to which results are generalizable to a broader population or the specificity or breadth of participant perspectives that inform the meanings or knowledge that emerge through analysis and interpretation. Appropriate sampling methods therefore differ in relation to the type of study being employed. In quantitative studies, researchers often strive to collect large and random samples, also referred to as probability samples, as this provides some assurance that they accurately represent the population of interest. When researchers rely on opportunistic samples (samples consisting of participants who are the most easily accessible), individuals selfselecting into a study, or small samples, their findings may be biased and therefore not generalizable (e.g., the sample may only reflect a particular subset of the LGBTQ population). Although it is possible and desirable to recruit a large sample to participate in a survey, it is much more challenging to do so for a qualitative study, such as those based

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on interviews, focus groups, or ethnographic inquiries. Yet qualitative studies offer the possibility to provide profound insight into the lives of LGBTQ people; the depth of knowledge obtained obviates the need for generalizability. In sum, sampling methods must be carefully evaluated in conjunction with the proposed research questions and the most relevant type of data for addressing research questions.

A Brief History of Sampling LGBTQ Studies from the 1940s through the 1980s focusing on LGBT people primarily included individuals from high-risk populations in an effort to address public and mental health issues. Early research on human sexuality conducted by Alfred Kinsey in the 1940s and Evelyn Hooker in the 1950s challenged long-held conceptualizations of homosexuality by demonstrating that sexuality exists along a continuum in which individuals do not simply identify as homosexual or heterosexual. (It is important to mention that 50 years ago, homosexual was understood as an identity; because the origins of the term come from an understanding of homosexuality as deviant, contemporary LGBTQ people typically eschew homosexual in reference to people and identities.) Kinsey took a novel approach to understanding the breadth of human sexuality— especially by including men and women who identified as homosexual and bisexual in his studies. Yet his sampling methods, which included the recruitment of prisoners, prostitutes, and those who voluntarily self-selected into his studies, were criticized for producing biased data and findings that were not applicable to the general LGBTQ (then “homosexual”) population and contributing to misconceptions about gay and bisexual men’s moral and mental health. A decade later, Hooker’s studies of homosexual or gay men who were participants in psychological counseling sessions were the first to point to societal stigma rather than homosexuality as the origin of compromised mental health for gay men. Her samples included generally healthy gay men (albeit seeking psychological treatment), and her studies

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dispelled some of the misconceptions that arose from earlier research. Kinsey’s and Hooker’s methods illustrate the importance of critically examining the characteristics of samples and how they do or do not represent broader LGBTQ populations. Through the 1980s, studies on LGBT populations were largely either psychologically focused for which samples were drawn from populations in treatment or were public health focused for which samples were drawn from medical venues. This is in stark contrast to studies in which samples are drawn from the general population of typically adjusted persons. Because homosexuality was considered a mental disorder until the early 1970s, studies up to that point primarily investigated its causes. Through the 1970s and 1980s, public health research began accounting for LGBT individuals and emphasized problems such as the transmission of STDs. The advent of HIV among MSM in the 1980s led to a growth in studies—first of gay men and ultimately of broader LGBTQ populations. Studies in the 1980s were often framed around health risk and HIV and therefore were often limited to those who were believed to be at the highest risk—specifically, urban, gay, and bisexually identified men as well as men who had sex with men. Research trends shifted in the 1990s as health issues relevant to LGBTQ people gained more attention in medical studies and research on public health. Yet because of the difficulties of identifying and studying this stigmatized and hidden population, research during this decade still was often based on small convenience samples (although as one prominent scholar, Anthony D’Augelli, once noted, “There was nothing ‘convenient’ about collecting these samples”). Such methods limited the generalizability of the findings from studies through the 1990s.

Contemporary Sampling Methods In the past 30 years, large population-based datasets in the United States (such as the National Longitudinal Study of Adolescent to Adult Health, the Youth Risk Behavior Survey [YRBS; in certain states], the Survey of Income and Program

Participation, and the Panel Study of Income Dynamics) have included questions about sexual identity and same-sex relationships, providing access to larger samples relevant to LGBTQ lives. Notably, survey data often require that researchers apply specific labels that may not reflect the complex ways in which individuals self-identify, or surveys rely on reports of behavior that may not accurately reflect an individual’s self-identity or attractions. The assumed representativeness of samples is therefore challenged by limitations in accurately distinguishing between individuals’ behaviors, attractions, and identities. Nevertheless, large-scale, randomly selected, population-based data began to include attention to LGBTQ lives in recent decades, and such data addresses some limitations of the samples of earlier LGBTQ research. Researchers are able to more confidently generalize findings and to reduce possible bias (data unique to a small sample within a population). Further, because the LGBTQ population is small and diverse, larger samples enable researchers to identify subgroups among LGBTQ people and have enough cases to make robust statistical inferences about those groups. For example, since 1990 the U.S. Census has allowed calculation of the percentage of households headed by same-sex couples (that year the category of “unmarried partner” was added). On one hand, this represented a significant step in gaining a deeper understanding of the demographics of the lesbian, gay, bisexual, and transgender (LGBT) population across the United States; on the other hand, this approach only allowed for identification of couples in households and did not include other key demographic information. Nevertheless, data from population-based datasets allow more nuanced understanding of the diversity of the LGBTQ population, offering valuable insight into unique challenges and concerns of LGBTQ individuals and families.

Ongoing Challenges In light of these issues related to sampling and LGBTQ populations, there are a number of challenges about which researchers and users of

School Choice in LGBTQ-Parent Families

research must be aware. Clearly there are unique challenges for recruiting LGTBQ people into samples. Specifically, LGBTQ people are a hidden and stigmatized population; the potential for negative repercussions of sexual-identity disclosure makes some LGBTQ people weary of research participation. These factors must be acknowledged and addressed to overcome obstacles of inclusion in LGBTQ samples. Moreover, the specific population or subpopulation of interest must be clearly defined, and accordingly, measures that appropriately account for the LGBTQ population of interest must be considered. Researchers must also carefully distinguish between sexual attraction, behavior, and identity, as individuals’ sexual experiences or desires may not accurately reflect how they self-identify. In summary, sampling and related methodological challenges have substantial implications for the knowledge base on the lives of LGBTQ populations and thus for guiding policy and practice to address their needs. Community-based samples of LGBTQ people have been crucial for establishing basic understandings of LGBTQ lives and continue to provide rich population-specific knowledge on topics that are not pertinent to the general population, such as minority stress and resilience. Largescale population-based datasets have begun to include measures that allow for attention to LGBTQ individuals, couples, and families and offer the advantages of results that are representative of diverse LGBTQ lives, with possibilities for comparisons to non-LGBTQ populations for a deeper understanding of group differences and disparities. The study of LGBTQ lives has made significant gains over the past half century, yet issues of sampling warrant further consideration to continue to strengthen knowledge of issues relevant to this diverse population. Jack K. Day and Stephen T. Russell See also “Big Data” Bias in LGBTQ Research; Ethical Research With Sexual and Gender Minorities; Methodological Decisions by Researchers of LGBTQ Populations; Online Surveys; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity; Scientific Integrity, Debates About

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Further Readings Binson, D., Blair, J., Huebner, D. M., & Woods, W. J. (2007). Sampling in surveys of lesbian, gay, and bisexual people. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities (pp. 375–418). New York, NY: Springer. Boehmer, U. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92(7), 1125–1130. Dean, L., Meyer, I. H., Robinson, K., Sell, R. L., Sember, R., Silenzio, V. M. B., . . . Xavier, J. (2000). Lesbian, gay, bisexual, and transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association, 4(3), 101–151. Gates, G. J. (2013). Demographics and LGBT health. Journal of Health and Social Behavior, 54(1), 72–74. Meyer, I. H., & Wilson, P. A. (2009). Sampling lesbian, gay, and bisexual populations. Journal of Counseling Psychology, 56(1), 23–31. doi:10.1037/a0014587 Rothblum, E. D. (2007). From science fiction to computer-generated technology: Sampling lesbian, gay, and bisexual individuals. In I. H. Meyer & M. E. Northridge (Eds.), The health of sexual minorities (pp. 442–454). New York, NY: Springer. Russell, S. T., & Muraco, J. A. (2013). The use of representative data sets to study LGBT-parent families: Challenges, advantages, and opportunities. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 343–356). New York, NY: Springer.

SCHOOL CHOICE FAMILIES

IN

LGBTQ-PARENT

LGBTQ parents (biological and adoptive) face a number of oppressive factors when selecting a school for their children and becoming involved in their children’s education. This entry explains the negative experiences LGBTQ parents may face when navigating through the school system simply because their family structure does not conform to society’s desired family structure of one cisgender (someone who conforms to the gender they were assigned at birth) mother and one cisgender father.

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School Choice in LGBTQ-Parent Families

Next, the entry identifies the unique qualities that LGBTQ parents look for when choosing a school for their children. The entry concludes with a description of current gaps in research and practice when it comes to understanding the school-related decision-making process of LGBTQ parents.

Oppressive School Factors LGBTQ Parents and Their Children May Face New laws and policies are increasingly being put in place to protect the rights of LGBTQ individuals— including those who are parents. In turn, such laws send the message that overt displays of bias and hatred toward LGBTQ individuals will not go unnoticed or unpunished. Unfortunately, less overt actions of discrimination toward LGBTQ individuals do not guarantee that subtle acts of discrimination, or microaggressions, will not take place. Research shows that LGBTQ parents are exposed to a variety of microaggressions in schools that cause a great deal of stress for parents and their children. Some microaggressions from school personnel include excluding LGBTQ parents from fully participating in school activities because they identify as LGBTQ. For example, leaving two lesbian parents out of a school activity because the activity is for “fathers only,” or not acknowledging that two mothers are present in the classroom or school office, are examples of microaggressions. Further, some teachers and school personnel question the parenting skills of LGBTQ parents and imply that a student’s poor behavior and/or academic struggles are related to their distinct family structure (i.e., having LGBTQ parents). On a more systemic level, schools fail to create and enforce inclusive policies and procedures, such as creating school curricula that represents LGBTQ individuals and families in a positive light. Unfortunately, teachers and school personnel might avoid acknowledging and discussing LGBTQ issues with students because of the erroneous belief that a conversation about sexual orientation will lead to a discussion about sexual behavior. Another reason for failing to expose students to healthy discussions of different family structures is the fear

that heterosexual parents in the school might disapprove. Yet the failure to acknowledge diversity within family structures exposes the ignorance of school personnel on LGBTQ issues and delivers the message that some students and parents are more important and worthy of protection than others. Moreover, schools often disregard the hardships that children of LGBTQ parents are exposed to as they navigate through a heteronormative school environment. When children of LGBTQ parents express concern after hearing insults toward LGBTQ individuals, such as hearing the word gay being use in a negative manner, teachers and other school personnel sometimes minimize the seriousness of the situation by stating that their interpretation of such words is not accurate. Due to this lack of support from school personnel, and in an effort to protect their children, some LGBTQ parents are forced to tell their children to not discuss their parents’ sexual orientation in school. This message of shame and secrecy causes stress for both the parent and the child and forces the entire family to go “in the closet.”

School Selection Process Among LGBTQ Parents In selecting an appropriate school for their children, parents, regardless of their gender expression or sexual orientation, go to great lengths to ensure their children receive the best possible education. For example, academic school performance and competitive academic programs are school qualities that most parents look for in an educational setting for their children. However, due to the potentially oppressive nature of schools toward LGBTQ parents, it is important to discuss the qualities that LGBTQ parents look for when selecting a school for their children. Some of these qualities include school academic reputation, location, LGBTQ-friendly environment, and overall school diversity. Much like their heterosexual counterparts, LGBTQ parents want to be able to provide their children with a good academic experience. For example, schools’ academic reputation in the

School Choice in LGBTQ-Parent Families

community is important for most parents, regardless of their sexual orientation or gender expression. It is important to mention, however, that parents who enroll their children in private schools are generally more concerned with a school’s academic reputation than those parents who send their children to public schools. This is mostly because parents who enroll their children in private schools have the financial means to be more selective, while those parents who send their children to public schools often have less flexibility in the selection of their child’s school. Furthermore, the percentage of LGBTQ parents who choose to send their children to public schools is lower than that of the national average. Research suggests that by considering a private school, LGBTQ parents are exercising their option to choose the school that best fits their views. It is important to note, however, that unlike their heterosexual counterparts, LGBTQ parents who choose to enroll their children in private schools prefer independent schools over religious schools. Further, research suggests that LGBTQ parents are more concerned with school acceptance of diversity, including issues that affect the LGBTQ community, than their heterosexual counterparts. LGBTQ parents go to great lengths to make sure that schools have LGBTQ-supportive personnel, students, and other parents. In addition to seeking a school with a high level of inclusiveness toward LGBTQ issues, LGBTQ parents are more likely to select a school that represents diversity overall (e.g., race, ethnicity, class, and cultures) than heterosexual parents. For example, LGBTQ parents value schools that provide ample special education services (e.g., services for students with learning disabilities and social and emotional needs) and schools with language programs (e.g., bilingual schools), as well as schools that have a positive climate toward families of diverse backgrounds. Some research has examined diversity within LGBTQ parents in terms of their valuing of LGBTQ friendliness and diversity when choosing schools. Research suggests that the younger the child, the more concerned LGBTQ parents are with choosing an LGBTQ-friendly school for their

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children. For example, research has found that LGBTQ parents of preschool-age children are more likely to be concerned with finding a school that is highly accepting of LGBTQ individuals and families than those LGBTQ parents with children in middle and high school. Other research has found that while the school’s valuing of diversity is an important quality for many LGBTQ parents, this quality is more salient among multicultural families (e.g., families where parents and children are not the same racial or ethnic identity) and parents of color. For example, in multicultural families where the child is a member of a racial- and/or ethnic-minority group, even when the parents are White, LGBTQ parents view school diversity as one of the most important factors when determining where to enroll their children. It is possible that being part of a double minority plays an important role. As research suggests, LGBTQ people of color need to learn to cope with living in a society that marginalizes them for their multiple minority status. Thus, it can be concluded that LGBTQ parents of color might want to expose their children to an environment where being a racial and/or ethnic minority is celebrated while instilling values of acceptance toward the LGBTQ community.

Moving Forward: A Call to Action The information presented in this entry offers an overview of the challenges that LGBTQ parents face when working with schools and the factors that they mostly value when selecting a school for their children. Nevertheless, this is an understudied area. Based on the gaps encountered in the LGBTQ literature, researchers and clinicians should further explore the specific factors considered by bisexual, transgender, and queer parents when choosing a school for their children, alternative school possibilities besides private and public schools, opportunities for creating a safe school environment for LGBTQ parents and their children regardless of their financial means, and the experiences of multicultural LGBTQ families in the school system. Research that explores the oppressive factors that LGBTQ parents are exposed to in schools and

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the school selection process has been based mostly on lesbian mothers and gay fathers. While there are commonalities among all LGBTQ people regarding their experiences with oppression, more research is needed in order to understand the particular factors that specifically affect bisexual, transgender, and queer parents as they choose schools for their children. Further research will help researchers, clinicians, and school personnel better understand, develop, and put in practice different interventions when working with LGBTQ individuals. Furthermore, most of the information about the school decision-making process of LGBTQ parents has only explored public and private schools. With a growing national interest in charter schools, it would be helpful to explore the perception of LGBTQ parents when choosing to send their children to a charter school rather than a traditional public or private school. Moreover, very little has been done to develop interventions to achieve a safe school environment for all LGBTQ parents and their children. Although LGBTQ parents often want to send their kids to an academically competitive school, the fact that some schools might not be LGBTQ friendly may prevent parents who do not have the financial means to send their children to a school that is both LGBTQ friendly and academically more competitive. Thus, interventions need to be developed in order for all schools to be welcoming and accepting of LGBTQ parents and their children. A safe school environment should not only be a privilege that LGBTQ parents who have the financial means to send their children to private school have. Those LGBTQ parents who do send their children to a public school are also entitled to the right to be welcomed and accepted into their school community. Finally, while research briefly describes the qualities that multicultural LGBTQ families consider when choosing a school for their children, there has been little exploration of why these parents are significantly more concerned with diversity in schools. Thus, further research should concentrate on this double minority group: LGBTQ multicultural families. Roberto L. Abreu and Alicia L. Fedewa

See also Home–School Partnerships in LGBTQ-Parent Families; LGBTQ-Parent Involvement and Advocacy in Schools

Further Readings Byard, E., Kosciw, J., & Bartkiewicz, M. (2013). Schools and LGBT-parent families: Creating change through programming and advocacy. In A. E. Goldberg & K. R. Allen (Eds.), LGBT-parent families: Innovations in research and implications for practice (pp. 275–290). New York, NY: Springer. doi:10.1007/978-1-46144556-2_18 Fedewa, A. L., & Clark, T. P. (2009). Parent practices and home-school partnerships: A differential effect for children with same-sex coupled parents? Journal of GLBT Family Studies, 5, 312–339. doi:10.1080/15504 280903263736 Fox, R. K. (2007). One of the hidden diversities in schools: Families with parents who are lesbian or gay. Childhood Education, 83(5), 277–281. Goldberg, A. E., & Smith, J. Z. (2014). Preschool selection considerations and experiences of school mistreatment among lesbian, gay, and heterosexual adoptive parents. Early Childhood Research Quarterly, 29(1), 64–75. doi:10.1016/j.ecresq .2013.09.006 Kosciw, J. G., & Diaz, E. M. (2008). Involved, invisible, ignored: The experiences of lesbian, gay, bisexual and transgender parents and their children in our nation’s K–12 schools. New York, NY: Gay, Lesbian & Straight Education Network. Lindsay, J., Perlesz, A., Brown, R., McNair, R., de Vaus, D., & Pitts, M. (2006). Stigma or respect: Lesbianparented families negotiating school settings. Sociology, 40(6), 1059–1077. doi:10.1177/003803850 6069845 Mercier, L., & Harold, R. (2003). At the interface: Lesbian-parent families and their children’s schools. Children & Schools, 25(1), 35–47.

SCHOOL CLIMATE This entry focuses on school climate for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) students. School climate can be defined as the social and physical conditions, values and

School Climate

attitudes, practices and programs, and policies of a school that influence student academic and psychosocial outcomes. School climates for LGBTQQ students are often characterized as negative because of the high level of bullying, harassment, and discrimination that students encounter because of their sexual orientation or gender identity and expression. Additionally, across studies, the majority of LGBTQQ students report that they feel unsafe at school because of their sexual orientation or gender identity and expression. This entry discusses the school-level contextual features (e.g., nondiscrimination policies) and school-based interpersonal relationships (e.g., teacher intervention in bias-based incidents) that contribute to school climate for LGBTQQ students.

Features of Schools That Foster (Un)Safe School Climates for LGBTQQ Students Several features of schools, such as district policies or the curriculum, contribute to negative school climates experienced by LGBTQQ students; importantly, these features are often rooted in heterosexism and cissexism. Heterosexism is the systematic privileging of heterosexuality relative to LGBQ identities or behaviors, and cissexism is the systematic privileging of individuals whose gender identity and expression match the sex that they were assigned at birth relative to transgender or gender-creative individuals. As such, certain features of schools, such as school policies that do not attend to LGBTQQ identities, curriculum that is not inclusive of LGBTQQ histories or related information (e.g., LGBTQQ identities in sexuality education), and the normative use of anti-LGBTQQ slurs to police gendered and sexual behaviors among peers, often go unchallenged and perpetuate the inequities experienced by LGBTQQ students. There are three salient school-level features that are associated with LGBTQQ students’ perceptions of school climate. These are school policies (e.g., nondiscrimination, anti-bullying), the physical structure of the school (e.g., access to gender-neutral bathrooms), and the availability of LGBTQQinclusive information and curriculum in schools

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(e.g., relevant LGBTQQ historical events are discussed in history courses). Additionally, there are four salient features of school-based interpersonal relationships that affect LGBTQQ students’ perceptions of the school climate. These are school personnel’s LGBTQQ competency (e.g., understanding of definitions, inequities experienced by LGBTQQ-identified people) and access to LGBTQQ-related trainings (e.g., a training on how to support LGBTQQ students who experience bullying); teacher and school staff intervention in biasbased bullying, harassment, and discrimination; the availability of gay–straight alliances (GSAs) or similar clubs in schools; and peer and school adult (e.g., teacher, school counselor) interactions related to sexual orientation and gender identity and expression. Next, these school features are discussed in depth, beginning with school-level features and ending with a discussion of school-based interpersonal relationships. School-Level Features

School policies that dictate who is (and who is not) protected from bullying, harassment, and discrimination have been at the forefront of research and advocacy efforts to understand and foster healthier school climates for LGBTQQ students. As of 2014, there was no U.S. legislation that protects students against school-based bullying, harassment, and discrimination that occurs because of their actual or perceived sexual orientation or gender identity and expression. Additionally, as of 2014, less than half of all U.S. states had enacted enumerated anti-bullying policies that included protections based on sexual orientation and gender identity and expression, and only 13 states and the District of Columbia had nondiscrimination policies that included sexual orientation and gender identity and expression. Notably, two states (South Dakota and Missouri) had laws that prohibited enumeration of protected groups in 2014, and eight states had passed “no promo homo laws” that forbid school personnel from discussing LGBTQQ people or issues in schools and/or that allowed personnel to provide only negative portrayals of LGBTQQ people. While policies may be

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viewed as unimportant to the everyday lives of students, substantial research suggests that enumerated policies that include both sexual orientation and gender identity and expression are associated with safer school climates for LGBTQQ students. That is, students—including LGBTQQ and straight/heterosexual students—who attend schools with inclusive enumerated policies are more likely to perceive their schools as safe spaces and are less likely to report hearing anti-LGBTQQ epithets or remarks, such as “that’s so gay.” Additional research has found that LGBTQQ students who attend schools with enumerated policies that include sexual orientation and gender identity and expression report lower levels of suicidality compared to students in schools without inclusive enumerated policies. Nonetheless, while policies provide the foundation for schools to support LGBTQQ youth and unequivocal legal protections for LGBTQQ students, students may not be aware of such policies or may not report anti-LGBTQQ bullying, harassment, and discrimination because they may believe that teachers or administrators will not follow up with the report. In addition to inclusive school policies, the physical structure of the school also helps to explain why some school climates are safe for LGBTQQ students while others are not. For transgender and gender-creative students, in particular, access to gender-neutral bathrooms and locker or changing rooms is essential for creating accepting school climates. Arguably, access to these types of facilities also benefits heterosexual and cisgender students who experience bullying or harassment in these school spaces that are often not supervised by a school adult. The presence of identifiable LGBTQQ safe spaces (e.g., safe zone stickers, rainbow stickers) and inclusion of LGBTQQ people and events on school posters, banners, and announcements are also important aspects of the school climate. While seemingly innocuous, LGBTQQ students may perceive their schools—or classrooms within a school—as safe places when they can more easily identify the physical spaces in the school where LGBTQQ identities and expressions are affirmed.

Finally, the availability of LGBTQQ-inclusive information and curriculum in the school context is positively associated with students’ perceptions of the school climate, academic achievement, and well-being. It is not surprising that seeing oneself represented in the curriculum, literature, or other information available in the school context is associated with more positive perceptions of the school climate by LGBTQQ students, given that persistent invisibility perpetuates systems of privilege and oppression, such as heterosexism and cissexism. Importantly, similar findings have emerged in studies of school climate among racial- and ethnicminority students in the United States, suggesting that textbooks, schoolwide campaigns, and other school materials need to include depictions and accounts that all students in a particular school can relate to and identify with. While research has clearly documented that LGBTQQ-inclusive curriculum and information in schools are beneficial for LGBTQQ students, the practices are also likely to be effective in reducing heterosexist and cissexist beliefs, attitudes, and behaviors among heterosexual and cisgender students and school adults. Yet, few studies have examined the associations between many of these safe-school strategies and outcomes with non-LGBTQQ populations. Interpersonal Relationships

At the interpersonal relationship level, school personnel’s access to trainings about LGBTQQrelated issues and their LGBTQQ-related competency has been a large focus of intervention work aimed at supporting positive and safe climates for LGBTQQ students. Teacher and administrator trainings focused on LGBTQQ people and issues are particularly important given that many teacher and administrator training programs do not educate students about LGBTQQ issues; thus, school personnel may lack the sufficient knowledge and skills needed to effectively support safe school climates for all students. Promising interventions exist that are effective in increasing educators’ LGBTQQ competency; these interventions aim to provide educators with an understanding of

School Climate

LGBTQQ-related terminology and resources available in ones’ school and community and to promote self-awareness of how to be inclusive when interacting with students and teaching curriculum. Additionally, these interventions aim to boost selfefficacy related to intervening in bias-based incidents related to sexual orientation and gender identity and expression. Notably, effective teacher or school staff intervention in bias-based bullying, harassment, and discrimination is associated with safer school climates for LGBTQQ students and better psychosocial and academic outcomes for students. Unfortunately, surveys find that teachers and school staff rarely intervene in bias-based incidents and are occasionally involved in the perpetration of these incidents. Further, similar to other forms of school-based bullying, harassment, and discrimination, LGBTQQ students rarely report biasbased incidents to school staff because they believe that teachers and school staff will not follow up with the issue or because they fear retribution from perpetrators. Additional research suggests that LGBTQQ students may be disciplined or punished for violating heterosexist or cissexist norms after they report a bias-based incident, and they are often blamed for their victimization and told that they are the problem. This negative school climate is associated with school absenteeism among LGBTQQ students, and an emerging body of literature has linked schools’ responses to LGBTQQ students’ experiences of bias-based incidents with the disparately high proportion of LGBTQQ youth involved with the juvenile justice system. Thus, it is critically important for schools and teacher training programs to include professional development opportunities that teach current and future school staff how to effectively intervene in bias-based incidents and how to help create welcoming and affirming school climates for all students. Finally, the ability for students to identify at least one supportive person at school, whether that individual is a peer or a school adult (e.g., teacher, administrator), is incredibly important for understanding students’ perceptions of school climate.

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GSAs or similar clubs provide opportunities for LGBTQQ students to meet affirming and accepting peers, and these school-based clubs often provide a sense of safety and support. Indeed, research on GSAs finds that the presence of a GSA is associated with more positive perceptions of school climate among LGBTQ students. While GSAs represent a positive contributor to school climate for LGBTQQ students, peer interactions within a school may foster negative perceptions of the climate, particularly when those interactions involve bias-based bullying, harassment, or discrimination. As discussed earlier in this entry, it is critically important that school staff effectively intervene in these negative peer interactions in order to improve the school climate for LGBTQQ youth. Equally important, emerging research also implies that interventions need to target peer bystanders to teach them how to intervene when a peer is being victimized. In addition to peers, most LGBTQQ students are able to identify at least one supportive adult in their school, and these students tend to have more positive perceptions of their school climate and report better academic and psychosocial outcomes. This research is consistent with the extant adolescent literature, suggesting that supportive, nonparental adults promote positive youth development among all youth. Russell B. Toomey See also Bullying, Rates and Effects of; Bullying, SchoolBased Interventions for; Gay, Lesbian & Straight Education Network (GLSEN); Gay–Straight Alliances (GSAs); Sexualities at School

Further Readings Chesir-Teran, D. (2003). Conceptualizing and assessing heterosexism in high schools: A setting-level approach. American Journal of Community Psychology, 31, 267–279. Griffin, P., & Ouellett, M. (2003). From silence to safety and beyond: Historical trends in addressing lesbian, gay, bisexual, and transgender issues in K–12 schools. Equity & Excellence in Education, 36, 16–114.

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School Professionals’ Responses to LGBTQ Training

Hatzenbuehler, M. L., Birkett, M., Wagenen, A. V., & Meyer, I. H. (2014). Protective school climates and reduced risk for suicide ideation in sexual minority youths. American Journal of Public Health, 104, 279–286. Human Rights Watch. (2001). Hatred in the hallways: Violence and discrimination against lesbian, gay, bisexual, and transgender students in U.S. schools. New York, NY: Author. Kosciw, J. G., Greytak, E. A., Bartkiewicz, M. J., Boesen, M. J., & Palmer, N. A. (2012). The 2011 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York, NY: Gay, Lesbian & Straight Education Network. McGuire, J. K., Anderson, C. R., Toomey, R. B., & Russell, S. T. (2010). School climate for transgender youth: A mixed method investigation of student experiences and school responses. Journal of Youth and Adolescence, 39, 1175–1188. Perrotti, J., & Westheimer, K. (2001). When the drama club is not enough: Lessons from the safe schools program for gay and lesbian students. Boston, MA: Beacon Press. Russell, S. T., & McGuire, J. K. (2008). The school climate for lesbian, gay, bisexual and transgender (LGBT) students. In M. Shinn & H. Yoshikawa (Eds.), Toward positive youth development: Transforming schools and community programs (pp. 133–149). New York, NY: Oxford University Press.

SCHOOL PROFESSIONALS’ RESPONSES TO LGBTQ TRAINING School professionals who are visibly supportive of LGBTQ youth are critically important to creating inclusive schools. These are educators who intervene when they witness homophobia, express support for LGBTQ rights, and create opportunities for gender and sexual diversity to be visible in the school environment. When LGBTQ youth are able to connect with these supportive educators, they experience greater educational success. However, practicing school professionals often feel ill-prepared to meet the needs of LGBTQ

students or are completely unaware that the needs exist. Research indicates that without education and professional development, teachers are unable to understand how to effectively apply school antiharassment policies or otherwise secure a safe learning environment. For example, when asked about their intervention efforts, teachers often report that, although motivated to intervene in heterosexual sexual harassment, they felt unsure about when or how to take action on behalf of LGBTQ students. School policies rarely provide guidance on applying sexual harassment policies to gender-based bullying experienced by LGBTQ and gender-nonconforming students, and without professional development, school professionals are often unable to recognize the connections between sexual harassment, gender-based bullying, and the heterosexist norms and values through which gender-based bullying operates. Educators are not formally trained to address problems of harassment and marginalization experienced by LGBTQ youth during their professional training. In the United States, university course work addressing the experiences of LGBTQ students is rare in undergraduate and graduate professional preparation programs. State departments of education include vague and inconsistent expectations for diversity education in their educator credential requirements, and national accrediting bodies for educator preparation (Council for the Accreditation of Education Preparation/National Council for Accreditation of Teacher Education [CAEP/NCATE], for instance) include broad requirements for educators to understand and accommodate the needs and experiences of all students without naming specific student differences such as race, class, religion, gender, or sexuality. Preparation programs are given flexibility to decide how to educate their students about diversity issues, and this has resulted in teacher, school counseling, and school leadership programs where LGBTQ issues are the lowest priority in the multicultural education curriculum. Professional development has, therefore, become the context where most training for school professionals on LGBTQ issues occurs.

School Professionals’ Responses to LGBTQ Training

Professional Development Content For practicing school professionals, professional development workshops have become the primary way to increase competence and address gaps in their preservice preparation. LGBTQ professional development is intended to address the problems of educators’ lack of knowledge about LGBTQ students’ experiences, lack of action when homophobic or sexist aggression occurs, homophobic attitudes, and resistance to curricular inclusion of LGBTQ topics. LGBTQ professional development for educators varies but generally includes content on risk factors for LGBTQ youth; correlations between social stigma or victimization and these risk factors; information about the social phenomena of bullying, sexual harassment, and microaggressions; strategies for violence intervention; and strategies for creating more inclusive school and classroom cultures. In some cases, professional development also includes content on the pitfalls of reducing LGBTQ students’ school experiences to bullying and victimization. Such models frame their strategies for improving school environments in terms of addressing schools’ investments in heteronormative values, rather than focusing solely on violence prevention or increasing the level of tolerance in a school environment.

Responses to Professional Development Research suggests that in-service training on LGBTQ issues can effectively increase knowledge of the LGBTQ student experience, support improved teacher attitudes toward LGBTQ students, and improve school climate. Educators who participate in one-time trainings generally report increased awareness about the pervasiveness of homophobia in schools, increased empathy toward LGBTQ students, and higher self-efficacy regarding intervention in LGBTQ harassment and implementation of recommendations for creating safer learning environments such as displaying Safe Space stickers, no-tolerance policies for homophobic language, and starting gay–straight alliances (GSAs). On the rare occasions when educators have opportunities to engage in a long-term series of trainings,

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research indicates that educators attain a greater depth of knowledge about heteronormativity and heterosexism. Over time, this increased knowledge can lead to naming gender-oppressive classroom practices in their own pedagogy and beginning to develop strategies for disrupting these patterns. Significantly, this body of research indicates that teachers who come to LGBTQ professional development with some previous awareness of homophobia and heterosexism report the most learning during training and more attempts to integrate this learning into their professional practice. Regardless of the professional development program content, educators’ responses and reflections on integrating their learning into their professional practice indicate that educators are interpreting LGBTQ educational issues as “risk” issues rather than equity issues. That is, educators tend to be preoccupied with preventing bullying, suicide, or other negative psychological and health outcomes, but they do not envision changes to school culture that could lead to more equitable school experiences for all. They place responsibility on themselves and on the dominant (heterosexual) students to express kindness and empathy but are positioning LGBTQ students as the cultural “other.” This paradigm for school improvement is limiting because it fails to address questions of how and why the school environment limits the visibility of diverse gender and sexual identities, thus providing LGBTQ students very little opportunity to be recognized and affirmed in school. Instead their student identities are reduced to “vulnerable” or “victim,” and educators are on notice that they need to be protected but not necessarily integrated into the social life of the school.

Time Limitations on Professional Development Although research makes clear the need to provide comprehensive training that addresses gender inequities and systems of marginalization, rarely is there time available for such professional development within the structure of the public K–12 school year. Most professional development on

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LGBTQ students occurs in short sessions from 30 minutes to three hours in length, and there is rarely opportunity for follow-up with the participants. Sufficient time is key not only for comprehensive address of the material and for understanding the complexity of marginalization but also for educator reflection and then application.

Conclusion Current scholarship on LGBTQ educator training continues to explore questions on how to empower educators to take on anti-heterosexist, equityminded professional practice within the parameters of professional development schedules in public K–12 schools. This inquiry has the potential to create new opportunities for scholars and K–12 educators to develop innovative professional development models that inform educators about the school experiences of LGBTQ youth, open dialogues about heteronormative school cultures, and provide educators with tools to create inclusive school cultures. Melissa J. Smith and Elizabethe Payne See also Education; School Climate; Schools as Heteronormative Spaces

Further Readings Greytak, E. A., Kosciw, J. G., & Boesen, M. J. (2013). Educating the educator: Creating supportive school personnel through professional development. Journal of School Violence, 12, 80–97. Payne, E., & Smith, M. (2010). Reduction of stigma in schools: An evaluation of the first three years. Issues in Teacher Education, 19(2), 11–36. Payne, E., & Smith, M. (2011). The reduction of stigma in schools: A new professional development model for empowering educators to support LGBTQ students. Journal of LGBTQ Youth, 8(2), 174–200. Payne, E., & Smith, M. (2012). Safety, celebration and risk: Educator responses to LGBTQ professional development. Teaching Education, 23(3), 265–285. Towery, I. D. (2007). Fostering gender equity in schools through reflective professional development: A critical analysis of teacher perspectives. Penn GSE Perspectives on Urban Education, 5(1), 1–25.

SCHOOL SELECTION See School Choice in LGBTQ-Parent Families

SCHOOLS SPACES

AS

HETERONORMATIVE

This entry is concerned with understanding schools as heteronormative spaces. It defines the term heteronormative by drawing on understandings from queer theory. The means by which schools might be seen as heteronormative is then explored. This discussion reveals how, through schooling practices and processes, heteronormative meanings and identities are produced as a normal part of everyday schooling experiences. The importance of understanding schools as heteronormative spaces lies in the negative implications this can sometimes have for LGBTQ students. Recognizing negative effects of heteronormativity for students is the first step to changing the heteronormative culture of schools.

What Is Heteronormativity? The term heteronormativity has been developed from the work of queer theorists such as Michael Warner, Judith Butler, and Eve Sedgwick in the late 1980s and early 1990s. These theorists have been interested in unpacking and disrupting identity categories particularly in relation to gender and sexuality. For example, instead of taking for granted what it means to be lesbian or heterosexual, these theorists ask questions about how we come to know how being lesbian or heterosexual is understood. Their work has been important in revealing the limitations of identity labels because of the binaries they establish such as male–female or homosexual–straight. Such binary categories are not always able to take account of complexities and nuances in the way these terms are lived. For instance, binary gender categories do not capture the experiences of an anatomical male who prefers

Schools as Heteronormative Spaces

to dress/live predominantly as a woman. It is as part of the work of queer theory to shift attention away from sexual and gender identities that the term heteronormativity has emerged. Prior to the advent of queer theory, research on sexual diversity at school focused on gay and lesbian students as a marginalized (identity) group. These studies revealed the way in which gay and lesbian students are discriminated against and subject to homophobia and heterosexism in schooling contexts. The focus was on gay and lesbian students (rather than those who perpetuated homophobia and heterosexism), often culminating in their depiction as “victims” in need of protection. Queer theorists who question the utility of identity categories have drawn attention away from gay and lesbian students as the focus of sexualities research and toward an understanding of the means by which discrimination occurs. This has meant a shift in onus from a deficit approach in which individual gay and lesbian students are perceived as “the problem” that schools need to fix and instead placing attention on those practices and processes that are disadvantaging. The concept of heteronormativity has provided a way of naming the everyday schooling practices and processes that can be disadvantaging for LGBTQ students, without needing to draw attention specifically to these students. Such attention can be problematic in school-based research when LGBTQ students are not “out” in this environment and/or do not wish to be. Heteronormativity describes the everyday and commonsense ways in which heterosexuality is privileged and assumed “normal” and “natural.” Within the existing critical sexualities literature in education, schools are seen as heteronormative because of the way they operate to establish heterosexuality as the default of human sexuality and “normal” while casting all other sexual identities (bisexual, gay, lesbian, homosexual) as “abnormal other.”

How Are Schools Heteronormative? Heteronormativity expresses itself both implicitly and explicitly in a myriad of schooling processes and practices. It can be found in all dimensions of

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these educational contexts from the level of institutional policy to classroom pedagogy (i.e., practices of teaching and learning). Heteronormativity is perhaps most easily witnessed as silence around lesbian, gay, bisexual, and transgender (LGBT) as well as intersex issues in each of these schooling dimensions. An example is when equity for LGBTQ is missing from school policy on student safety while there are strong regulations regarding the avoidance of sexism, racism, and religious freedom. At other times, heteronormativity is apparent when LGBTQ is included within the curriculum— for instance during sexuality education—but in a way that represents these identities negatively as “other,” or “pathologically” as “illness.” A welldocumented example of this is when the only mention of homosexuality is in relation to comments such as “it is typically gay men who contract HIV/ AIDS.” As it is not possible to highlight all the means by which schools can be seen as heteronormative, two examples are explored next. These examples illustrate how heteronormativity operates via the unofficial curriculum of schooling and within classroom interactions between peers and between teachers and students.

Heteronormativity in the Unofficial Curriculum Part of heteronormativity’s power is that it operates in ways that might be difficult to recognize because these practices are so entrenched as “normal” within the social fabric of schooling. Debbie Epstein recounts an example of this “normality” in her work on sexualities and masculinities in the United Kingdom. One of her interview participants, Ayo, described how when he was 7 years old, his teacher had organized a “mock wedding” for students to participate in. It was during the time of the marriage of Prince Charles and Lady Diana, and the mock wedding ceremony was engineered as a “fun” way for the children to engage with this moment in history. Ayo, who was African Caribbean, described how he was selected as a groom and that the little girl supposed to be his bride burst into tears because she did not want to marry him. Eventually, after some persuasion from

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the teacher, he and this girl, along with several other couples, progressed up an imaginary aisle and got married. In his telling of this story, Ayo mentions that although the boys did not dress up, the girls wore wedding dresses. At the end of his narrative he also makes what might initially appear a random comment: “We didn’t do any Black history.” This activity did not comprise part of the formal curriculum at Ayo’s school. It was devised as a “playful” extracurricular activity by the teacher to enable the children to participate in the country’s celebratory mood generated by a royal wedding. Even though it wasn’t designed to officially teach students anything, this activity contained many heteronormative lessons. In this way, it can be seen to form part of the practices that render schools as heteronormative spaces. These learnings comprise an aspect of the unofficial curriculum of schooling (also known as the hidden curriculum), where students learn things that are not intentionally taught. It might be argued that through this activity Ayo and his classmates learned that weddings are an event to be celebrated and subsequently desired. Marriage involves opposite-gender couples; there were no same-gender couples in the mock ceremony. Weddings also hold greater investment for females, as evidenced in the way the girls wore brides’ dresses but the boys did not dress up. In this way, normative understandings of gender (i.e., what it means to be male or female) are reinforced via girls’ preoccupation with appropriate feminine clothing and appearance. And perhaps Ayo’s comment about the lack of Black history was not so arbitrary after all, given that the wedding followed White, British conventions. As Ayo is himself African Caribbean, this experience may have contrasted starkly with his own cultural experiences of such ceremonies. These learnings are heteronormative in the way they prescribe certain ways of being and doing, at the intersections of gender, race, and sexuality, as “normal.” This normality is inscribed through the sense of this activity as being “fun” and the idea that a wedding is something to celebrate and therefore marriage is something that children should want in their futures. A seemingly innocuous activity

like a mock wedding ceremony can be seen to offer students many unofficial lessons about sexuality that are heteronormative.

Heteronormativity in Classroom Interactions Another way in which heteronormativity is inherent in schooling practices is through homophobic classroom interactions. Homophobia is a heteronormalizing practice that draws power from the normalization of heterosexuality and denigration of same-gender attraction. Insults such as “faggot” or “lezzo” have currency because they mobilize the power of heterosexuality as “normal” while designating same-gender attraction as “deviant.” In this author’s New Zealand-based research in secondary schools with students aged 16 to 18, there have been many examples of such heteronormative interactions. In one recent study, a young lesbian described her own experiences of such practices, indicating both peer and teacher involvement. The following narrative was divulged by Rosemary (16 years) during a focus group in which students (who were part of a lesbian, gay, and bisexual [LGB] community group) described their experiences of being LGBQ at school. When I was at Kennedy College [pseudonym] and actually I had told a couple of close friends that I thought I was gay and then one of them went and told the rest of the school and that was it, it was after that I decided to leave because [pause] I knew that it was a big homophobic atmosphere and I knew that there was no stage in which I was going to that school that I was gonna “come out” but to have it forced upon me by this group of like homophobic idiots who you know you just couldn’t cope with it because people wouldn’t sit next to you, even a few teachers stopped asking you questions when I put up my hand you know. No one picks it up, no one, I’d be in class and like if I’d said something, like I’d get this “oh, little dyke” or something like, and the teachers would totally ignore it, no one would do anything.

Rosemary’s narrative indicates that the homophobic atmosphere at her school was so unbearable she had to leave. Not only was she unwillingly “outed” by so called friends and taunted by other

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students as a “little dyke,” but teaching staff did nothing to intervene in these interactions. While there is much research documenting homophobia within peer group cultures at school, incidences of teacher complicity are less common. When teachers fail to reprimand the homophobic actions of students, they perpetuate a culture in which heterosexuality is normalized and all other sexualities are demonized. While these might seem only small and commonplace moments in the school day, they form part of the micro practices that make schools heteronormative spaces.

Conclusion Schools can be seen as heteronormative spaces in the way their practices and processes produce meanings about heterosexuality as “normal” and all other sexualities as “abnormal other.” Students learn these lessons by way of schools’ official and unofficial curricula. In the official curriculum, this learning can typically occur when acknowledgment of LGBTQ identities is missing or when mention of these identities is derogatory or characterized as pathological. Another example of a heteronormative practice in the official curriculum is when these students are discriminated against by either peers or their teacher. The denigration of LGBTQ identities and concerns can be more difficult to discern in the unofficial curriculum. This difficulty arises because the unofficial curriculum includes those things students learn but are not intentionally taught. A classroom activity as seemingly innocuous as a mock wedding ceremony, for example, can convey meanings about heterosexuality to students that render this sexuality “normal” and other sexualities “abnormal.” Such official and unofficial practices are what make schools heteronormative spaces. Louisa Allen See also Education; Heterosexism; Homophobia; School Climate; Sexual Education Mandates for Inclusion

Further Readings Allen, L. (2007). Keeping students on the straight and narrow: Heteronormalising practices in New Zealand

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secondary schools. New Zealand Journal of Educational Studies, 41(2), 311–332. DePalma, R., & Atkinson, E. (2009). Interrogating heteronormativity in primary schools: The No Outsiders Project. Stoke-on-Trent, Staffordshire, England: Trentham Books. Epstein, D., O’Flynn, S., & Telford, D. (Eds.). (2003). Silenced sexualities in schools and universities. Stokeon-Trent, Staffordshire, England: Trentham Books. Gunn, A., & Surtees, N. (2011). Matching parents’ efforts: How teachers can resist heteronormativity in early childhood settings. Early Childhood Folio, 15(1), 27–31. Martin, K. (2009). Normalizing heterosexuality. American Sociological Review, 74, 190–207. McNeill, T. (2013). Sex education and the promotion of heteronormativity. Sexualities, 16(7), 826–846. Monk, D. (2011). Challenging homophobic bullying in schools: The politics of progress. International Journal of Law in Context, 7(2), 181–207. Myers, K., & Raymond, L. (2010). Elementary school girls and heteronormativity. Gender and Society, 24(2), 167–188.

SCHOOL-TO-PRISON PIPELINE The school-to-prison pipeline (STPP) is a term used to describe the process that pushes some youth out of school and into juvenile detention, which places them at risk of entry into adult criminal systems. The process is supported by a range of school policies and practices, as well as increased surveillance of youth in and outside of school. The STPP disproportionately affects underrepresented youth, including youth of color; youth with disabilities; undocumented youth; youth in foster care; and most recently, lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) youth. Youth who have more than one underrepresented identity may be most vulnerable to the STPP. This entry covers school policies and practices that facilitate the STPP, who is affected, and strategies suggested to stop its continued production. This content addresses an emergent and understudied issue regarding LGBTQ youth and schools.

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School Policies and Practices That Support the School-to-Prison Pipeline Exclusionary Discipline

A series of school policies and practices have been identified that support the STPP. Perhaps the most significant of these practices are exclusionary discipline practices or practices that exclude youth from their schools and classrooms and include punishments such as detention, in-school suspension, out-of-school suspension, and expulsion. Exclusionary discipline is heavily relied upon in schools that have a “zero-tolerance” approach to students’ misbehavior. Zero-tolerance policies mean that schools automatically use exclusionary discipline in the event of student misconduct. Exclusionary discipline can be used for more serious offenses such as carrying a weapon, fighting, bullying, or using drugs and/or alcohol. However, exclusionary discipline has also been used to punish youth for other behaviors such as truancy (i.e., missing school) and being disruptive in class. Zerotolerance policies and those who enact them have been highly criticized and have received media attention for their use in nonthreatening situations. For example, some children have been suspended for bringing fingernail clippers to school or for hugging their teachers. More recently, with LGBTQ youth, exclusionary discipline has been used to punish same-sex displays of affection and violations of gender norms, such as a boy wearing a skirt. There are several concerns with exclusionary discipline. The predominant concern is that there are discipline disparities based on race or ethnicity, immigrant status, disability, and sexual and gender identity. Extant research has documented that these youth are more likely to be suspended and expelled from school than their peers. Discipline disparities at the school level carry over to disparities at the level of juvenile and adult detention, which is the predominant method for tracking the STPP. For example, youth of color (particularly African American, Latina/o, and Native American youth) are more likely to be suspended and expelled than their White peers. They are also

more likely to be sent to juvenile detention and are more likely to be incarcerated as adults than their White peers. This same trend has now been found for LGBTQ and gender-nonconforming youth in that they experience higher rates of suspension and expulsion from school than their heterosexual peers and peers that conform to gender norms. LGBTQ youth are also overrepresented in juvenile detention systems. Exclusionary discipline has also been criticized as a disciplinary tactic not only because it disproportionately punishes some youth but that it is also an ineffective solution to creating a safe and equitable learning environment. Schools that use zerotolerance or exclusionary practices do not have higher test scores, lower truancy rates, or less student misbehavior. When schools use exclusionary discipline, they also fail to consider the other factors that are related to youths’ misbehavior or truancy. In the case of LGBTQ youth, many youth report skipping or missing school due to feeling unsafe. In schools with zero-tolerance discipline policies, these youth may be suspended or expelled for being truant, which fails to address the reason for their truancy. Further, some schools have fined students for being truant, which can create a roadblock for students to return to school if they are unable to pay the fine. Similarly, LGBTQ youth have reported being suspended or expelled from school for fighting with those who have bullied them on account of their sexual orientation or gender expression. In these instances, zero-tolerance policies mean that school administrators punish both the student who engaged in bullying behavior and the student who engaged in selfdefense. LGBTQ youth who fought back as an act of self-defense or to prevent further bullying indicated that exclusionary discipline did not solve the conflict they had with other students nor did it create dialogue to address homophobia or transphobia. There are further concerns for LGBTQ youth that make them particularly vulnerable to the STPP. For instance, some school administrators have “outed” or disclosed a student’s sexual

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orientation or gender identity to parents when notifying them of their child’s violation of school rules. For parents who are not supportive of their child’s sexual orientation or gender identity or expression, it may place the student at risk of being rejected by their family as well as jeopardize their housing and financial support. For LGBTQ youth, poverty and family rejection can make it difficult for youth to attend school, and it puts them at risk of encountering juvenile detention as they may have to rely on illegal means to support themselves financially. LGBTQ youth are also overrepresented in the homeless population and in the foster care system; both factors increase their risk of exclusionary discipline and entry into criminal systems. Inhospitable School Climate

Another important factor to consider when examining the STPP is the overall school climate. There are several other school factors that create schools that are inhospitable and facilitate the STPP. For instance, underresourced public schools serve a large number of students on inadequate funding. Cuts to educational funding make it difficult for schools to attract and pay high-quality teachers, to hire school counselors, to provide support services for students with disabilities, and to provide new technology and textbooks to facilitate learning. Schools that are underfunded also tend to rely on police officers or campus resource officers to handle discipline; these schools tend to have metal detectors, security cameras, regular searches of students’ property, as well as the continuous presence of police. When police are present in schools, school-based arrests are more common, and there are consistent reports of school-based arrests for minor, nonviolent infractions. These arrests bring youth one step closer to entry into juvenile detention, which is highly correlated with adult conviction. Beyond school discipline and a lack of funding is the current trend of high-stakes testing. This creates a school culture that values teaching to the test as opposed to overall student learning. It also often means sacrificing culturally relevant curriculum,

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the arts, physical education, and other courses that are considered extraneous and nonessential in the pursuit of high test scores. Further, in such environments, when students miss school due to exclusionary discipline, feeling unsafe, or familial/ personal demands, it becomes easy to fall behind academically. In these cases, underperforming students are regularly discharged, encouraged to drop out, take the GED (General Education Development exam for students who did not receive a high school diploma), or transfer to alternative schools, most of which rely on online education that can be equally disengaging for youth. Schools benefit when low-scoring students leave school. As a school, their test scores are higher, which is often directly linked to the amount of funding they will receive at the state and federal level. In an education system that emphasizes test scores and for schools that are underfunded and understaffed, it becomes easier to push out low-performing students or students who are viewed as problematic.

Strategies to Disrupt the School-to-Prison Pipeline Several key stakeholders including policy makers, scholars, researchers, educators, activists, and students have begun to develop strategies to disrupt the STPP. In January 2014, the U.S. Department of Education released a school discipline guidance package for schools to utilize in order to reduce overreliance on punitive and exclusionary discipline practices and develop sustainable solutions to keep students in school and learning. It centers on creating a positive school climate through prevention and intervention efforts that reduce schoolbased arrests, minimize out-of-class time, and train teachers to become aware of the disproportionate impact of exclusionary discipline on underrepresented students. Others have identified further action steps needed at the federal, state, and local levels. For instance, in addition to eliminating the use of exclusionary discipline and reliance on school security officers, schools are called to use alternative discipline strategies such as restorative justice and social

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emotional learning. Restorative justice practices focus on repairing relationships, resolving conflict, and reducing harm between the persons involved in a dispute and/or affected by it, while continuing to hold students accountable for their actions. Socioemotional learning teaches students how to build and sustain supportive relationships through the management of emotions, expression of empathy, and setting goals to respond to challenges in healthy and productive ways (e.g., “When I get angry, I will ask to take a walk instead of speaking or acting violently”). If school police officers are to remain in schools, it is suggested that they are trained in appropriate responses to minor infractions, that students are not searched unless there is probable cause that the student has committed a felony, and that school-based arrests and ticketing are limited to serious offenses such as possession of dangerous weapons, sale of illegal drugs, and fighting that has resulted in serious bodily harm. Furthermore, youth advocates ask for funding to be reallocated to hire mental health professionals such as school counselors and social workers instead of campus police and security officers. Rapid response to bullying is also needed, particularly in response to bullying on the basis of sexual orientation and gender identity, which can further alienate LGBTQ students from school and often punishes them in the process. Last, data collection on school discipline, school-based arrests, and school bullying and victimization that is disaggregated by race or ethnicity, age, gender, grade, disability, as well as sexual orientation and gender identity will not only help provide a clear portrait of disparities across these categories but also serve as a tool to understand which students are most vulnerable to the STPP and whether implemented strategies to disrupt the STPP are effective. Shannon Snapp See also Bullying, Rates and Effects of; Education; Policing Masculinities and Femininities; School Climate

Further Readings Advancement Project. (2010). Test, punish, and push out: How zero-tolerance and high stakes testing funnel

youth into the school-to-prison pipeline. Washington, DC: Author. American Psychological Association Zero Tolerance Task Force. (2008). Are zero tolerance policies effective in the schools?: An evidentiary review and recommendations. American Psychologist, 63, 852–862. doi:10.1037/0003-066X.63.9.852 Burdge, H., Licona, A. C., & Hyemingway, Z. T. (2014). LGBTQ youth of color: Discipline disparities, school push-out, and the school-to-prison pipeline. San Francisco, CA: Gay–Straight Alliance Network and Tucson, AZ: Crossroads Collaborative at the University of Arizona. Carter, P., Fine, M., & Russell, S. T. (2014). Discipline disparities series: An overview. Bloomington, IN: The Equity Project. Gay–Straight Alliance Network, Advancement Project, & Alliance for Educational Justice. (2012). Two wrongs don’t make a right: Why zero-tolerance is not the solution to bullying. San Francisco, CA: Gay–Straight Alliance Network. Himmelstein, K., & Bruckner, H. (2010). Criminal justice and school sanctions against nonheterosexual youth: A national longitudinal study. Pediatrics, 127, 49–57. doi:10.1542/peds.2009-2306 Snapp, S. D., Hoenig, J. M., Fields, A., & Russell, S. T. (2015). Messy, butch, and queer: LGBTQ youth and the school-to-prison pipeline. Journal of Adolescent Research, 30, 57–82. doi:10.1177/0743558414557625 U.S. Department of Education. (2014). Guiding principles: A resource guide for improving school climate and discipline. Retrieved from http://www2.ed.gov/policy/ gen/guid/school-discipline/guiding-principles.pdf

SCIENTIFIC INTEGRITY, DEBATES ABOUT Most professional associations, including the American Psychological Association (APA), the American Educational Research Association (AERA), and the American Sociological Association (ASA), have codes of ethics, each offering similar guidelines for their members to follow. For example, the ASA Code of Ethics outlines five principles that should guide sociologists: (1) professional competence; (2) integrity; (3) professional

Scientific Integrity, Debates About

and scientific responsibility; (4) respect for people’s rights, dignity, and diversity; and (5) social responsibility.1 This entry reviews some issues related to these principles of ethical conduct and provides some examples to illustrate ethical issues that may arise while conducting research on LGBTQ populations.

Five Principles of Ethical Research Scholars should consider the previously named ethical principles as they teach, conduct research, interact with their colleagues, and represent their research to the public. At face value, these principles seem transparent; however, ethical dilemmas may arise for which there are no easy answers. These dilemmas also may be more likely to occur when addressing a controversial or politicized topic or conducting research on a topic in which the researcher has strong political views. Having an ideological stance, however, does not inevitably result in unethically produced research. What is essential is that the researchers and the scientific community remain critical of their own and other research, regardless of the finding and one’s personal views on the topic. No specific procedures can be instituted that will prevent all unethical practices; however, social scientists can strive for the utmost integrity by considering the following ethical principles when conducting their own research and reviewing the research of others.

Professional Competence Scholars should be competent in their fields of study, continually educate themselves, keep up with emerging issues, adhere to the scientific standards of their discipline, and consult with experts in their field to produce high-quality research and course materials. To do otherwise is incompatible with the ethical standards of social and behavioral disciplines and increases the likelihood of questionable methodological decisions and low-quality research. As an illustration, consider a study that argued that the adult children from same-sex families experience disadvantages relative to two-biological-parent families. This study, by sociologist Mark Regnerus,

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was criticized on multiple methodological grounds: for example, the survey questions used in the study made it difficult to accurately identify lesbian and gay parents and, in turn, same-sex family households. He relied on a measure of relationship history to categorize respondents as being raised in a same-sex family and did not sufficiently consider whether respondents had actually lived with parents who identified as lesbian or gay for any amount of time. This resulted in children from very different backgrounds being categorized as raised in a same-sex family. His inattention to measurement issues, along with other methodological problems, led some scholars to question the ethics of this research endeavor.

Integrity Social scientists should be honest, fair, respectful, and sensitive to the welfare of others as they teach, research, review their peers, and speak to the public. Their work should inspire confidence, and they should never knowingly deceive the public either in their own work or in how their work is represented in the media. For example, while scholars may disagree as to whether it is unethical to publish in journals with little or no peer review (e.g., open-access journals or pay-to-publish journals), most scholars would agree that media reports should more heavily rely on articles published in journals with more stringent review standards and that researchers whose work is not subject to stringent reviews should be more cautious in promoting their work in media. This is among the reasons that scholars who study LGBTQ issues often question the ethics of the media representation of some articles that, unlike most peer-reviewed studies, claim that there are notable negative outcomes for children from same-sex families or that there are serious psychological consequences for identifying as LGBTQ. The public—and, in some cases, the media—is unlikely to distinguish between rigorously and minimally reviewed articles. Presenting minimally refereed articles as comparable in quality to studies that have adhered to the norms of the discipline would be misleading to the public and, in the views of some, potentially in violation of ethical standards.

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Even if scholars do not misrepresent their research, social scientists should also consider the extent to which it is their responsibility to correct the ways in which other individuals share their research with the academic community and with the public. For example, some scholars question whether Mark Regnerus, the sociologist mentioned earlier, was sufficiently diligent in preventing others from using the results from his study on children’s outcomes to claim that lesbians and gays make poor parents or to advocate against samesex marriage. In his article, Regnerus claimed his results did not shed light on the same-sex marriage debate, but it is possible that he made little effort to correct individuals who overstated the results of his study, or it is possible that he did make this effort but did not make other academics aware of this effort. This example illustrates the complexity of defining which practices are ethical and which are not.

Professional and Scientific Responsibility Scholars should abide by the highest scientific and professional standards and respect each other regardless of their different theoretical, methodological, and professional approaches to science. They have a shared responsibility to ensure that public trust is not compromised and that scientific knowledge is not distorted. Scholars’ reactions to research show how they share the burden of producing scientifically responsible research. For example, several scholars critiqued Regnerus’s study because it was funded by two organizations with clear ideological stances, the Witherspoon Institute and the Lynde and Harry Bradley Foundation, which some believe may have influenced his conclusion. In addition, a recent book titled No Differences? How Children in Same-Sex Households Fare, published by one of the same organizations, only includes papers from authors who have a single ideological view and does not seriously consider how the authors’ data analysis strategies shaped the book’s claims. Some critics contend that research funded by partisan organizations is more susceptible to biased accounts of social phenomena, which could distort the production of scientific knowledge. The possibility of bias has led

some to question whether such studies should even be seriously considered in the body of the literature on LGBTQ-parent families. Although funding organizations do not inevitably impact a study’s findings, if they have a clear political view (whether liberal or conservative), scholars should consider this possibility. Other issues that can raise concerns about professional responsibility are the research timeline and the relationships among data, methods, and findings. At minimum, researchers should not rush the research project and instead should spend whatever time is necessary to thoroughly conducting data analyses once all of the data have been collected. In the Regnerus case, questions were raised about his analysis procedure because his paper was submitted to the journal before all of the data were collected. To some critics, the abrupt timing of the submission of his paper for review appears inconsistent with scientific protocol to carefully and methodically analyze the data, which usually takes a large amount of time.

Respect for People’s Rights, Dignity, and Diversity Social scientists should make every effort to eliminate or, at minimum, reduce bias in professional activities. They should be aware of differences in power and resources between themselves, their colleagues, their research subjects, and their students and should not tolerate any status-based discrimination related to age; gender; race; ethnicity; national origin; religion; sexual orientation; disability; health conditions; or marital, domestic, or parental status. Scholars’ and their funders’ personal beliefs, attitudes, and values could represent a conflict of interest, but such views should not prevent them from questioning their own research. For example, scholars should not design research in such a way that it tells them what they expect or want to find—a criticism that has been launched at Regnerus. Journal editors should also work to obtain balanced critiques of an article by identifying appropriate, knowledgeable reviewers. Reviewers should refuse to review an article if they have conflicts of interest. In the Regnerus study, for example,

Scientific Integrity, Debates About

several scholars were concerned that (1) some of the apparent reviewers were affiliated with organizations with political views that aligned with the conclusions of the study and (2) some of these apparent reviewers had collaborated with the author in the past. While these factors may or may not have prevented the reviewers from objectively evaluating the research by scientific criteria, even the appearance of conflict of interest can reduce others’ confidence in the review process.

Social Responsibility Scientists should advance knowledge for the public good. For example, they should design research that will allow them to identify the social support children need to thrive in a diverse array of family situations and identify what institutions can do to protect vulnerable populations from experiencing discrimination. While some scholars believe that one way to identify factors that will improve individuals’ lives is to compare the experiences of people raised in different family structures, sociologist Tey Meadow disagrees. Meadow advises us to consider whether asking some empirical questions is unethical. She has argued that comparing family structures implies that one of these groups is socially desirable and reconstructs the dominance of the more powerful group and that this type of research cannot improve the lives of the individuals living in any of these family structures. Meadow’s argument suggests that social scientists should look beyond the perceived advantages of their research to seriously consider any potential disadvantages of their studies. Considering that many scholars see more benefit than harm from making family comparisons, her stance against comparing family structures to one another demonstrates, once again, the complexity of researching ethically.

Conclusion To produce rigorous scientific knowledge that inspires confidence and improves the lives of individuals, social scientists should adhere to the ethical principles outlined previously during research design, data collection, analysis, review, and presentation phases of the research process. These

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ethical principles apply regardless of the scholars’ orientations and political beliefs, or the conclusions of a study. This entry illustrates how social scientists have questioned the ethical practices of a study that reported negative outcomes from being raised by gay and lesbian parents. It is important, however, to emphasize that scholars should expect the same quality of research even if the study concludes that children from same-sex families fare just as well as or better than others. Social scientists should make a good faith effort to produce high-quality, honest research that does not harm the welfare of individuals; however, it is not always clear whether social scientists have violated any ethical principle. No person is ever privy to the motivations of scientists and the decisions behind their practices, and scholars can only interpret others’ intentions. In other words, research may result in flawed methods and findings, even if a scholar has made a good faith effort to produce research competently. For example, scholars who claim to have not been conflicted by the ideological stances of their funding agencies may truly believe that that is the case. Still, it is crucial that scientists take a critical stance on their own research and that of others and that they make an effort to amend any flaws once discovered. Kristin Kelley and Brian Powell See also Children With LGBQ Parents, Academic Outcomes; Children With LGBQ Parents, Psychosocial Outcomes; Ethical Research With Sexual and Gender Minorities; Methodological Decisions by Researchers of LGBTQ Populations; Population-Based Surveys, Collection of Data on Sexual Orientation and Gender Identity

Note 1. The APA ethical code consists of five similar principles: (1) beneficence and nonmaleficence, (2) fidelity and responsibility, (3) integrity, (4) justice, and (5) respect for people’s rights and dignity.

Further Readings American Sociological Association Committee on Professional Ethics. (2008). ASA Code of Ethics. Retrieved from http://www.asanet.org/images/asa/docs/ pdf/CodeofEthics.pdf

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Barrett, D. (2012). Presentation, politics, and editing: The Marks/Regnerus articles. Social Science Research, 41, 1354–1356. Brief of Amici Curiae Social Science Professors in Support of Defendants. Robicheaux, et al. v. James D. Caldwell, et al. (May 12, 2014) (No. 13-5090). Brief of Amicus Curiae American Sociological Association in Support of Respondent Kristin M. Perry and Respondent Edith Schlain Windsor. Dennis Hollingsworth et al. v. Kristin M. Perry, et al. and United States v. Edith Schlain Windsor (February 28, 2013) (Nos. 12–144, 12–307). Cheng, S., & Powell, B. (2015). Measurement, methods, and divergent patterns: Reassessing the effects of samesex parents. Social Science Research, 52, 615–626. Cohen, P. N. (2013). Regnerus affair timeline, with maze. Family Inequality. Retrieved from https:// familyinequality.wordpress.com/2013/08/06/ regnerus-affair-timeline-with-maze Cohen, P. N. (2015). Children in same-sex parent families, dead horse edition. Family Inequality. Retrieved from https://familyinequality.wordpress.com/2013/08/06/ regnerus-affair-timeline-with-maze Gates, G. J. et al. (2012). Letter to the editors and advisory editors of social science research. Social Science Research, 41, 1350–1351. Herek, G. (2008). From Russia with hate: Paul Cameron at Moscow State U. Sociology Dept. Beyond Homophobia. Retrieved from http://www .beyondhomophobia.com/blog/category/junk-science Meadow, T. (2013). Queer numbers: Social science as cultural heterosexism. Social (In)Queery. Retrieved from http://socialinqueery.com/2013/08/14/queernumbers-social-science-as-cultural-heterosexism Moore, M. R., & Stambolis-Ruhstorfer, M. (2013). LGBT sexuality and families at the start of the twentyfirst century. Annual Review of Sociology, 39, 491–507. Osborne, C. (2012). Further comments on the papers by Marks and Regnerus. Social Science Research, 41, 779–783. Perrin, A. J., Cohen, P. N., & Caren, N. (2013). Are children of parents who had same-sex relationships disadvantaged? A scientific evaluation of the no-differences hypothesis. Journal of Gay & Lesbian Mental Health, 17, 326–336. Regnerus, M. (2012). How different are the adult children of parents who have same-sex relationships?

Findings from the new family structures study. Social Science Research, 41, 752–770. Regnerus, M. (2012). The new family structures study. Austin: The Population Research Center, University of Texas at Austin. Regnerus, M. (2012). Parental same-sex relationships, family instability, and subsequent life outcomes for adult children: Answering critics of the new family structures study with additional analyses. Social Science Research, 41, 1367–1377. Sherkat, D. E. (2012). The editorial process and politicized scholarship: Monday morning editorial quarterbacking and a call for scientific vigilance. Social Science Research, 41, 1346–1349. Stacey, J., & Biblarz, T. J. (2001). (How) does the sexual orientation of parents matter? American Sociological Review, 66, 159–183.

SECOND-PARENT ADOPTION Second-parent adoptions are a specialized legal procedure of particular and continuing importance to lesbian-parent families. In some regards they resemble stepparent adoptions, which are relevant to a broader range of families. They may also be of use to gay male couples who use surrogacy if only one man gains legal status as a parent as a result of the surrogacy. Second-parent adoptions were developed to serve planned lesbian-parent families. When lesbian couples plan a family, they often use assisted insemination. This allows one woman to give birth to a child. Unless she is a party to a surrogacy agreement, the woman who gives birth is automatically recognized as a legal parent of the child. Her partner or wife, however, may not be recognized as a legal parent. Recognition as a legal parent is very important. Legal parents have significant rights and responsibilities with regard to their children. These include the right to make important decisions regarding matters such as medical care, religion and education, and the responsibility of providing financial and emotional support for the child. Legal parents can generally control who the child will spend time

Second-Parent Adoption

with as well. And in the event of a custody dispute, legal parents have a very significant advantage over all those who are not legal parents. Legal parents are sometimes able to exclude others— including social parents without legal recognition as parents—from contact with the child. A situation in which one member of the couple is a legal parent and the other member is not potentially problematic. Since the inception of planned lesbian-parent families, there have been cases in which the legal mother of a child has used her preeminent status to defeat the claims of a former partner and social comother. Many of these cases have been bitter, hard fought, and divisive. In some of these cases, the nonlegal mother has lost all contact with the child. Although in other cases, nonlegal mothers have been able to retain contact—sometimes quite limited contact—with the child, this may require litigation, which can be both expensive and wearing. In response to these cases, defenders of lesbianparent families sought a way for the nonlegal comother to gain full legal recognition as a parent. This led to the development of second-parent adoptions. When a second-parent adoption is successfully completed, the child has two legal parents who stand, in the eyes of the law, on equal footing. Each has the same rights and obligations, each the same entitlement to contact with their child. In the event of acrimonious separation, allocation of time with the child would be decided as in any traditional custody case involving parents who separate. While a mediated settlement might well be possible (and is typically desirable), ultimate resolution of the case by a court is also possible. In deciding such a case, the court allocates time with both parents, generally in accordance with its view of “the best interests of the child.” Second-parent adoptions differ from traditional adoptions in one crucial regard. In a traditional adoption, the adoptive parent or parents step into the shoes of the birth parent or parents. The rights of the original parents are terminated. In a secondparent adoption, the lesbian partner and comother adopts the child without terminating the legal rights of the initial legal mother. She becomes a

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second parent to the child. It is this distinctive feature that gives the procedure its name. The resemblance between second-parent adoptions and stepparent adoptions is clear. In a stepparent adoption, the stepparent becomes a legal parent and the original parent remains a legal parent. Early arguments for second-parent adoptions noted the similarity but also the important differences: Stepparents generally join a family sometime after the birth of the child and the establishment of the first parent–child relationship. Lesbian comothers are coparents from the beginning of the family formation process and typically participate in decisions regarding how the family will come into being. As gay male couples have begun to create families through surrogacy, second-parent adoptions may also be important to them. The legal status of intended parents in a surrogacy arrangement varies. In some jurisdictions, it may be that only the man who provides sperm is recognized as a legal parent. His partner or husband must then complete a second-parent adoption to secure full legal status. Second-parent adoptions may also be used to secure the rights of the gay or lesbian coparent where the planned family is created via adoption. This may be necessary if the couple chooses to form their family via adoption but the state or country from which they will adopt does not permit gay or lesbian couples to adopt jointly. In this circumstance, one member of the couple may adopt a child from a jurisdiction with restrictive laws as a single person and her partner may complete a second-parent adoption in a more accommodating state. Historically, second-parent adoptions have not been available in all states, and in some states, their availability has varied county by county. It is not always easy to ascertain the law in a particular jurisdiction as second-parent adoptions may be available by local practice without reported opinions or statutory support. It is essential to consult with a knowledgeable lawyer about the availability of second-parent adoptions in any particular locale. Many states also have

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Self-Insemination

residency requirements that restrict the availability of adoption—including second-parent adoption— to those who reside in a state. Thus, one cannot simply choose a hospitable state and seek to complete a second-parent adoption there. Competent legal advice is crucial. Even as the legal landscape for same-sex parent families has changed dramatically over the past decade, second-parent adoptions remain crucial. Once an adoption has been properly completed in a state that has proper jurisdiction—be it a secondparent adoption, a joint adoption, or an individual adoption—all other states must recognize and give legal effect to that adoption. This is required by the Full Faith and Credit Clause of the U.S. Constitution. Other avenues for securing parental rights may not lead to status that will be recognized by hostile states. In particular, if claims to legal status as a parent rest on a marriage between the two women, hostile states may assert that they are not obliged to recognize the status. Julie Shapiro See also Custody and Litigation, LGBQ Parents; Joint Adoption; Legal Rights of Nonbiological Parents; Surrogacy, Legal Considerations of

Further Reading Joslin, C. G., Minter, S. P., & Sakimura, C. (2014). Lesbian, gay, bisexual and transgender family law. Eagan, MN: Thomson Reuters.

SELF-INSEMINATION This entry addresses self-insemination. It emphasizes lesbian couples who self-inseminate with donor sperm and examines how law and society recognize the relationship between the mothers, the baby, and the donor. Self-insemination is a version of donor insemination (DI), a practice to which female same-sex couples who want to have a baby together often turn. This means that one of the women in the

couple seeks to become pregnant by inseminating sperm (via a syringe) into the vagina. This sperm has been donated by a man who has agreed that the couple can use his sperm to have a child but who in most cases is not intending to have, and is not expected to have, any further role in the child’s life. The intended parents of the child are the two female partners, and so the child is born into a family with two mothers. Often, DI takes place in a fertility clinic. However, it is also common that female same-sex couples, especially, arrange to inseminate themselves, using the sperm of a friend or acquaintance. Single women may also use self-insemination. Female same-sex couples have been having children through self-insemination for the past three or four decades. This is in part because they were excluded from DI in clinics for many years. In the United Kingdom, for example, lesbians only began gaining access to fertility clinics in the early 2000s. As more and more such clinics are now accepting female same-sex couples, many such couples now choose the clinic route to have a baby. At the same time, self-insemination remains an important and common practice. This is partly because of the cost of fertility treatment. For example, in the United Kingdom, one cycle of DI (called intrauterine insemination or IUI) with donor sperm cost around £1700 per cycle in 2014 (at the London Women’s Clinic). The cost in the United States is around $800 (at the California Cryobank). If a woman fails to conceive and needs the more invasive fertility procedure known as in vitro fertilization (IVF), then one cycle of IVF and donor sperm costs in the region of £4200 in the United Kingdom (in the United States, the average cost is approximately $12,400). IVF does not guarantee that a woman will become pregnant, and many women need several cycles of treatment before they conceive. Frequently, IVF does not work at all, even after repeated cycles. As the costs of IUI and IVF become prohibitive, self-insemination may be the only option. Another reason, beyond cost, why some women choose to self-inseminate is that they want a donor who is known to them and to the child. Sometimes

Self-Insemination

they want him to have a distant role: a sort of uncle figure, but sometimes they want the child to be able to call the donor “Dad” and for the two to have regular contact. Some women bring their own known donor to the clinic (this is more common in the United States than in the United Kingdom), but often women who know their own donor choose to self-inseminate as this also avoids the high costs of clinical treatment. In self-insemination, the couple has to find a donor and agree with him how he is going to relate to the child. A couple can approach a friend, or they can find someone previously unknown to them. Once they have identified a donor, they need to go through the process of agreeing if and how he should have any involvement in the child’s upbringing. This process can be very complicated because the law often does not recognize the intentions behind self-insemination, which is that the lesbian mothers are the recognized acting parents of the child while the donor, despite his genetic link, is neither recognized, nor acts, as the child’s parent. Instead, the law treats the donor as the child’s legal father. In the United Kingdom, a donor who donates sperm to a clinic has no rights or obligation as a father, but a donor who donates in self-insemination can be recognized in law as the legal father. Similarly, in California, for example, the California Family Code does not secure parental rights of the lesbian couple over and against those of the donor when self-insemination takes place outside the clinic context. Consequently, the donor can gain parental rights. Such a situation makes both the donor and the two mothers vulnerable because the donor can gain the right to be involved in the child’s life, even if he initially denied wanting involvement. This can mean that a couple, against their wishes, is required to involve the donor in the decisions they make as parents and in their everyday lives. But it can also mean that the donor can be recognized as the legal father against his wishes, and for example, have to pay child support until the child is 18. The impact on personal life is significant, and so the stakes are high for all parties.

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Couples who self-inseminate try to resolve this difficult situation in different ways. Some couples choose to self-inseminate with a good friend. They see this as a safer route because the couple knows the donor, and so they feel that they can trust him. Trust is important because they need to know that the donor is not going to change his mind and that he will not transmit any sexually transmitted infections (STIs), which is another important issue to consider. Other couples choose to inseminate with a stranger: a man found through an advertisement on the Internet, for example. They can avoid telling him their real names, or where they live, and thus they can protect themselves by making it very difficult for him to seek them out. Equally, a “stranger” donor can protect himself by not stating his real name or where he lives. But there are drawbacks to both routes. If there is a falling-out in a relationship with a donor friend, the couple does not have the protection afforded by anonymity. On the other hand, it is more difficult to tell if a “stranger” donor is trustworthy. Self-insemination is an important alternative to clinical DI and offers the opportunity for those who cannot afford the costs of medical treatment to have children. However, it is complicated because the law often does not recognize the intentions behind queer families formed in this way. Petra Nordqvist See also Assisted Reproductive Technologies (ARTs); Sperm Donors, Known; Sperm Donors, Unknown; Transition to Parenthood and Parental Roles

Further Readings Luce, J. (2010). Beyond expectation. Lesbian/bi/queer women and assisted conception. Toronto, Canada: University of Toronto Press. Mamo, L. (2007). Queering reproduction: Achieving pregnancy in the age of technoscience. Durham, NC: Duke University Press. Nordqvist, P., & Smart, C. (2014). Relative strangers: Family life, genes and donor conception. London, England: Palgrave Macmillan.

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Senior Living Programs and Policies

SENIOR LIVING PROGRAMS AND POLICIES LGBTQ older adults are a large and growing segment of the older adult population. As the baby boomer generation ages into senior living programs like senior centers, long-term care facilities, retirement communities, and nursing homes, they will be looking for LGBTQ-affirming services and environments. A number of LGBTQ-specific facilities are now open or in development, but given their size relative to the number of LGBTQ older adults, mainstream senior living programs and facilities are facing the need to enact policies to protect their LGBTQ constituents. Several such policies are outlined next. Publicly funded or nonprofit LGBTQ senior housing has opened or is being developed in Chicago; Washington, D.C.; Los Angeles; Minneapolis; Philadelphia; San Francisco; and Vancouver; several more cities have privately unfunded facilities. There are a growing number of LGBTQ senior centers and LGBTQ organizations offering programming for older adults. Many of these organizations are associated with SAGENet affiliates, a national group of organizations linked with SAGE (Services and Advocacy for GLBT Elders), the nation’s oldest and largest organization dedicated to improving the lives of LGBTQ older adults. Because LGBTQ-specific aging service providers are a very small fraction of the overall aging network, it is important that all aging service providers work to create a space that is welcoming and affirming for LGBTQ older adults, their families, and loved ones. Aging service providers can make several changes to their policies to ensure that LGBTQ older adults feel more comfortable accessing aging services. Sending an inclusive message starts with intake questions, interviews, and how an organization collects demographic information. At the beginning of an interview or intake form, it is helpful for organizations to clearly state their confidentiality policies and explain how the constituent’s personal information will be used and shared throughout

the organization. This can help the constituent to understand the protections in place to safeguard their personal information and may make them more comfortable self-identifying as LGBTQ. Similarly, sexual orientation, gender identity, and gender expression should be included in nondiscrimination policies and these policies should be prominently displayed and explained to the constituent before beginning the interview. Intake forms and interviews should include questions about sexual orientation and gender identity and these questions should be optional. Staff should ask open-ended questions that do not assume the constituent’s sexual orientation or gender identity. For example, instead of asking “Are you married?” a question that for many older adults assumes heterosexuality, staff could say, “Tell me about the important people in your life.” It is helpful for staff to review policies and definitions of “family” to ensure that they include “families of choice”—people who are not blood or legal relations but who the constituent considers to be family. LGBTQ older adults may be estranged from their biological families and often rely on families of choice for informal care and support. Providers should ensure that the constituent has completed advance directives and has established who will be able to make legal or medical decisions on their behalf should they become incapacitated, review visitation policies to ensure that they include a discussion of the constituent’s right to receive visitors that she or he designates, and create a clear way for constituents and their loved ones to alert staff if they feel disrespected, uncomfortable, or are being abused by staff or other constituents. Facilities should ensure that a single-stall gender-neutral restroom is made available for both staff and constituents. Transgender people, like everyone else, must be able to use whatever restroom aligns with their gender identity. Assignments for sex-segregated facilities should be made according to the constituent’s gender identity, and not sex assigned at birth, surgical status, or bodily morphology. Staff should always know and use the constituent’s preferred name and pronouns, even when that constituent is not in the room. If a constituent’s transgender status is medically relevant

Sense of Belonging/School Climate in LGBTQ-Parent Families

information, staff should explain to the constituent why they are asking questions about transgender status or medical history, and ensure that this information is protected like all other medical information. Programming staff should work to create LGBTQ-specific programming. For example, due to the changing legal landscape regarding same-sex marriage, any legal clinics or retirement advice should be provided by someone familiar with the specific legal and financial concerns faced by LGBTQ older adults and their families. Programs and events open to all participants should be discussed and advertised in a way that is inclusive of LGBTQ older adults. For example, an LGBTQ older adult who sees a flyer for “Family Day” might not feel that their partner or family of choice would be welcome at that event. This message could be edited by adding the language “All families welcome” and including images of LGBTQ older adults. Finally, visual cues like nondiscrimination policies, rainbows, pink or purple triangles, and images of LGBTQ people and their families can signal that the organization welcomes LGBTQ older adults. These cues should only be put in place if the organization is truly a safe environment for LGBT older adults. One important way to ensure that an organization is safe for people to be openly LGBTQ-identified is to provide staff with LGBTQ cultural competency training and strive to have a diverse staff that includes LGBTQ-identified individuals. LGBTQ aging cultural competency trainings and audits are available nationally through the National Resource Center on LGBT Aging (the NRC), as well as various local organizations. Tim R. Johnston See also Aging, Social Relationships, and Support; Discrimination Against LGBTQ Elders; Elder Abuse; Health Care System; Services and Advocacy for GLBT Elders (SAGE)

Further Readings Frederiksen-Goldsen, K., Kim, H., Emlet, C., Muraco, A., Erosheva, E.