Fighting against LGBT Discrimination

To promote health for all, providers must advocate against discriminatory legislation like “bathroom bills” that limit transgender individual’s access to public accommodations. In the last year, 16 states debated these bills, while 14 proposed policies limiting transgender students’ rights at school. We know that lesbian, gay, and bisexual (LGB) individuals experience poorer health outcomes in states that fail to protect them against hate crimes and other forms of discrimination. Prejudicial mistreatment can contribute to chronic “minority stress” when perpetrated based on one’s racial, gender, or sexual identity. Sexual minority stress helps explain LGB health disparities, including an excess of psychiatric disorders and physical health problems compared to heterosexuals. Bisexual individuals, in particular, are at heightened risk for minority stress and related health concerns because many experience anti-bisexual prejudice from heterosexuals as well as gay men and lesbians.

A recent study found that bisexual-specific minority stress is related to poorer physical health. Bisexuals who experienced more anti-bisexual prejudice, hostility and exclusion from family, friends and strangers reported more pain, poorer general health, and poorer overall physical health, even after considering demographic information (e.g., age, education, race) and sexual minority stress in general. Transgender bisexuals experienced the most bisexual minority stress and the worst physical health. This research provides yet more evidence that sexual and gendered health disparities are avoidable and unjust because they are related to social determinants like stigma, prejudice, and discrimination. Such disparities mean transgender bisexual Americans likely have higher health care costs, lower quality of life, and higher mortality; this results in social and economic losses to families, communities, and society.

At a minimum, providers should conduct staff trainings about health disparities related to bisexual minority stress and to bisexual and transgender identities more generally. By failing to become aware of the best practices related to transgender identity and sexual orientation, providers risk inadvertently contributing to sexual minority stress in their own patients. Yet, it is not enough to address the relationship between bisexual minority stress and health only for individuals seeking our care. We must fully support policies prohibiting gender and sex discrimination in health care, employment, and education to promote health in all policies.

This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Satcher Health Leadership Institute. It is written by Rose Grace Grose, PhD. She is a Health Policy Leadership Fellow.

Abstract

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (? = -0.16), greater pain (? = -0.16), and poorer general health (? = -0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.

PMID: 27834488

Katz-Wise, SL, et al. The Journal of Sex Research. 2017; 54 (7): 899–910.