Contact Hours: 2
This online independent study activity is credited for 2 contact hours at completion.
To provide healthcare providers with an overview of some of the many forms of discrimination that the lesbian, bisexual, gay, transgender, queer/questioning (LGBTQ) person experiences.
Gay rights in the United States has come a long way since the Stonewall Uprising of 1969, however LGBTQ persons still face discrimination under the law when it comes to housing, public accommodations, parenting, and even criminal justice. This learning exercise provides a small overview of some of the many forms of discrimination that the LGBTQ person experiences.
By the end of this learning activity, the learner will be able to:
- Describe gender identity and gender expression terminology as it relates to the lesbian, bisexual, gay, transgender, queer/questioning (LGBTQ) person.
- Define public accommodations, and its affects within the LGBTQ community.
- Review the various forms of discrimination that people within the LGBTQ community experience.
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|A person who confronts heterosexism, sexism, homophobia, biphobia, transphobia and heterosexual privilege in themselves and others out of concern for the well-being of Lesbian, Gay, Bisexual, Transgender, Queer/questioning, Intersex, Asexual/aromantic/agender/ally (LGBTQIA+) people.
|Generally characterized by not feeling sexual attraction or a desire for partnered sexuality. Asexuality is distinct from celibacy, which is the deliberate abstention from sexual activity.
|Fear or hatred of people who are bisexual, pansexual, or omnisexual.
|A person whose primary sexual and affectional orientation is toward people of the same and other genders, or towards people regardless of their gender.
|Refers to voluntarily making public one’s sexual orientation and/or gender identity.
|The prefix cis- means “on this side of” or “not across.” A term used to call attention to the privilege of people who are not transgender.
|A word to describe a person who dresses, at least partially, as a member of a gender other than their assigned sex. This carries no implications of sexual orientation.
|A person (often a woman) who appears as a man. Generally, about an act or performance. This has no implications regarding gender identity.
|A person (often a man) who appears as a woman. Generally, about an act or performance. This has no implications regarding gender identity.
|A sexual orientation toward people of the same gender.
|A social construct used to classify a person as a man, woman, or some other identity. Fundamentally different from the sex one is assigned at birth; a set of social, psychological, and emotional traits, often influenced by societal expectations
|How one expresses oneself, in terms of dress, mannerisms and/or behaviors that society characterizes as “masculine” or “feminine.”
|A person whose gender identity and/or gender expression falls outside of the dominant societal norm for their assigned sex, is beyond genders, or is some combination of them.
|The assumption that all people are or should be heterosexual. Heterosexism excludes the needs, concerns, and life experiences of lesbian, gay, bisexual, and queer people while it gives advantages to heterosexual people. It is often a subtle form of oppression, which reinforces realities of silence and invisibility.
|A sexual orientation in which a person feels physically and emotionally attracted to people of a gender other than their own.
|The irrational hatred and fear of LGBTQIA+ people. Homophobia includes prejudice, discrimination, harassment, and acts of violence brought on by fear and hatred. It occurs on personal, institutional, and societal levels.
|An outdated term to describe a sexual orientation in which a person feels physically and emotionally attracted to people of the same gender.
|The fear and self-hate of one’s own LGBTQIA identity, that occurs for many individuals who have learned negative ideas about LGBTQIA+ people throughout childhood. One form of internalized oppression is the acceptance of the myths and stereotypes applied to the oppressed group.
|People who, without medical intervention, develop primary or secondary sex characteristics that do not fit “neatly” into society’s definitions of male or female. Many visibly intersex people are mutilated in infancy and early childhood by doctors to make the individual’s sex characteristics conform to society’s idea of what normal bodies should look like. Intersex people are relatively common, although society’s denial of their existence has allowed little room for intersex issues to be discussed publicly.
|A woman whose primary sexual orientation is toward people of the same gender.
|Abbreviation for Lesbian, Gay, Bisexual, and Transgender. An umbrella term used to refer to the whole community.
|Terms used to describe people who have romantic, sexual, or affectional desire for people of all genders and sexes.
|A gender identity that embraces full universe of expressions and ways of being that resonate with an individual. It may be an active resistance to binary gender expectations and/or an intentional creation of new unbounded ideas of self within the world.
|This can include, but is not limited to, gay, lesbian, bisexual, transgender, intersex, and asexual people. This term has different meanings to different people. Some still find it offensive, while others reclaim it to encompass the broader sense of history of the gay rights movement. Can also be used as an umbrella term like LGBT, as in “the queer community.”
|A categorization based on the appearance of the genitalia at birth.
|The components of a person that include their biological sex, sexual orientation, gender identity, sexual practices, etc.
|An enduring emotional, romantic, or sexual attraction. Sexual orientation is fluid. Asexuality is also considered a sexual orientation (See above definition of asexuality)
|The fear or hatred of transgender people or people who do not meet society’s gender role expectations.
|Used most often as an umbrella term. Some commonly held definitions: Someone whose gender identity or expression does not fit (dominant-group social constructs of) assigned birth sex and gender. A gender outside of the man/woman binary. Having no gender or multiple genders.
|A person who lives full-time in a gender different than their assigned birth sex and gender. Some pursue hormones and/or surgery while others do not. Sometimes used to specifically refer to trans people pursuing gender or sex confirmation.
|This is an outdated and problematic term due to its historical use as a diagnosis for medical/mental health disorders. Cross Dresser has replaced transvestite.
Gay rights in the United States is evolving. Historically, gay rights, and the lack thereof were exhibited during the Stonewall riots, also called the Stonewall uprising. The riots were a series of violent confrontations that began in the early hours of June 28, 1969. ⁷ The confrontations occurred between police officers and gay rights activists outside the Stonewall Inn, a gay bar that was in New York’s Greenwich village. In 1969, gay relationships were illegal in New York. As a result, gay men, lesbians, and transgender persons would go to gay bars; places of refuge where they could socialize safely without the threat of harassment. Because it was known that people in the gay, lesbian, gay, bisexual, transexual, queer (LGBTQ) community would go to the gay bars, the bars would often be subject to harassment by police officers. ⁷ The Stonewall Inn was frequented by police and its patrons were frequently harassed. On June 28, 1969, police entered the Stonewall Inn and arrested the employees for selling alcohol without a license, arrested many of the patrons, and cleared the bar which at the time, was in accordance with a New York criminal statute that authorized the arrest of anyone not wearing at least three articles of gender-appropriate clothing. The raid at Stonewall Inn was the third raid on a Greenwich Village gay bar within in a short period, however this time people who were outside the bar did not retreat or scatter as they usually did in the past. The policemen called for reinforcements and barricaded themselves inside the bar while some 400 people rioted outside Stonewall Inn.
The riots outside the Stonewall Inn lasted for five days. Although there had been other protests by gay groups, the Stonewall incident was perhaps the first-time people in the LGBTQ community saw the value in uniting behind a common cause. ⁷ The Stonewall riots became a galvanizing force and a catalyst for political activism. The LGBTQ community’s activism sparked the formation of scores of gay rights organizations, including the Human Rights Campaign, GLAAD (formerly Gay and Lesbian Alliance Against Defamation), PFLAG (formerly Parents, Families and Friends of Lesbians and Gays), and Queer Nation. In 1999 the U.S. National Park Service placed the Stonewall Inn on the National Register of Historic Places, and in 2016 President Barack Obama designated the site of the Stonewall uprising a national monument. In 2019, shortly before the 50th anniversary of the riots, New York City’s police commissioner, James P. O’Neill, issued an apology on behalf of the police department saying, “The actions taken by the NYPD were wrong—plain and simple.”
Gay rights in the United States has come a long way since the Stonewall Uprising of 1969, however LGBTQ persons still face discrimination under the law when it comes to housing, public accommodations, parenting, and even criminal justice. ¹ The following provides a small overview of some of the many forms of discrimination that the LBGTQ person experiences.
Shockingly, hate crimes against LGBTQ people are still prevalent across the country. In 2015, nearly 20% of hate crimes committed in the United States were due to sexual orientation, and another 2% of crimes were committed because of gender identity. ³
There has also been an epidemic of violent crime against transgender individuals, particularly trans women of color. Transgender women of color are among the most vulnerable minorities in the country, fighting against racism, sexism, transphobia, and frequently, poverty which puts them at higher risk for violence. ¹˒³ Still, many states across the country do not include gender or sexual identity under their hate crime laws. Some states only cover sexual orientation, and few states have no hate crime laws at all. The following are facts regarding domestic violence in the LGBTQ community³:
- Approximately 45% of lesbian women and 60% of bisexual women have experienced rape, physical violence, or stalking by an intimate partner at some point in their lifetime in comparison to 35% of heterosexual women.
- Approximately 25% of gay men and 35% of bisexual men have experienced rape, physical violence, or stalking by an intimate partner in their lifetime in comparison to 30% of heterosexual men.
- People who are bisexual are more likely to experience sexual violence in comparison to people who do not identify as bisexual.
- African American LGBTQs are more likely to experience physical intimate partner violence in comparison to those who are not African American.
- White LGBTQs are more likely to experience sexual violence in comparison to those who do not identify as white.
- LGBTQs on public assistance are more likely to experience intimate partner violence compared to those who are not on public assistance.
- Transgender people more likely to experience threats or intimidation, harassment, and police violence within intimate partner violence. Forms of abuse that can occur within relationships where one partner is transgender, include:
- Ridiculing the transgender partner’s body or appearance
- Ridiculing the transgender partner’s identity as “bisexual,” “trans,” “femme,” “butch,” “gender queer,” etc.
- Telling the transgender partner that he or she is not a real man or woman
- Using offensive pronouns such as “it” to refer to the transgender partner
Same-sex partner abuse is common and may be difficult to identify, and LGBTQ victims may be reluctant to report domestic violence.¹ Part of the reason maybe that support services such as shelters, support groups, and hotlines are not readily or routinely available. Furthermore, members of the LGBTQ community may be denied assistance and domestic violence services because of homophobia, transphobia, and biphobia. This results in unsupported victims. Often, the perpetrator and victim may have the same friends or support groups.³ Abusive partners in LGBTQ relationships use all the same tactics to gain power and control as abusive partners in heterosexual relationships, such as emotional, physical, or sexual abuse, financial control, isolation and more. Abusive partners in LGBTQ relationships also use power and control over their victim with societal factors that compound the complexity a survivor faces in leaving or getting safe in an LGBTQ relationship, such as threatening to make their sexual preferences public. ¹˒³
Resources available include, but are not limited to:
- The LGBT Foundation: https://www.lgbt.foundation
- The National Domestic Violence Hotline: 1-800-799-7293/1-800-787-3224 (TTY)
- The Network / La Red Hotline:1-617- 742-4911, http://www.thenetworklared.org/
- National Domestic Violence Hotline:1-800-799-7233, www.ndvh.org
- Gay Men’s Domestic Violence Project: http://www.glbtqdvp.org/
- GALAEI – Queer Latin@ Social Justice: www.galaei.org
- The Network / La Red: http://www.thenetworklared.org/
According to the American Association for Marriage and Family Therapy, studies estimate that there are approximately 594,000 same-sex partner households, with about 27% of those households having children.⁸ The rise in same-sex parenting is partially due to the increase in options available for same-sex couples to become parents. Although most children of same-sex couples are biological children of one of the parents, a growing number are the result of donor insemination, surrogacy, foster care, and adoption.
Most research studies show that children with two mothers or two fathers are just as well adjusted as children with heterosexual parents.⁸ In fact, one comprehensive study of children raised by lesbian mothers or gay fathers concluded that children raised by same-sex parents did not differ from children with heterosexual parents in terms of emotional functioning, sexual orientation, stigmatization, gender role behavior, behavioral adjustment, gender identity, learning and grade point averages. This may be because many of the parenting tasks faced by same-sex parents are similar to those faced by heterosexual parents, which include providing appropriate structure for children while also being warm and accepting, setting limits, teaching open and honest communication, healthy conflict resolution, and monitoring of child’s peer network and extracurricular activities. ¹Although same-sex couples have the same desires of having children that become healthy, productive members of society, they may experience homophobic attitudes and beliefs, and social stigma related to being same-sex parents. Concerns within the same-sex parent families include⁸:
- The child/children experiencing bias and discrimination because of having same-sex parents.
- Discrimination in parenting and custody arrangements where sexual orientation or gender identity status may be used to restrict or deny custody.
- Relationships and problems with the non-biological parent figure who was involved with conceiving process of their partners child.
- Experiencing bias and discrimination by extended family members.
- Experiencing internalized homophobia which is defined as a set of negative attitudes and affects toward homosexuality in other persons and toward homosexual features in oneself. Effective parenting may be influenced by gay and lesbian parents’ ability to accept and acknowledge their own identity, and how they are able to negotiate living in a heterosexist, homophobic, or otherwise discriminatory society, while rearing their children in a family unit that is not socially sanctioned.
Surprisingly, only a handful of states have laws in place that allow gay couples to parent together. States that allow same-sex couples to have a second-parent adoption include California, Colorado, Connecticut, Washington D.C., Idaho, Illinois, Indiana, Maine, Massachusetts, Montana, New Jersey, New York, Oklahoma, Pennsylvania, and Vermont. ⁸
Five states legally allow adoption agencies to deny adoption to a same sex couple because of their sexual orientation, and California is the only state that prohibits discrimination for both sexual orientation and gender identity in adoptions.
Gay conversion therapy is any attempt to change a person’s sexual orientation, gender identity, or gender expression.² Because gay conversion therapy has come under increasing scrutiny, those who practice it frequently change their terminology to avoid detection. At first glance, some of the terms may seem harmless. Terms for conversion therapy often include²:
- Addressing sexual addictions and disorders
- Eliminating, reducing, or decreasing frequency or intensity of unwanted Same-Sex Attraction (SSA)
- Encouraging relational and sexual wholeness
- Ex-gay ministry
- Healing sexual brokenness
- Promoting healthy sexuality
- Reparative therapy
- Sexual Attraction Fluidity Exploration in Therapy (SAFE-T)
- Sexual Orientation Change Efforts (SOCE)
- Sexual reorientation efforts
- Sexuality counseling
The American Psychological Association and the American Psychiatric Association have both made statements regarding the use of conversion therapy. They are as follows¹˒²:
American Psychological Association
Affirms that same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity; reaffirms its position that homosexuality per se is not a mental disorder and opposes portrayals of sexual minority youths and adults as mentally ill due to their sexual orientation concludes that there is insufficient evidence to support the use of psychological interventions to change sexual orientation; encourages mental health professionals to avoid misrepresenting the efficacy of sexual orientation change efforts by promoting or promising change in sexual orientation when providing assistance to individuals distressed by their own or others’ sexual orientation.
American Psychiatric Association
In 1997 American Psychiatric Association (APA) produced a fact sheet on homosexual and bisexual issues, which states that “there is no published scientific evidence supporting the efficacy of “reparative therapy” as a treatment to change one’s sexual orientation.”²
The potential risks of reparative therapy are great and include depression, anxiety, and self-destructive behavior, since therapist alignment with societal prejudices against homosexuality may reinforce self-hatred already experienced by the patient. ²Many patients who have undergone reparative therapy relate that they were inaccurately told that homosexuals are lonely, unhappy individuals who never achieve acceptance or satisfaction. The possibility that the person might achieve happiness and satisfying interpersonal relationships as a gay man or lesbian are not presented, nor are alternative approaches to dealing with the effects of societal stigmatization discussed. Therefore, APA opposes any psychiatric treatment, such as reparative or conversion therapy, that is based on the assumption that homosexuality per se is a mental disorder or is based on the prior assumption that the patient should change his or her homosexual orientation.
In a vast majority of states, children can still be sent to gay conversion therapy. ² There are eight states that have banned the practice for minors, the most recent of which was Oregon, under the direction of Gov. Kate Brown, who is openly bisexual. ²
Although the recent supreme court ruling bans discrimination in the workplace based on sexual or gender identity, it still occurs. Maintaining employment and a satisfactory lifestyle can prove difficult when LGBTQ people are at risk of having their employment terminated because of their identities.⁵ This problem is compounded when LGBTQ people can also legally be denied housing based on their identities. For instance, Housing and Urban Development’s (HUD) Equal Access Rule requires equal access to HUD programs without regard to a person’s actual or perceived sexual orientation, gender identity, or marital status.⁵ Housing providers that receive HUD funding or have HUD-insured loans are subject to the Rules. Likewise, the Fair Housing Act prohibits housing discrimination on the basis of race, color, national origin, religion, sex, familial status, and disability, however, New Hampshire and Wisconsin do not have state or local laws that prohibit gender identity/expression housing discrimination.⁵ Even though laws are in place for most states to prevent LGBTQ housing discrimination, the HUD has still reported that same sex couples experience unfavorable treatment in renting homes and purchasing homes.
Federal nondiscrimination laws do not prevent discrimination in public accommodations based on gender identity, sex, or sexual orientation. The laws only specify protected characteristics such as disability, color, national origin, race, and religion. ¹⁰ Although there are no nondiscrimination federal laws regarding gender identity, most states interpret sex to include gender identity. These states prohibit gender identity and sexual orientation discrimination in connection with public accommodations. The laws associated with the states give transgender people the right to be free from harassment, the right to not be refused entry, participation, or services on the basis of gender identity, and the right to present oneself in a way that is consistent with one’s gender identity. ¹⁰
Public accommodation is described as any place that provides the public with goods and services, including gas stations, grocery stores, health clinics, homeless shelters, hospitals, libraries, schools, social services, retail stores, and restaurants. ¹⁰ The use of public accommodations has been in the forefront regarding public restroom use by transgender people. Depending on state and local laws, denying a transgender person access to a public restroom that coincides with their gender identity may qualify as discrimination. For instance, school-age children should be able to use the restroom that suits their gender identity and not the gender on their birth certificate, or the gender that the school identifies. Forcing a child to use a restroom that does not match their gender identity may qualify as discrimination. Likewise, hospitals are considered public accommodations and are covered by the Federal Affordable Care Act and hospital accreditation standards, which prohibits discrimination based on gender identity.
Some states have attempted to block transgender people’s access to public restrooms based on gender identity. For example, North Carolina passed a “bathroom bill” (the Public Facilities Privacy & Security Act) in 2016, but the state repealed its most controversial provisions a year later after significant national backlash. ¹⁰
Although most states recognize that transgender people need public access that is equal to everyone else, not all of them do. Transgender people may still experience discrimination despite civil rights laws in place The discrimination is most likely to occur because of the transgender person not being protected by a local or state law, which can also predispose them to acts of violence. ¹
LGBTQ persons often face barriers to accessing health services which can result in worse health outcomes. These challenges can include discrimination, rejection, stigma, and violence from families and communities, as well as inequality in the workplace and health insurance sectors, substandard healthcare, and outright denial of care because of an individual’s sexual orientation or gender identity.⁶ For instance, LGBTQ youth are more likely to have health issues because of substance abuse and mental health issues, and transgender people can face discrimination from health insurers simply for identifying as transgender. In many states, insurance companies can discriminate based on sexual and gender identity. The following are health-related concerns within the LGBTQ community⁶:
- Elderly LGBT people face additional barriers to health because of isolation and a lack of social services and culturally competent providers.
- Gay men are at higher risk of HIV and other STDs, especially among communities of color.
- Lesbians and bisexual females are more likely to be overweight or obese.
- Lesbians are less likely to get preventive services for cancer.
- LGBT populations have the highest rates of tobacco, alcohol, and other drug use.
- LGBT youth are more likely to be homeless.
- LGBTQ youth are 2 to 3 times more likely to attempt suicide than others.
- Transgender people have a high prevalence of HIV/STDs victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGB individuals.
Statistics about criminal justice and LGBTQ people in general are lacking. However, some groups of LGBTQ people are disproportionately likely to encounter the criminal justice system, particularly LGBTQ youth and transgender people. Historically bias, abuse, and profiling toward LGBTQ people by law enforcement has contributed to disproportionate contacts with the justice system.⁹ Perhaps, because many LGBTQ people have had negative experiences when interacting law enforcement in the past, these victims of violence are reluctant to report it. Moreover, LGBTQ people are disproportionately poor, and while people may end up in jail or prison for many different reasons, people who are poor are more likely to end up incarcerated. ¹
According to the National Transgender Discrimination Survey, 16% of transgender adults have been incarcerated. This compares with 3% of all adults who have ever been in prison. ⁹ Also, an estimated 4-8% of youth identify as LGBTQ. Family rejection, homelessness, and hostile environments with harsh disciplinary actions often serve as a catalyst for LGBTQ youth to enter the juvenile justice system.
Regardless of being a perpetrator or victim, LGBTQ persons often face significant challenges when navigating the criminal justice system. This issue is compounded by a tendency of some law enforcement to disbelieve allegations by victims. For instance, a minority transgender woman who has a history of sex working may not be believed when she makes a complaint regarding rape. A study of California prisons found that transgender women in men’s prisons were 13 times as likely to be sexually abused as other prisoners.⁹ Also, law enforcement may be less likely to believe that violence has occurred when it happens even though persons who identify as non-heterosexual are three times as likely to experience it.1
Although most anti-gay sodomy laws have been changed, there are still some statutes related to sex and Human Immunodeficiency Virus (HIV) that are commonly enforced in a discriminatory way.⁹ For instance, a transgender person who is convicted of a crime may be incarcerated in an institution that is opposite their gender identity. Also, the same transgender person may be prevented from receiving hormone therapy, and likewise, an LGBTQ person who is also HIV positive may be isolated from the rest of the incarcerated population within an institution. And transgender person may also be isolated or confined for protection.
Just as in any other setting, sexual abuse behind bars can lead to post-traumatic stress disorder, depression, substance abuse, HIV, and other infections that can take a heavy toll on survivors, their families and communities, and public budgets.
There are some battles that cannot be won in the courtroom, though they can certainly be helped along by judicial decisions and laws crafted and passed to ensure equality. But outside of the US legal system, LGBTQ people still face discrimination, fear, and violence that results in physical, mental, and emotional harm. Homeless youth who identify as LGBTQ often end up on the streets because they are rejected by their family members. LBGTQ youth are more likely to experience violence, be in dangerous situations, participate in crime, and encounter various forms of trauma that can have life-long consequences and effect life quality. For instance, approximately 40% of transgender adults and 20% of LGBTQ adults have reported attempting suicide. The rate for the rest of the population is less than 5%. The United States has really progressed in protecting the rights of the LBGTQ community since the Stonewall Inn riots, but there is still much more that must be accomplished to improve equality within the community.
- 9 battles the LGBTQ community in the US is still fighting. (2017, June 20). Global Citizen. https://www.globalcitizen.org/en/content/9-battles-the-lgbt-community-in-the-us-is-still-fi/
- Conversion therapy. (n.d.). GLAAD. https://www.glaad.org/conversiontherapy?response_type=embed
- Domestic violence and the LGBTQ community. (n.d.). The Nation’s Leading Grassroots Voice on Domestic Violence. https://ncadv.org/blog/posts/domestic-violence-and-the-lgbtq-community
- General definitions. (n.d.). LGBT Resource Center. https://lgbt.ucsf.edu/glossary-terms
- Housing discrimination and persons identifying as LGBTQ. (n.d.). https://www.hud.gov/program_offices/fair_housing_equal_opp/housing_discrimination_and_persons_identifying_lgbtq#_State%20and%20Local%20Laws
- Lesbian, gay, bisexual, and transgender health | Healthy people 2020. (n.d.). Healthy People 2030 | health.gov. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health
- NYC data: Stonewall inn riot – 1969. (n.d.). Baruch College – The City University of New York (CUNY). https://www.baruch.cuny.edu/nycdata/disasters/riots-stonewall.html
- Same-sex parents and their children. (n.d.). American Association for Marriage and Family Therapy. https://www.aamft.org/Consumer_Updates/Same-sex_Parents_and_Their_Children.aspx
- Standing with LGBT prisoners: An advocate’s guide to ending abuse and combating imprisonment. (2018, October 18). National Center for Transgender Equality. https://transequality.org/issues/resources/standing-lgbt-prisoners-advocate-s-guide-ending-abuse-and-combating-imprisonment
- Transgender rights in public accommodations. (2019, February 18). Justia. https://www.justia.com/lgbtq/transgender-rights/public-accommodations/