Catering to sex,sexual, and gender diversity: An exploratory study on the effects of LGBTI awareness training on aged care staff in Tasmania,Australia

The Australian National LGBTI Ageing and Aged Care Strategy seeks to address the lack of recognition of older lesbian, gay, bisexual, transgender, and intersex (LGBTI) adults living in aged care. Awareness training for aged care staff forms a crucial part of this strategy, but the impact of such educational programs are yet to be examined. In this article, we examine the effects of LGBTI awareness training on staff working in an Australian aged care facility. These staff perceived the awareness training as valuable, but the outcomes from it were limited. Therefore, we indicate changes that are necessary to support the translation of training into practice.     

Delivering LGBT-sensitive substance use treatment to sexual minority women

Abstract

Epidemiologic studies have consistently found elevated rates of alcohol and other substance use among sexual minority women (SMW), and despite calls for “lesbian, gay, bisexual, and transgender (LGBT)-specific” services and culturally tailored interventions, few such services exist. This study involved qualitative interviews with directors from substance use treatment programs (N?=?10) about how they addressed the needs of SMW. Strategies implemented primarily focused on creating a safe and welcoming environment for sexual minority clients. Findings highlight challenges involved in meeting the treatment needs of SMW and provide guidance to researchers and service providers on how to improve the quality of care for them.     

“I'm still raring to go”: Successful aging among lesbian,gay, bisexual,and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

Masculinity and Tom Identity in Thailand

Abstract

Thai lesbian women engage local cultural meanings of masculinity in the creation of personal identities. Lesbian identity in Thailand is largely framed in terms of “butch-femme” gender role-playing, with the masculine woman referred to as tom and the feminine woman dee. According to informants, the dynamics between toms and dees differ from the normative expectations and experiences of hetero-sexuality for Thai women. Although Thai toms express their identity in terms of being “like men,” they often differ from typical Thai male attitudes in terms of attitudes towards female sexuality, masculine sensitivity, and expectations from women in terms of long-term relationships. I conclude that Thai tom-identity is positioned against both normative Thai femininity and masculinity. This paper addresses the feelings towards sexuality and self-identity of many Thai lesbians, and seeks to help health and welfare professionals be sensitive to cultural nuances of gender identity, and attitudes towards relationships and sex among lesbian Thai women.     

Transformations of Transgender

Abstract

Transgender males, called kathoey in Thai, are an ancient and widespread phenomenon in Asia and especially Southeast Asia. In this paper I consider Thai transgender males from a more contemporary perspective, focusing on changes in the definition and presentation of kathoey in the last two decades. These changes are related to alterations of the sex scene in western countries, the application of new medical technologies, and the development in Thailand of a new kathoey” c a -reer.” I base my study on in-depth interviews conducted in Thailand and the Netherlands. I discuss the inadequacy of conceptualizing ka-thoey as a category of homosexuals, arguing that kathoey first and foremost have to be seen as women. From this perspective, kathoey s' relationships with the partners they prefer become more understandable. I also interpret kathoeys' preference for farang(Caucasian) partners, the meanings they ascribe to having a sex-change operation, and their sexual behaviour from the perspective of considering them as women. I conclude with recommendations for social service work among kathoey and a reflection on the theory of sexual and erotic excitement.     

Specifying Long-Term Care Provider Responsiveness to LGBT Older Adults

In-depth interviews and focus groups with lesbian, gay, and transgender older adults addressed the question “What does it mean for long-term care providers to be responsive to lesbian, gay, bisexual, and transgender (LGBT) older adults?” Sixteen domains of long-term care provider responsiveness to LGBT older adults were identified, including awareness of centrality of partners, knowledge of importance of preferred gender expression, openness to welcoming LGBT older adults, and ability to create LGBT-safe environments. Future research should include LGBT elders who belong to ethnic minority groups, bisexual elders, and LGBT older adults who do not identify with LGBT labels.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Ageing and exercise: building body capital in old age

Background

Research that provides better understanding of the motivational processes in older age to maintain a healthy and active lifestyle is sought after. We apply theoretical approaches to cultural capital, active and healthy aging health to shed light on the women’s experiences in maintaining physical capabilities through an active lifestyle, and thereby facilitating their own inclusion in society. Thus, the aim of this paper is to explore why older home dwelling women over the age of 70 years or more spend time in physical exercise and their experiences about the importance of participating in group exercise for their daily life.This paper reports on a qualitative study based on interviews with 16 older women aged 70 years or more and regularly attending group exercise classes in the community at an established workout center. The data were analyzed the data using an inductive content analysis approach.

Results

Three overreaching and interrelated themes emerged from the interviews: “Building body capital for independence”, “Building body capital to maintain vitality and being in control” and “Building resources for social interaction”. The findings suggest that group exercise is important for building body capital. The group exercise helped the women in building bodily ability to manage everyday life, maintain vitality, being in control, pursue social interaction and live independently. These body resources were important for these older women’s experience of the manageability and meaningfulness of daily life.

Conclusion

This study has provided insights into older women’s understanding and experiences of the challenges of everyday life within a theoretical framework of cultural capital and health. The women acquired cultural health capital, and more specifically body capital, by participating in the group exercise classes. The women’s investment in body capital through regular physical activity created resources which facilitated social participation. Therefore professionals need to be aware of this when performing group exercise.

     

Loneliness and Belongingness in Older Lesbians: The Role of Social Groups as “Community”

This article explores loneliness and isolation in older lesbians, looking at the benefits offered by an over-55 fortnightly social group in Yorkshire. I argue that the women interviewed were more vulnerable to loneliness than their heterosexual counterparts as a direct consequence of many years of privacy and self-concealment and because they were more likely to be single, childless, and have fractured relationships with birth families; all significant losses viewed by the women as the “price you paid” for being a lesbian. Although the group did not completely alleviate loneliness, it provided a place of safety and offered a sanctuary where participants could be themselves and where friendships and other groups were formed. For many women, the group's exclusivity to older lesbians and bisexual women was deeply significant and influenced their decision to attend. I suggest that such groups have a vital role to play in promoting older lesbian, gay, bisexual, and transgender well-being and offering protection against loneliness and isolation in older age.     

Where The Trans Men and Enbies At?: Cissexism,Sexual Threat,and the Study of Sex Work

In this article, I examine the existing research on transgender sex workers and explore how cissexism and sexism overlap and shape this work. Overall, researchers assume that all trans sex workers are women, and all male sex workers are assumed to be cisgender. Transmasculine and other gender non‐conforming sex workers are absent from studies of sex work. Researchers in public health and criminology dominate the literature and this research is limited because it focuses only on trans women and because it focuses primarily on disease and trauma, and almost exclusively on HIV. The literature I examined treats transgender women as a public health “problem” to be solved, rather than addressing their experiences and needs as workers and as people in our society. I argue that in order to have useful applied and policy implications aimed at harm reduction, researchers must use a sociological lens to document what structural conditions push and pull people of various genders into sex markets in the first place. Finally, I advocate for the use of queer, intersectional, and transnational frameworks in future lines of inquiries as a way to push the sociological and public health literature on sex work forward in a way that will benefit all sex workers, their advocates, and service providers.     

Rehearsing Gender and Sexuality in Modern Thailand

Abstract

In this paper I draw on a series of interviews with gay-identified Thai men, and with male bar workers and their clients in order to chart the traditions, discourses, and institutional contexts contributing to the construction of gender and sexual identity in Thailand. I argue against the uncritical application of Western paradigms to the study of Thai sexuality and present a view of gender and sexuality that is “fluid and pragmatic.” I consider difficulties associated with sexual choice and levels of acceptance and toleration, and look at examples of how sex work has been socially constructed. Finally, I discuss the attachment of Thai male bar workers to the “gay” community.     

Provider and Care Workforce Influences on Quality of Home-Care Services in England

Abstract

A key trend in home care in recent years in England has been movement away from “in-house” service provision by local government authorities (e.g., counties) towards models of service commissioning from independent providers. A national survey in 2003 identified that there were lower levels of satisfaction and perceptions of quality of care among older users of independent providers compared with in-house providers. This paper reports the results of a study that related service users views of 121 providers with the characteristics of these providers. For the most part, characteristics associated with positive perceptions of quality were more prevalent among in-house providers. Multivariate analyses of independent providers suggested that aspects of the workforce itself, in terms of age and experience, provider perceptions of staff turnover, and allowance of travel time, were the most critical influences on service user experiences of service quality.     

Traversing the Margins: Intersectionalities in the Bullying of Lesbian,Gay, Bisexual and Transgender Youth

SUMMARY

This study explores the perspectives of service providers and youth advocates on bullying of lesbian, gay, bisexual and transgender (LGBT) youth and intersectionalities in LGBT peer victimization. In depth, semi-structured interviews were conducted with nine key informants (4 male, 4 female, 1 transgender male; 4 gay, 3 lesbian, 2 non-identified; 6 white, 1 South Asian, 2 Middle Eastern) recruited using purposive sampling from diverse education and social service settings. Narrative thematic analysis and a constant comparative method were used to identify themes. Five themes emerged from the data: (1) “transgressing gender norm boundaries”; (2) homophobic sexism vs. sexist homophobia; (3) “you choose sexuality or you choose race”; (4) newcomer youth and citizenship; and (5) “multiple wires together … create the cage.” Findings suggest the importance of an intersectional approach to conceptualizing and addressing LGBT bullying and to uncovering the differential experiences of bullying among LGBT youth. Bullying related to sexual orientation should not be assumed to be the only or primary form of violence shaping the lives of LGBT youth.     

“Welcome! Oh,wait…” Transgender Military Service in a Time of Uncertainty

In 2014, the Department of Defense began a broad review of transgender military service. Following this review, in 2016, the Obama Administration announced a policy of transgender inclusion in the military. However, in 2017, before enactment of that policy, President Trump announced the reinstatement of a ban on transgender military service. Although, in the last five years, these events have garnered much media attention, sociologists have generally left them unexplored. In this article, I begin the process of incorporating transgender military experience into sociological discussions by examining how transgender service members navigate their uncertain status vis-à-vis military service. In so doing, I explore how transgender personnel might be “doing transgender” (Connell, Gender & Society24(1):31) in the context of shifting norms about who can and cannot officially exist within the ranks of the military as well as possibilities for future research examining transgender military experience more broadly.     

A ‘new materialist’ lens on aging well: Special things in later life

Aging well is a process of making sense of self and aging. Over the last two decades, researchers have studied how individuals make self-meaning through person–object relations. Much of this work has focused on how individuals assign meaning to special objects, yet little is known about the influence of the physicality of these things on this meaning-making. This paper introduces a “new materialist” lens to aging-well research by distilling and synthesizing key assumptions from diverse bodies of literature. Each assumption is illustrated with data from a recent series of interviews with older women. The paper demonstrates how this theoretical perspective may be applied to study the making of self-meaning through such later-life transitions as widowhood. A new materialist lens can enhance understanding of identity construction, and more broadly, aging well, in terms of later-life relationships with special things.     

A decade of changes: Within-group analysis of LGBTQ individuals' perceptions of their community context and the relevance for social service providers

The previous decade has seen a drastic shift in the social environment for lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. It is not surprising then to find that the perceived “best” and “worst” aspects of life for nonmetropolitan LGBTQ individuals have also changed. We use data from two cohorts of the Rainbow Illinois survey to examine differences between responses in 2000 and 2011. Furthermore, we examine demographic differences in the perception of what is “best” and “worst” among the 2011 cohort. Results suggest that although the general social climate has improved for some, it remains problematic for others. Implications for social service providers are thoroughly discussed.     

The Turn from “What” to “How”: Garfinkel's Reach Beyond Description

John Heritage described Harold Garfinkel's central question as “how do social actors come to know, and know in common what they are doing and the circumstances in which they are doing it.” The case of Agnes illuminates the methods by which members produce intelligible actions and recognizable—even “natural”—gender orderliness. With this central interest as a starting point, this article offers some observations about transgender women in prison and their creative adaptation to life behind bars.     

THe Use of Hormone Therapy in the Male-to-Female Transgender Population: Issues for Consideration in Thailand

ABSTRACT

Objectives: Prejudice against transgender people is evident around the world with discrimination in many aspects of life, including access to health care. Even in Thailand, where male-to-female (MTF) transgender people are particularly visible and society is reputedly accepting, barriers to attaining appropriate health care still exist. The vast majority of MTF transgender people in Thailand are reported to be taking hormone therapy; however, most do not seek medical advice regarding these regimens, with the initiation and tailoring of medication often being guided by sympathetic peers instead. The objectives of this review are to consider hormone therapy in the context of the Thai population and provide recommendations regarding ways to improve practice and reduce health risks. Methods: The data analysis in this article represents a comprehensive literature review regarding hormone therapy for MTF transgender people including the guidelines for initiation, prescribing, and monitoring of hormone therapy, risks for serious adverse events and reported hormone use by the MTF transgender population in Thailand. Results: There is a notable lack of published research regarding hormone therapy in the transgender population. Guidelines, whilst relying considerably on expert opinion, do provide clear recommendations on the initiation, maintenance and monitoring of hormone therapy. Comparison of endocrine guidelines with reported practice in Thailand reveals significant opportunities for improvement in MTF transgender hormone therapy. Conclusions: The incautious use of hormone therapy may represent a considerable health risk behavior undoubtedly contributing to the morbidity and mortality in MTF transgender people. Although there is currently considerable focus on sexually transmitted infections in the MTF transgender population, a more comprehensive approach to health care is required, including education for transgender people and the health professionals who attend to them regarding appropriate hormone therapy.     

“She was a little bit unrealistic”: Choice in healthcare decision making for older people

This paper examines autonomy, choice, options, and power in healthcare decision making for older people. Using discourse analysis and a case study from data gathered as part of an ethnographic field study we critique a common conceptualization of healthcare decision making as patients choosing from an array of options offered by healthcare providers. A discourse of “giving options and being realistic” used by healthcare providers is contrasted with the experience of a single patient's transitional care from hospital to home after hip fracture. This illustrates how a wide variety of actors, institutions, values, and resources take precedence in determining a discharge destination. While the accounts given by healthcare providers cast patient choice in respectful terms, an ethnographic approach illustrates that the “choices” are structured by a discourse which simplifies the complexity of what is offered and who gets to choose. In the case study the patient's choice was subjugated by expertise and institutional concerns; her options were largely illusory; and her autonomy was “at risk” due to her age, poor health, and limited resources. We use Foucault's ideas about discourse and governmentality to question the scope of agency in healthcare decision making. We argue that the conceptualization of informed patients making autonomous choices acts as “misdirection” which deflects problem solving and discussion away from a productive examination of the differences between healthcare system offerings and client needs. We conclude by posing questions to reorient the debate surrounding healthcare decision making for older adults and recommend a more participatory approach to designing social services.