Among LGBTQ people, those who are gender nonconforming (GNC) may be at heightened risk of both discrimination and underutilization of healthcare-yet little is known about what happens during healthcare encounters to compel GNC individuals to continue or avoid seeking future care. This study qualitatively examines the healthcare experiences of a racially diverse sample of 34 adult LGBTQ cis women, transgender men, and nonbinary individuals in a metropolitan area of the United States who do not conform to dominant biomedical schemas of sex and gender. GNC individuals experience embodied disruption in medical settings when patients are mis/recognized; providers respond to disruption in ways that further distress patients. Broadly, participants report similar experiences across racial and gender identities, but patients manage disruption somewhat differently depending on their embodied positions to gender norms. This study contributes to literature of stress, stigma, and sex, gender, and sexuality within medicine by illuminating how stigmatizing healthcare interactions deter LGBTQ individuals from seeking healthcare. Findings point to the importance of considering both structural factors and embodied visibility in future research addressing how stigma and discrimination manifest within health settings to disadvantage LGBTQ groups.

No abstract

No abstract

Research consistently demonstrates that family relationships are key determinants of health, but most research on health and families focuses on a heterosexual and cisgender context. Sexual and gender identities often are overlooked or erased in family and health research. We present an overview of the current state of research on LGBT families and health, using a life course approach and pointing to the ways that LGBT people's experiences of families occur within a broader social structural context, with implications for their health and the health of their family members. We focus on parenthood, parent-child ties, intimate relationships, and caregiving. We also identify two theoretical obstacles for studies ofLGBT families and health as well as important research areas for moving forward, such as the inclusion of non-binary and queer identities in our studies of family and health. Incorporation of LGBT and other queer families and family forms into our health research interrogates assumptions within family and health research and offers insight into how to move the field forward.

Objective This study examines how married straight and lesbian women understand sexual changes in midlife. Background Sexual satisfaction is key to marital quality, yet marital sex typically diminishes in midlife. Little is known, however, about how married straight and lesbian women make sense of midlife sexuality. Comparing the narratives of lesbian and straight women can reveal how midlife events, relational contexts, and gender norms drive women's experiences of and responses to diminishing sex. Method Inductive and deductive analyses were performed on interviews with a convenience sample of 16 straight and 16 lesbian mostly high‐status married couples in Massachusetts. Results Lesbian and straight women suggest that sexual activity and desire diminish over time due to health, aging, and caregiving events, yet lesbian women additionally emphasize the importance of weight gain, caregiving for adult parents, and shared experiences of menopause. Women further describe distress when their sex lives diverge from norms specific to marriage and their sexual identities. Moreover, women report relationship work designed to maintain or reignite sex; when compared with straight women, lesbians describe more work and a stronger sense of duty to keep sex alive and uniquely describe medical providers as unhelpful in addressing sexual challenges. Conclusion The results suggest that relational contexts and cultural discourses shape straight and lesbian women's experiences of distress and comfort about diminishing sex in marriage.

No abstract

This study examined substance use and sexual risk correlates of HIV testing among cisgender gay, bisexual, and other men (MSM) and transgender and nonbinary individuals (TSM) who have sex with men in Kazakhstan. We analyzed baseline data from an HIV prevention trial collected prior to intervention deployment (N = 304). Multivariable logistic regression analyses revealed that lifetime HIV testing was positively associated with poly-drug use (AOR = 4.4, 95% CI [2.0, 9.9]) and negatively with sexual risk (AOR = 0.4, 95% CI [0.2, 1.0]). Similarly, recent HIV testing was positively associated with polydrug use (AOR = 2.7, 95% CI [1.4, 5.2]) and negatively with sexual risk (AOR = 0.5, 95% CI [0.3, 0.9]). Current HIV testing was negatively associated with sexual risk (AOR = 0.6, 95% CI [0.3. 0.9]). Findings support the value of integrating drug treatment with HIV testing among MSM and TSM in Kazakhstan.

In effort to address fundamental causes and reduce health disparities, public programs increasingly mandate sites of care to capture patient data on social and behavioral domains within Electronic Health Records (EHRs). Data reporting drawing from EHRs plays an essential role in public management of social problems, and data on social factors are commonly cited as foundational for eliminating health inequities. Yet one major shortcoming of these data-centered initiatives is their limited attention to social context, including the institutional conditions of biomedical stratification and variation of care provision across clinical settings. In this article, we leverage comparative fieldwork to examine provider and system responses to mandated data collection on patient sexual orientation and gender identity (SOGI), highlighting unequal clinical contexts as they appear across a large county safety-net institution and an LGBTQ-oriented health organization. Although point of care data collection is commonly justified for governance in the aggregate (e.g., disparity monitoring), we find standardized data on social domains presents a double-edged sword in clinical settings: formal categories promote visibility where certain issues remain hidden, yet constrain clinical utility in sites with greater knowledge and experience with related topics. We further illustrate how data standardization captures patient identities yet fundamentally misses these unequal contexts, resulting in limited attenuation of inequity despite broad expectations of clinical change. By revealing the often-invisible contexts of care that elude standard measurement, our findings underline the strengths of qualitative social science in accounting for the complex dynamics of enduring social problems. We call for deeper engagement with the unequal contexts of biomedical stratification, especially in light of increasing pressure to quantify the social amidst the rising tide of data-driven care.