The British government on Monday (14 June) eased blood donation rules for gay, bisexual and queer men – yet activists warn harmful restrictions remain.
Blood donation rules in England, Scotland and Wales have long screened out donors if they are a man who has had oral or anal sex with another man.
This is because male donors were asked to disclose whether they have had sex with another man during checks.
But coming into effect on World Blood Donor Day and following recommendations from a health committee, British blood services will now assess donor eligibility on a person-by-person basis instead of applying a blanket restriction.
So, rather than just men, all people regardless of gender and sexuality will be asked the same questions on recent sexual activity, if any.
This means anyone who has had the same sexual partner for the last three months will be eligible, allowing more LGBT+ folk than ever before to donate blood, platelets and plasma.
It’s a long-sought for shift in policy quickly hailed as “historic” by top LGBT+ advocates, but sexual health groups warned that the blood donation process is still riddled by “barriers”.
“Patient safety is at the heart of everything we do,” said the blood service’s chief nurse for blood donation Ella Poppitt.
“This change is about switching around how we assess the risk of exposure to a sexual infection, so it is more tailored to the individual.
“We screen all donations for evidence of significant infections, which goes hand-in-hand with donor selection to maintain the safety of blood sent to hospitals.”
It’s a simple fact that LGBT+ people are at high risk of developing eating disorders.
A Stonewall study found one in eight LGBT+ people experience an eating disorder and, according to a Beat survey, 37 per cent of LGB respondents wouldn’t feel confident seeking help.
Researchers recently found 18 per cent of boys who identify as gay and 13 per cent of boys who are bisexual experience eating disorders, compared with three per cent of heterosexual boys.
Gay men have battled eating disorders for decades, which are often connected with anxiety and confusion regarding sexuality, but many still struggle to access treatment.
Here are the stories of five gay men who have lived with eating disorders.
Lawrence Smith: ‘I felt destined to fail at existing as an adult’
Lawrence Smith, 29, is an actor and singer who had long-term issues with anorexia nervosa, diabulimia and general disordered eating.
“A key factor in my issues was lack of confidence in myself,” he explained.
“I felt destined to fail at existing as an adult, so I adopted the misguided belief that, were I to be ill, I wouldn’t need to engage with the real world.
“This had dangerous effects on my Type One diabetes.”
Lawrence also possessed a hatred of his body and the diabetes he’s had since a young age and used his eating disorder as punishment.
“I’ve been out as a gay man for ten years,” he said.
“I was lucky with the reaction to my coming out, but I had a lot of internal confusion proceeding this, and I was convinced I didn’t deserve love.
“I was surrounded by folks my age discussing their sex lives, so I felt isolated even further with my added eating disorder habits.”
Lawrence wishes his treatment focussed more on his diabetes, as none of his therapists were well versed in diabetes, so diabulimia continued to affect him.
He also highlighted the need to stop viewing eating disorders as a “women’s illness”.
“When I was seeking help 12 years ago, the resources I received all focused on female experiences of eating disorders. I felt absolutely alienated.
“I can only hope things have improved over the years, especially when the number of gay men battling eating disorders has risen.”
Jason Wood: ‘Embracing my vulnerability has been so scary’
(Jason Wood)
Jason Wood, 35, is an office events coordinator and blogger who has struggled with orthorexia.
“After joining Weight Watchers in high school I became fixated on counting calories, which made me feel in control during turbulent times,” Jason said.
“Several years later I was classified as high risk for colorectal cancer, the same disease that took my dad when I was 11.
“I didn’t want to die young so I developed a mental list of ‘good’ and ‘bad’ foods based on fad diets and clean eating influencers, whose diets I viewed as the epitome of health.”
Jason never thought he had an eating disorder, as he didn’t match the stereotypes.
He realised he needed help after an outburst in a restaurant when the food he wanted wasn’t available.
“My husband expressed concerns, so I scheduled an appointment the following week, but it wasn’t until months later I realised orthorexia was what I was battling,” he said.
Jason found it difficult actually finding treatment, however, as a man with a lesser-known eating disorder, and saw several professionals before receiving appropriate care.
Fortunately, he’s now in recovery and wants other gay men to know they deserve help.
“Embracing my vulnerability has been so scary,” he said, “but also really rewarding because I’m getting my life back.”
Dr Sunni Patel: ‘I just wanted to be accepted and avoid bullying for my size’
Dr Sunni Patel, 35, is a business director and gut health advocate who suffered from bulimia and excessive fasting as a teen.
“My issues stemmed from the insecurity of how I looked,” he shared.
“Coming from an Asian background there’s an unhealthy focus on how one looks and acts, and I gained weight as a teenager, so fasting felt like a quick way to lose weight and seem attractive.
“I just wanted to be accepted and avoid bullying for my size.”
Sunni is still on his coming out journey, but anxiety about how others may perceive him made him body-conscious.
“Coming from a conservative background and studying in healthcare meant I couldn’t discuss my eating disorder,” he added. “I was ashamed of my struggle, so I chose to self manage it.
“The gay dating scene also seems very body focused and extremely difficult to navigate because the easiest access to the gay world is through hookup apps and porn.
“It was hard to find people who understood what I was going through.”
Sunni wishes he was able to confidently talk about his struggle because he still battles with BDD (body dysmorphic disorder).
When asked his advice for fellow gay men, Sunni wants people to remember that others in the community shouldn’t pressure you to be a certain way: “Be you and find contentment in that, then you’ll attract the right people.”
Sam Thomas: ‘I would hide in the toilets during lessons and eat’
(Sam Thomas)
Sam Thomas, 35, is a writer and mental health campaigner who developed bulimia as a result of homophobic bullying in school, which manifested into CPTSD (complex post-traumatic stress disorder).
“I would hide in the toilets during lessons and eat,” Sam said. “Over time I evolved from bingeing episodes to bingeing and purging.
“Hardly anyone knew or had reason to be concerned.”
Sam attempted to seek help at 16 and again at 18 but never received treatment for bulimia. Fortunately, he was eventually able to recover, but his bulimia was replaced with alcoholism years later.
“At 18 the doctor focused on my depression rather than bulimia, I was put on antidepressants and referred for counselling,” he continued.
“I’ve often wondered if I were a woman with the same symptoms I might’ve been referred to eating disorder services.
“The concept of being a gay man having eating disorders was unknown 20 years ago. There was no information easily available, nor were there any support groups.”
Sam wants to remind readers that people from all walks of life have eating disorders: “Eating disorders are indiscriminate and anyone can be affected.”
Cassius Powell: ‘Seeing my father in tears encouraged me to seek help’
(Cassius Powell)
Cassius Powell, 38, is a dancer and personal trainer who was diagnosed with anorexia at 15, which was a result of low self-esteem and confusion in his teens.
“I placed a lot of self-worth on my physicality,” Cassius explained.
“I read an article about Leonardo DiCaprio that became the catalyst for my eating disorder. I thought his size was why he was so desired. This was also wrapped up in my suppressed sexual desire for him.
“I quickly became obsessed with exercise and food.”
Cassius didn’t realise the impact of his eating disorder until he confessed to giving away food at school to his father.
“He broke down at the wheel as we drove home one night. Seeing my father in tears encouraged me to seek help.”
Cassius rebuilt his relationship with food following appointments with a dietician, but it’s taken a long time to realise his value isn’t measured by looks.
“Even now I sometimes catch myself over-exercising and being strict with food but, because I’m kinder to myself, I can manage it.”
Cassius’ eating disorder was impacted by suppressing his sexual identity until coming out aged 25.
“I felt like being gay wasn’t acceptable,” he said, “so I tried to shut off any gay thoughts or feelings, which of course is impossible to control.
“What is easy to control, however, is the food you put into your body.”
He also wishes more attention could’ve been given to the mental aspect of eating disorders during treatment, as well as the eating.
“It’s only in the last five years I’ve tackled my OCD, anxiety and depression, which were key factors in my eating disorder,” Cassius shared.
A British midwifery magazine has shared an incredible cover that shows that, yes, trans men can give birth – and you bet it ticked off transphobes.
In a cover designed by illustrator Lauren Rebbeck for its 24th volume in May, The Practising Midwife emphatically said that trans men who give birth are “amazing”.
Part of the magazine’s Normal Birth series, the cover features a trans Black man after giving birth to a baby as his partner looks on in pride. His fist raised in the air, showing a rainbow tattoo with the words “right on” underneath.
Of course, because their hobby is hate, the cover quickly became the target of transphobic Twitter trolls and anti-trans pressure groups.
After The Practising Midwife shared a roundup of some of its recent covers in June, it abruptly entered the radar of a cavalcade of anti-trans Twitter accounts who decided to focus their collective efforts on attacking a… midwifery magazine.
This being from the same group who have previously assailed a mental health charity for, er, proudly standing up for trans rights.
But the magazine refused to be buffeted by the pile-on and issued a statement on Twitter on Monday (28 June), proudly coming out swinging for trans rights.
“We are committed to representation at all levels and also to ensuring that our publications provide a safe space for all birthing people and maternity care workers to learn, care and share with one another,” it read.
The American Medical Association (AMA) has delivered a firm rebuke to the spate of anti-trans bills attempting to criminalise healthcare for trans youth.
Arkansas became the first state to ban puberty blockers and gender affirming treatment for trans minors in April, while similar bills are currently being considered in up to 20 state legislatures
State representatives are pushing their discriminatory bans through despite firm opposition from medical and healthcare advocacy groups, including the AMA – which is the largest association of physicians in the United States.
The American Medical Association recommitted to its already established position in a wide-ranging statement issued on Tuesday (15 June).
The group characterised such bills as “governmental intrusion into the practice of medicine” and said efforts to ban healthcare for trans minors will ultimately prove “detrimental”.
“Legislatures in 20 states this year proposed banning physicians and other health care professionals from providing medically necessary gender-affirming care to transgender and gender-diverse youth,” the AMA said in a statement.
“In response to this legislative trend, physicians and medical students at the AMA’s House of Delegates meeting voted to meaningfully expand the organisation’s strong opposition to undue restrictions on medical care to populations that have been politicised in state legislatures.”
AMA will support human rights by opposing anti-trans bills
Michael Suk, AMA board member, said that gender-affirming care is “medically necessary” and “evidence based” and insisted that it “improves the physical and mental health of transgender and gender-diverse people.”
The AMA drew attention to a letter it delivered to the National Governors Association in April which argued government overreach in healthcare can have “tragic consequences for transgender individuals”.
“The AMA is a strong supporter of human rights and freedoms and will continue to strongly oppose discrimination based on an individual’s sex, sexual orientation, or gender identity,” the statement said.
The group promised to keep working to protect trans and gender diverse young people’s right to “explore their gender identity under the safe and supportive care of a physician”.
There was widespread outcry when Arkansas legislators banned healthcare for trans youth in April – but that law is far from the end of the road for transgender people in the United States.
Similar bills are either currently being considered, or have already been considered, in Tennessee, Texas, Florida, Missouri, Alabama, Montana, Louisiana, New Hampshire, South Carolina, North Carolina, Utah, Georgia and others.
Dr. Stephanie Ho, a family medicine physician in Fayetteville, Arkansas, said she’s had state legislators in her exam room before.
Ho, who has provided gender-affirming care to transgender people in the state since 2015, is also an abortion provider, so she is familiar with lawmakers’ restricting the care she provides. She said she wasn’t surprised when the Legislature overrode Gov. Asa Hutchinson’s veto of a bill last month that would ban puberty blockers, hormones and surgery for transgender minors.
“I think that it’s kind of ridiculous that we’ve gotten to the point that we’re letting politicians dictate how health care is delivered and what kind of care can be given to whom,” said Ho, a fellow with Physicians for Reproductive Health.
“I think the last thing I’ve ever wanted, being an abortion provider or somebody who provides gender-affirming care, is to have a politician in the back of my mind in the exam room making me think about ‘Oh, I wonder if I should do this, if it’s OK,’” she said. “They’re essentially trying to practice medicine without a license. And that’s incredibly wrong.”
Arkansas was the first state to pass a ban on transition care for minors. Tennessee Gov. Bill Lee last week signed a similar billbarring prepubertal youths’ access to transition care like hormone therapy. Advocates say no doctors in the state provide hormone therapy for prepubertal youths, The Associated Press reported.
So far this year, state legislatures have considered 35 bills to ban or limit gender-affirming care for trans minors, according to the Human Rights Campaign. Physicians say that the bills negatively affect their patients’ health before they even become law and that they require doctors to go against medical standards of care. Legal experts say the bans could also open providers and hospitals up to lawsuits or put them at risk of losing federal funding.
Ho is trying to support her patients as best she can until Arkansas’ law takes effect this summer.
“It’s just a matter of making sure that my patients know that, whether I can provide them hormones or not, we’re still here for them to support them in any way that we can,” she said. “Of course, I’m going to practice within the bounds of the law, whether I agree with it or not, because me being in jail doesn’t help any of my other patients at all.”
Creating ‘contingency plans’
Some physicians, like Dr. Izzy Lowell, who founded a telemedicine practice called QMed in Atlanta in 2017, started planning for the bills months ago.
Dr. Izzy Lowell, second right, founder of QMed.Bonnie Heath
In April, Alabama’s Senate passed a bill that would have made it a felony for doctors to provide minors with gender-affirming care. The bill died Monday after the House missed the deadline to vote on it. Lowell said that when it first passed, the minor patients she treats in Alabama were scared and frustrated.
“It was clear that the state of Alabama was coming after transgender teens, and we talked about some contingency plans,” she said. “Based on each case, I tried to give them as many refills as possible and told them: ‘Go pick up as much of your medicine as you can. I don’t know when I’ll see you again.’”
Lowell is licensed and practices in 10 states via telemedicine, so she also talked with her legal team and with patients in states considering bans about how her patients could continue care should their states ban it. She said her patients’ parents would have to drive to other states, which would “place an extraordinary burden on these families.”
“If they were, for example, able to get over the border into Tennessee or South Carolina and sit in a parking lot somewhere, I could see them technically with my South Carolina license or Tennessee license or my North Carolina license and perhaps find a local pharmacy there and have them pick up the prescription, but it would be a day’s worth of driving for them to get somewhere where I could see them legally,” she said.
Because leaving the state just to get care would be a burden, families in states where transition care restrictions have passed have movedor are considering moving.
The costs of losing ‘lifesaving’ care
Many minors whose parents don’t have the time or money to drive out of state would be forced to stop transition care if their states passed laws like Arkansas’, which comes with potentially life-threatening health risks, physicians say.
Major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the Endocrine Society and the American Psychological Association, support gender-affirming care for trans youths and oppose efforts to restrict access.
Supporters of the Arkansas bill argue that transition care for minors is “experimental” and that trans minors often change their minds about their genders and detransition later in life. Medical experts say neither of those claims are backed by scientific evidence. On the contrary, research has found that access to gender-affirming care such as puberty blockers reduces the risk of suicide among trans youths.
Ho said the danger is evidenced by what happened when Arkansas’ bill passed through one legislative chamber. Dr. Michele Hutchinson, a physician at the Arkansas Children’s Hospital Gender Spectrum Clinic, testified before the state Senate in March that there were “multiple kids in our emergency room because of an attempted suicide, just in the last week,” after the House passed the bill.
Ho said that “since then, I have had one of my own patients attempt suicide,” adding that she has talked to her patients about what would happen if a judge doesn’t block Arkansas’ law from taking effect. The law also bars her from referring her patients to other physicians who provide gender-affirming care. Unless her patients were able to leave the state, they would be likely to lose access to hormones, so she talked to them about what that would mean.
Lowell said forcing people who were assigned female at birth to stop testosterone would cause them to suffer symptoms of low testosterone, which include inability to concentrate and low energy. “They would start doing badly in school most likely, until their bodies started producing estrogen a few months later, and then they would restart their periods, restart breast growth, and it would undo all of the changes that we tried to achieve with testosterone.”
If people assigned male at birth were forced to stop taking estrogen, it “would be like going through instantaneous menopause,” Lowell said. For about a year, they could have symptoms like hot flashes, night sweats, irritability and mood swings, among other issues, such as negative impacts on emotional well-being.
Doctors worry that minors who already receive and rely on transition care would get hormones illegally if they had to. Dr. Ricardo Correa, a board member of GLMA: Health Professionals Advancing LGBTQ Equality, treats trans veterans in Phoenix, where, he said, trans people have traveled to the border to buy hormones illegally when they can’t get them. He said state bans would worsen the problem.
“It will just create chaos in the system from black markets that are going to start selling this kind of medication in that state,” he said.
Lowell said that hormone therapy is safe when it is monitored by a doctor but that using it without medical supervision could cause health problems, such as liver failure, kidney failure or heart problems.
“There’s very serious consequences of completely unmonitored, sort of black market medication use in this situation,” she said.
‘A form of medical malpractice’
Legal experts and advocates say that in addition to having dangerous health impacts, bans on gender-affirming care for transgender youths could expose health care providers to legal and regulatory problems.
Valarie Blake, a law professor at West Virginia University specializing in health care law, said there’s “a pretty strong case” that Arkansas’ law is discriminatory under Section 1557 of the Affordable Care Act, which protects against discrimination based on sex.
The Biden administration announced this month that it would interpret Section 1557 to protect against discrimination based on sexual orientation and gender identity — reversing a Trump-era policy that cut protections for transgender people.
Hospitals and physicians receiving federal funding, such as Medicare and Medicaid payments, are required to comply with laws like Section 1557, Blake said; otherwise, they risk losing the funding.
Arkansas’ law could trigger that risk by allowing physicians and hospitals to prescribe puberty blockers and hormones to cisgender minors for precocious puberty but not transgender teens.
“If the reason that they’re not doing it for transgender teens is because of the fact that they’re transgender, then there’s a very good case that the reason that they’re refusing the treatment is based on the gender identity and not anything else,” Blake said.
“It really puts health care workers in an untenable position when the federal government makes it plain that this is discrimination and has the money to back it up to basically say, ‘We can pull away all of the resources,’ and yet the state persists,” she said.
The American Civil Liberties Union argued in a lawsuit it filed Tuesday against Arkansas that the trans health restrictions are unconstitutional, but Blake said that’s not set in stone.
“We don’t have clear precedent on the books yet to suggest that LGBTQ categories are fully protected in that manner, which is why we’ve been seeing various kinds of Equal Rights Amendment-type laws trying to work their way through Congress,” she said, referring to the Equality Act, a bill that would protect LGBTQ people from discrimination in housing, employment, public accommodations, education and other areas of life.
The bill passed the House in February, but it has stalled in the Senate. “If something like that passes, then suddenly Arkansas as a state is in big trouble,” Blake said.
Lowell said thinking about the potential legal issues “keeps me up at night.” Physicians are required to give patients several months’ warning when they can’t see them anymore and to do their best to find other providers who can see them if they’re unable to.
But laws like Arkansas’ bar physicians from referring patients to other providers for transition care. “In this case, I can’t do any of those things, and I just have to say, ‘Bye,’ and ‘I’m not allowed to see you anymore,’” she said. “That’s patient abandonment, which is a form of malpractice.”
Lowell said that when the first restrictions were introduced several months ago, she felt angry and anxious all the time.
“I worry about what might happen to my patients if these bills are passed and worry about going to jail myself,” she said. “I struggle with the question of what I would do: continue to support my patients and risk going to jail for years or follow these hateful laws? Thankfully, I have not had to answer this question yet, but I will never abandon my patients.”
I’ve been teaching at a New York City college for almost five years, and I’m still in touch with a number of my former students. Many reach out for career advice, or help on getting a job, or wanting a letter of recommendation, and I’m always happy to oblige.
However, I was caught off guard recently when a former student told me that he decided not to get the COVID-19 vaccine. This person reads my column and knows that I’ve written a lot about the pandemic during the last year, including speaking to a number of medical experts including Dr. Fauci, Dr. Mike Osterholm and science writer Laurie Garrett. The student assumed that I was the closest thing to an “expert” that they could find, and I sensed he was challenging me about his decision.
My immediate answer was, “Get the damn vaccine!” The student did not respond to my strong command, and I’m worried that I might have missed an opportunity to convince him otherwise?
I’m wondering if many of us have friends, relatives or even partners who are hesitant to get the vaccine, and when confronted with that uncertainty, are we left trying to figure out how to provide the right response?
Vaccine rates have started to fall precipitously, with the pace of daily inoculations falling 35 percent from their highest levels just a couple of weeks ago. Some still lack access to the vaccine, others have just not got around to getting one, and many are either still wavering or adamantly saying it’s not for me. And many are confused, afraid or feel slighted.
The New York Timesreported this week about LGBTQ+ people feeling invisibile with regard to how COVID data is accrued.
The Times also said, “Communities of color and other marginalized groups have faced some of the most severe coronavirus outcomes, yet have received a smaller share of vaccines. L.G.B.T.Q. people could face similar problems but may be overlooked because they aren’t counted.”
The vaccine debate is likely to be raging for the next few months. President Biden is determined to have 70 percent of Americans vaccinated by July 4. The argument seems to be, unfortunately, a political one. Nearly 60 percent of U.S. adults have now received at least one shot, according to a recent poll, but a whopping 45 percent of Republicans say they did not plan to get vaccinated, while two-thirds of Democrats have already been vaccinated.
Why is there so much hesitancy and controversy around these life-saving and life-alerting vaccines? Is the Biden administration doing enough to convince wavering Americans to get vaccinated? And how do you go about changing the mind of someone you know who is opposed to getting the shot?
I reached out to out ABC News Medical Contributor Dr. Darien Sutton for some help getting answers to these questions. First, why all the debate and why all the waffling?
“Throughout the pandemic, there has been a consistent environment of fear and misinformation, instigated from the previous administration, and it all started at the beginning when people often felt there were too many mixed messages and too many signals. Eventually it became more and more difficult to make decisions about how to deal with the virus,” Dr. Sutton explained.
“With the change in administrations in January, we have been given more straightforward information and more relevant data that has helped unionize the message. So, while things have changed, it doesn’t negate where we started. All the confusion created a lot of deliberation, and increased deliberation time periods, and this has resulted in a more elongated and difficult process about whether or not to get the vaccine.”
The Biden administration has been more honest and upfront, but will they be able to sell the vaccine across party lines across the country? Right now, it seems the message is that you can get back to normal sooner if you just get these shots?
“Yes, you can tell patients what they can do with the vaccine versus what they cannot do,” Sutton said. “However, I think patients want to hear answers to questions about what’s in it for them. Specifically, how does it benefit them in their personal lives? I think people don’t care as much about going to the movies again, for example, versus getting assurance that the vaccine is safe, effective and useful.”
Is that the answer then to the quandary about trying to convince someone to get the vaccine? Push its safety and effectiveness? “I think it’s important to listen and ‘ask’ the undecided first what is the basis of their concern,” Sutton believes. “Is it fear? Is it fear of reaction? Is it fear of getting sick and not having health care to get treatment.”
After you’ve heard out the person’s concerns, Dr. Sutton said the next thing you should do is “tell.” “You need to tell the person that the vaccine has been proven to be effective, protective, and it prevents person to person transmission, so there’s less chance to spread the virus, and as such it will keep you, and your loved ones, out of hospital and not cause financial burdens. After that, you need to just give the person space to think about their decision.”
I told Dr. Sutton about my former student, who is Black, and that it seems tricky to push him on something he seems sensitive about. “I’m having the same issue with my own family,” he revealed. “I come from a large Black family that remains hesitant and was raised in an environment where medicine is not trustworthy.”
“Historically, you have instances like the Tuskegee experiment for example, or in Puerto Rico with women and birth control, where minorities and poorer communities were used as guinea pigs. Many Black families and people of color feel they were used for research that benefited privileged white communities, so there’s a whole history there that has resulted in disinclination and unwillingness.”
On top of all this hesitation, understandable in some circumstances, comes the news that a booster shot might be required later this year or early next. Did Dr. Sutton feel that was the case? That we would all have to queue up again for another round of shots?
“It’s hard to say. We’re still closely following the efficacy rates and ranges of the first vaccines. What we’re seeing is that it has been effective in bolstering the immune system, and we’re hopeful that it will remain durable and long lasting and protect against other variants.”
Sutton theorized that the COVID-19 vaccine might be what’s referred to as a repetitive vaccine, similar to the annual flu shot that most of us get each fall and winter.
Finally, the CDC has said that Americans could be almost back to normal by this summer, July specifically. Did Sutton concur with that optimistic outlook? “Yes,” he quickly agreed. “People ask me all the time if we will have to go into lockdown again, and I don’t think that will happen.”
“We have done a great job of vaccinating those 65 and over, and others who were more susceptible to the disease. And we’ll ramp up vaccinations for teens and children in the next few weeks. As we know, young people were commonly asymptomatic transmitters of the virus, so as they get vaccinated, we’ll see further reductions in transmissions. All of this means that we will decrease the chances of our hospitals being overrun again, and that most of us will start to resume a normal way of life.”
A consistent level of parental support, even if it’s negative, leads to better mental health outcomes for lesbians and gay men, according to a small new study.
The report, released this week at the American Psychiatric Association’s annual meeting, found that individuals whose parents were initially unsupportive of their sexual orientation but became more accepting with time were most likely to report symptoms of anxiety and depression.
Researchers at the Chicago School of Professional Psychology surveyed 175 cisgender gay men and lesbians about the initial and current levels of parental support they received regarding their sexuality.
Based on their responses, the subjects were divided into three groups: Those whose parents’ reaction was consistently positive, those whose parents’ reaction was consistently negative and those whose parents’ reaction shifted from negative to positive. (A fourth group, individuals whose parents were initially positive but shifted to negative, was excluded because it was too small to analyze.)
The groups were then given two assessments frequently used to determine mental health: the general anxiety disorder-7questionnaire and a patient health questionnaire. The first questionnaire found those with consistently positive support and those with consistently negative support had “mild anxiety,” while those whose parents evolved from negative to positive had “moderate anxiety.” The latter questionnaire, which rates symptoms of depression, found those with static parental reactions exhibited “mild depression,” while those whose parents shifted their support had what is considered “moderate depression.”
Lead author Matthew Verdun, a doctoral candidate in applied clinical psychology at the Chicago School of Professional Psychology and a licensed family therapist, said many factors could be at play, including that family rejection can lead gays and lesbians to find new, healthier support systems.
“In coming out, we learn how to cultivate meaningful relationships and navigate across social context,” he said. “Who are safe people to come out to? How do I identify the people who are going to accept all of me, including my orientation?”
Re-establishing the bond with a previously unaccepting parent could mean ending therapy or abandoning a chosen family, he said. And just because a parent is more accepting doesn’t mean the environment is a positive one.
“If a parent goes from being unsupportive to supportive, are they abandoning some of their relationships that may still be unhealthy?” Verdun said. “Are they part of a faith tradition that rejects their child or says they’re an abomination? If the parent comes around but doesn’t shift out of that belief system, that’s going to affect their child.”
Previous research has generally linked negative responses from family to a higher probability of LGBTQ mental health issues: According to a 2010 study by the Family Acceptance Project, lesbian, gay, bisexual and transgender young adults who reported low levels of family acceptance in adolescence were over three times more likely to have suicidal thoughts and to report suicide attempts, compared to those with high levels of family acceptance.
But those studies, Verdun noted, look at the dynamic at one point in time, usually when the individual has just come out or is still living at home. “I wanted to know what happens over time,” he said.
The findings can be useful for mental health providers, he said, but they shouldn’t be interpreted as meaning that rejecting your gay or lesbian child is a healthy response.
“If I was talking to parents, I’d say supporting your child is key,” Verdun said.
Psychiatrist Jack Drescher, author of “Psychoanalytic Therapy and the Gay Man” and a former editor of the Journal of Gay and Lesbian Mental Health, called the findings “rather surprising.”
“It’s not the result we expect, based on clinical evidence,” Drescher, who was not involved in the study, said. “But when we don’t know the answer, the answer is always to do more study. I’d love to see qualitative research — get narratives of the people involved and see what themes emerge among those who had the experience of having negative and later positive responses.”
Suicide rates among young people have been on the rise in recent years, according to the Centers for Disease Control and Prevention, but gay and bisexual youths are almost five times as likely to have attempted suicide as their straight peers.
And, despite advances in the fight for LGBTQ equality, a new report finds that young gay people today are even more likely to have attempted suicide than in previous generations.
Researchers at the Williams Institute, a sexual orientation and gender identity think tank at UCLA School of Law, found that 30 percent of lesbian, gay and bisexual respondents ages 18 to 25 reported at least one suicide attempt, compared to 24 percent of those 34-41 and 21 percent of those 52-59.
The study, published last month in the journal PLOS One, also revealed that these young adults are experiencing higher levels of victimization, psychological distress and internalized homophobia than older generations.
“We had really expected it would be better for the younger group,” said lead author Ilan H. Meyer, a distinguished senior scholar of public policy at the institute. “But at the same time, we knew data from other studies has shown LGB youth do a lot worse than straight youth — and not much better now than in earlier times.”
Meyer and his colleagues surveyed 1,518 respondents who identified as lesbian, gay or bisexual (trans people were included in a separate study). Participants were divided into three cohorts: the “Pride” generation, those born from 1956 to 1963; the “Visibility” generation, born from 1974 to 1981; and the “Equality” generation, born from 1990 to 1997.
Using the Kessler Scale, a clinical measure of psychological distress, they found that members of the Equality generation reported almost twice as many symptoms of anxiety and depression as the Pride generation. Many factors influenced the data, Meyer said, including the fact that people are coming out younger than ever.
“That can be a positive, of course,” he said. “But it can also backfire and expose you to a lot of harassment and victimization. You might not be prepared for the consequences.”
Members of the Equality generation reported coming out to a family member at age 16 on average, compared to 22 for the Visibility generation and 26 for the Pride generation.
That can put them at risk of rejection at a time when they rely most on family for emotional and financial support, said Amy Green, vice president of research for The Trevor Project, an LGBTQ youth crisis intervention and suicide prevention organization.
According to a survey by the organization last year, 40 percent of LGBTQ youths ages 13 to 24 had seriously considered attempting suicide in the previous 12 months.
“It’s not that the world isn’t making progress for LGBTQ people, it’s that recent progress has resulted in an amazing community of young people who understand who they are but still live in a world where others may be unkind to them, reject them, bully them or discriminate against them,” Green said in an email. “And we know these experiences of victimization can compound and produce negative mental health outcomes.”
The advent of social media and the internet has also greatly affected the Equality generation’s sense of identity.
“When we asked them about other people in the community, the younger group’s answers were always — always — about social media, not about real-life encounters,” Meyer said. “People are very cruel online, whether it’s Twitter or Grindr.”
Meyer said that before he examined interviews accompanying the survey, he expected to hear people in their teens and 20s present “a different way of being gay.”
“But one of the first narratives I listened to was from an 18-year-old Latino from San Francisco, and his narrative was the same as we’ve heard for generations — homophobia, exclusion, shame. The evolution [in LGBTQ rights] hadn’t impacted his life as much as you’d expect.”
Members of the Equality generation reported more anti-LGBTQ victimization than their older counterparts, Meyer said. Nearly 3 out of 4 (72 percent) said they had been verbally insulted about their identity, and almost half (46 percent) said they had been threatened with violence. More than a third (37 percent) reported having been physically attacked or sexually assaulted.
“I believe in the power of institutions and social structures changing. I really do,” Meyer said. “But I think real progress takes longer than we think. Just because we’re seeing change doesn’t mean every gay kid’s parents are accepting or that their friends are embracing them.”
There were some silver linings: Of the three groups, members of the Equality generation most reported feeling connected to the LGBTQ community.
“That was actually surprising, because we hear so much about people feeling like they don’t belong,” Meyer said. “But this suggests there is still pride, despite the difficulties and negativity, sometimes even from within our own community.”
Coming out younger has also given them more resiliency, he added.
“Coming out earlier gives you a great start on life, even if you face hardships,” he said. “This generation is already out when they get to college. They have a better sense of who they are. Older generations had to wait longer to live their authentic lives.”
If you are an LGBTQ young person in crisis, feeling suicidal or in need of a safe and judgment-free place to talk, call the TrevorLifeline now at 1-866-488-7386.
With the inauguration of President Joe Biden, I hope we may now see the kind of leadership on LGBTQ issues we need. As a gay African-American man living with HIV, I have lived through two pandemics. Under both HIV/AIDS and COVID-19, LGBTQ people have had to shoulder the burden of discrimination while fighting to survive. I hope that 2021 is the year that changes.
I was diagnosed with HIV in 1984, in the early years of the epidemic. I lost many friends in the years that followed. So many of us in that time never expected to live a full life ourselves. After watching our friends die, it became hard to imagine that we’d ever make it to our 40th birthday — let alone retirement. The discrimination we experienced and the looming threat of the virus made it difficult to build careers and save for the golden years we never thought we’d see. I’ve lost jobs due to discrimination myself, and the stress of it nearly killed me. That’s why today, I help advocate for LGBTQ elders and folks on social security.
I have seen every stage of the HIV/AIDS crisis, from the pandemic, to its aftermath, to the present day. I know how much work it takes to survive and thrive in the face of this virus. As the administrator of a group home for folks recovering from HIV-related hospital stays, a member of the local HIV Planning Council, and a care outreach specialist for a community clinic, I’ve seen the kind of discrimination people still face. I once worked with a pregnant woman who was turned away from a local hospital for being HIV-positive. Because our clinic existed, she got the care she needed and her baby was born healthy.
In recent years, advances in prevention and access to testing and treatment have led to encouraging declines in new diagnoses. But stigma and anti-LGBTQ bias continue to have consequential effects on testing decisions. Time and again, I have spoken with clients who choose to hide their condition or status to avoid ostracization and discrimination. According to a recent research report by the Williams Institute at the University of California, Los Angeles, 44 percent of Black LGBTQ adults have either never been tested, tested when they felt at risk, or once every two years or less. It’s an alarming statistic that falls far too short from CDC recommendation for testing frequency for HIV, which is at least once a year or more frequently.
Despite these challenges, it’s possible to live a full and healthy life with HIV/AIDS. As Americans, we should be able to participate in all aspects of daily life with dignity and respect, and without fear of discrimination. If we wholeheartedly want to end the HIV epidemic in the United States, we must seize the moral high ground and ensure LGBTQ Americans are provided with equal rights, better access to care, and increased secure housing. Federal nondiscrimination legislation will help us get there.
Although it’s important to celebrate how far we’ve come, right now, 50 percent of LGBTQ people live in the 29 states that lack comprehensive statewide laws explicitly prohibiting discrimination against LGBTQ people, including here in my home state of Georgia. And in the midst of a pandemic and the accompanying economic crisis, it’s inhumane that millions of us can still be denied housing or medical care just because of who we are or who we love. Situations like these enable the spread of HIV.
Our nation is going through a profound change, but our values of treating others as we would want to be treated remains the same. The Equality Act would ensure that all LGBTQ Americans can live, work, and access public spaces and medical care free from discrimination, no matter what state we call home. It’s the right thing to do — which is why this type of legislation has broad and deep support across lines of political party, demographics, and geography. Public support is at an all-time high, with 83 percent of Americans saying they favor LGBTQ nondiscrimination protections, including 68 percent of Republicans and a majority in every state in the country.
After all, equality is not a Democratic or Republican value, it’s an American value. It’s also the smart thing to do as we work to end the HIV epidemic in America.
Nathan Townsend is a 66-year-old Black gay man living and thriving with HIV for 36 years. He devotes his time and efforts helping to promote health equity and equal access to care for his community.
Bisexual men are more likely to experience eating disorders than either heterosexual or gay men, according to a new report from the University of California San Francisco.
Numerous studies have indicated that gay men are at increased risk for disordered eating — including fasting, excessive exercise and preoccupation with weight and body shape. But the findings, published this month in the journal Eating and Weight Disorders, suggest that bisexual men are even more susceptible to some unhealthy habits.
In a sampling of over 4,500 LGBTQ adults, a quarter of bisexual men reported having fasted for more than eight hours to influence their weight or appearance, compared to 20 percent of gay men. Eighty percent of bisexual men reported that they “felt fat,” and 77 percent had a strong desire to lose weight, compared to 79 percent and 75 percent of gay men, respectively.
Not everyone who diets or feels fat has an eating disorder, said a co-author of the study, Dr. Jason Nagata, a professor of pediatric medicine at UCSF. “It’s a spectrum — from some amount of concern to a tipping point where it becomes a pathological obsession about body weight and appearance,” Nagata said.
Of all the respondents, 3.2 percent of bi males had been clinically diagnosed with eating disorders, compared to 2.9 percent of gay men. That stacks up to 0.6 percent of heterosexual men, according to research from the Yale University School of Medicine.
Nagata said the discrepancies highlight the need to conduct eating disorder research on various sexual identities independently. “Prior studies on eating disorders in sexual minority men have grouped gay and bisexual men together, so it was difficult to understand the unique characteristics in bisexual men.”
Several factors may be at play, he said, including “minority stress,” the concept that the heightened anxiety faced by marginalized groups can manifest as poor mental and physical health outcomes.
“LGBTQ people experience stigma and discrimination, and stressors can definitely lead to disordered eating,” Nagata said. “For bi men, they’re not just facing stigma from the straight community but from the gay community, as well.”
The bisexual advocate and author Zachary Zane said this “double discrimination” often leads to loneliness, depression and a fear of coming out.
“We face ostracization from both sides, or if we’re embraced by the LGBTQ world, it’s because we’re hiding our authentic selves,” Zane said. “When you feel everything is out of control, [food] is something you can have control over. I can understand how that would be appealing.”
Thirty percent of bi men in the survey reported being afraid of losing control of their eating, and nearly a third said they had difficulty focusing on work or other activities because they were thinking about food, eating or calories.
While binge eating was similar among gay and bi men in this report, a 2018 American Psychiatric Association study of university students found that bisexual men were three times as likely to binge eat as their gay classmates and five times as likely as heterosexual male students.
Subjects for the report were chosen from the Pride Study, the first large-scale, long-term national health study of sexual and gender minorities, sponsored by UCSF and other institutions.
It relies on self-identification for sexual orientation and allows respondents to choose multiple identities or even write in their own. For the sake of the report, Nagata’s team categorized cisgender men who identify as bisexual, pansexual, polysexual or otherwise attracted to more than one gender as “bisexual-plus.”
Bisexuals, the largest demographic in the LGBTQ community, face numerous health disparities, including higher rates of obesity, substance abuse, binge drinking, sexually transmitted illnesses, cardiovascular disease and even some forms of cancers. Thirty-nine percent of bisexual men say they have never told a doctor about their sexual orientation, three times the percentage of gay men, according to a 2012 study by the Williams Institute.
A recent study in JAMA Pediatrics found that, in the first three years after having come out, bisexuals were twice as likely to start smoking as lesbians or gay men.
Bisexual youth are at an elevated risk for self-harm: Forty-four percent of bi high schoolers have seriously considered suicide, compared to a quarter of gay teens and less than 10 percent of heterosexual students, according to a 2011 study from the University of IllinoisCollege of Education. And a 2013 report in the Journal of Adolescent Health found that suicidal thoughts did not decrease as they entered adulthood, as they did for gay and straight people.
But few diagnostic tools or treatment programs make adequate distinctions, Nagata said, even for gender: Most assessment tools for eating disorders, for example, were devised for cisgender women, and they can overlook behaviors more common among men, like eating more to gain mass. While only 3 percent of the bisexual male study subjects had been diagnosed with eating disorders by clinicians, nearly a quarter met the criteria based on their answers.
“Raising awareness of these differences is the first step,” he said. “Having tailored interventions for LGBTQ people, for bisexual people, is just common sense. It’s not a one-size-fits-all treatment program.”
Zane said that if researchers want to help bi men with eating disorders, they need to address the unique roots of bi men’s depression, anxiety and need for control.
“When researchers lump bi and gay men together, it not only contributes to bi erasure — implying that bi men have the same struggles and identity as gay men — it also leads to ineffective treatments,” he said. “If the goal is to actually help bisexual men, then all research needs to parse them out from gay men, period.”
