Minorities within Minorities – the evidence base relating to minority groups within the LGB&T community – Varney

Minorities within Minorities – the evidence base relating to minority
groups within the LGB&T community
Author: Dr Justin Varney, Consultant in Public Health Medicine, GLADD

The experience of growing up different within ethnic communities can create additional pressures and challenges as the two cultural norms may conflict.1 2 3

This may be compounded in migrant ethnic communities due to size and social isolation.
Although the evidence suggests that there are no significant differences in sexual development milestones, sexual orientation, or sexual behavior between different ethnic groups of LGB youth, there is evidence from the US that black and latino youth are less involved with gay-related social activities and disclose their sexual orientation to fewer people over time.

Black young people showed stronger certainty over their sexual identity and more positive attitudes to homosexuality than white youth, leading the authors of the study to conclude that cultural factors do not impede the formation of identity but may delay engagement with positive gay role models and community forums.4
Research comparing British Indian and British Pakistani gay men demonstrated differences between immigrant community experiences where ethnicity, religion and sexuality interact differently in different ethnic contexts.5
Specific research6 in the UK into the experiences of migrant gay men highlighted that these men are particularly vulnerable because of their socio-economic circumstances in the UK, with higher risk of mental ill health and sexual risk behaviours.
Interestingly, in international research a poorly defined gay identity was a significant predictor of sexual risk taking, with men in one study with undefined gay identities being 3.6 times more likely to have unprotected anal intercourse than those with a defined identity.7 This correlates with the higher rates of HIV infection reported in the same study in ethnic minority gay men (22%). Although it is important to note that a defined gay identity is not the same as being directly engaged with the gay community, as research into community attachment has demonstrated that ethnic community attachment may be a protective factor in the presence of gay self-identification.8
There is some evidence that ethnic minority gay men living with HIV are prone to more psychological stress related to their gay lifestyle than Caucasian gay HIV positive men,9 and this is replicated in wider research into psychological stress and ethnicity in LGB youth.10

A large UK study11 into mental health need which analysed sexual orientation and gender identity found that black and minority ethnic (BME) LGB respondents were less likely than white LGB respondents to have considered suicide. This may reflect the strong cultural and religious taboos among BME groups to suicide. In contrast US studies12 have found suicidal thoughts and ideation reported in BME gay and bisexual men.2
A large national study in the US looked at ethnic differences in smoking behaviour among LGB adults and found that all LGB racial groups had higher cigarette smoking prevalence than their heterosexual racial counterparts and smoking of hookahs was higher among white and hispanic LGB people than heterosexual people. Internal comparison between ethnic LGB groups found that rates of smoking cigarettes were significantly lower among black, and Asian LGB people than white LGB people, in contrast smoking of cigars and clove cigarettes was significantly higher amongst black LGB people than white LGB people.
London based research13 found that BME LGB people were more likely to experience physical abuse and more likely to have experienced harassment from a stranger than white LGB people. The combined impact of homophobia/ transphobia and racism can play out over a lifetime and research into perceptions of ageism amongst gay men at
different stages and ethnicities found that older black gay men perceived the highest level of ageism and were most disengaged with coping styles and mechanisms, although the study that explored this did not find outcomes.14
UK research suggests that there is no evidence that sex between men is either less or more common among any minority ethnic group compared with the ethnic majority.15
There is virtually no research into ethnic differences among the trans community. There is one study19 based on a small sample of ethnic minority male to female trans identified youth in the US which highlighted a range of needs including homelessness, unemployment, substance misuse, unprotected anal intercourse and higher rates of HIV
positive status, especially amongst African-American youth.

However, in another report20 of the same study this subgroup of African-American trans youth were less likely to be involved in high-risk sex. The report highlighted the need for further research into the risk behaviours amongst trans BME youth.
Stonewall’s research into the health needs of lesbian and bisexual women, ‘Prescription for Change’, has found clear differences in their health compared to that of women in general. Lesbian and bisexual women are more likely to have smoked and to drink heavily than women in general. Levels of attempted suicide and self-harm are much higher than
in the wider population. In addition, half of lesbian and bisexual women have had a negative experience of healthcare in the past year.
The national surveys by Stonewall provide some insight into the differences in health behaviours across BME LGB people, particularly when compared with the outcomes for the total LGB sample for England in the same surveys.21
Exploration of the results from the schools survey conducted by Stonewall which asked 1,614 LGB young people aged 11 to 19 years to complete a survey about their experiences in school or college found that:

  • ŸŸ More than 3 in 4 (76%) BME gay and bisexual boys have thought about taking their own life compared to 56% of white gay and bisexual boys.
  • 71% of lesbians and bisexual girls thought the same with no significant difference
    across ethnic background.
  • ŸŸ Over 8 in 10 (83%) BME lesbian and bisexual girls deliberately harm themselves compared to 71% of white lesbians and bisexual girls.
  • 36% of gay and bisexual boys have self-harmed with no significant difference across ethnic background.

Analysis of the findings for BME lesbian and bisexual women found that:
ŸŸ

  • A third currently smoke, which is slightly higher than the total sample rate (28.7%) and higher than the rates among women in general.
  • ŸŸ 70% had a drink in the last week and a third drink three or more days a week compared to a quarter of women in general, which was higher than the total sample rates in England.Ÿ
  • More than 2 in 5 (44%) have taken drugs in the last year, six times more likely than women in general, which was higher than the total survey sample rate of 35%.
  • ŸŸ 7% have attempted to take their own life in the last year which was higher than the sample population (5%).
  • ŸŸ A quarter (26%) have deliberately harmed themselves in the last year compared to 0.4 % of the general population and 20% in the total sample population.
  • 1 in 5 (21%) have an eating disorder compared to 1 in 20 of the general population, this was similar to the general sample findings.
  • More than half (55%) are not out to their GP or other healthcare professionals.

There are also some significant differences amongst lesbian and bisexual women from different ethnic backgrounds:
ŸŸ

  • Only 1 in 8 (12%) black lesbian and bisexual women said their healthcare professional acknowledged they were lesbian or bisexual after they had come out. 1 in 4 (26%) white lesbian and bisexual women have received this acknowledgement.
  • ŸŸ More than 1 in 4 (28%) lesbian and bisexual women of mixed or other ethnicity deliberately harmed themselves in the last year compared to 21% of black women, 20% of white women and 17% of Asian women.
  • ŸŸAlmost half (46%) of mixed and other ethnicity lesbian and bisexual women have taken drugs in the last year compared to a third (34%) of white women. 37% of black women and 35% of Asian women have taken drugs in the last year.

Analysis of the results for BME gay and bisexual men found that:

  • ŸŸMore than a quarter (27%) currently smoke compared to 22% of men in general and 26% in the total sample population.Ÿ
  • 7 in 10 (69%) had a drink in the last week and 3 in 10 drink on three or more days per week, which although higher than the general population, is lower than the total sample population.
  • ŸŸ More than half (53%) have taken drugs in the last year compared to just 12% of men in general and 52% in the total sample population.
  • 1 in 4 (26%) report being in ‘fair’ or ‘bad’ health compared to 1 in 6 men in general, similar to the total sample finding.
  • 5% have attempted to take their own life in the last year. Just 0.4 % of men in general attempted to take their own life in the same period, and the proportion in the total sample was only 3%.
  • 1 in 12 (8%) have harmed themselves in the last year compared to just 1 in 33 men in general who have ever harmed themselves and the total sample finding of 6.5%.
  • 1 in 6 (15%) have had problems with their weight or eating in the last year compared to 4% of men in general, although this was lower than the proportion found in the total sample (21%).
    ŸŸ
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