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By Davina Kotulski, Ph.D.
Table of Contents
I. LGBT Terminology
Sexual Orientation Terminology is an important part of being a culturally competent clinician when working with LGBT clients. Below you will find several important terms, however, when working with someone from a sexual minority it is best to ask that client how they refer to themselves and how they would like you to refer to them.
A. Sexual orientation- refers to a person’s romantic or sexual attraction (i.e. heterosexual, bisexual, homosexual).
B. Gender orientation- refers to how one identifies themselves with regard to gender (i.e. male, female, both, neither).
C. Homosexuality- a sexual orientation characterized by romantic or sexual desire for members of the same sex. Homosexuality is a clinical term and the words Gay or Lesbian are preferred.
1. Sub-Categories of Homosexuality
a) Lesbian- refers to females with a sexual orientation directed towards females.
b) Gay- refers to either males or females with a sexual orientation directed towards members of their same sex.
D. Heterosexuality- a sexual orientation characterized by romantic or sexual desire for members of the other sex.
E. Bisexuality- a sexual orientation characterized by romantic or sexual desire for members of both sexes. Bisexual refers to persons who are attracted to both males and females. Bisexuality can fall anywhere between the sexual orientations of homosexuality and heterosexuality meaning that an individual who is bisexual may be more attracted to one sex or gender over the other.
Biphobia, which is similar to homophobia, describes a fear people have of individuals with a bisexual sexual orientation. Biphobia stems from the belief that only heterosexuality and homosexuality are genuine orientations and a person who is bisexual is either truly straight, has not fully “come out of the closet,” or is simply a promiscuous individual incapable of monogamous commitment. Bisexual persons may also be the target of homophobia and hate crimes. The military considers bisexuality a reason for discharge under the Don’t Ask, Don’t Tell Policy. Bisexual persons may also be discriminated against by some within the gay community as well, as seen with the term “hasbian” to refer to bisexual lesbians currently with a male partner.
II. Gender Orientation Terminology
A. Transgender- An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth. The term may include but is not limited to: transsexuals, cross-dressers, genderqueers, two spirits and other gender-variant or gender non-conforming people. Many transgender people may identify as female-to-male (FTM), male-to-female (MTF), neither or both. Transgender people may or may not choose to alter their bodies hormonally and/or surgically. Gender orientation is completely separate from sexual orientation. Therefore, you should not assume that an MTF will be interested in being with men or that a FTM is attracted to females. Gender orientation and sexual orientation are distinct. It is important to use the descriptive term preferred by the transgender person and to elicit from them who their romantic attachments are with. Never assume.
B. Transsexual- People who desire to have or have achieved a different physical sex from their physical sex at birth. For example, they have felt like a man trapped in a woman’s body or a woman trapped in a man’s body.
C. Transvestite and Cross Dressers- The term was coined by Magnus Hirschfield in 1915 in Berlin to describe a group of people who wore clothes of the opposite sex.
D. Genderqueer- a person who does not fit into the traditional two-gender or gender-binary system. Some people identify a little with both genders, others with no gender at all. Others view gender as a continuum with either gender as poles and themselves somewhere in the middle. Some prefer gender-neutral pronouns or no-pronouns at all and use only their name.
E. Two-Spirit- A contemporary Native American term which refers to a masculine and feminine spirit embodied in one person. It also can refer to LGBTI Native Americans. Some tribes have their own words to refer to the two-spirit person who before Christian influence was a sacred person (i.e. Nadli in Navajo and Wintke in Lakota). Today these terms carry negative connotations like the words “faggot” or “lezzie.” In the past, however Nadli and Wintke had a special place in society, (i.e. baby-naming, marital counseling, etc).
F. LGBTI
Refers to lesbian, gay, bisexual, transgender, and intersexed people. Often shortened ton LGBT or LGB Sometimes includes Q for questioning or queer.
G. Queer
Queer is a word that historically had many negative connotations associated with it. However, it has been adopted by younger LGBTI people and more radical left-leaning political individuals. This term is controversial in the LGBT community and still perceived as a negative term by some. If you use this and you are not “queer” use this term with caution.
III. Physical Sex Terminology
A. Male-XY Chromosome, male secondary sex characteristics.
B. Female- XX Chromosome, female secondary sex characteristics.
C. Intersexed- refers to ambiguous or both male and female sexual characteristics (including hormonal or chromosomal characteristics).
IV. Kinsey Sexual Orientation Scale
Alfred Kinsey was a biologist at the University of Indiana who began studying human sexuality. Kinsey published two important books on male and female human sexuality. In his research, Kinsey found that 10% of the population is homosexual. He also created the Kinsey Scale in 1948 to describe the range of human sexuality.
Kinsey Sexual Orientation Scale
A. Exclusively heterosexual experience
B. Predominately heterosexual experience only incidental homosexual experience
C. Predominately heterosexual experience but more than incidental homosexual experience
D. Equally heterosexual & homosexual experiences
E. Predominately homosexual experience but more than incidental heterosexual experience
F. Predominately homosexual experience only incidental heterosexual experience
G. Exclusively homosexual experience
V. Vivienne Cass and the Homosexual Identity Formation Model
In 1979 Vivienne Cass created an identity formation model to describe the coming out process for sexual minorities, she called it the Homosexual Identity Formation model. The Homosexual Identity Formation (HIF) model is composed of six stages: (a) identity confusion, (b) identity comparison, (c) identity tolerance, (d) identity acceptance, (e) identity pride, and (f) identity synthesis. This model, created by Vivienne Cass (1979, 1990), suggests that individuals who would be labeled by society as “homosexual” begin to experience same-sex erotic feelings and are initially confused by these feelings and their sexual orientation. Cass suggests that as the individual begins to identify these feelings they gradually move through stages in a linear fashion. The stages go from denial of their homosexual feelings through stages of tolerance, acceptance, and then finally integration of these feelings into the whole self. According to Cass a person may become stuck in the first stages and may never fully accept and integrate their sexual orientation with their over all identity.
VI. Special Concerns
A. Unique Challenges LGBT Families Face
Federal Relationship Recognition
According to the General Accounting Office’s last update, there are approximately 1,138 federal rights, benefits and protections associated with federal marital status. The DOMA law that was passed in 1996, denied same-sex couples in the United States 1,138 federal marriage rights. Under this law, same-sex couples are denied access to the equal protection clause and full faith and credit act which means that their legal marriages, civil unions, or domestic partnerships are not recognized in states that don’t already recognize marriage between same-sex couples or marriage-lite alternatives like civil unions or domestic partnerships.
Up until the June 26th, 2013 U.S. Supreme Court ruling same-sex couples were denied all 1,138 federal marriage rights. However, the Supreme Court ruled in ( vs. that Section 3 of the DOMA was unconstitutional, thus couples who are legally married in states that recognize same-sex marriage now are able to apply for those 1,138 federal marriage benefits. Unfortunately, couples who do not reside in those states, couples who are in civil unions or domestic partnerships, or couples whose states only offer civil unions and domestic partnerships are not eligible for federal benefits.
These marriage rights significantly impact a same-sex couple’s/family’s ability to protect itself, its assets, and its members. A small sample of marriage rights include the ability to provide health care, take family medical and bereavement leave, receive pensions and social security, make medical and burial decisions, file joint taxes, receive discounts or employment benefits as a family or married person, own property as spouses without harsh and unfair tax consequences, and the right to sponsor a spouse for the purposes of immigration. For a comprehensive list of marriage rights and how marriage denial impacts same-sex couples and their families, please refer to Love Warriors: The Rise of the Marriage Equality Movement and Why It Will Prevail (2010).
June 26, 2013: Supreme Court rulings on same-sex marriage hailed as historic victory
http://www.cnn.com/2013/06/26/politics/scotus-same-sex-main/The constitutionality of sections 1 and 2 of the DOMA law have not been challenged in court. Therefore, unless the U.S. Congress and Senate pass a bill striking down all of DOMA and it is signed into law by the President or until a DOMA case challenging sections 1 and2 make it the United States Supreme Court, the law will remain in effect continuing to deny full equality to same-sex couples and LGBT Americans and their families in 37 states and U.S Territories.
States with Same-Sex Marriage Recognition
As of July 1, 2013, same-sex marriage is recognized and performed in the following 13 states: Massachusetts (2004), Connecticut (2008), Iowa (2009), Washington, DC (2009), Vermont (2009), New Hampshire (2010), New York (2011), Washington (2012), Maine (2012) Maryland (2013) Delaware (2013), Rhode Island (2013), Minnesota (2013), (California 2013). Same-sex marriage is also recognized and performed on the following Pacific Northwest tribal lands provided one member of the couple is a registered member of that tribe: Coquille-Oregon (2009) and Suquamish-Washington (2011).
Same-Sex Marriage in California
California has been the ongoing battleground for same-sex marriage. Same-sex marriage was legally recognized and performed in the state of California for a brief window of time, from May 16, 2008 to November 4, 2008. All 18,000 couples whose marriages were performed during that time period were legally upheld by the California State Supreme Court. However, after the passage of Proposition 8 on November 4, 2008, all marriages between same-sex couples in California were halted.
On February 6, 2012, a federal appellate court ruled that Proposition 8 was unconstitutional. However, a stay on same-sex marriage issued by a lower court ruling kept same-sex couples from legally marrying in California until 2 days after the case was reviewed by the U.S. Supreme Court who ruled on June 26, 2013 that the defenders of Prop 8 did not have legal standing to bring the case to trial in the first place. As of June 28th same-sex couples have been able to get legally married in California, although a new court case against same-sex marriage has been accepted by the California State Supreme Court.
February 6, 2012: California Gay Marriage Case May Be Headed to Supreme Court
http://www.bloomberg.com/news/2012-02-07/california-s-gay-marriage-ban-ruled-unconstitutional-by-u-s-appeals-court.htmlJuly 16, 2013: Gay Marriage Foes Lose State Supreme Court Plea
http://www.mercurynews.com/samesexmarriage/ci_23664796/gay-marriage-foes-lose-state-supreme-court-plea.htmlStates With Other Forms of Relationship Recognition
The following states offer Civil Unions which come with most of the rightsof civil marriage: Hawaii, Illinois, and New Jersey. It is important tonote that Civil Unions were a separate and unequal form of relationships recognition available only to same-sex couples as a substitute for full marriage equality. Thus far, every state that enacted Civil Unions and then legalized same-sex marriage has then chosen to dissolve the availability of “civil unions.” Those states have either upgraded the same-sex couples civil union to marriage or has required them to then seek a marriage license and dissolved the civil union.
Domestic partnerships vary by state with regards to the number of relationship rights and whether or not opposite-sex couples are also entitled to engage in the statewide domestic partnership registry. Domestic parternships are available to same-sex couples in the following states: California, Maine, Maryland, Nevada, Oregon, Washington, Washington, DC, and Wisconsin. As of July 1, 2013, domestic partnerships continue to be available to same-sex couples even in states that have legalized same-sex marriage with the exception of Washington state. After June 30, 2014, domestic partnerships in Washington will only be available to couples in which one partner is sixty-two years of age or older.
California Secretary of State FAQs about Domestic Partnership Registry
http://www.sos.ca.gov/dpregistry/faqs.htmUpdated map of the U.S. with legal same-sex marriage
http://en.wikipedia.org/wiki/File:Samesex_marriage_in_USA.svgRelationship Recognition Around the World
As of June 1, 2013, the 13 following countries have marriage equality for same-sex couples: Argentina, Belgium, Brazil, Canada, Denmark, France, Iceland, the Netherlands, Norway, Portugal, South Africa, Spain and Sweden. Same-sex marriage is performed in some jurisdictions in Brazil and Mexico. Uruguay (August 1, 2013) and New Zealand (August 19, 2013) will have equal marriage for same-sex and different sex couples.
There are at least 24 more countries that allow for Civil Union and Registered Partnerships. Spain, Canada, Belgium, the Netherlands, South Africa, Iceland, Sweden, and many other countries grant their citizens the right to sponsor a same-sex partner for the purposes of immigration, however, at this time, the United States does not recognize the same-sex spouse or partner of an American citizen for the purposes of immigration.
Adoption
LGBT people and same-sex couples have experienced discrimination in the area of adoption. For example, until recently gay men and lesbians were forbidden from adopting children in the state of Florida. In 1977, the Florida Legislature, influenced by the anti-gay rhetoric and fear tactics of the “Save Our Children” campaign, passed a bill in 1977 which legally denied “homosexuals” the right to adopt. The bill was to remain in effect for 33 years. In November, 2008, the law was overturned by a state circuit court Judge who ruled that denying LGBT people and same-sex couples the right to adopt was unconstitutional and that there was “no rational basis to prohibit gay parents from adopting.” As it is with many cases for LGBT equality, this case was appealed and the ban against gay adoption was not lifted until September 2010. Discrimination against gay parents continues in other states and in other countries.
To read more on discrimination against same-sex parents adopting go to: http://en.wikipedia.org/wiki/Gay_adoption#
B. Challenges of LGBT Youth
According to several studies, gay, lesbian, and bisexual youth are 8.4 times more likely than their heterosexual counterparts to attempt suicide (Ryan, C.,Huebner, D., Diaz, R.M., and Sanchez, J. (2009). Additionally, gay youth are more likely to be bullied and because of that to be at greater risk for depression, anxiety disorders, and school failure (National Mental Health Association, 2002). Ryan et. al. (2009) also suggest that LGBT teens are nearly 6 times more likely to experience significant symptoms of depression and more than 3 times more likely to engage in high-risk behaviors. In his 1999 study on teenagers who are gay or bisexual, Garofalo found “that these young people are more likely to engage in other high risk behaviors: alcohol consumption, drug and tobacco use and sexual activities with multiple partners.” Russell’s study in 2001 confirmed Garofalo’s findings that gay teens have a higher incidence of depression and substance abuse. According to Russell, these youth are “not having their emotional needs met, so they’re using and abusing substances.” Russell extrapolated from his findings that gay teens are “literally self-medicating.”
Ryan, C., Huebner, D., Diaz, R.M., and Sanchez, J. (2009).Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults. Pediatrics Vol. 123, No. 1., pp. 346 -354.. (doi: 10.1542/peds.2007-3524)
Russell, S. (August 2001) Gay and Lesbian Youths At Greater Risk for Suicide, American Journal of Public Health.
Garofalo, R. (May 1999) Archives of Pediatric and Adolescent Medicine.
Gibson, P. (1989) Secretary’s Task Force on Youth Suicide, National Mental Health Association
Landau, E. (2010). “For LGBT teens, acceptance is critical.” http://www.cnn.com/2010/HEALTH/12/06/lgbt.teens.punishment.problems/index.html Retrieved 2-16-12.
C. Challenges LGBT Seniors Face
As is noted in Why You Should Give a Damn about Gay Marriage and Love Warriors: The Rise of the Marriage Equality Movement and Why It Will Prevail,LGBT seniors face a unique set of challenges that their non-gay peers do not. LGBT seniors are often not able to live with their partners in retirement homes who do not allow unrelated or unmarried people to share an apartment. Most retirement homes are connected with religious affiliations that are not welcoming to gays. LGBT people are denied spousal benefits such as social security survivor’s benefits, pensions, and healthcare of a deceased spouse, all benefits afforded heterosexual surviving seniors. According to the Pride Senior Network, the Minnesota Board on Aging, and Senior Action in a Gay Environment LGBT seniors suffer poorer medical care because they are 1) less likely to go to a physician for fear of having to explain who they are who their partners are because they don’t want to get substandard medical care, 2) there is documented proof that physicians express a bias and make disparaging remarks about LGBT patients, and 3) LGBT people have been neglected or received sub-standard care by homophobic physicians (Kotulski, 2004 and 2010).
D. HIV/AIDS
HIV/AIDS was first thought of as a “gay disease,” some called it the “gay plague” and attributed it to God’s punishment for homosexual behavior. In the U.S., the disease was noticed when gay men in the largest metropolitan areas were coming down with opportunistic infections like Kaposi’s Sarcoma (KS), a rare form of cancer that tended to occur in older people, and Pneumocystis carinii pneumonia (PCP), a rare lung infection.
People knew very little about the disease and many, including a doctor for the CDC, thought that only homosexuals were at risk for the disease. The disease had many different names in the early eighties GRID, (gay-related immune deficiency), AID (acquired immunodeficiency disease) and then finally it was defined and designated as AIDS (Acquired Immune Deficiency Syndrome). It was at this point that the transmission through sexual contact was identified. Then, gradually people began to learn of transmissions via blood. There continued to be much misinformation about the spread of AIDS. Many people thought it could be transmitted through handshakes, kissing, or simply touching an infected person.
According to the CDC Website “Nearly 25 years after the first report of a handful of cases of a nameless deadly disease among gay men in New York and Los Angeles, there are still over 1 million persons living with HIV in the United States. About one-fourth of those with HIV have not yet been diagnosed and are unaware of their infection. The “new” syndrome discovered 25 years ago has become one of the deadliest epidemics in human history, killing more than 25 million people around the world, including more than 500,000 Americans.” http://www.cdc.gov/hiv/spotlight.htm