LGBTQ People, Intersectionality, and Chronic Illness and Disability: Increasing Cultural Competence of Sevice Providers

Chapter Highlights

• 1.

  Societal perceptions toward LGBTQ people in general and perceptions regarding LGBTQ people with chronic illness and disabilities.

• 2.

  Discrimination and stigma toward LGBTQ people.

• 3.

  The effects of discrimination and stress on LGBTQ people’s mental well-being.

• 4.

  Additional challenges and discrimination of LGBTQ BIPOC members in employment, service delivery, and in the LGBTQ community.

• 5.

  Cultural aspects of the LGBTQ community and strategies service providers can use to improve cultural competence when working with LGBTQ people with and without disabilities.

Learning Objectives

Upon completion of this chapter, the reader should be able to:

• 1.

  Identify intersectional implication for LGBTQ people with chronic illness and disabilities,

• 2.

  Identify psychosocial challenges for LGBTQ people with chronic illness and disabilities,

• 3.

  Identify behavioral and cultural competencies of service providers on the social, vocational, and well-being of LGBTQ people with chronic illness and disabilities, and

• 4.

  Identify strategies for service providers to be inclusive of LGBTQ people in service.

Introduction

LGBTQ (lesbian, gay, bisexual, transgender, queer or sometimes questioning) and others is an umbrella term including two distinct aspects of identity: sexual orientation and gender identity. Sexual orientation describes a person’s sexual or romantic attraction for relationships with people of the same sex, the other sex, or both sexes, whereas gender identity refers to an individual’s personal sense of having a particular gender (being male, female, or something else). Gender identity is internal and is not necessarily visible to others. In addition, “gender expression and gender role conformity further describe the extent to which a person does or does not adhere to expected gender norms and roles” (Kates et al., 2018, p. 2). However, it is important to understand that, as an identity label, sexual orientation may not correspond to the full range of a person’s sexual behavior. Moreover, one should not assume that all LGBTQ persons use identical language to refer to themselves, their pronouns, and their relationship partners (Margolies et al., 2019). The service provider/provider (i.e., counselor, clinician, therapist, social worker, medical staff, practitioner) should listen to the client and follow their lead, and when in doubt, ask the individual how they or their partner should be described (Ehrenfeld et al., 2019). The LGBTQ community consists of a cross-cultural, broad range of community members and includes all races and ethnic backgrounds, religious affiliations, socioeconomic status, disability diversity, and intersectional social positionalities (Bass & Nagy, 2022).

Worldwide, 1.6% of men identify as homosexual and 0.9% as bisexual. For women, 0.8% identify as lesbian and 1.4% as bisexual (Varrella, 2021). According to the 2021 Gallup survey, 18 million (7.1%) of adults in the United States identify as LGBTQ. Of these, more than half of LGBT adults (57%) identify as bisexual, about a quarter (21%) as gay, with 14% identifying as lesbian and 10% as transgender. Another 4% identify with another non-heterosexual term to describe their sexual orientation, such as queer or same-gender-loving. LGBTQ identification has been stable in older generations and rising in younger generations, with Generation Z nearly doubling since 2017, when only the leading edge was born between 1997 and 1999 (Jones, 2022). Individuals identifying as LGBTQ by birth cohort indicate an increase for each subsequent generation. Traditionalists (1913-1943) account for 1.4% LGBTQ, Baby Boomers (1946-1964) 2.4%, Generation X (1965-1979) 3.2%, and Millennials (1989-1998) 7.3%. Also, increases in LGBTQ identification are more pronounced in women than men and Black, Indigenous, People of Color (BIPOC) than Whites (Gates, 2017).