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At a time when lesbian, gay, bisexual, and transgender individuals-often referred to under the umbrella acronym LGBT-are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.

Examining trans- healthcare as a key site through which struggles for health and justice take shape Over the past two decades, medical and therapeutic approaches to transgender patients have changed radically, from treating a supposed pathology to offering gender-affirming care. Based on ethnographic fieldwork in New York City and Buenos Aires, Care without Pathology moves across the Americas to show how trans- health activists have taken on the project of depathologization. In New York, Christoph Hanssmann examines activist attempts to overturn bans on using public health dollars to fund trans- health care. In Argentina, he traces how trans- activists marshaled medical statistics and personal biographies to reveal state violence directed against trans- people and travestis. Hanssmann also demonstrates the importance of understanding transphobia in the broader context of gendered racism, ableism, and antipoverty, arguing for the rise of a thoroughly coalition-based mass mobilization. Care without Pathology highlights the distributive arguments activists made to access state funding for health care, combating state arguments that funding trans- health care is too specialized, too expensive, and too controversial. Hanssmann situates trans- health as a crucible within which sweeping changes are taking place-with potentially far-reaching effects on the economic and racial barriers to accessing care.

Minority status in the United States often accompanies diminished access to education, employment, and subsequently health care. This volume explores factors that have contributed to health disparities among racial, ethnic, and sexual minorities.

“This is an excellent text for master’s and doctoral program multicultural/diversity courses. It is time that mental health professionals reach out to further understand the LGBTQI+ community, and this book, written with empathy, knowledge, and wisdom, is a strong addition to the field.” —Catherine B. Roland, EdD, LPC, NCC President, American Counseling Association 2016–2017 “This is the logical ‘next’ book on counseling with LGBTQI+ people written by a new generation of LGBTQI+ authors and researchers. These new voices offer a fresh vision of where the LGBTQI+ community is at this point in history, and give a road map to current issues and interventions that are being used to help LGBTQI+ people.” —Mark Pope, EdD Former President, American Counseling Association Curators’ Distinguished Professor, University of Missouri–Saint Louis

Jennie Kermode MA (hons) MRes is Chair of Trans Media Watch and author of Transgender Employees in the Workplace: A Guide for Employers. She has written for The Independent, The New Statesman, Pink News and New Internationalist. She lives in Paisley, UK.

Background Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals’ lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes. Methods Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting. Results 75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial ( n  = 1), quasi-experimental pretest–posttest without control ( n  = 39), posttest only with control ( n  = 1) and posttest only without control ( n  = 3). Training modalities were multiple modalities with ( n  = 9) and without simulation ( n  = 25); single modality with simulation ( n  = 1); and with didactic lectures ( n  = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health ( n  = 28, effect size range = 0.28 – 1.49), (2) skills to work with LGBTQ + clients ( n  = 8, effect size range = 0.12 – 1.12), (3) attitudes toward LGBTQ + individuals ( n  = 14, effect size range = 0.19 – 1.03), and (4) behaviors toward LGBTQ + affirming practices ( n  = 7, effect size range = 0.51 – 1.11). Conclusions The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals’ cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.

Background Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. Methods We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. Results We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed ( n  = 137; 92%), believed training should be mandatory ( n  = 141; 94%) and were willing to engage in more training ( n  = 138; 92%). Around half believed their physiotherapy program ( n  = 80, 54%) and clinical placements ( n  = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors ( n  = 69, 46%) and clinical instructors ( n  = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most ( n  = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). Conclusions Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.

The Modern Clinician’s Guide to Working with LGBTQ+ Clients is a ground-breaking resource for therapists working with LGBTQ+ clients whose identity expressions span all gender-, sex-, and relationship-diverse groups. Combining the author’s extensive clinical experience with contemporary evidence-based research, the chapters of this book explore the origins and development of sexual minority groups, going beyond lesbian women and gay men to include transgender and gender nonbinary people, kink and polyamory, bisexuality and pansexuality, and those who identify as asexual or aromantic. The text also offers in-depth coverage of clinical work with transgender, gender-nonconforming, and nonbinary clients of all ages. With a wealth of therapeutic strategies and case studies, this resource helps professionals respond to this ‘Big Tent’ community in an informed and empathetic way. Spanning sexuality, gender, relationships, and age groups, The Modern Clinician’s Guide to Working with LGBTQ+ Clients is an invaluable reference for psychotherapists in a broad range of clinical settings.

Putting the ethical tools of philosophy to work, Ellen K. Feder seeks to clarify how we should understand \"the problem\" of intersex. Adults often report that medical interventions they underwent as children to \"correct\" atypical sex anatomies caused them physical and psychological harm. Proposing a philosophical framework for the treatment of children with intersex conditions-one that acknowledges the intertwined identities of parents, children, and their doctors-Feder presents a persuasive moral argument for collective responsibility to these children and their families.

Pourquoi les personnes LGBT sont-elles plus à risque de subir des violences sexuelles ? Comment réagissent-elles à ces agressions ? Quels sont leurs besoins ? Et quelle aide leur est alors offerte ? À partir d’une recherche menée d’une part auprès de victimes relatant leurs expériences, en particulier quand elles ont cherché du soutien, et d’autre part auprès d’organismes d’aide aux victimes, les auteurs font le constant suivant : le sexe, le genre et l’orientation sexuelle des gens font parfois en sorte qu’ils ne reçoivent pas l’attention ou les services requis. Sont par conséquent proposées des solutions imaginatives, tablant sur une collaboration accrue entre organismes LGBT et organismes d’aide aux victimes.