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Lesbian, Gay, and Bisexual (LGB) Veterans

"If you are not personally free to be yourself in that most important of all human activities... the expression of love... then life itself loses its meaning."
Harvey Milk
~ Navy Veteran and Politician ~

Basics

LGB Veterans Basics

  • Lesbian, gay, bisexual, and straight/heterosexual are terms that people use to identify their sexual orientation. Everyone has a sexual orientation. Lesbian, gay, and bisexual (LGB) people, the topic of this mini-clinic, experience same-sex attractions instead of or in addition to other-sex attractions.
  • Some lesbian, gay, bisexual, and heterosexual people also identify as transgender or gender non-conforming, which means they have a different identity than what is associated with sex assigned at birth. The information here includes LGB people who are both transgender and cisgender (non-transgender). For information specific to transgender people, explore the Transgender Mini-Clinic.
  • An estimated 1 million gay and lesbian Americans are Veterans (approximately 2.8%) with 65,000 gay and lesbian active duty service members. Women are overrepresented among LGB Veterans with an estimated 2.9% active-duty women who identify as lesbian/bisexual compared to 0.6% of active-duty men who identify as gay/bisexual. Women make up only 15% of active-duty personnel.1
  • LGB people are motivated to join the military for similar reasons to their heterosexual peers – patriotism, life direction, and a family history of service. Some LGB people additionally join the military to escape family rejection or violence.
  • Department of Veterans Affairs (VA) serves LGB Veterans2 and specifically has current non-discrimination policies to protect LGB Veterans when they seek care.

1 Gates, 2010.
2 Kauth & Shipherd, 2016.

Healthcare Considerations

Healthcare Considerations

  • LGB people have a long history of military service, but have only been able to serve openly since 2011 when the Don’t Ask, Don’t Tell (DADT) was repealed. LGB service members and Veterans have organized to support each other via a number of service organizations over the years, including the Coalition of Gay Service People, OutServe – Service Members Legal Defense Network, Service Academy Gay & Lesbian Alumni Association Network, Alexander Hamilton Post 448, and American Veterans for Equal Rights. The Department of Veterans Affairs (VA) served LGB Veterans despite DADT. Nevertheless, the history of military discrimination continues to impact LGB Veterans’ impression of inclusivity at the VA.
  • Assessing sexual orientation and comfortably integrating these identities into care with all Veterans is important to positive health outcomes. Currently only a minority of LGB veterans have open conversations with their providers about their identity.
    • Among LGB Veterans, 62% said that none of their providers had asked about sexual orientation.1 Of providers who know Veterans’ sexual orientation, 43% do not discuss sexual orientation even when it is relevant to healthcare.2 Indeed, the majority of VA providers in one study (79%) reported that they would rarely, if ever, talk about sexual orientation with Veterans.3
    • These findings are similar to providers outside the VA, where medical personnel report 80% of patients will be offended by asking about sexual orientation, whereas only 11% of patients say that they will be offended.
    • Interestingly, Veterans are actually more likely to answer questions about sexual orientation on surveys than non-Veterans.4
  • LGB Veterans may have experienced rejection from both other Veterans and from anti-military LGB civilian groups. LGB Veterans generally benefit from social connections, and reducing isolation and avoidance can be particularly important. Whether connected to individuals or groups, other LGB Veterans can provide a sense of shared experience.5 Many VA facilities offer support groups for LGB Veterans.
  • Additionally, many LGB people assemble a “chosen family”6 as a response to experiences of rejection. “Chosen family” members are a source of resilience and strength in LGB life and should be respected and integrated by providers into work with LGB Veterans. Importantly, VA policy recognizes families of choice in its visitation policies.
  • LGB Veterans’ racial and ethnic identities, socioeconomic status, religious or spiritual affiliation, age cohort, disability status, and era of service, among other characteristics, are also important social aspects of identity that impact Veteran experience, worldview, and treatment, and should be integrated into treatment.
  • Assessing one’s own biases about LGB people is an essential component of providing LGB-affirmative care. 7 Questions to ask yourself include:
    • Do I make assumptions that everyone is heterosexual/straight unless told otherwise?
    • Do I feel LGB identities are as valid as a heterosexual identity?
    • Do I feel nervous when a client talks about their LGB identity or same-sex relationships?
    • How do I feel about same-sex marriage?
    • Do I have any stereotyped beliefs about LGB people (such as, “gay men are promiscuous,” “lesbian women hate men,” “bisexual people are experiencing a temporary phase”)?
    • Do I feel sorry for or feel pity for LGB people?
  • Conversion or reparative therapy is a practice which assumes same-sex attraction is pathological. Conversion therapy is ineffective and has been shown to cause harm, including increasing suicidality. These practices are unethical and illegal in several jurisdictions and are prohibited at VA. 8
  • Veterans who were dishonorably discharged under DADT or prior regulations regarding sexual orientation face the burden of upgrading their discharge with the Department of Defense in order to access Veteran benefits. Veteran’s service organizations can assist with this process. See OutServe-SLDN’s Discharge Upgrade Process for further information.

1 Sherman, Kauth, Shipherd, & Street, R. 2014a.
2 Simpson, et al., 2013.
3 Sherman, Kauth, Shipherd, & Street, 2014b.
4 Ruben, Blosnich, Dichter, Luscri, & Shipherd, 2017.
5 Anderson & Smith, 1993; [LINK].
6 Weston, 1997.
7 Kapila, 2014.
8 Department of Veterans Affairs, 2017; [LINK].

Health Disparities among LGB Veterans

Health Disparities among LGB Veterans

  • Research has shown that stigma influences health, including social relationships, coping behaviors, and access to resources.1 Minority stress is a concept that describes how sexual minority health disparities can be explained in large part by stressors induced by a hostile, homophobic culture, which often results in a lifetime of harassment, maltreatment, discrimination and victimization and may ultimately impact access to care. 2 , 3
  • Some stressors experienced by LGB people include encounters with homophobia, divisions within LGB communities (include experiences of biphobia, sexism, racism, etc.), vigilance to danger in a homophobic world, lack of family support in the face of homophobia, and a sense of shame or negativity about their LGB identity.4
  • LGB Veterans face increased health disparities in comparison to both their LGB civilian and heterosexual Veteran peers due to the increased stress related to being a member of a minority group.
    • LGB Veterans experience lower overall health status and rates of routine and preventive care, as well as higher rates of smoking, alcohol and substance abuse, discrimination, stigma, exposure to physical/sexual violence, trauma experiences, HIV, STIs, asthma, some cancers, and risk for mental illnesses. 5 , 6 , 7 , 8 This includes LGB Veterans’ increased rates of PTSD and depression.
    • Anxiety and concealment of one’s sexual orientation while in the service has been linked to PTSD and depression. 9
  • LGB Veterans are at higher risk for suicide compared with heterosexual Veterans.10 Integrating suicide assessment and safety planning are important components of treatment. The Veteran’s Crisis Line (1-800-273-8255, press 1) provides phone counseling as well as online chat.
  • Assessing and discussing sexual health is important for all people. Gay and bisexual men (and other men who have sex with men) are disproportionately affected by HIV and STIs. Of particular note, recent medical advances have allowed a more effective option for preventing HIV infections through the use of Pre-Exposure Prophylaxis (PrEP). It is essential to discuss safer sex practices in a non-shaming way with LGB people with multiple partners or with HIV positive partners without consistent condom use and educate them on their options to protect themselves. See the Online Education and Resources section for additional information on assessing sexual health.
  • Promoting resilience among LGB people is essential. Some examples include:
    • Seeing their experience as fitting into the context of LGB communities/movements and history
    • Promoting alternatives to shame and negativity about their LGB identity
    • Openly expressing and validating emotions
    • Having social connections that validate the painful emotions that can happen after experiences of homophobia
    • Connecting to LGB communities4
  • DADT may have contributed to LGB Veterans being unable to report physical and sexual abuse they experienced while serving and prevented them from seeking support afterward. 11 It is important to provide LGB affirmation and follow your Veteran’s lead with regard to if, when, and how they feel comfortable “coming out,” or disclosing their sexual and/or gender identity.12 Lesbian and bisexual women Veterans serving in the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) era are more likely to have experienced both military and childhood sexual trauma than heterosexual women.13
  • Intimate partner violence (IPV) among LGB people has historically been inadequately recognized and addressed. Bisexual women are at particular risk of experiencing IPV.14 LGB populations may also be less likely to report their experiences of IPV.

1Hatzenbuehler, Phelan, & Link, 2013; [LINK].
2 Marshal et al., 2008.
3 Meyer, 2003.
4 Russell & Richards, 2003; [LINK].
5 Lehavot & Simpson, 2014.
6 Blosnich, Foynes, & Shipherd, 2013.
7 Blosnich, Farmer, Lee, Silenzio, & Bowen, 2014.
8 Blosnich & Silenzio, 2013.
9 Cochran, Balsam, Flentje, Malte, & Simpson, 2013; [LINK].
10 Blosnich, Mays, & Cochran, 2014; [LINK].
11 Burks, 2011; [LINK].
12 Johnson, Rosenstein, Buhrke, &Haldeman, 2015; [LINK].
13 Mattocks, et al., 2013; [ LINK].
14 Brown & Herman, 2015; [LINK].

VA Services, Education, and Resources

VA Services, Education, and Resources

VA has made significant strides in assuring LGB Veterans have access to quality care. Most VA facilities have a LGBT Veteran Care Coordinator. This person serves as a point of contact for LGBT Veterans in order to facilitate referral to any LGBT-specific services that may be offered, provide information and advocacy with regard to LGBT-inclusive VA policy, and facilitate improvements in clinical care for LGBT Veterans

Online Education and Resources

Useful Resources



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