Veterans with Lesbian, Gay, Bisexual and Queer Identities
An estimated 1 million gay and lesbian Americans are Veterans (approximately 2.8%) with 65,000 gay and lesbian active duty Service members. The information here focuses on lesbian, gay, bisexual, and queer (LGBQ) people who are cisgender (non-transgender). For information specific to transgender people, explore the transgender Veteran section.
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 LGBQ 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
LGBQ people are motivated to join the military for similar reasons to their heterosexual peers – patriotism, life direction, and a family history of service. Some LGBQ people additionally join the military to escape family rejection or violence.
Department of Veterans Affairs (VA) serves LGBQ Veterans2 and specifically has current non-discrimination policies to protect LGBQ Veterans when they seek care.
1Gates, 2010; 2 Kauth & Shipherd, 2016
A Marine Veteran opens up about his identity
Tim served in the Marines under “Don’t Ask, Don’t Tell.” The pressure of hiding his identity led to stress, isolation, and heavy drinking. He knew he needed to seek help after relationship problems led to substance misuse. Now, Tim is living well as an openly gay Veteran.
Video Source: Make the Connection
LGBQ 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military service, but have only been able to serve openly since 2011 when the Don’t Ask, Don’t Tell (DADT) policy was repealed. LGBQ 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, Modern Military Association of America, Service Academy Gay & Lesbian Alumni Association Network, and American Veterans for Equal Rights. The Department of Veterans Affairs (VA) served LGBQ+ Veterans despite the Department of Defense’s DADT policy. Nevertheless, the history of military discrimination continues to impact LGBQ+ Veterans’ impression of inclusivity at the VA.
Everyone has a sexual orientation. Lesbian, gay, bisexual, and queer (LGBQ) people, the topic of this section, experience same-sex attractions instead of or in addition to other-sex attractions. Some lesbian, gay, bisexual, queer, and heterosexual people also identify as transgender or gender diverse, which means they have a gender identity that differs from their sex assigned at birth. Assessing sexual orientation and comfortably integrating these identities into care with all Veterans is important for positive health outcomes. Currently only a minority of LGBQ+ 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 80% of medical personnel worry that patients will be offended if asked about sexual orientation, whereas only 11% of patients say they might be offended.
Interestingly, Veterans are actually more likely to answer questions about sexual orientation on surveys than non-Veterans.4
While LGB Veterans report discrimination in healthcare, a protective factor is good patient-provider communication which has been shown to buffer against the health risk behavior of tobacco use.
LGBQ+ Veterans may have experienced rejection from both other Veterans and from anti-military LGBQ+ civilian groups. Like most people, LGBQ+ Veterans generally benefit from social connections and reducing isolation and avoidance can be particularly important. Through connection with individuals or groups, LGBQ+ Veterans can gain a sense of shared experience.5 Many VA facilities offer support groups for LGBQ+ Veterans.
Additionally, many LGBQ+ people assemble a “chosen family”6 as a response to experiences of rejection. “Chosen family” members are a source of resilience and strength in LGBQ+ life and should be respected and integrated by providers into work with LGBQ+ Veterans. Importantly, VA policy recognizes families of choice in its visitation policies.
LGBQ+ 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 health care.
Assessing one’s own biases about LGBQ people is an essential component of providing LGBQ+-affirmative care.7 Questions to ask yourself include:
Do I make assumptions that everyone is heterosexual/straight unless told otherwise?
Do I feel LGBQ+ identities are as valid as a heterosexual identity?
Do I feel nervous when a client talks about their LGBQ+ identity or same-sex relationships?
How do I feel about same-sex marriage?
What stereotyped beliefs do I have about LGBQ+ 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 LGBQ+ people?
Conversion or reparative therapy is a dangerous 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.
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 LGBQ+ people include encounters with homophobia, divisions within LGBQ+ communities (including experiences of biphobia, sexism, racism, etc.), vigilance to violence in a homophobic world, lack of family support in the face of homophobia, and a sense of shame or negativity about their LGBQ+ identity.4
LGBQ+ Veterans face increased health disparities in comparison to both their LGBQ+ 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 including intimate partner violence and Military Sexual Trauma, 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 or text support at 838255.
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 sexual transmitted infections (STIs). An effective option for preventing HIV infections is the use of Pre-Exposure Prophylaxis (PrEP). It is essential to discuss safer sex practices in a non-shaming way with LGBQ+ people with multiple partners or with HIV positive partners without consistent condom use and educate them on their options to protect themselves. See the VA Services, Education and Resources section for additional information on assessing sexual health.
Promoting resilience among LGBQ+ people is essential. Some examples include:
Seeing their experience as fitting into the context of LGBQ+ communities, movements and history
Promoting alternatives to shame and negativity about LGBQ+ identities
Openly expressing and validating emotions
Having social connections that validate the painful emotions that can happen after experiences of homophobia or rejection
Connecting to supportive LGBQ+, Veteran, or LGBQ+ Veteran communities4
DADT may have contributed to LGBQ+ Veterans being unable to report physical and sexual abuse experienced while in the military and prevented them from seeking support. 11 It is important to provide LGBQ+ 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 Veterans.13
Intimate partner violence (IPV) among LGBQ+ people has historically been inadequately recognized and addressed.14 Bisexual women are at particular risk of experiencing IPV.15 LGBQ+ populations may also be less likely to report their experiences of IPV.
1 Hatzenbuehler, Phelan, & Link, 2013; 2 Marshal et al., 2008; 3 Meyer, 2003; 4 Russell & Richards, 2003; 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 ;10 Blosnich, Mays, & Cochran, 2014; 11 Burks, 2011; 12 Johnson, Rosenstein, Buhrke, &Haldeman, 2015; 13 Mattocks, et al., 2013; 14Dardis, Shipherd, & Iverson, 2017; 15 Brown & Herman, 2015
VA Services, Education, and Resources
VA has made significant strides in assuring LGBQ Veterans have access to quality care. All VA facilities have a LGBTQ+ Veteran Care Coordinator. This person serves as a point of contact for LGBTQ+ Veterans in order to facilitate referral to any LGBTQ+-specific services that may be offered, provide information and advocacy with regard to LGBTQ+-inclusive VA policy, and facilitate improvements in clinical care for Veterans with LGBTQ+ and related identities.
Online Education and Resources
LGBTQ+ Programs at VA Facilities
Assessing Sexual Health
LGBTQ+ Employment Resource - Pride@Work
Human Rights Campaign’s Healthcare Equality Index - a measure of LGBTQ+ equity and inclusion in healthcare settings. Many VA facilities participate.