An ecological analysis of hope amongst Asian rainbow young people in Aotearoa New Zealand

Rainbow research tends to prioritise gender and sexuality experiences over the racialised experiences of Asian rainbow young people. Informed by an intersectional lens, we employed a hope-based ecological framework to examine how multiple overlapping axes of oppression (e.g. cisgenderism, heterosexism and racism) shape the aspirations of these youth. We drew on the voices of Asian participants from the 2021 Aotearoa New Zealand Identify Survey, who had responded to an open-text question on their hopes for rainbow young people (n = 217; age range = 14 to 26). The content analysis identified seven prominent categories of hope across three ecological levels (macro exo and meso). These categories were societies: 1) break away from cisheterosexist expectations; 2) confront racism and intersection with cisheterosexism; 3) promote rainbow-inclusive education; 4) ban sexual orientation and gender identity change efforts; 5) improve access to culturally safe health care; 6) dismantle white-dominated rainbow spaces; and 7) provide more rainbow-inclusive family support. These hopes were constructed amidst the desire to challenge unacceptance and exclusion by the wider society for not adhering to white cisheterosexist expectations. The study provides critical insights for community organisations, education settings, and government to consider in addressing the diverse needs of Asian rainbow young people.

Associations between water insecurity and mental health outcomes among lesbian, gay, bisexual, transgender and queer persons in Bangkok, Thailand and Mumbai, India: Cross-sectional survey findings

Background

Water insecurity disproportionally affects socially marginalized populations and may harm mental health. Lesbian, gay, bisexual, transgender and queer (LGBTQ) persons are at the nexus of social marginalization and mental health disparities; however, they are understudied in water insecurity research. Yet LGBTQ persons likely have distinct water needs. We explored associations between water insecurity and mental health outcomes among LGBTQ adults in Mumbai, India and Bangkok, Thailand.

Methods

This cross-sectional survey with a sample of LGBTQ adults in Mumbai and Bangkok assessed associations between water insecurity and mental health outcomes, including anxiety symptoms, depression symptoms, loneliness, alcohol misuse, COVID-19 stress and resilience. We conducted multivariable logistic and linear regression analyses to examine associations between water insecurity and mental health outcomes.

Results

Water insecurity prevalence was 28.9% in Mumbai and 18.6% in Bangkok samples. In adjusted analyses, in both sites, water insecurity was associated with higher likelihood of depression symptoms, anxiety symptoms, COVID-19 stress, alcohol misuse and loneliness. In Mumbai, water insecurity was also associated with reduced resilience.

Conclusion

Water insecurity was common among LGBTQ participants in Bangkok and Mumbai and associated with poorer well-being. Findings signal the importance of assessing water security as a stressor harmful to LGBTQ mental health.

Socio-sexual norms and young people's sexual health in urban Bangladesh, India, Nepal and Pakistan: A qualitative scoping review

In South Asia, young people face myriad challenges and opportunities regarding their sexual lives relating to varied experiences of norms and restrictions; gender norms and socio-sexual taboos limit communication around sexual health which in turn can affect sexual health outcomes. In this article we focus on norms affecting young people's sexual health experiences in urban settings in Bangladesh, India, Nepal, and Pakistan. We conducted a scoping review of peer reviewed empirical studies based on qualitative data pertaining to young people's experiences of sexuality and sexual health in Bangladesh, India, Nepal, and Pakistan. We searched four electronic databases for articles published (2010-2022), using terms relating to sexual health, young people, and South Asia. Sixteen articles met the inclusion criteria with sample size ranging from 9 to 180. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for the design and analysis of this study. We synthesised the included articles using thematic analysis. The studies covered topics such as sexual health services and contraceptive use; sexuality education and communication; and gender and sexual violence. Recurring findings included: parental and societal expectations around premarital 'sexual purity' through abstinence; limited communication around sexuality between young people and parents/adults; gender norms limiting young women's sexual and reproductive decision making; and an absence of research on experiences of sexual and gender minorities. We identified common themes as well as prominent gaps which must be addressed if we are to capture diverse experiences and build a better evidence base to improve sexual health services for young people in the region. The body of research fails to include experiences of young people with diverse gender, sexual orientation, and sex characteristics.

'Coming out'/self-disclosure in LGBTQ+ adolescents and youth: International and Indian scenario - A narrative review of published studies in the last decade (2012-2022)

Background

People who identify themselves as Lesbian, Gay, Bisexual, Transgender, Queer, and others (LGBTQ+) go through a process of self-exploration and self-identification during adolescence, and the process resolves when one decides to self-disclosure. The experience of 'Coming Out' (CO) can be positive, leading to acceptance and a feeling of liberation, or it can be harmful, leading to stigma, humiliation, and discrimination, subsequently leading to significant psychological distress.

Aim

This study was to do a narrative review on the studies published in the area/topic of CO in youth in the last decade (2012-2022) and to look for factors that act as barriers and facilitators of CO. Additionally, we have tried to look for differences in CO in LGBTQ+ adolescents and youth in the Western world vis-a-vis Indian/Eastern societies.

Materials and Methods

An extensive literature search in electronic databases, PUBMED, Web of Science, EMBASE, Medline, Scopus, and search engine 'Google Scholar' using specific search terms and assessment of all published articles until 20th May 2023 was done.

Results

Twenty-three studies were found eligible for data extraction, which discussed the problems faced during the CO process. Most of the studies are from developed countries, and only one is from India. Eleven were qualitative studies, 11 were cross-sectional studies, and one was a case study. The qualitative studies focused on generating themes of CO along with various issues/problems faced by the participants. The cross-sectional studies mainly explored parental reactions, stigma, parental support, psychological distress, and perceived stress in the participants. Major themes emerging from the qualitative studies were the experience of prejudice from various strata of society, such as parental, societal, racial, cultural, and religious factors that lead to problems of hiding, internalized homophobia, and anticipatory rejections that put this population under extreme conditions. Limited research is available from Eastern societies. More recently, the new generation of adolescents has taken the help of social media platforms for self-disclosure.

Conclusions

CO is an elaborate multi-step process that considers the presence of parental/family and societal support, cultural/traditional values, and several psychosocial factors that determine the degree of positive outcomes. Emerging data indicated an improved trend of adolescents deciding to come out to families or in online platforms, both of which are associated with challenges, more in eastern collectivistic societies and developing countries.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

Pride or Closet? Unpacking Experiences of Minority Stress, Coping, and Resistance among Gender and Sexual Minorities in India

In India, sexuality has long been a silent battleground, which has led to the legal acceptance of non-heteronormative practices in recent years. Given the risk of facing difficulties and social discrimination, questions may arise on the consequences of revealing non-heteronormative gender identity and sexual orientation. Using data from a two-year qualitative immersive study on the queer individuals in India and extant theories on Concealed Stigmatized Identity and Minority Stress, we explore the dynamics of disclosure, or "Coming-out of the closet" and construct a narrative on their lived experiences of stress and coping associated with marginal gender identity. Thematic analysis reveals that informants elaborate, borrow, and adapt perceptions and experiences of denial and loss of agency as queer individuals. Disclosure and Coming-out help them to find the "safe others." The findings indicate that this kinship and entitativity result in measurably higher well-being, happiness, and meaning in life. We conclude that rising above the minority stress can be the beginning of endless possibilities in different spheres of life for gender and sexual minorities. Participants' narratives unpack the embodied and contextual stereotypes and taboos and the precarity of living with non-normative identities. The paper makes a compelling argument that coping with gender marginalization, vulnerability, and loss of dignity can be achieved through a sense of purpose and meaning.

Enabling Young People from Informal Urban Communities to Exercise Their Right to Sexual and Reproductive Health: A Practice-Based Study

This qualitative study explores how comprehensive sexuality education located within a broader positive youth development approach informed transformations among young people from informal urban communities in India. A thematic analysis of data obtained from the young people, their parents, and frontline workers revealed that securing the cooperation of families was possible for the program because sexual and reproductive health education was not a stand-alone intervention, but a part of a larger approach seeking to build capacities of young people. The strategic introduction of sexual and reproductive health communication helped the participants to overcome inhibitions about the topic. Enhanced awareness of gender, pubertal changes, gender-based violence, and child sexual abuse was evidenced post participation. Improved agency was manifest through decision making, critical thinking, confidence, mobility, and articulation, especially among girls. Program interventions to enhance sexual and reproductive health awareness of parents and communities and to improve health services and facilities were bolstered through youth engagement. Such contribution by the young reinforced their knowledge and skills, strengthened agency, and cemented family and community support. A holistic program situated within the positive youth development approach thus seemed a pragmatic vehicle to promote comprehensive sexuality education for young people in vulnerable urban communities.

An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts)

BACKGROUND

Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health-recommended protective measures.

OBJECTIVE

We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect.

METHODS

SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor-delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern.

RESULTS

The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022.

CONCLUSIONS

The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34381.

“Their Untold Stories…”: Lived Experiences of Being a Transgender (Hijra), A Qualitative Study From India

Background: Transgender is an umbrella term, used to encompass people who have a gender identity or gender expression, which differs from their sex assignment at birth. Being independent of sexual orientation, they have often been classified as the “third sex.” Based on various sociocultural traditions and beliefs, they are frequently “othered,” discriminated, and stigmatized against. This has led to their limited social inclusion and participation. In the social diversity of a populous country like India, transgenders are termed as “hijra’s,” belonging to a separate social community. Their experiences, perceptions, and unmet needs are rarely evaluated.

Methods: Qualitative approach was used to explore the “lived experience” of 4 individuals who are part of the “hijra” community in Kolkata. These individuals were born with ambiguous primary sex characteristics. In-depth interview was conducted with these participants with subsequent transcription. Interpretative phenomenological analysis (IPA) was used for analysis.

Results: A total of 2 superordinate themes (identity issues, relationship issues) and 6 subordinate themes emerged from the analysis (identification with feminine gender, perceptions regarding caregivers, perception regarding siblings, perception regarding childhood peer groups, identification with the hijra community, societal rejection). The findings have been discussed in terms of identity process, social and cultural construal of hijras in this part of the world.

Conclusion: In India, the transgenders (hijra community) represent a unique subculture besides the heterosexual groups. Understanding their relationships, sexuality and societal interactions are vital for their psychosocial well-being and related interventions. This study adds to the shared understanding of their marginalization and lived experiences, in their own voices.