PPHC 17: Sex, Gender, Sexuality, and Determinants of 2SLGBTQ+ Health

Question 1

Sex

What is sex?

Answer 1

assigned sex at birth is the physical sex designation someone is given at birth (medical and legal assignments)

• typically based on external physical anatomy
• commonly assigned sexes are female or male

Question 2

Sex

What factors may go into categorizing sex?

Answer 2

chromosome compositions, hormone levels, secondary sex characteristics, water content, fat distribution, etc.

• these factors can change over the course of a person’s life

Question 3

Intersex

What is intersex?

Answer 3

born with anatomy or sex characteristics (such as genitals, hormones, chromosomal patterns) that fall outside of ranges generally assigned female or male

• some intersex people are not aware that they are intersex, while others may realize when they enter puberty or when they try to have biological children
• can be subjected to non-consensual medical procedures that change their anatomy to fit with typical definitions of male and female, experiencing medical trauma as a result

Question 4

Gender

What is gender?

Answer 4

includes, but is not limited to, an individual’s gender identity and gender expression, along with society’s constructed gender norms, roles, behaviours, activities, and attributes

Question 5

Gender

What is gender identity?

Answer 5

person’s understanding of their gender

• separate from assigned sex at birth
• can be fluid
• include woman, man, non-binary, gender-fluid, and agender

Question 6

Gender

How are all identities, not only gender, constructed?

Answer 6

constructed in the context of societal narratives and have cultural contexts that influence how individuals behave, perceive labels, etc.

Question 7

Gender Expression and Gender Roles

What is gender expression?

Answer 7

how one outwardly expresses gender – ie. through name and pronoun choice, style of dress, voice modulation, etc.

• how one expresses gender might not necessarily reflect one’s perceived or actual gender identity – ie. person with a beard presenting at your pharmacy may not identify as male

Question 8

Gender Expression and Gender Roles

What are gender roles?

Answer 8

socially constructed and culturally specific behaviours, such as communication styles, careers, family roles, and more, that are imposed on people based on their biological sex assigned at birth

Question 9

Gender Expression and Gender Roles

How does gender vary among cultures?

Answer 9

• gender interpretations and expectations vary widely among cultures and often change over time
• some cultures have more than two genders, and consequently more than two gender roles

Question 10

Gender Modality

What is gender modality?

Answer 10

how a person’s gender identity stands in relation to their assigned gender or sex at birth

• not everyone uses terms related with gender modality uniformly – some people may choose to claim their gender modality as part of their gender identity, or not

Question 11

Gender Modality

What is transgender?

Answer 11

person’s gender identity does not align with the cultural expectations of their assigned sex at birth

Question 12

Gender Modality

What is cisgender?

Answer 12

person’s gender identity aligns with the cultural expectations of their assigned sex at birth

Question 13

Gender Diversity

What is gender diversity?

Answer 13

all genders together make up the gender diversity of humanity

• gender diversity is not a synonym for transgender or non-binary people

Question 14

Describe the imprecision of sex and gender today.

Answer 14

• society continues to use imperfect or imprecise language to describe sex and gender – ie. use of terms male and female
• in the context of research, what and how data is collected impacts the ways in which we view and experience the world – what we measured (ie. variables) in health and clinical research can have long-term consequences, and findings from research inform policy makers on how they should allocate resources and create policies

Question 15

What is sexuality?

Answer 15

important part of a person’s identity

Question 16

What is sexual orientation?

Answer 16

person’s attraction (or lack thereof) to another person or persons

• include sexual attraction, romantic attraction, aesthetic attraction, etc.

Question 17

Two-Spirit (2S)

What is Two-Spirit?

Answer 17

community organizing strategy or tool, or way to describe one’s self for the Indigenous people of Turtle Island

• this terminology can be used to facilitate Indigenous Peoples’ connections with Nation-specific expressions and roles of gender and sexual diversity

Question 18

Two-Spirit (2S)

In what contexts can 2S be used?

Answer 18

in the context of gender, sexual orientation, or neither

Question 19

Two-Spirit (2S)

How is 2S used in the context of sexual orientation?

Answer 19

2S can be claimed by an Indigenous person who also identifies as LGBTQ+ in the Western context, or as an expression of sexual orientation for an Indigenous person who does NOT identify with Western LGBTQ+ communities

Question 20

Two-Spirit (2S)

How is 2S used in the context of gender?

Answer 20

2S is often claimed by an Indigenous person as a placeholder or an opt-out from the Western gender binary

Question 21

Relationship Structures

What are the different types of relationships?

Answer 21

• monogamy (one partner)
• non-monogamy (not to exclusive to one partner)
• polyamory (more than one partner)
• platonic relationships (intimate relationships without sex or romance)

Question 22

Relationship Structures

Are relationships romantic or sexual

Answer 22

can be both romantic and sexual in nature, only one of the two, or neither

Question 23

Fluidity

Answer 23

• concepts and language around sexual orientation, gender identity and expression are not set in stone
• concepts and labels exist to help people make sense of and describe their experiences and find and build communities – these concepts and labels evolve over time to better serve the communities that use them

Question 24

What are the factors that can result in the underrepresentation of 2SLGBTQ+ people in large-scale surveys?

Answer 24

• research may overlook and exclude 2SLGBTQ+ communities
• research may conflate multiple 2SLGBTQ+ identities
• society may criminalize 2SLGBTQ+ people
• people may feel guilt or shame about their identities
• people may not know enough about 2SLGBTQ+ identities to put a name to their experiences
• people may not feel safe disclosing their identities

Question 25

What are determinants of health?

Answer 25

factors that contribute to a person’s health

Question 26

What are some of the determinants of health? (5)

Answer 26

- biology and genetics – ie. sex, age - individual behaviour – ie. smoking - social environment – ie. discrimination, income, gender - physical environment – ie. air quality - health services – ie. having health insurance

Question 27

What are health disparities?

Answer 27

type of difference in health that is closely linked with social or economic disadvantage

Question 28

Health Disparities What are the physical health disparities among 2SLGBTQ+ individuals?

Answer 28

2SLGBTQ+ individuals often have poorer physical health compared to cisheterosexual counterparts - increased rates of cancer, CV disease, asthma, diabetes, arthritis

Question 29

Health Disparities What are the mental health disparities among 2SLGBTQ+ individuals?

Answer 29

2SLGBTQ+ communities experience higher rates of depression, anxiety, OCD, suicidality, self-harm, and substance use, and twice the risk of PTSD in compared to cisheterosexual peers - 2SLGBTQ+ youth are more likely to struggle with depression and more likely to seriously consider suicide - self-harm: > 50% of gender diverse (TG, NB, questioning) youth in BC cut or injured themselves on purpose in the past year

Question 30

Health Disparities What are the sexual health disparities among 2SLGBTQ+ women?

Answer 30

cisgender lesbian and bisexual women, and women who have sex with women (WSW) are at higher risk of: - breast, ovarian, and endometrial cancers and are less likely to access regular pap testing and HPV vaccines

Question 31

Health Disparities What are the sexual health disparities among 2SLGBTQ+ men?

Answer 31

cisgender gay and bisexual men, and men who have sex with men (MSM) are at greater risk of: - STIs – including syphilis, HPV, hepatitis, HIV

Question 32

Health Disparities What are the sexual health disparities among 2SLGBTQ+ trans, non-binary, and gender-nonconforming clients?

Answer 32

trans, non-binary, gender-nonconforming clients are at higher risk of: - HIV - unintended pregnancies and are less likely to access preventative health services such as STI screening and pelvic exams due to fear of discrimination, discomfort

Question 33

Health Disparities How robust is data on 2SLGBTQ+ populations?

Answer 33

- few large-scale studies have examined the health of 2SLGBTQ+ communities - when interpreting statistics about 2SLGBTQ+ communities, be mindful that terminology used in research questions do not always reflect the language and identities used and claimed by communities – ie. if a survey limits its sexual orientation options to straight, gay/lesbian, and bisexual, which option should a person who does not use any of those labels choose - 2SLGBTQ+ people in Canada are underrepresented and sometimes misrepresented in health research

Question 34

What are the determinants of health that affect 2SLGBTQ+ people?

Answer 34

- income - education - employment - social and community context - health and health care - neighbourhood and built environment

Question 35

Determinants of Health that Affect 2SLGBTQ+ People Income

Answer 35

- higher rates of poverty among bisexuals, trans people - racialized 2SLGBTQ+ individuals are paid less than their cisheterosexual counterparts - white and racialized SGM people have higher poverty rates than same-race cisheterosexual counterparts

Question 36

Determinants of Health that Affect 2SLGBTQ+ People Education

Answer 36

gender diverse youth maybe more likely to be absent if they feel unsafe in a hostile school climate

Question 37

Determinants of Health that Affect 2SLGBTQ+ People Employment

Answer 37

trans people – 15% unemployed (vs. 5% of the USA population)

Question 38

Determinants of Health that Affect 2SLGBTQ+ People Social and Community Context

Answer 38

- LGBTQ+ youth may be overrepresented in juvenile justice systems - in 2023, majority of gender diverse youth had experienced bullying in the past year, including 78% of trans boys, 72% NB youth, 65% of questioning students, and 58% of trans girls - BC has a law to protect and promote human rights (BC Human Rights Code) – protects from being treated badly or denied a benefit

Question 39

Determinants of Health that Affect 2SLGBTQ+ People Health and Health Care

Answer 39

- lack of insurance coverage - discrimination in healthcare – refusal of care, health provides being rough or abusive

Question 40

Determinants of Health that Affect 2SLGBTQ+ People Neighbourhood and Built Environment

Answer 40

trans people particularly experience housing discrimination

Question 41

What is intersectionality?

Answer 41

recognition that social identities (such as race, class, disability, sexual orientation, and gender identity) create overlapping and interdependent systems of discrimination or disadvantage - different factors of one's identity (ie. race, gender, disability) are all tied to one's SDH (ie. income, employment, food security, housing) –they should not be considered as separate and unrelated factors

Question 42

Describe intersectionality and the 2SLGBTQ+ population.

Answer 42

racialized 2SLGBTQ+ people experience 5% high rate of unmet mental health needs in compared to non-racialized 2SLGBTQ+ people, and 16% higher rate of unmet mental health needs in compared to non-racialized, cisheterosexual people

Question 43

What are the resilience factors of 2SLGBTQ+ people and communities?

Answer 43

they have always advocated for themselves, leading to improvements to healthcare access and services we see today - connectedness – access to spaces and relationships that affirm identities (ie. supportive families, schools, and communities) lowers rates of suicide - formal and informal peer networks have formed in response to inequitable healthcare to meet the needs and support the health of 2SLGBTQ+ people - community organizations conduct research on the health of 2SLGBTQ+ communities to better represent 2SLGBTQ+ people in health research individual and community resilience help 2SLGBTQ+ people thrive but it does not mean that resilience can always overcome structural barriers