Annotated Bib, post 1

Delgado, Adolph Joseph, Danielle Gordon, and Phillip Schnarrs. “The Effect of Discrimination and Stress on Sexual and Behavioral Health among Sexual Minority Servicemen.” Journal of Gay & Lesbian Mental Health 20, no. 3 (July 2016): 258–79. doi:10.1080/19359705.2016.1141344.

 

 

 

Introduction

Don’t Ask Don’t Tell (DADT)

The military is estimated to have 37,071 gay and bisexual men serving, either actively or in the reserves, totaling about 1.5% of all servicemen. Further, there is estimated to be 12,965 gay and bisexual men that are retired from the reserves. However, this number is likely significantly underrepresentation due to an old military policy, DADT, that forced lesbians, gays, and bisexuals to mask their sexuality. Fortunately, these numbers no longer have to be estimates, as DADT has been repealed as of September 20, 2011. However, the repeal of DADT has not removed heteronormative roles caused by long time discrimination against homosexuals.

Stress

Service members experience more stressful situations than civilians. This source refers to other studies to prove that service members have increased risks of mental distress, such as anxiety or depression, negative health behaviors, such as alcohol consumption, and risky sexual behavior, such as unprotected sex. In addition to the likely aforementioned issues, sexual minorities in the military also experience social isolation, stigmatization, and discrimination. This source recognizes that DADT has limited the research that could have been done on active duty sexual minorities. This source wants to focus on the effect of discrimination and mental distress on negative health behaviors for sexual minority servicemen. The source acknowledges, however, that there has been research conducted on sexual minority civilians and sexual minority veterans.

Discrimination

Discrimination against homosexual and bisexual service members has been documented as far back as World War I (WWI). Sodomy became illegal; thus, numerous sexual minority service members were discharged. During World War II (WWII), the American Psychiatric Association classified homosexuality as a mental illness, labeling any homosexual or bisexual service member as unfit for the military. In 1982, the U.S. military wrote the Department of Defense (DOD) directive 1332.14 stating explicitly that homosexuals were to be excluded from military service solely based on their sexual orientation. DADT, however, passed in 1993 by Congress, allowed homosexuals to serve.

This source recognizes a handful of studies have reported negative outcomes of discrimination among LGB service members, and references a study of 71,570 service members. 39% of 71,455 active duty respondents reported being aware of harassments based on sexual identity. The referenced study also found a negative correlation between rank, education, and training on awareness of harassment: that is, the higher rank, education, and training, thw lower their awareness of harassment was.

This source references another study, conducted in 2013, in which, 38 lesbian, gay, bisexual, and transgender (LGBT) veterans and current service members felt much relief when meeting others. They also described their discomfort at VA services due to a lack of trust in some staff questioning sexual orientation. Many veterans keep their sexual orientation hidden after being discharged due to “a heteronormative culture that rejected their true identity.”

Risky sexual behavior

Sexually transmitted infections (STIs) are a globally common cause of illness that affects economic, health, and social aspects of one’s life. STI prevention, such as usage of a condom, are important in preventing HIV. Knowledge-based programs in STD clinics have not shown to be an effective prevention intervention. Understanding specific risk behaviors have greater potential to yield behavior changes with effective intervention.

The U.S. has underscored the importance of STD care and prevention. Military service members tend to have higher STD rates than their civilian counterparts, notably during deployment or wartime. The military also tries to do a knowledge-based approach, rather than changing risk behavior or focus on persons at risk for increased HIV infection. The Centers for Disease Control and Prevention (CDC) stated that STIs have been increasing for men who have sex with men (MSM). MSM are 17 times more likely to develop anal cancer than heterosexual men, which is likely caused by HPV.

Because of the military’s historically negative view on homosexuality, there is a large chunk of information on the sexual health of LGB service members that is missing. Many LGB service members sought out civilian medical practitioners. Because of ethical dilemmas in providing care to LGB service members, medical professionals avoided documentation of the LGB’s identities and medical history.

Negative health behavior

This source gives a paragraph of information on the nation’s statistics for alcohol and drug substances. Heavy drinking can lead to cardiovascular disease, high blood pressure, strokes, and liver disease, along with psychological ailments such as depression, anxiety, antisocial personality disorder, and sociopathy.

This source states that the policy makers over the U.S. military underscore prevention in heavy drinking and tobacco use, and argues that it contradicts the DOD’s goal to maintain military readiness. The DOD desires to “prevent and minimize the effects of heavy alcohol, other drug, and tobacco use on military performance and promote behaviors that contribute to health and fitness.” However, norms tended to encourage alcohol and tobacco usage. Alcohol is used in many ways: to prove masculinity, celebrate, reward, let loose, etc. Similarly, tobacco is used as a way of unwinding and socializing. Both of these detrimental substances are available to the military at reduced prices.

In 1986 the DOD pushed for health promotion. Smoking programs used social support to discourage tobacco use, in addition to prohibited smoking areas. Knowledge-based presentations on tobacco became required for incoming personnel, whereas alcohol, and other drugs had counseling and education for at-risk populations. The DOD directive included nongovernmental agencies, education, and drug urinalyses. There is a gap, as aforementioned, on the health of LGB service members, but there are numerous studies on drug and alcohol usage of LGB civilians.

Numerous studies have shown that sexual minorities have higher risk of smoking tobacco and marijuana than heterosexuals. This source again acknowledges the lack of research in current military climates after DADT’s repeal, and that hypotheses were generated based on literature on discrimination for LGBT civilians and reports from LGBT veterans.

The purpose of this study is to increase the knowledge about sexual and behavioral health of gay and bisexual servicemen, investigating if these individuals experienced discrimination and psychological stress. Further, to see if discrimination and stress would affect negative health behaviors (tobacco and/or alcohol usage) and risky sexual behavior (having casual sexual partners). This source claims that the data is an important first step to see if heteronormative roles still exist in the military. The source defines the possibilities of sexual minorities experiencing discrimination or not, engaging in more negative behaviors or not, and engaging in more risky sexual behavior or not.

Methods

Respondents

85 males, ranging from 20 to 68 (with a median of 32.17) volunteered to participate. Participants were recruited either by email or web postings on social media, which then directed them to a questionnaire survey entitled, “The Effects of Discrimination and Stress on Sexual & Behavioral Health among Sexual Minority Servicemen.” 51 (60%) respondents were heterosexual, 25 (29%) were gay, and 9 (11%) were bisexual. Majority of respondents were white, followed by 24% Hispanic, 7% Black, 5% Asian, and 2% classified as “other.” Nearly two-thirds of respondents were veterans. 40% were Army, followed by 13% Air Force, 12% Marine Corps, 11% Navy, and 2% each for Coast Guard and National Guard. More than half had some college or associates degree, were currently enrolled, or had a four-year degree.

The study had criteria to ensure that the sample represented only gay, bisexual, and straight servicemen for accurate data. A separate study was done for transgender populations because of their unique experiences. For simplicity, this study focuses on men.

Participant recruitment and data collection

The study used a cross-sectional design, using a convenience sample conducted by aforementioned methods. They were given a consent form to complete before answering the 10-15-minute survey. When the survey was over, participants were shown links to counseling services in the case that they felt uncomfortable.

Measures

The demographics of sexual orientation, military status, and ethnicity were assigned numerical values. The survey gathered information on questions about condom use (1 = yes, 2 = no) and behavioral factors, such as “Where you under the influence of alcohol when you last had sex” (1 = yes, 2 = no) and “In the past 3 months, how many casual partner(s) have you engaged in sexual activity with, not counting a main partner?” These questions were to evaluate the risky sexual behavior.

Participants also took The Everyday Discrimination Scale and The Depression Anxiety and Stress Scale (DASS). The negative health behavior levels were measured using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

Depression and Anxiety, Alcohol and substance abuse, and Discrimination

DASS includes 3 scales with 4 point measurements to measure the negative emotional states of depression, anxiety, and stress over the participant’s past week. A sum is calculated based on each respondent’s experience and compared to the norms. Scale-level correlations were strongly correlated for each scale.

ASSIST measures substance use, including alcohol, and has a 0-38 rating for a 6 item scale. Higher numbers indicate higher probability of severe health, social, financial, and legal issues.

The Everyday Discrimination Scale, an 11-item scale using 6 points, measures day to day acts of discrimination. Correlation reports that scores are significantly correlated to internalizing and externalizing symptoms.

Discussion and Results

The purpose of the study was to understand if gay and bisexual servicemen had experienced more discrimination and stress compared to heterosexual counterparts. The study also assessed what factors contributed to increased negative health and sexual behaviors. Though the study had limitations, it is the first attempt to gain insight and ignite further research in this topic.

Gay and bisexual (GB) servicemen reported to experience more discrimination than their heterosexual counterparts. 35% of respondents experienced discrimination at their workplace. Even though DADT has been repealed, the source explores 3 possible reasons for this fact. First, the sample’s majority included GB servicemen that were enlisted during DADT, thus, they experienced the discriminatory policies before and during DADT. Second, at the time of this study, DADT had only been repealed for 3 years, so it is likely that those enlisted at the time of the study enlisted before DADT was repealed and experienced discrimination due to the policy. Lastly, this could simply indicate the prominent heteronormative tradition and military culture.

The source says that DOD has taken steps to remove inequality, but some policies still pose a threat toward equality for all sexual orientations. For example, the Uniform Code of Military Justice or the fact that any LGBT is prohibited from donating blood.

Fortunately, there was no difference in stress levels of GB and heterosexual men. This is likely because the military has much standardization in jobs and financials. Previous studies have revealed sexual minorities to experience more discrimination and stress, as this source recognizes, but it did not appear in this study. The source indicates it may be easy to recall a discriminatory event, but not the stress one experienced. It can be interpreted that this similar level of stress shows that the military and VA have done well to make sure service members aren’t under great levels of stress.

Research proved that sexual orientation was a predictor to use alcohol, use tobacco, and have casual sex partners. Contrary to hypotheses based on studies of GB civilians and veterans, GB servicemen had lower likelihoods of all three considerations. Possible explanations include being a GB serviceman reduces the propensity of engaging in such behaviors. Despise the known and displayed negativity towards homosexuality, many GB men still enlisted, indicating initial resilience. This resilience may be an explanation for why GB had lower rates, as they’ve already learned to be resilient in hardships. Another possibility for lower rates could be the consequences if caught. Given that the sample was largely veterans, it’s possible that they’d be careful in their behaviors for the sake of the secrecy of their sexual orientation.

The source recognizes the limitations, included the cross-sectional design that limited the range of respondents, cluster analyses, as this limits the individuals’ specific experiences, and the small size itself makes it hard to generalize. The source also recognizes that it may not be representative considering the recruitment was online and directed towards sites that focused on GB servicemen.

After recognizing the several limitations, the source explains how, to their knowledge at the time, this was one of the first studies to explore “how discrimination and stress affect gay and bisexual servicemen, identify whether discrimination is still prevalent in the military, and de ne how stress affects psychological functioning across servicemen.” These findings will help identify protective factors against discrimination and negative health behaviors in future studies, which will thus help with culturally tailored interventions.

Final Thoughts

I chose this as one of my sources because I found it necessary to consider the mental health of gay and bisexual servicemen when considering the bisexuals and gays in the military and how their treatment and experience has changed over time. This study, which was more detailed and had more evidence than others, included a convenience sample of 85 men in the military that were recruited through social media posts. The data collected showed a strong correlation with sexual orientation and discrimination, but not for negative health  behaviors, physically or psychologically. This is relevant to understand the social and cultural effects in the military for the AIDS/HIV community because a major concern was gay nd bisexual men contracting STIs or STDs. These results push for studies to further explore this and fix the discrimination and negative health behaviors. However, we must recognize that this sample does likely contain bias, since the servicemen studied were volunteers. This resource works in conjunction with research on homosexuals in the military, but this delves deeper into the subject by examining their personal mental and sexual health, or lack thereof, because of certain laws. It also shows how DADT caused such a gap in research and information on GB servicemen and gave many possible explanations for results, such as the fear of consequences. DADT and this source  reveal the political aspect of the AIDS community because of its effect on GB men being discharged or hidden in the military.

 

 

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