Healthcare, like housing, must be considered in combination with some of the other issues that the LGBTQ+ community faces. A conversation with stakeholders highlighted the fear of the trifecta of lack of housing options, poor medical care, and a thin familial safety net that many in our community face.28

“Navigating still the medical community is a difficulty for many gay people of my generation and you know what do we do with long term care, many… LGBTQ elders have been separated from their families or have no children and so as we get older what do we do about long term care. What do we do about our right to sexual expressions if you’re in nursing homes or other kinds of communities for the service of the older community.” 29

As you read through this section, consider the many ways in which health care intersects with other social positions and social problems. For the LGBTQ+ community there is a unique history of the community’s relationship to the medical field which is fraught. It makes the question of healthcare more than just delivering a service, but also about how the medical field has played a significant historical role in limiting the humanity of the community

Supportive & inclusive learning environments: School cultures & curriculums

Health and wellness starts when we are young and encompasses being able to understand one’s body. Our society is particularly prurient about sex and sexuality which makes locating good information particularly fraught. The web remains a place akin to the wild west for people who are starting to explore their sexuality, and schools remain places where conversations of sex and sexuality are few and far between.

It is important that we distinguish between school culture and school curriculum. Often they are utilized interchangeably, particularly in backlash conversations that focus on the fear around sex in sexuality.30 However, most of the young people we spoke to did not talk about sex education as a curricular content area, what they wished for longingly was a culture of acceptance that would mean being able to grow up and learn in a school where they did not have to endure bullying, where there are policies on the books that are enforced to protect LGBTQ+ students as they navigate primary through secondary school, and where they have mentors and counselors who can support them. Said one student currently enrolled in Rhode Island College, about her earlier middle and high school experience:

“I tried to put myself in a box. I ended up suffering from internalized homophobia, which I’m learning more and more trying to get out of that box and accepting myself. So, my main concern is just having some sort of education, a counselor to help you through, like being in the closet and not really knowing where to look, and just having a safe space …in the community where I feel like I belong.”31

A couple of the youth we spoke to were also connected to the Cops Not Counselors movement in the state that advocates moving funding from student resource officers (in school law enforcement) to much needed counselors. LGBTQ+ students very much felt the lack of funding that could go towards creating a culture that cared about community more than a narrow definition of safety-by-protection. It was a theme we heard repeatedly, even in our older respondents:

if you put money into building a strong and healthy community you need to put fewer resources into traditional public safety and security.

An example of a particularly effective model of this is the Central Falls School Department. Central Falls pairs young LGBTQ+ people with counselors, social workers, and referral networks to attorneys and mental health professionals.

Rhode Island school curriculums still emphasize abstinence (as the primary way to avoid sexually transmitted infections (STIs) and pregnancy)32 and though they are required to be inclusive they are not required to be comprehensive.) Sex education in the state is supposed to include information on sexual orientation and gender identity, but in practice youth found the inclusion of LGBTQ+ content to be mostly absent; the primary focus on heteronormative sex. This discriminates against LGBTQ+ who are left without any meaningful conversation on their experience of sex and sexuality.

The current push to ban books across the country that cover LGBTQ+ themes (as well as race) has a chilling effect on providing accurate and supportive representation. This campaign sends a message that if these books can be banned in schools, then it is possible to ban students from even talking about being LGBTQ+. As a state Rhode Island has avoided these harmful challenges, but recent local examples of book banning attempts that focus on LGBTQ+ books highlight the state is not immune.33

Many times it isn’t until a student arrives to college and happens to take a class that addresses gender and sexuality (and those classes do not reach most students) that they may even hear about some of the biological and social reality of gender, sex, and sexuality. One participant in a focus group shared that it was through their college courses that they began to understand ideas of gender fluidity, LGBTQ issues and a spectrum. Middle and high school classes had previously provided health education only.

The stifling of conversations around sex, sexuality, and gender actually do the opposite of what advocates of abstinence-based programs believe. Education that focuses on people’s actual practices around forming healthy relationships, rather than solely on risk reduction of pregnancies and STIs is a much more powerful way to reduce the latter.34 The current paradigm of teaching sex education is woefully inadequate for LGBTQ+ youth. Another of our focus group participants spoke about how powerful it would be to begin the process of inclusivity for LGBTQ+ people not only when we’re talking about sex and sexuality, but before when teaching about acceptance, difference, healthy relationships, and joy.

A 2013 national study found that fewer than 5% of lesbian, gay, bisexual and transgender (LGBT) students aged 13–21 reported that their health classes had included positive representations of LGBT-related topics. Another study from 2015 conducted among millennials showed that only 12% were taught about same-sex relationships in sex education class.35

“The other thing that I feel like education could do is to demystify queerness, because a lot of the abuse I’ve suffered in schools, from my peers and even from my teachers, doesn’t come from not knowing the queerness exists, it comes from a very simplified definition of what it is that is often manipulated by those who would seek to exploit anti-queer sentiment as a way to gain power…. Education that is queer, inclusive, and teaches kids especially at younger ages that like, hey, sometimes people are queer, gay and trans and that’s beautiful. …Where I feel it needs to be done the most is those younger years, so people really have an opportunity to have that be ingrained in their system before they start.” 36

The absence of an expansive curriculum in our primary and secondary schools that understands difference and diversity as beauty, is a reflection of all our public services in the state. By focusing on youth and schools we build a resilient and confident next generation of LGBTQ+ adults. Understanding our bodies means being able to seek out the care needed. Below are some key data points that highlight these issues for LGBTQ+ youth and adults.

  • Prior to and including the US Supreme Court decision to protect same-sex marriage rights, states that legalized same-sex marriage saw significant decreases in suicide attempts among adolescents.37
  • Sexual minority persons overall are significantly less likely to have health insurance than heterosexual persons in the US. Bisexual persons are 1.8 times as likely as heterosexual persons to be enrolled in a public insurance plan (Medicare, Medicaid, etc.).38 LGBQ women tend to have lower rates of health insurance coverage. Among sexual minority individuals in the US,attributes that are associated with reduced access to needed services (age, citizenship, education, and income) are also associated with having no health insurance. Specifically, sexual minority women are 1.7 times as likely to be uninsured than men.39
  • 40% of LGBT elders in their 60s and 70s have reported that their healthcare providers are unaware of their sexual orientations. Two out of three transgender adults feel that as they age, they will experience increased lack of access to healthcare services.40
Selene Means, photographer for the report, and friends hanging out in community and sharing the joy of capturing friends the way they see themselves.
Selene Means, photographer for the report, and friends hanging out in community and sharing the joy of capturing friends the way they see themselves.


The arc of HIV and AIDS care from pandemic and acute care in the 80s-90s, to long term care with broad medical and social services, to now care for the larger aging population with long-term HIV and AIDS is one that will need a broad array of both social and medical services. Many of our LGBTQ+ organizations developed within and were shaped by the AIDS pandemic. The AIDS pandemic changed the nature of what community organizations provided and it also shaped the way the community was seen by the dominant heterosexual community. Many of the organizations that once focused entirely on HIV and AIDS work have expanded as the needs of the community have.

About 2,500 Rhode Islanders were diagnosed with and living with HIV through the end of 2017.

An estimated 7-8% of individuals who are HIV-infected do not know their status which suggests the numbers above may be an underestimate of all Rhode Islanders living with HIV. In the past decade, 53.7% of newly diagnosed cases were among gay, bisexual, or other men who have sex with men (GBMSM). From 2014-2018, that percentage has increased to 57.6%.41 Like other areas in the United States, young gay/bisexual Black/African American and Hispanic/Latino men in Rhode Island have been increasingly affected by HIV.42 Unlike Massachusetts, there is no budget line for HIV/AIDS services in Rhode Island, which makes funding more challenging and heavily dependent on grants and fundraising.

HIV/AIDS may not be at its pandemic level, particularly in the United States, but it still affects the LGBTQ+ community, such as the complex needs of an aging population with long-term HIV, and a younger more diverse community that is still exposed. Locally, AIDS Care Ocean State continues to serve the community with HIV and AIDS, and organizations like Project Weber/Renew have a broad grassroots outreach to people with HIV and AIDS who often do not receive care.

Gains in HIV treatment have resulted in people who are HIV-positive are living longer lives. HIV+ people are a growing segment of Rhode Island’s population.43 There are currently around 1,300 HIV+ people living in Rhode Island over the age of 50. (stats estimated based on the Centers for Disease Control: HIV/AIDS Surveillance Report, 2007 and the Rhode Island STI 2018 Surveillance Report.) That number is suspected to rise by 70% by 2030, which means there will be between 1,800-2,000 elders living with HIV in Rhode Island. The vast number of those folks will be members of the LGBTQ+ community. This means that out of the total number of LGBTQ+ elders in Rhode Island, a good portion will need complex care related to their HIV+ status and comorbidities, behavioral health needs, access to transportation, and coordination of care.

Because focus groups are not an ideal space to talk about sensitive health care issues, we found our one-to-one interviews yielded more in-depth conversations on HIV and AIDS. One of our conversation partners shared extensively about their experience with HIV as well as working within organizations that serve people with HIV and AIDS.


“If you don’t have the strength and ability to advocate for yourself, it’s clear that no one else is going to do that for you. But that is exhausting… having to always be an advocate for yourself and other people when the systems are supposed to be designed to be your advocates. And there you go in, and they’re not. And so, I think it’s always been hit or miss.”44

For this community member part of the issue was organizational.

“So one of the issues that I see a lot of organizations that are, quote, unquote, ‘queer-serving’ organizations is they’re not run by queer people. They’re run by professional cisgender folks that have the institutional knowledge of how to serve people living with certain diseases or certain psychosis or things like that, or in certain lifestyles, but they’re not necessarily part of that community. So there is always going to be that disconnect in terms of the care needed versus care provided. And well, that disconnect won’t end until we have more people from those communities actually leading those initiatives and leading those organizations to be able to provide those resources to their community, in terms of demystifying care.” 45

And because of the stigma that still exists around HIV and AIDS, people who sought care had to face the possible knee jerk responses from healthcare providers.

“So things that are missing. When your doctor and your nurse are outside of your door talking about your HIV status as if it’s like leprosy or something and even— that’s like such an outdated term, but like other communicable diseases that may or may not be worse off. But this is if I’ve already become stigmatized in that space. So, how do you teach someone not to have a reaction to something that they maybe were reactive to? How do you teach someone to not make a whole bunch of facial expressions when they look at your chart and see that you have HIV? Or then how do I not internalize that knowing that I’m going into that space, and a new space, and I have to disclose my HIV status because that’s what you do in medical spaces”.46

In a focus group that spent some time speaking on health care in general, a community member talked about how many doctors neglect to ask him important questions. Those questions included:

“So basically who do I have sex with? Do you have multiple partners, even though you may be in a committed relationship, do you have more than one partner? You know, those types of things.”47

Stigma, providers who lack training in addressing the particular needs of the community, an avoidance of talking about sex in general along with the assumption of heteronormative and monogamous practices can mean that people are not getting the care and information they need.

Finally, there are cultural concerns that should be addressed when caring for people with HIV and AIDS. Some communities (ethnic and religious) have particularly strong responses towards people with HIV and AIDS. And other communities might have a strong negative response towards the medical establishment itself. In the following conversation, this individual talks about the challenge of joining a vaccine trial for HIV because of the fear of medical tests within the Black community.

“It was a four year commitment and going in weekly or every two weeks for blood work and all kinds of interviewing of behaviors um so that was that was hard and so. I couldn’t tell many of my friends because I had no idea what their reaction would be so it took awhile for me to settle in with feeling confident and okay about it. When I talked to my Black friends they were horrified that I was doing this given the history of how the medical community had treated Black people in the past, you know rather it was a Tuskegee Institute or other kinds of of trials that Black people were subjected to through the medical profession without their consent and how many of them had died from so they could not believe that I would be trusting of the medical establishment and do this. But these were difficult times, so they required difficult decisions to make and so. So I continued with that. And then did other work in between those four years to try to recruit from the Black community volunteers for the AIDS vaccine trials and so as I would go into Black churches, I would certainly be thrown out and called all kinds of names and abusive behaviors because it was just strong, such strong condemnation of my participation in these kinds of activities.”48

A recent study showed that the effect of the abuses at Tuskegee towards Black men from the 30s through the 70s have had a wide reaching and devastating effect on the Black community to this day that reach far beyond its local ramifications.49 The study reinforces the importance of building trust particularly within Black,50 Indigenous,51 and communities of color,52 that have seen abuses by the state and medical community.

There remains a significant gap in outreach to Latinx communities in Rhode Island. The expansion of Latinx/Hispanics in the state alongside continuing stigma within the Latinx community indicates a growing need to make sure information and care can reach Latinx folks.

Hispanic/Latinx persons constitute 16.3% of the Rhode Island population (US Census Bureau QuickFacts: Rhode Island), but only 7.81% of the 2018 BRFSS Rhode Island sample and 9.73% (n=29) of LGB adults in the Rhode Island sample. This means there is a need for culturally-competent studies to reflect more accurate data. In 2018, LGB adults reporting Hispanic/Latinx race/ethnicity were significantly less likely to have health insurance coverage compared to non-Hispanic/Latinx LGB adults (79.3% versus 94.4%, respectively). Hispanic/Latinx LGB adults were more likely to report a past diagnosis of at least one chronic disease compared to non-Hispanic/Latinx LGB adults (58.6% versus 39.8%).

One key informant interviewee suggested creating discrete ways for STI, gender and sexuality screening at “Know Your Rights’’ and other informational meetings at the consulates—this is a place where Latinx people gather besides faith-based institutions that could become a way to connect them with health services. This could be done with the Mexican consulate, specifically.

Trans focused health care

August Seabrooke photographed by Selene Means in 2017
August Seabrooke photographed by Selene Means in 2017. Here is a quote from August about that photo shoot, “During that time, I was free to explore my identity outside of being the eldest brother of an immigrant family. My roots and sense of responsibility for my family stretches back generations. When I was away for college, I was allowed to forget that for a bit and to enjoy those who understood me and those who accepted me during my most vulnerable times. These pictures are from a time of my “second” puberty in which I got to experience myself in ways that felt most aligned with who I am and who I was at the time. It was a time of change, growth, hardships, and mental fortitude. It was a time of learning about empathy for me. It was a time where I got to debut my journey towards self actualization.

Finding health care with knowledgeable and accepting practitioners was a huge issue for many of the people we spoke to. In conversations with providers that focus on LGBTQ+ people, gender care was one of the largest reasons for seeking care. Many of these same people felt judged and or often given incorrect and misleading information when seeking care from non-LGBTQ+ focused providers. If there was a health care provider who was both knowledgeable and accepting, it might take months for an appointment. Healthcare providers, such as Thundermist, Lifespan, and Open Doors, who see a large number of trans clients, are often at capacity. But there is an enormous need for informed and sensitive providers across the entire state.

There are two key issues within care for transgender individuals: first is general healthcare competency and second is more specifically gender-affirming healthcare.

Healthcare competency

Most transgender and gender non-conforming persons lack access to competent, welcoming health care providers. Often when seeking routine medical care, their gender becomes the only aspect that providers see (particularly for mental health care). Trans individuals refer to this as the “broken arm syndrome”53 where any health issue gets filtered first through their gender first, even if just a cold or a flu. A similar critique has been brought up within the fat community and the disabled community. In all three, there is an assumption that a particular visible body must must always be the prime medical reason behind all care. It is a limiting and discriminatory lens.

The 2015 Transgender Survey results from Rhode Island yielded the following insights:

  • 24% of those who saw a health care provider in the past year reported having at least one negative experience related to being transgender. This included being refused treatment, verbally harassed, or physically or sexually assaulted, or having to teach the provider about transgender people in order to get appropriate care.
  • In the past year, 33% of respondents did not see a doctor when they needed to because of fear of being mistreated as a transgender person, and 33% did not see a doctor when needed because they could not afford it.54

Said one practitioner,

“We want to normalize and integrate trans care into everyday care. So that it is not trans care, [instead] it is the basic minimum of how we treat people…that trans people are normal, that we’re just people, that caring for bodies is what medical care is about. Not caring for cis bodies and then caring for trans bodies as a specialty, but caring for human beings.” 55

Someone who had sought care told us that their experience seeking care from practitioners who said they were LGBTQ+ friendly, did not always mean they were up to date on what that care should look like.

“I think that a lot of the providers that we do have in Rhode Island, they’re overbooked, understaffed… There’s a lot of providers out there who are either ignorant of trans health or they don’t acknowledge [it] or they provide a very minimum level of care. I like to say…that it’s like the difference between going to a modern doctor and a doctor from the civil war in level of care and expertise. It’s heavily dated.” 56

Gender-affirming healthcare

Gender-affirming healthcare—care that can includes hormone therapy and surgical interventions—is challenging to attain in our complicated healthcare environment. Some of the hurdles that are faced are: finding a primary care physician who is knowledgeable about gender-affirming care, having your insurance in order, get a consultation for surgery if desired/needed–which can take upwards of a year, and finally facing the possibility of having coverage denied.

The 2015 Transgender Survey stated that 26% of Rhode Island respondents experienced a problem in the past year with their insurance related to being transgender, such as being denied coverage for care related to gender transition or being denied coverage for routine care because they were transgender.

As one of our practitioners related:

“So the hard part is that the health system in and of itself is a disaster. It’s a mess. We have doctors that are seeing patients for only 15 minutes. We have folks at clinics that are way overworked, serving way more people that they should be serving. And that’s because of the billing system that we have. Therefore training and competency— well sometimes it’s competency but I prefer the framework of cultural humility—is relegated to a secondary importance.”57

The care that trans persons want is a more holistic form of care that recognizes both the physical and emotional needs that might be required to make them feel whole. That this care is often a part of a significant journey someone has undertaken is an important element to consider in providing care.

Some healthcare systems recognize this need and have created positions for “navigators” to work with clients and make sure they have the information they need to get the health care they desire.

“As peer navigators, we help people navigate the red tape around legal and medical gender-affirmation in the community and within our [practice]. So we help people with everything from helping them gather together their documents, to get their name changes taken care of, to helping them prepare appeals when they’ve been denied for gender-affirming care with their insurance companies, to doing trainings at different schools and organizations to help them become more gender-affirming within their organizations as well. So just really helping families— being able to enable them with the tools to be able to carry forward to do their own advocacy over time.” 58

Mental health support

Our conversations around health often returned to the great need for LGBTQ+ informed and identified mental health professionals. For youth, this might be a counselor or mentor who helps them build a healthy relationship to who they are amidst hostility that may surround them in schools and in homes. As people get older, finding a mental health professional may be a key way to heal from trauma. Some people felt their mental health concerns were pushed aside and so getting the correct care and getting that care covered under insurance was a significant challenge.59

“Well, I think with my mental illnesses, like depression and anxiety and PTSD, they might not take me as seriously being a transgender person. I don’t know why, but I just feel like I get put on the back burner a lot of the time with healthcare. Now that I have specialists, I’m all set, but trying to get those referrals was really hard.” 60

The challenges of finding mental health care are beyond competency or “cultural humility”, the two biggest hurdles are the expense of mental health care and finding LGBTQ+ therapists who accept insurance. One person also pointed out that the very structure of schooling for practitioners and its expense often weeded out exactly the people that are needed in the field.

“I can’t— you know, I can’t help but wonder how many other trans people could possibly be going into social work or psychology or other related professions if it weren’t for the fact that you commit to 600 hours of unpaid labor as an intern. And unless you are an extraordinarily privileged trans person who has family support, and you’re doing this at 19, or 20, 22 years old, when you still live at home with mom and dad…how do people do that when they also have to work full time jobs? Those create barriers to us getting the diversity of professionals that we need out into the community.”61

There have been some important changes. Practitioners we spoke to reflected on those changes that have been made in the last couple of decades. One trans woman therapist spoke about how the profession had dealt with trans individuals by just not dealing with them. Or in her case, passing them along to her.

“I would have therapists at other mental health facilities send me their clients just to talk about [their] trans issues. And that just borders on malpractice, it’s not something that can be isolated from the rest of an individual’s life but that’s kind of how we did it back then.”62

The separation between medical and mental health care led to a siloing of care. One person who had worked for some time at Butler in the 90s noted that:

“We wouldn’t even take an AIDS patient at Butler because for us it was a medical issue. And even though it obviously had a lot of mental health impact and emotional impact, we saw that clearly outside of our scope, While a lot of people in the community were suffering… We just didn’t do anything to really help that community. And even among the psychiatrists and social workers, LGBT issues weren’t addressed. I mean, they weren’t even discussed among professionals. It’s not even a topic that the psychiatrist at the hospital were even willing to have. I mean, there was no starting point.”63

The most-recently available data for Rhode Island from the 2015 Transgender Survey show that 49% of respondents experienced serious psychological distress in the month before completing the survey (based on the Kessler 6 Psychological Distress Scale). 10% of respondents reported that a professional, such as a psychologist, counselor, or religious advisor, tried to stop them from being transgender. Further differences exist among trans subpopulations, as trans men have higher rates of frequent mental distress than trans women and gender nonconforming persons.64 Trans women and men have higher rates of prior problem alcohol use (31% and 30% among trans women and men, respectively) and prior problem use of other drugs (21% and 25%, respectively).65 Nonbinary persons have higher rates of binge alcohol use (58% in the past year).66 In a study conducted in 2020, LGBQ women and men had high rates of binge alcohol use (48% and 58%, respectively).67

Thankfully there have been significant changes within the medical care climate that LGBTQ+ have the possibility of finding practitioners.. But this doesn’t change the fact that the way mental health is covered by many insurance companies leaves most people unable to find someone they can afford. Many of the best practitioners are unwilling to accept insurance coverage because of the poor rate of reimbursement. This reflects how as a society we do not value mental health care, and see it primarily as an individual issue not a collective one.

With thinning supports LGBTQ+ must develop the queer kinship safety nets that can provide support.

“Community…is absolutely central to any person healing or recovering….the majority of people I came across had experienced some significant trauma… because of their LGBTQ identity. And while clinical supports are important…if you don’t have someone in your community that you can look to, you have no idea where to go…. because LGBTQ people in general do not have a lot of people that they can look to in their broader community. So when we think about Rhode Island, if you’re a transgender youth in Rhode Island, where are you looking? You might have Youth Pride, then what? Then what happens to you? And if you’re 25, and you now aged out of all the youth programs, then what’s for you? Nothing. Nothing is for you, not even housing.” 68

This segues into our final large discussion on building and reimaging community for LGBTQ+ people.

Broad health care data points to consider:

Sidney Lane and Olivia Jenkins
Sidney Lane, Ocean State Advocacy and Olivia Jenkins, Recovery Housing Activist and LGBTQ Advocate leading a Narcan Training at Small Format, an LGBTQ-centered cafe and art gallery.
  • Nationally, 13% of LGBT elders have been denied healthcare or received inferior care due to their sexual orientation.69
  • Sexual minority persons overall are significantly less likely to have health insurance than heterosexual persons in the US. Bisexual persons are 1.8 times as likely as heterosexual persons to be enrolled in a public insurance plan (Medicare, Medicaid, etc.).70
  • Greater social support is associated with lower rates of substance use; however, sexual minority adults in the US report lower rates of social support and higher rates of substance use than heterosexual adults. This suggests that a lack of peer and community support systems may be a factor in disparities in substance use disorders between sexual minority and heterosexual adults.71
  • An LGBTQ+ friendly policy climate (legal protection against sexual orientation discrimination in employment, housing, and public accommodations) is associated with better self-rated overall health, routine healthcare utilization, and health insurance coverage among LGB adults nationally.72
  • LGBTQ+ people experience intimate partner violence at rates equal or higher than their heterosexual counterparts. In 2015, about 27% of LGBTQ+ survivors attempted to access emergency shelter. Of those survivors who attempted to access emergency shelter, 44% were denied. The most commonly reported reason that survivors were denied shelter was barriers related to gender identity (71%), highlighting the negative consequences of sex segregated emergency shelter options for LGBTQ survivors.73


27. Haupt, Angela. 2022 “The rise in book bans, explained” Washington Post, June 9

28. Retrieved Oct 27, 2022

29. Focus Group Nov 22, 2021 (16:6; 88)

30. Abstinence-only education (a version of sex education that focuses on not having sex to prevent pregnancy and STIs) ) has been shown to be ineffectual at best and at worse actually leads to higher rates of the things it imagines it counters such as teen pregnancy and STIs.; Society for Adolescent Health and Medicine “Abstinence-Only-Until-Marriage Policies and Programs: An Updated Position Paper of the Society for Adolescent Health and Medicine” Journal of Adolescent Health, 2017.


32. A study from Great Britain showed that most yonger people wanted education that focused on life-skills and that was sex-positive, whereas few places offered that. [] Other research has demonstrated that abstinence-only education is inadequate from a public health perspective as well. []

33. Kosciw JG et al., The 2013 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual and Transgender Youth in Our Nation’s Schools, New York: Gay, Lesbian & Straight Education Network (GLSEN), 2014; R.P Jones and Daniel Cox, “How Race and Religion Shape Millennials Attitudes on Sexuality and Reproductive Health: Findings from the 2015 Millennials, Sexuality, and Reproductive Health Survey” Public Religion Institute,

34. Focus Group Nov 22, 2021 (16:9; 100)

35. “Difference-in-differences analysis of the association between state same-sex marriage policies and adolescent suicide attempts” by J. Raifman, 2017.

36. “Growing Up Today Study and Nurses’ Health Study” by Tabaac et al., 2020

37. “Who are the remaining uninsured sexual minority adults under the Affordable Care Act?” by G. Gonzales et al., 2019.

38. “Out & Visible: Experiences and Attitudes of Lesbian, Gay, Bisexual and Transgender Older Adults, Ages 45-75” Robert Espinoza, 2014.

39. Rhode Island HIV, Sexually Transmitted Diseases, Viral Hepatitis, and Tuberculosis Report, 2018

40. Rhode Island HIV, Sexually Transmitted Diseases, Viral Hepatitis, and Tuberculosis Report, 2018

41. Rhode Island HIV, Sexually Transmitted Diseases, Viral Hepatitis, and Tuberculosis Report, 2018

42. Interview Nov 19, 2021 (8:17; 67)

43. Interview Nov 19, 2021 (8:14; 67)

44. Interview Nov 19, 2021 (8:18; 73)

45. Oral history interview with Freemen T. Freemen March 20, 2020.

46. Interview conducted by V. Thomas






52. 2015 U.S. Transgender Survey.

53. Interview Nov 10, 2021 (10:17; 107)

54. Focus Group July 14, 2021 (18:15; 317 – 319)

55. Interview Nov 17, 2021 (2:6 ¶ 33)

56. Interview Nov 10, 2021 (10:2; 13)

57. LGBQT+ populations in the US have higher rates of many indicators of poor mental health compared to heterosexual populations. Among US men, gay and bisexual men have significantly higher rates of “severe psychological distress” (6.8% and 9.8%, respectively) compared to heterosexual men (2.8%). “Comparison of health and health risk factors between lesbian, gay, and bisexual adults and heterosexual adults in the United States: Results from the National Health Interview Survey” by G. Gonzales et al., 2016.

58. Focus Group Aug 17, 2021 ( 17:7; 100)

59. Interview Nov 10, 2021 (10:18; 107)

60. Gwendolyn Howard Interviewed by V. Thomas

61. Focus Group Aug 17, 2021 (17:14; 117 – 118)

62. “Gender and frequent mental distress: Comparing transgender and non-transgender individuals’ self-rated mental health” by H. P. Crissman, et al., 2019. Used BRFSS data.

63. “Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study” by B.T. Barger, et al., 2020.

64. Ibid.

65. “Characterization of substance use among underrepresented sexual and gender minority participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study” by B.T. Barger, et al., 2020.

66. “Interview Nov 18, 2021 (4:6; 31)

67. “The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults” Karen I. Fredriksen-Goldsen et al., 2011.

68. “Growing Up Today Study and Nurses’ Health Study” by Tabaac et al., 2020.

69. “Functional and structural social support, substance use and sexual orientation from a nationally representative sample of U.S. adults” by E. M. Kahle et al., 2020.

70. “State-level climate, anti-discrimination law, and sexual minority health status: An ecological study” by A. Solazzo et al., 2018.

71. National Coalition of Anti-Violence Programs, “Lesbian, Gay, Bisexual, Transgender, Queer, and HIV-Affected Intimate Partner Violence in 2015: A report from the National Coalition of Anti-Violence Programs” New York City Gay and Lesbian Anti-Violence Project, Inc. 2015,

Building community, kinship networks, & mentoring

This section of the report is oriented around the following questions: What are the possibilities for a capacious, dynamic LGBTQ+ community? And what models of support and funding can we create that are designed to support an expansive definition of our community and its intersecting needs?

Read the Next Chapter