Pride month brings renewed focus to LGBTQ+ stressors and challenges

By Douglas Holl, Army Public Health Center Public AffairsJune 17, 2021

The Army Public Health Center is preparing a report, expected to be released this fall, examining the stressors impacting Army family health, including those experienced by LGBT Soldiers and their families. (U.S. Air Force photo by Louis Briscese).
The Army Public Health Center is preparing a report, expected to be released this fall, examining the stressors impacting Army family health, including those experienced by LGBT Soldiers and their families. (U.S. Air Force photo by Louis Briscese). (Photo Credit: Louis Briscese) VIEW ORIGINAL

ABERDEEN PROVING GROUND, Md. – As the Department of Defense and military services continue to celebrate gay pride month, there is a renewed focus on the stressors and challenges experienced by lesbian, gay, bisexual and transgender service members and their families.

As part of a focused effort to examine the health of the Army family, the Army Public Health Center is preparing a report, expected to be released this fall, examining the stressors impacting Army family health, including those experienced by LGBT Soldiers and their families. One particular area of focus for the report is the stressors experienced by sexual minority groups, including perceived stigma and sexual victimization.

According to the 2018 DOD Workplace and Gender Relations Survey of Active Duty Members, which included questions about sexual orientation but not gender identity, about 14 percent of female survey respondents and 3 percent of male survey respondents identified as LGB. The survey also noted that 7 percent of female respondents and 5 percent of male respondents selected “prefer not to answer,” indicating there is a subset of Soldiers on which the Army lacks visibility with regard to sexual orientation; and that up to 23 percent of female Soldiers and 9 percent of male Soldiers may be underrepresented and understudied sexual minorities.

A recent RAND study titled Sexual Assault of Sexual Minorities in the U.S. Military also examined the 2018 WGRA data and found service members who identify as LGB or who do not indicate that they identify as heterosexual represented only 12 percent of the active component population in 2018, but accounted for approximately 43 percent of all sexually assaulted service members in that year.

In his remarks June 9 as part of DOD Pride Month, Secretary of Defense Lloyd J. Austin III noted that progress has been made for a new generation of LGBT soldiers, sailors, airmen, guardians and Marines openly and proudly serving their country since the repeal of “Don’t ask Don’t Tell” 10 years ago. But he said more needs to be done.

“Our work isn’t done until we tackle the challenge of sexual assault and harassment in the force,” said Austin. “And we know that service members from this community are at elevated risk of such crimes.”

Dr. Matthew Beymer, an APHC epidemiologist, said one of the challenges when looking at the WGRA data as well as data from the DOD’s 2018 Health Related Behavior Survey, which asks service members questions about health-related issues that can affect force readiness or the ability to meet the demands of military life, is there is limited surveillance data on LGBT military personnel experiencing sexual assault.

“Few studies have investigated the underlying causes or risk factors for LGB service members who have experienced sexual assault,” said Beymer. “This is clearly an issue that could benefit from any allocation of resources and evidence-based investigation.”

The Sexual Assault of Sexual Minorities in the U.S. Military reached a similar conclusion.

“Successfully preventing these assaults might require understanding the circumstances in which they occur and the motivations of the attackers. In particular, it would be critical to learn if sexual assaults on service members who do not describe themselves as heterosexual are primarily hate crimes or harassment based on sexual orientation rather than crimes with sexual motives.”

Another area requiring more clarity is to better understand the stressors facing LGBT Soldiers and family members as sexual minority groups, said Lisa Polyak, an APHC senior environmental engineer, who is collaborating with Beymer to prepare the Health of the Army Family vignette focused on this issue and who has also experienced some of these stressors with her partner as they raised their two daughters over the past three decades.

“It’s reasonable to assume that stressors in the military population largely mirror stressors in the civilian population,” said Polyak. “Decades of discrimination based on sexual orientation in policy, religion and K-12 education, where these minority groups experienced bullying, have led to minority stress.”

A meta-analysis published by the National Institutes of Health in 2008 of 214,344 heterosexual and 11,971 non-heterosexual people reported disparate rates of adverse mental health outcomes. Specifically, non-heterosexual people had a 2.5-fold higher risk for suicide attempt when compared to heterosexual people and were also at higher risk for depression and anxiety.

“Over this past year, we lost a gay Soldier to suicide,” said Capt. Matt Visser, commander 40th Public Affairs Detachment, 101st Airborne Division, Fort Bragg, North Carolina, who identifies as gay. “Despite all the organizational progress on inclusivity, I had to wonder what could have been done to prevent this loss. Could we have improved access to in-person behavioral health support, which had mostly transitioned to telephonic care at our installation as a COVID mitigation measure? Would an increase in equal opportunity training on sexual minorities have improved organizational awareness, cohesion, and sense of belonging?”

In addition, other studies have demonstrated higher odds of both sexual assault victimization and re-victimization among lesbian and bisexual women in the U.S. compared to heterosexual women.

Beymer said there is also a need for meaningful data on the health status of transgender service members.

“We are aware of only two DOD surveys that queried for transgender status among service members (2015 HRBS, 2016 WGRA), but neither of these surveys reported health outcomes for transgender personnel,” said Beymer.

The 2015 U.S. Transgender Survey (the largest survey examining the experiences of transgender people in the U.S.) found that transgender people experience significant health disparities relative to the U.S. population:

  • ·39 percent of respondents experienced serious psychological distress compared with 5 percent of the U.S. population;
  • 40 percent of transgender respondents have attempted suicide in their lifetime, nearly nine times the rate in the U.S. population (4.6%)

In January, President Joe Biden issued two executive orders that impact DOD transgender individuals: EO 1398, "Preventing And Combating Discrimination On The Basis Of Gender Identity Or Sexual Orientation," and EO 14004, "Enabling All Qualified Americans To Serve Their Country In Uniform."

"The revised policies in these instructions restore the DOD's original 2016 policies regarding transgender service,” said John Kirby, Pentagon press secretary. “Specifically, they prohibit discrimination on the basis of gender identity or an individual's identification as transgender. They also provide a means to access into the military in one's self-identify gender, provided all appropriate standards are met.”

The services are still in the process of updating their policies to bring them in line with the executive orders. Within the federal government, many organizations are adapting some of these recommendations that the Army could also implement to improve Army support to transgender Soldiers:

  • In accordance with DODI 1300.28 (In-Service Transition for Transgender Service Members), support and resource gender transition
  • Adopt transgender-inclusive policies such as allowing service members to identify their preferred pronouns, and encourage the workforce to respect and use the pronouns of choice.
  • Offer transgender diversity training to all service members
  • Offer resources and support groups for transgender service members and their families

The coming Health of the Family report will offer some recommendations for senior leaders and policy makers to address some of these issues, said Beymer and Polyak. The lack of demographic data on LGBT Soldiers means that senior Army Leaders are unaware of the issues affecting the health and readiness of at least 5 percent (or more) of their Soldiers.

“I think the Army, through policy, has attempted to be more inclusive and accepting of LGBTQ+ persons,” said 1st Lt. Ashley Carrillo, a social work intern at the Carl R. Darnall Army Medical Center, Fort Hood, Texas. “More trainings on sexuality and inclusive language would be a helpful start. When someone is asked, ‘Do you have a significant other?’ rather than asking a female, ‘Are you married and what does your husband do?’ it allows for open dialogue and the space for someone to share what they are comfortable sharing, and does not place someone in a position to have to defend, explain, educate or feel judged.”

Awareness of the health and readiness issues faced by LGBT personnel begins with collecting demographic data in the same way we collect demographics on age, sex, race and ethnicity, said Polyak.

Polyak explained improvements in demographic visibility of sexual minority service members must address both sexual orientation (to provide visibility on LGB Soldiers) and gender identity (to provide visibility on transgender and gender non-conforming Soldiers).

“Engaging in targeted data collection will allow the Army to assess the needs of LGBT Soldiers and, by extension, their Families, more accurately, thus facilitating policy and programs that ensure equitable health outcomes for all Soldiers, regardless of sexual orientation,” said Polyak.

The deficit of sexual orientation and gender identity data in U.S. population health surveys and studies has been flagged by the U.S. Surgeon General in the Healthy People 2030 project as a priority issue in order to improve health status for LGBT populations.

“In order to improve access and remove barriers to care, the Department of Defense should incorporate LGBTQ+ voluntary demographic data collection. Integrating these data would enhance our ability to construct human resource and healthcare practices that better serve LGBTQ+ communities and their families,” said Visser.

Austin concluded his DOD Pride event remarks saying, “Our work isn’t done until we recognize that the health of the force fully incorporates mental health, including for LGBTQ+ service members. That’s why we recommit to treating all wounds, both visible and invisible. And our work isn’t done until we create a safe and supportive workplace for everyone – free from discrimination, harassment, and fear.”

Keep up to date on the latest Health of the Army Family, or HoAF, information by visiting APHC’s HoAF campaign page.

The Army Public Health Center focuses on promoting healthy people, communities, animals and workplaces through the prevention of disease, injury and disability of Soldiers, military retirees, their families, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.