Shari Brotman

The Impact of Coming Out on Health and Health Care Access: The Experiences of Gay, Lesbian, Bisexual and Two-Spirit People

Abstract This paper documents the experiences of health care access among gay, lesbian, bisexual and Two-Spirit (glbt-s) people in Canada. In particular, it addresses the importance of coming out as glbt-s to the development of good health and appropriate care. The paper reflects upon the impact of hiding ones sexual orientation on glbt-s peoples experience of and use of health care resources and the responsibility of health care institutions to address homophobia and create supportive environments in order to facilitate the coming out process in health care settings. The central role of health care policy makers with regard to the articulation of gay-positive policy and practice in health care institutions is highlighted.

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.

Reclaiming Space-Regaining Health

Abstract This paper documents the experiences of Two-Spirit people, both within society generally and in the context of health and health care. Findings of a national qualitative research study on gay, lesbian, bisexual, and Two-Spirit peoples health care are reported with particular attention placed upon Two-Spirit peoples notions of identity and community, the meaning of health, and the experience of health care barriers within and outside of Aboriginal communities. Currently, the body of academic research on health and health care access largely excludes gay, lesbian, bisexual, and transgendered/transsexual people (glbt). The smaller growing body of research on glbt health has little reference to Two-Spirit people. This paper attempts to redress these glaring absences.

Ageing with HIV/AIDS: a scoping study among people aged 50 and over living in Quebec

ABSTRACT The population of people aged 50 and over represents a significant proportion of people living with HIV in Western nations. While the number of older people living with HIV is rapidly increasing in Canada, research originating in this country remains relatively scarce. This article therefore proposes to describe the impact of the intersection of HIV and ageing on the identities and lived experiences of people living with HIV of 50 and over (PLHIV50+), both on an individual and social level, in order to offer a picture of their lived experience. Using a phenomenological approach, nine semi-structured individual interviews with PLHIV50+ (men and women) were undertaken. Data analysis identified several central themes which constituted the essence of their experience of the intersection of HIV and ageing, such as the experience of premature ageing, the impact of HIV on intergenerational relationships, the shrinking of ones social network, rejection experienced by the older population, a difficult return to work and a deterioration in living conditions. The results of this research highlight the many challenges faced by PLHIV50+, on physical, relational, work and economic levels. Even though some of the problems faced by PLHIV50+ were related to the experience of corporal changes and a deterioration of health, our research was able to highlight the societal and structural factors underlying the stigma of HIV and ageing.

The Impact of Caregiving Older Women’s Experiences of Sexuality and Intimacy

Using an adapted phenomenological approach, the current study explores older women’s stories about the ways in which providing care to their spouse or partner has affected their sexual and intimate lives. Findings suggest that older women’s sexual identities and experiences of sexuality are marked by both ageist constructions of “older woman as asexual” and loss of self associated with taking on the role of caregiver. Findings also suggest that women resist these constructions of self through the development of other forms of intimacy in their lives. Suggestions for increasing opportunities to address women’s realities in service provision are highlighted.

Ethnic and Lesbian: Understanding Identity Through the Life-History Approach

Canadian lesbians of ethnic ancestry experience many identity struggles as a result of being in multiple situations within both their own ethnic communities and their chosen lesbian communities. The case study presented here used a life-history approach to explore these dynamics. The life and experiences of one lesbian of ethnic ancestry are examined to highlight the usefulness of the life-history method in uncovering the complex realities that ethnic lesbians face in the creation of their subjective identities.

The Primacy of Family in Elder Care Discourse

Abstract Although public and institutional policy states that the presence of family to provide care should not limit older peoples access to public services, it does occur in practice. When family members are perceived as being able to contribute to the care of their elderly relatives, the frequency and duration of public sector support diminishes. This reality is particularly important to address with respect to ethnic elders where the perception and expectation of increased family involvement by public sector workers is commonplace. This article reports on the findings of a qualitative study addressing the experience of access among ethnic minority elderly women. It highlights the primary role of families in the discourse of home care and the resulting pressures this places on older ethnic women and their families. Suggestions for improving services are also mentioned.

Northern Enlightenment: Legal Recognition of Same-Sex Marriage in Canada

Social workers have an ethical and professional responsibility to promote social justice and equality for oppressed groups, including sexual minorities. Advocating for the legal recognition of same-sex marriage is one way to enact this responsibility. The legal recognition of same-sex marriage is a significant accomplishment toward equality for gay and lesbian Canadians—one in which the social work profession played a role by presenting a legislative brief to policymakers. Although legislative advocacy is cited as a social policy change tool, the literature gives little attention to it, especially in regard to equality and social justice for LGBT people. This statement, subsequently adopted by the Canadian Association of Social Workers, is presented here to help social service workers better understand the significance of legal recognition of same-sex marriage, particularly as a minority rights issue. It is also presented as an example of a legislative advocacy tool. To inform policy change efforts elsewhere, we conclude by offering our reflections on the statement and lessons learned.

Understanding the experiences of racialized older people through an intersectional life course perspective

This article proposes the development of an intersectional life course perspective that is capable of exploring the links between structural inequalities and the lived experience of aging among racialized older people. Merging key concepts from intersectionality and life course perspectives, the authors suggest an analytic approach to better account for the connections between individual narratives and systems of domination that impinge upon the everyday lives of racialized older people. Our proposed intersectional life course perspective includes four dimensions: 1) identifying key events and their timing, 2) examining locally and globally linked lives, 3) exploring categories of difference and how they shape identities, 4) and assessing how processes of differentiation, and systems of domination shape the lives, agency and resistance among older people. Although applicable to various forms of marginalization, we examine the interplay of racialization, immigration, labour and care in later life to highlight relationships between systems, events, trajectories, and linked lives. The illustrative case example used in this paper emerged from a larger critical ethnographic study of aging in the Filipino community in Montreal, Canada. We suggest that an intersectional life course perspective has the potential to facilitate a deeper understanding of the nexus of structural, personal and relational processes that are experienced by diverse groups of older people across the life course and into late life.

Providing Health and Social Services to Older LGBT Adults

Little is known about the home care context for lesbian, gay, bisexual, and transgender (LGBT) older adults, most of whom, like the general older adult population, prefer to stay in their home and community for as long as possible. The very limited LGBT-focused home care literature available suggests that there are unique concerns about providing care in the home. In this chapter, access to affi rmative home care services for LGBT older adults is located within the context of the LGBT health services access research literature. A program of research focused on identifying key access and equity indicators and associated prompts to assist organizations to provide high-quality, affi rmative home care for these populations is described.