Editorial

As diverse as the lived experiences of lesbian, gay, bisexual, transgender (LGBT), and other sexual minorities, the cultures and societies that make up the Latin American and Caribbean region present unique challenges, but also present unique opportunities for advancing human rights, access to healthcare, appreciating diversity, and consolidating shared identities. Same-sex sexuality is highly stigmatized in the Caribbean. Most member states retain colonial era laws criminalizing same-sex intimacy, except for countries like the Dutch Antilles, French Martinique, and Cayman Islands that fall under the legal jurisdiction of countries in which same-sex sexuality is no longer illegal. In this special issue of the International Journal of Sexual Health: LGBT Health and Well-Being in the Caribbean, we explore social and psychological factors that impact access to health and path for self-actualization for sexual minority communities in diverse cultures across the Caribbean.

This body of work emanates from research priorities articulated in a joint forum with representatives of civil society, the health sector, and from academia, convened in January 2014 in Kingston, Jamaica under the auspices of the Department of Medicine, University of the West Indies and the HIV Center for Clinical and Behavioral Studies, Columbia University, with the support of the Foundation for AIDS Research and AIDS Fonds, to reflect on the state of well-being of sexual minorities in Jamaica and the Caribbean at large. Together, we acknowledged the strides made by partners in advancing the welfare of this population and the resiliency exhibited by sexual minorities themselves in the face of continual adversity and marginalization. We had put forward a shared vision for programs and initiatives that would build on these accomplishments and address important gaps that impact the well-being and health of sexual minorities.

Trans voices

The voices of transgender and transsexual (trans) individuals have conventionally been subsumed into the chorus of the wider LGB and sexual minority community, putatively uniform in their needs, aspirations, and priorities. In helping to break that mold, Padilla et al. usher us along the deeply personal, yet highly social, journeys of trans individuals in Puerto Rico who are driven by the need for belonging, self-actualization through bodily transformation, and celebrated rite of passage in trans culture, while enduring enormous odds of violent victimization, socioeconomic exclusion, and significant health disparities.

Identity and society

Sexual identity development is a dynamic process occurring across the various stages of the life course, and individuals navigate through complex stages of uncertainty, self-awareness, shared identity, integration, disclosure, and advocacy. Disclosure impacts social mobility and life prospects, as captured by Rodríguez-Díaz et al. among LGBT individuals in Puerto Rico, and affects access to and acceptability of healthcare services, as outlined in studies in Puerto Rico by De León et al., suggesting that LGBT who disclose sexual identity to healthcare providers are more likely to have had a recent HIV test, know their partners’ HIV status, and access health services. Disclosure to family has unique considerations. White et al. highlight among Jamaican gay and bisexual men that general sense of connectedness with one's family, economic independence, and one's perceived sense of control over timing of disclosure may be important factors that influence outcomes.

Sexual identity is an intimate, individual process of becoming, but is influenced by societal norms and expectations on what it means to be sexual. West deftly dissects how our beliefs and expectations of gender roles for men in Jamaica shape sexual restrictiveness and societal rejection of homosexual sex and intimacy between men, and even heterosexual intercourse that involves sexual practices of homosexual repute, like anal sex. This builds on West's previous work demonstrating that anti-gay prejudice can be ameliorated through positive cross-group interactions between gay and heterosexual Jamaicans (West & Hewstone, 2012), or through positive imagery involving interactions with gay Jamaicans (West, Husnu, & Lipps, 2014). But West highlights that even heterosexual sex is not free of policing, and which is not explained by anti-gay attitudes, but perhaps the desire to stave off any perceived threats to the social constructs of masculinity, its fragility belied by its rigid prescriptions and proscriptions.

Through advocacy and a collective sense of shared sexual identities globally, there has been the emergence of a maturing population of out LGBT individuals. Developments, directly and indirectly related to sexual identity, have revealed new challenges and needs for LGBT and sexual minorities, including for example ageing and HIV, aging LGBT, and cancer risk. Soto-Salgado et al. examine our public health approach to cervical cancer risk, its epidemiology in a well-defined geographical region in Puerto Rico, and the unique burden, awareness, and demand for cancer prevention among women who have sex with women.

Healthcare professionals, sexual minority clients, and cultural competency

Rambarran and Grenfell report on the experiences of general practitioners in Barbados in engaging LGBT patients, to assess perceived self-efficacy and training needs, and inform curriculum design for undergraduate and postgraduate training programs and continuing medical education. Rambarran and Simpson provide complementary insight by capturing the healthcare experiences of women who have sex with women in Guyana, the sole country on the South American continent with English as its official first language, and sharing much in common historically and politically with the Caribbean. With one of the highest suicide rates in the world, sexual minority women in Guyana are at particularly high risk for suicidality and unattended mental health needs. Indeed, much more work is needed to aid our understanding of culturally specific factors that influence this disparity in order to inform appropriate public health strategies.

Conclusion

Wellness encompasses not only the absence of disease or ailment, but all facets of life that impact life prospects and the ability to attain self-actualization, have access to national resources, and participate fully in nation building. It is our hope that this body of work will spawn a renewed interest in scientific, multidisciplinary research to aid our understanding of social and health disparities that impact some of the potentially most vulnerable in our societies.