Navigating Queer Street: Researching the Intersections of Lesbian, Gay, Bisexual and Trans (LGBT) Identities in Health Research
by Julie Fish
De Montfort University
Sociological Research Online 13(1)12
<http://www.socresonline.org.uk/13/1/12.html>
doi:10.5153/sro.1652
Received: 19 Jun 2007 Accepted: 8 Nov 2007 Published: 21 Mar 2008
Abstract
Health researchers engaged in the project of identifying lesbian, gay, bisexual and trans (LGBT) health as a distinct topic for study have often emphasised the differences in health and health care from heterosexuals and similarities among LGBT people. This work has sometimes rendered invisible the experiences of disabled, black and minority ethnic and other groups and has contributed towards the homogenisation of LGBT communities. In this paper, intersection theory is used to explore how diverse identities and systems of oppression interconnect. As a theory, intersectionality requires complex and nuanced thinking about multiple dimensions of inequality and difference. Drawing on the work of Crenshaw (1993), I use three types of intersectionality: methodological, structural and political to explore how the meanings of being lesbian may be permeated by class and gender and how racism and heterosexism intersect in the lives of black and minority ethnic gay men and women. Intersection theory offers possibilities for understanding multiple inequalities without abandoning the politics of social movements.
Keywords: Intersection Theory; Homogeneity; Diversity; Lesbian; Gay; Bisexual and Transgender Research; Inequality; Health
Introducing intersection theory
1.1 Intersection theory was developed to address the exclusion of black women from feminist theorising and research. In early second wave analyses, women as a group were seen to have a shared identity which was popularised in the notion of sisterhood. One group of women, mainly white, middle class and able-bodied, had taken their position to be the situation of women in general (Spelman, 1990). Gender was considered to be the central organising category in analysing oppression and independent of other aspects of identity, such as race (or class). But for black women, this dichotomy compartmentalized their struggle: against racism as a black person and against sexism as a woman. Early theories of difference had proposed an approach in which women were added into research agendas which were primarily concerned with men. Rejecting this additive approach, feminist sociologists called for an alternative theorising that captured the combination of race and gender.1.2 Intersectional approaches maintain that gender and race are not independent analytic categories that can simply be added together (Browne and Misra, 2003). As a theoretical approach, intersectionality conceives of social inequalities as interdependent and mutually constituted (Weber, 2006). The focus of analysis is expanded from merely describing similarities and differences to one which shows how multiple identities and systems of oppression interconnect (Gamson and Moone, 2004).
1.3 The term intersectionality is ascribed to the work of Kimberlé Crenshaw who developed the metaphor from the notion of intersections in the US road system:
‘Intersectionality is what occurs when a woman from a minority group … tries to navigate the main crossing in the city…The main highway is ‘Racism road’. One cross street can be Colonialism, then Patriarchy Street… She has to deal not only with one form of oppression but with all forms…’ (Crenshaw cited in Yuval-Davis, 2006: 196).
1.4 Feminists have used intersection theory to examine the inter-relationship of ‘race’, gender and class in relation to health (Mullings and Schulz, 2006); the labour market and employment (Adib and Guerrier, 2003) and affirmative action programmes (Steinbugler et al. 2006). While intersectionality has emerged as a ‘major research paradigm’ in women’s studies (McCall, 2005: 1771), it has not been explicitly considered in LGBT sociological theorising. There is, however, a developing interest in the ways multiple identities interconnect (e.g. Bhugra, 1997; Yip, 2004; Taylor, 2005; Fish, 2006).
1.5 This paper considers the relevance of intersection theory as an analytical tool in the development of LGBT research and knowledge production. To this end, I adopt a view of methodology as a set of coherent ideas about the theory, methods and data produced in the conduct of research (c.f. Harding, 1987). The paper argues that by incorporating intersection theory as a methodological framework, LGBT research may be more likely to account for the diversity of LGBT communities and to incorporate understanding of how one’s social location is mediated by heterosexism, racism and/or sexism. It builds on Young and Meyer’s (2005) proposal that intersection theory may lend important insights for LGBT health research. In this analysis, three circumstances appear to make intersection theory especially relevant. First, the under-representation of marginalised groups within LGBT communities has formed part of debates in health research since the early 1990s (Pollinger Haas, 1994). In response to criticism, a number of LGBT health researchers have sought to address these exclusions by methodological innovations (e.g. Martin and Dean, 1993, Hickson et al. 2004). Second, LGBT health research, particularly in the US where the body of work is now substantial, is dominated by the biomedical, quantitative research paradigm and there is a relative lack of sociological theorising. Third, intersection theory, building on feminist theories of difference (e.g. Young, 1990), is a policy oriented approach. LGBT health research is concerned with informing health care strategy and improving access to, and delivery of, services; intersection theory may make a fruitful contribution to this rights-based approach.
1.6 The paper first considers the notion of assumed similarities and the ways this has homogenised LGBT communities, it then explores how intersection theory differs from other approaches in LGBT sociological theorising. In the following sections, three types of intersectionality (methodological, structural and political) are used to examine how the meanings of being lesbian may be permeated by class and gender and how racism and heterosexism intersect in the lives of black and ethnic minority gay men and women. The paper attempts to make a theoretical contribution to the conceptualization of multiple identities and oppressions through an examination of intersectionality.
Disrupting heteronormative discourses of the homogenous homosexual
2.1 Early feminist research identified women as a class and illustrated differences between the health of women and that of men (e.g. Ehrenreich and English, 1973). Similarly, in making the case that LGBT communities comprise a group which experience health inequalities, current research (in particular, that which is located within the positivist quantitative research paradigm) has sought to examine the ways that the health needs of LGBT people differ from those of the heterosexual population. In studies of lesbian health, researchers have identified differences in risk for developing breast cancer between lesbians and heterosexual women (Roberts et al. 1998); alcohol consumption (Bloomfield, 1993) and sexual assault and abuse (Hughes et al. 2001). This emphasis could be broadly characterised as conceptualising differences between dominated and dominant groups. But while the similarities within LGBT communities have been emphasised, differences have been obscured. These discourses of homogenisation have been used as a strategy in the politics of recognition; the notion that LGBT people have (some) common experiences of oppression is not widely understood. Researchers, then, have endeavoured to emphasise the ‘common threads’ among LGBT people’s experiences to argue that LGBT people experience health inequalities and draw attention to the barriers in accessing health care (Scott et al. 2004; 12). LGBT health activists and researchers have used homogenising discourses as a political strategy in the attempt to constitute LGBT communities as an equality strand.2.2 While LGBT researchers have developed the notion of shared identities and interests for political purposes in order to identify LGBT people as a social category, heteronormative assumptions paradoxically hold that LGBT communities are homogenous. For example, Experian’s household-based geodemographic system, which is widely used by public sector agencies to classify areas of social need, identifies sixty-one different social groups; gay (sic) communities are identified in only one of them (Retrieved 10 Sept 2007 from <http://www.business-strategies.co.uk/sitecore/content/Public%20sector/Health.asp>). In widely held perceptions, LGBT communities are middle class and white. Assumptions of middle class status were recently perpetuated in a UK government document which suggested that the annual salaries of lesbians and gay men are up to ‘£10,000 higher than the national average’ (Women and Equality Unit, 2006: 40). Assumptions that LGBT communities consist only of white people are illustrated by Susan Cochran, co-researcher of the classic US national black lesbian study, in discussion of her experience of the peer review process:
‘I once had a manuscript returned to me unreviewed by a top journal, the only time in my career this has ever happened, because the editor informed me that his readers were not interested in research on black lesbians. He implied my sample must be biased, because it was difficult to imagine that my research team could find 600 black lesbians to fill out questionnaires in the first place’ (Solarz, 1999: 143).
2.3 Although there has been some success in identifying LGBT people as a social category, the focus on inter group differences, (that is between LGBT people and their heterosexual counterparts), has occluded intra group differences, (that is the differences within LGBT as an inequality category, for example, in terms of race, disability and age). Moreover, heteronormative discourses constitute LGBT communities as a homogenous and privileged community which can buy itself out of social disadvantage. Although this research has tended to be under-theorised, I would ascribe its influence to the politics of identity (Greaves et al, 2007). In seeking to avoid the limitations of this approach, other sociological approaches to inequality, in particular queer theory, have sought to deconstruct inequality categories.
How does intersection theory differ from other approaches in LGBT sociological theorising?
3.1 Queer theory is possibly the most visible approach in the field of LGBT sociological theorising (Gamson and Moon, 2004) [1]. In common with other post structuralist approaches, the liberatory project of queer theory is the deconstruction of identity categories:‘Many of the current efforts in lesbian and gay theory … have begun the difficult but urgent textual work necessary to call into question the stability and ineradicability of the hetero/homo hierarchy...But how exactly do we bring the hetero/homo opposition to the point of collapse. How can we work it to the point of critical exhaustion, and what effects – material, political, social - can such sustained effort to erode and to reorganize the conceptual grounds of identity be expected to have on our sexual practices and politics?’ (Fuss, 1991: 1).
3.2 Queer theorists point to the arbitrary, unstable and exclusionary nature of identity categories; people’s identities, experiences and social locations do not fit neatly within a single category. The stability of identity categories is illustrated by the dichotomous sex/gender system of men and women; a taken for granted assumption in the Western cultural tradition. The ‘natural attitude’ is that gender is unchanging: ‘if you are female/male, you always were female/male and you always will be’ and there are no transfers from one sex/gender to another (Kessler and McKenna, 2000: 12). Trans people place themselves outside the traditional female/male dichotomy and subvert the notion of fixed sex/gender categories. McCall (2005) describes this is an anticategorical approach which is concerned about the socially constructed nature of gender and she highlights the ways that these approaches have deconstructed gender, ‘race’ and sexual identity.
3.3 Queer theory seeks to deconstruct overarching categories and, in the process, contribute to the deconstruction of inequality. As McIntosh (1993) argues, it is not concerned with disputes about what it means to be LGBT: whether bisexuals are really gay or trans people are really women. Queer theory does not engage with the debates about hierarchies of oppression which beset the movement in the 1980s. It is ‘a form of resistance, a refusal of labels, pathologies and moralities’ (McIntosh, 1993; 31). This refusal of labels is represented by (among others) the growing use of the terms MSM or WSW (men who have sex with men or women who have sex with women). Although the term MSM was introduced to reflect the idea that behaviours, not identities, place people at risk for HIV, Young and Meyer (2005) argue that it contributes to the erasure of the sexual minority person in public health discourse and obscures the politics of LGBT actions to secure access to health care.
3.4 Intersection theory offers possibilities for mediating the tension between assertions of multiple identities and the ongoing necessity of group politics (Crenshaw, 1993). Crenshaw (1993) identifies two categories of intersectionality: structural and political which I will consider in relation to LGBT health. Yuval-Davis (2006) has added a third - methodological intersectionality; as most work in LGBT health has been undertaken in relation to methodology, this category will be considered first. My discussion of the three categories of intersectionality draws upon Crenshaw’s work (1989; 1993) and that of other intersectional theorists (e.g. Verloo, 2006; Mullings and Schulz, 2006).
Methodological intersectionality
‘Most of the empirical...research on or with lesbians and gay men is still conducted with overwhelmingly white, middle class, young, able-bodied participants, most often urban, college student or well-educated populations’ (Greene, 2003: 378).4.1 Since the early 1990s, LGBT health research has been criticised for the homogeneity of its samples (Pollinger Haas, 1994). Rather than attributing this homogeneity solely to the exclusionary practices of LGBT researchers, in the previous sections, I considered political and discursive reasons for these omissions. In this section, I would, in part, attribute the homogenous samples recruited to the heteronormativity of research methodologies. Sampling frames form criteria in decisions about the quality and reliability of research findings, but their heteronormativity is rarely discussed. The most commonly used frames for sampling the general population in the UK do not identify households whose occupants are lesbian, gay, bisexual or trans (e.g. the Electoral Register and the Postcode Address File). LGBT researchers then, do not have access to the so-called ‘gold standard’ of sampling frames, the random method (Solarz, 1999: 37). Instead, researchers have adopted a number of innovative ways of facilitating the inclusion of diverse groups within LGBT research. Although the move towards greater inclusivity is more likely to be motivated by political agendas (the need for diversity) rather than by theoretical concerns about intersectionality (which consider the implications of difference), they do represent first steps towards incorporating intersectionality in research samples. Two methodological innovations are considered below: the effectiveness of different sampling methods in facilitating the inclusion of diverse groups and the use of inclusive definitions in research designs (see Fish, 2006 for more detailed discussion).
4.2 Lacking a random sampling frame, LGBT researchers have considered the effectiveness of different recruitment methods in obtaining participants who were differentiated on the basis of ‘race’, class, levels of being ‘out’ and age. Martin and Dean (1993) showed that the population of gay men recruited through a public health clinic was quite different to that obtained through other sources – they were younger, had lower annual incomes, were primarily African-American or Hispanic and less likely to be a member of a gay group or organisation. Hickson et al. (2004) illustrated that the recruitment method used was significantly associated with different demographic characteristics. Of the three sampling methods used (Pride events, booklet and online), men with low education were much more likely to use the booklet; this method was also more likely to recruit Black and Asian men. White ‘other’ men were more likely to use Pride events, while white British men were more likely to use the internet. Researchers have often advocated the use of random sampling techniques in order to better represent diversity among research participants (e.g. Solarz, 1999). But when Martin and Dean (1993) compared the demographics of their study, which used non-probability methods, to the samples of studies using random methods, they found that the composition of the samples were broadly similar. Among LGBT communities, both probability and non-probability methods are likely to produce homogenous samples. (Fish, 2000)
4.3 Lesbian health research has often used self identification as lesbian as a criterion for inclusion in studies; it was considered an improvement on the use of setting (e.g. a bar) as a criterion (Fish, 2006). But because many black and minority ethnic (BME) LGBT people may not use the term lesbian or gay to describe themselves, many may have been excluded from research. More recently, health researchers have devised multiple definitions of sexual identity along dimensions of ‘desire, behaviour and identity’ (Solarz, 1999: 31). Inclusive definitions are believed to encourage the participation of under-represented groups.
4.4 These developments have gone some way towards identifying alternative methodologies for researching among LGBT communities and towards facilitating diversity. However, there has been little use of intersectional analysis to illustrate how these differences impact on the health status and healthcare experiences of marginalised constituencies within LGBT communities. The following sections consider how such an analysis may reveal how multiple identities and systems of oppression interconnect in the everyday lives and experiences of LGBT people.
Structural intersectionality
5.1 Crenshaw describes structural intersectionality as the ways in which ‘the location of women of color at the intersection of race and gender makes our experiences…qualitatively different from that of white women’ (1993: 1245). Structural intersectionality is concerned about patterns of social inequality. In her research about the changing structure of class and racial inequality among women, McCall (2005) examines different dimensions of wage inequality. Intersectional approaches within the qualitative research paradigm reflect on accounts of multiple, shifting and simultaneous presentations of the self (Valentine, 2007).5.2 This section considers both approaches within intersectionality: the lived experiences of multiple identities and the health inequalities along different dimensions of social categories. It considers how racism and heterosexism act together to reinforce inequalities and how class exploitation amplifies heterosexism (c.f. Verloo, 2006). Other intersectional theorists have pointed to the difficulties of specifying how the simultaneity of ‘race’, class and gender affect people’s daily lives and how these inequalities impact on health (Mullings and Schulz, 2006). There are few analyses of the ways that sexual identity intersects with ‘race’ or class. In the examples which follow, I first explore how the experience of coming out may differ for a black gay man in comparison to a white gay man. In the second example, I explore how lesbians’ classed positions may qualitatively affect their experiences of being lesbian. Finally, I consider how inequalities in mental health experiences may differ within LGBT communities.
Identity formation and coming out in black and white LGB communities
5.3 Coming out to others is seen as the quintessential experience of being lesbian, gay or bisexual; conversely, hiding one’s sexual identity from others implies that the individual is not being true to oneself (Keogh et al. 2004). Coming out refers to two phenomenological experiences: acknowledging one’s identity to oneself and telling others that one is lesbian, gay or bisexual. The public acknowledgement of one’s LGB identity is widely considered to indicate psychological health and high levels of self esteem. Coming out to a health care worker is a common theme in LGB health research and is believed to be associated with a number of health benefits (Cant, 2005).
5.4 While the literature on identity formation and coming out is extensive, Cass’s (1979) model of identity formation continues to exert influence upon our understandings. Cass (1979) identified a six staged model[2], but it is the first two stages that are of particular relevance to this analysis. In the first stage, the individual feels alienated from all others and has a sense of ‘not belonging’ to society at large (1979: 221). If the individual moves on to the next stage, they seek out other LGB people to alleviate these feelings and find acceptance. The benefits of the second stage lie in the opportunities to meet a partner; the provision of role models; practice in feeling more at ease with oneself as an LGB person; a ready made support group and validation of the self as LGB.
5.5 In this characterisation, coming out is conceived of as a relatively homogenous experience that holds true across LGB communities whether the person is disabled, working class, older or BME. But this assumption may rely, culturally and conceptually, on white, western constructs. Because BME LGB people may be less likely to be open about their sexual identity to anyone but their close friends (Bhugra, 1997; Galop, 2001; Yip, 2004), the characterisation of coming out as a universal experience may serve to pathologise the coming out experiences of BME LGB.
5.6 The very meanings of being gay may vary when applied to one’s own racial group as compared to another (c.f. Mullings and Schulz, 2006). Clarence Allen describes some of the challenges in forging a black gay identity: ‘It is never easy coming out in a society that, at best, accepts homosexuality on a superficial level (if it is kept secret…) and, at worst physically attacks and sometimes kills lesbians and gay men. Having to open ourselves up to extra abuse or ‘allow’ ourselves to be doubly oppressed is not done without great thought’ (Cole Wilson and Allen, 1994: 123-4). Discourses about identity formation and coming out do not account for the ways in which the experiences of BME LGB may differ from their white counterparts. Coming out may have different implications; the decision to adopt an overtly gay identity may be viewed as a repudiation of one’s ethnicity (Greene, 2003). These different meanings may be complex and ambivalent. While Black lesbians appear to be more likely than white lesbians to maintain strong involvements with their families, to have children, to have continued contact with men and their heterosexual peers and to depend on family members for support (Solarz, 1999; Greene, 2003), they may also be more likely to identify as lesbians and to have had sexual experiences with women (Morris and Rothblum, 1999).
Lesbians’ classed positions: white working class and middle class lesbians
5.7 Class mediates experiences of health: wellbeing and longevity are powerfully shaped by one’s social location in relation to income, education and occupation. Heteronormative discourses constitute LGB people as middle class and insulated from the health inequalities experienced by other social groups. These assumptions have contributed to the erasure of white working class lesbian identities and experiences. In one of the few studies, McDermott (2004) draws upon Bourdieu’s concepts of linguistic capital and habitus to explore lesbians’ classed positions. She notes that the linguistic ease and communicative competence of the middle-classes distinguish them from working-class lesbians. She draws attention to the scarcity of positive class discourses; in many, the working-class are depicted as deviant and lacking in self-control. Habitus mediates our interaction with the social world; the personal accounts of working-class lesbians are characterised by a lack of confidence, self-worth and expectation. Working class lesbians in Taylor’s (2005) study described how scene space required particular classed displays, images and performances to enable entry. Multiple claims were made: having the money, the right clothes, the right style and taste and looking like a lesbian shows that a lesbian woman deserved to be there, but these claims often meant unaffordable presentations.
Experiences of mental health within LGBT communities
5.8 In the past decade, there has been growing concern about mental health problems in LGBT communities. Research suggests that LGBT people experience increased psychological distress in comparison to heterosexual men and women, despite similar levels of social support and quality of physical health (e.g. King et al. 2003). Gay and bisexual men are more likely to have attempted suicide in comparison to their heterosexual counterparts (Remafedi et al. 1998). But little is known about how health needs differ within LGBT communities: few large-scale studies exist. King et al.’s (2003) research is the only European study of mental health which has recruited over a thousand LGB participants; their data suggest that BME LGB people were less likely than their white counterparts to have considered suicide. This difference may be explained by cultural or religious taboos about suicide, by the relatively small proportions of BME people in the study or attributed to different attitudes towards suicide within BME communities. An intersectional approach would be concerned about how and why LGBT people from BME communities have different experiences of mental health. Some studies suggest that BME communities may be particularly affected by homophobic violence; experiences of discrimination are associated with poor mental health. Moreover, the impact of racism and homophobia on BME LGBT mental health in the UK requires investigation. In Diaz et al.’s (2001) study of the mental health of gay and bisexual Latino men, many men reported experiences of racism within the gay community, discomfort in spaces primarily attended by whites and being sexually objectified owing to their race/ethnicity.
5.9 Intersectional analyses are limited by the dearth of research about the experiences of groups within LGBT communities. These absences are considered in the following section.
Political intersectionality
6.1 In Crenshaw’s (1993) formulation, political intersectionality relates to the ways inequalities are relevant to political strategies. She found that crime statistics for domestic violence are classified by sex or race, but not by sex and race. The Los Angeles Police Department and domestic violence activists were opposed to the release of statistics because of concerns that they might unfairly represent black communities as violent and reinforce stereotypes about black men. Crenshaw (1993) argued that the refusal contributed to the silence about domestic violence and was against the interests of black women. Political intersectionality then, refers to the ability of groups located at the intersections to mobilize politically; in terms of their access to data to support their claims and how the interests of groups at the intersections are often perceived to be in conflict with those of others.6.2 I conceive of political intersectionality as political organising (within social movements) and political processes (adopted by governmental and other organisations). Questions for consideration include: How can knowledge produced about multiple inequalities contribute to tackling discrimination? What are the political costs and barriers to producing such knowledge? My discussion focuses on the extent to which politically relevant and recognised institutions are in place to address LGBT inequalities; the absence of statistics for sexual identity; and the degree to which LGBT concerns are represented within political processes. Verloo (2006) suggests that sexual identity is rarely institutionalized as an inequality category. By contrast, class has a high degree of institutionalized representation (in political parties and trade unions), and gender is institutionalized in government (the Women and Equality Unit and a Minister for Women) (Verloo, 2006). There may be a turning point in the political institutionalization of sexual identity; the newly established Equality and Human Rights Commission (EHRC) will offer protection from discrimination on the grounds of sexual identity for the first time and its cross-cutting agenda may be more responsive to multiple inequalities.
6.3 Among LGBT communities, the absence of data on sexual identity is conspicuous: we do not know how many LGBT people live with children, what kinds of jobs they do or where they live. There are only estimates about the size of the LGBT population in the UK. In recent debates about the possibility of including a question in the 2011 census, the General Register Office for Scotland queried whether sexual identity indeed constitutes a social or civil condition (GROS, 2006). While sexual identity is the only equality strand which is not included as a social category in the census, there is also an absence of local and central government research and statistics that include any measure for it. Population level indicators for social exclusion, poverty or family composition are not available (McManus, 2003). There are few, if any, desegregated data which might identify inequalities between different constituencies within LGBT communities. These issues form contested debates within LGBT communities: there are concerns about privacy, the intrusiveness and perceived relevance of the questions. The collection of data that can be desegregated requires individuals to declare their sexual identity. There are also debates about the fluidity of sexual identity in relation to other equality strands; some see sexual identity as less stable than other social categories, such as ‘race’.
6.4 The degree to which LGBT concerns can be represented within political processes is constrained by the lack of infrastructural support for the LGBT voluntary and community sector. As Cant (2006) has argued, the income of the LGBT sector in London is less than 1% of the whole voluntary sector while the proportion of LBGT people is approximately 6% of the capital’s population. One of the cornerstones of the New Labour project for democratic renewal is the commitment to refocus public services through the participation of active citizens who are seen as sources of relevant knowledge. This participative-democratic model is designed to make public services more accountable to the needs and priorities of local communities. The model requires consultation with established groups and organisations. In the process of devolution in Northern Ireland, groups representing women, disabled people and religious organisations were often organised and in a position to prepare submissions on a range of departmental policies. But the Department of Agriculture and Rural Development found that there was no group to represent the concerns on how rural development policies impact on LGB people (Donaghy, 2004). In Wales, the consultation at first omitted LGB people, however, when they were included, they showed a greater level of engagement and satisfaction with the workings of the new structure, they reported benefit from having their view heard and they were more likely to have joined their organisation with the expectation of being able to take part in the political process (Fevre, 2005).
6.5 In relation to sexual identity, political intersectionality is inflected by the different ways that the processes of inequalities are perpetuated. In the earlier example, for black women, the struggle was in gaining information about domestic violence and how their interests were not served by the refusal to make the data accessible. For sexual and gender identity, there are few data about the social category that could be used to inform an intersectional analysis.
Conclusion
7.1 LGBT health is a longstanding site of contestation and political activism; prominent campaigns have included HIV/AIDS, self insemination for lesbians and the declassification of LGB identity as a mental disorder. Heterosexist notions, which linked LGBT identities to disease, were enshrined in legislation.[3] These struggles required oppositional politics which emphasised both a shared identity and experiences of oppression. The process of recognising as social and systemic what was formerly perceived as isolated and individual has characterised LGBT identity politics and has been a source of ‘strength, community and intellectual development’ (Crenshaw, 1993: 1242). LGBT health as a research discipline, which grew out of these political struggles, countered assumptions which constituted LGBT health as inherently pathological and provided accounts of health inequalities. Health and social inequalities are rooted in relationships that are defined by ‘race’, class, age, disability, religion, gender and gender identity; single social categories, however, fail to encapsulate the range of experiences and social locations. Anticategorical approaches propose that these categories are frameworks of domination; by divesting them of social significance, theorists in this tradition envision an end to inequality. But the deconstruction of identity categories has similarly ignored differences within LGBT communities and (as discussed earlier) obscured the politics of LGBT actions to secure access to health care.7.2 By contrast, intersectionality starts from the premise that there are relationships of inequality among social groups, and despite their fluidity, takes those relationships as the centre of analysis. The project of examining these relationships demands the provisional use of categories; indeed, McCall (2005) argues the impossibility of avoiding the strategic use of categories for political purposes. The continuing project for LGBT health research and activism is to build inclusive categories which acknowledge the multiplicity of sexual and gender identities. Intersectional approaches facilitate consideration of the ways that ‘race’, class and gender are experienced simultaneously in people’s everyday lives; they allow us to explore, for example, how the meanings of being lesbian may be permeated by class and gender and how coming out experiences may differ among BME communities.
Notes
1 This is not intended as a critique of queer theory, it attempts to highlight the ways that the two approaches differ and have different political goals.2 Although Cass’ model has been critiqued by Kitzinger (1987), this critique takes a different approach.
3 Section 28 of the 1988 Local Government Act.
Acknowledgements
I would like to thank Bob Cant, the editor of this special issue of Sociological Research Online, and three anonymous reviewers for their comments.
References
ADIB, A., & Guerrier, Y. (2003). The Interlocking of Gender with Nationality, Race, Ethnicity and Class: the Narratives of Women in Hotel Work. Gender, Work and Organization, 10(4), 413-432.
BHUGRA, D. (1997). Coming out by South Asian gay men in the United Kingdom. Archives of Sexual Behavior, 26(5), 547-557.
BLOOMFIELD, K. (1993). A Comparison of Alcohol-Consumption between Lesbians and Heterosexual Women in an Urban-Population. Drug & Alcohol Dependence, 33(3), 257-269.
BROWNE, I., & Misra, J. (2003). The intersection of gender and race in the labor market. Annual Review of Sociology, 29, 487-513.
CANT, B. (2005). Exploring the implications for health professionals of men coming out as gay in healthcare settings. Health and Social Care in the Community, 14(1), 9-16.
CANT, B. (2006) Out for the counting. Diversity in Health and Social Care, 3 (3): 161-162.
CASS, V. C. (1979). Homosexual Identity Formation: A Theoretical Model. Journal of Homosexuality, 4(3), 219-235.
COLE WILSON, O., & Allen, C. (1994). The Black Perspective. In E. Healey & A. Mason (Eds.), Stonewall 25: The Making of the Lesbian and Gay Community in Britain (pp. 112-136). London: Virago Press.
CRENSHAW, K. (1989). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 139-168.
CRENSHAW, K. (1993). Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanford Law Review, 43(6), 1241-1279.
DIAZ, R. M., Ayala, G., Bein, D. E., Henne, J., & Marin, B. V. (2001). The Impact of Homophobia, Poverty, and Racism on the Mental Health of Gay and Bisexual Latino Men: Findings from 3 US Cities. American Journal of Public Health, 91(6), 927-932.
DONAGHY, T. B. (2004) Mainstreaming: Northern Ireland's Participative Democratic Approach. Policy & Politics, 32(1), 49-62.
EHRENREICH, B. and English, D. (1973) Complaints and Disorders: The sexual politics of sickness. New York: The Feminist Press.
FEVRE, R. (2005). Social Capital and the Participation of Marginalised Groups in Government. Cardiff: Cardiff University. ESRC (R000239410).
FISH, J. (2006). Heterosexism in Health and Social Care. Basingstoke: Palgrave.
FISH, J. (2000). Sampling Issues in Lesbian and Gay Psychology: Challenges in Achieving Diversity. Lesbian and Gay Psychology Review, 1(2), p. 32-38.
FUSS, D. (1991). Inside out: lesbian theories, gay theories. New York: Routledge.
GALOP. (2001). The Low Down, Black Lesbians, Gay Men and Bisexual people talk about their experiences and needs. London: Galop.
GAMSON, J., & Moon, D. (2004). The Sociology of Sexualities: Queer and Beyond. Annual Review of Sociology, 30, 47-64.
GREAVES, B., Fish, J., Graham, D., Broderick, N., Evans, H., & Moore, R. (2007). The health and social care needs of lesbian, gay and bisexual people in Leicester. Leicester: Unpublished report submitted to the Leicester Public Health Partnership.
GREENE, B. (2003) Beyond heterosexism and across the cultural divide - developing an inclusive lesbian, gay and bisexual psychology: A look to the future. In L. Garnets & D. C. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences. New York, NY: Columbia University Press.
HARDING, S. (1987) Feminism and Methodology. Bloomington: Indiana University Press.
HICKSON, F., Reid, D., Weatherburn, P., Stephens, M., Nutland, W., & Boakye, P. (2004) HIV, sexual risk, and ethnicity among men in England who have sex with men. Sexually Transmitted Infections, 80(6), 443-450.
HUGHES, T. L., Johnson, T., & Wilsnack, S. C. (2001). Sexual assault and alcohol abuse: A comparison of lesbians and heterosexual women. Journal of Substance Abuse, 13(4), 515-532.
KEOGH, P., Weatherburn, P., Henderson, L., Reid, D., Dodds, C., & Hickson, F. (2004). Doctoring Gay Men: Exploring the contribution of General Practice. Portsmouth: Sigma Research.
KESSLER, S., & McKenna, W. (2000). Gender Construction in Everyday Life. Feminism & Psychology, 10(1), 11-29.
KING, M., McKeown, E., Warner, J., Ramsay, A., Johnson, K., Cort, C., Wright, L., et al. (2003). Mental health and quality of life of gay men and lesbians in England and Wales: Controlled, cross-sectional study. British Journal of Psychiatry, 183(6), 552-558.
KITZINGER, C. (1987) The Social Construction of Lesbianism. London: Sage.
MARTIN, J. L., & Dean, L. (1993). Developing a Community Sample of Gay Men for an Epidemiological Study of AIDS. In C. Renzetti & R. Lee (Eds.), Researching Sensitive Topics (pp. 82-99). Newbury Park, CA: Sage Publications.
MCCALL, L. (2005). The Complexity of Intersectionality. Signs: Journal of Women in Culture and Society, 30, 1771–1800.
MCDERMOTT, E. (2006). Surviving in dangerous places: Lesbian identity performances in the workplace, social class and psychological health. Feminism and Psychology, 16(2), 193-211.
MCINTOSH, M. (1993). Queer theory and the war of the sexes. In J. Bristow & A. R. Wilson (Eds.), Activating theory: lesbian, gay, bisexual politics (pp. 30-52). London: Lawrence & Wishart.
MCMANUS, S. (2003). Sexual Orientation Research Phase 1: A Review of Methodological Approaches. Retrieved 21 June 2007 from: <http://www.scotland.gov.uk/Publications/2003/03/16650/19351>
MORRIS, J., & Rothblum, E. (1999). Who Fills Out a Lesbian Questionnaire? The Interrelationship of Sexual Orientation, Sexual Experience with Women and Participation in the Lesbian Community. Psychology of Women Quarterly, 23(3), 537-557.
MULLINGS, L., & Schulz, A. J. (2006). Intersectionality and health: An introduction. In A. J. Schulz & L. Mullings (Eds.), Gender, race, class and health: Intersectional approaches. San Francisco: CA: Jossey-Bass.
POLLINGER HAAS, A. (1994). Lesbian Health Issues: An Overview. In A. Dan (Ed.), Reframing Women's Health: Multidisciplinary Research and Practice (pp. 339-356). Thousand Oaks, CA: Sage Publications.
ROBERTS, S. A., Dibble, S. L., Scanlon, J. L., Steven, P. M., & Davids, H. (1998). Differences in Risk Factors for Breast Cancer: Lesbian and Heterosexual Women. Journal of the Gay & Lesbian Medical Association, 2(3), 93-101.
REMAFEDI, G., French, S., Story, M., Resnick, M. D., & Blum, R. (1998). The Relationship Between Suicide Risk and Sexual Orientation: Results of a Population-based Study. American Journal of Public Health, 88(1), 57-60.
SCOTT, S. D., Pringle, A., & Lumsdaine, C. (2004). Sexual Exclusion: Homophobia and Health Inequalities: A Review of Health Inequalities and Social Exclusion Experienced by Lesbian, Gay and Bisexual People. London: UK Gay Men's Health Network.
SPELMAN, E. (1990). Inessential woman: problems of exclusion in feminist thought. London: The Women's Press.
SOLARZ, A. (Ed.). (1999). Lesbian Health: Current Assessment and Directions for the Future. Institute of Medicine. Washington, DC: National Academy Press.
STEINBUGLER, A. C., Press, J. E., & Johnson Dias, J. (2006). Gender, Race, and Affirmative Action: Operationalizing Intersectionality in Survey Research. Gender and Society, 20, 805-825.
TAYLOR, Y. (2005). The gap and how to mind it: Intersections of class and sexuality (research note). Sociological Research Online, 10(3) <http://www.socresonline.org.uk/10/3/taylor.html>.
VALENTINE, G. (2007). Theorizing and Researching Intersectionality: A Challenge for Feminist Geography. Professional Geographer, 59(1), 10-21.
VERLOO, M. (2006). Multiple Inequalities, Intersectionality and the European Union. European Journal of Women's Studies, 13(3), 211-228.
WEBER, L. (2006). Reconstructing the landscape of health disparities research: Promoting dialogue between feminist intersectional approaches and biomedical paradigms. In A. J. Schulz & L. Mullings (Eds.), Gender, race, class and health: Intersectional approaches. San Francisco: CA: Jossey-Bass.
WOMEN & EQUALITY UNIT. (2006). Getting Equal: Proposals to Outlaw Sexual Orientation Discrimination in the Provision of Goods and Services. London: DTI.
YIP, A. (2004). Negotiating space with family and kin in identity construction: the narratives of British non-heterosexual Muslims. The Sociological Review, 52(3), 336-349.
YOUNG, I. M. (1990). Justice and the politics of difference. Princeton, N.J.: Princeton University Press.
YOUNG, R. M., & Meyer, I. H. (2005). The Trouble With "MSM" and "WSW": Erasure of the Sexual-Minority Person in Public Health Discourse. American Journal of Public Health, 95(7), 1144-1149.
YUVAL-DAVIS, N. (2006). Intersectionality and Feminist Politics. European Journal of Women's Studies, 13(3), 193-209.
