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.
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.
‘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).
‘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.
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.
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, 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).
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.
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.
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.
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.
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