Guest Editorial

WE HAVE TO TALK ABOUT STONEWALL This issue of ANS represents a turning point to remedy the neglect of sexual and gender minority groups—cultures in their own right. The issue includes 2 articles addressing nursing and health care needs of these groups. In this Guest Editorial, Drs Dorsen and Caceres call for an end of the long-standing neglect of and discrimination against people who identify as LGBTQ+. The name “Stonewall” may not be familiar to you. Or, perhaps, you know that it is somehow related to the struggle for lesbian, gay, bisexual and transgender (LGBTQ+) equality but are not sure how. If you are like most nurses, you probably don't know why this event, celebrating its 50th anniversary this month, is considered one of the most significant moments in LGBTQ+ history. It is time for that to change. It is time for that to change. The Stonewall Riots took place in New York City in June 1969 after a routine raid of the Stonewall Inn, a bar in Greenwich Village frequented by gay men, lesbians, bisexuals, drag queens, street youth, and transgender persons. Raids at that time were common practice—it was illegal to be LGBTQ+ or to serve liquor to LGBTQ+ persons. Homosexuality was considered a mental illness and was listed as such in the Diagnostic and Statistical Manual (DSM). The FBI kept track of suspected LGBTQ+ persons, and exposure could lead to harassment, arrest, loss of employment, and loss of family. Known LGBTQ+ gathering spots were frequent targets of law enforcement—police arrested patrons and employees, and newspapers often printed the names of those arrested the following day. But in the early morning hours of June 28, 1969, the LGBTQ+ community at the Stonewall Inn, emboldened by the civil rights struggles of Black Americans, women, and other oppressed groups, fought back against harassment and injustice. Six days of riots followed, and the LGBTQ+ equality movement was born.1 We don't routinely teach the history of civil rights struggles in nursing, but we should. As you will read in this special edition of Advances in Nursing Science, focusing on culture, race, and discrimination, current and historical experiences of stigma and marginalization deeply affect all aspects of health, from access to and utilization of care to risk and risk behaviors to disease patterns and outcomes. This is certainly true for LGBTQ+ populations. Research suggests that the LGBTQ+ community has inequities in mental health, substance use, diabetes, cardiovascular disease, and certain cancers and experience significant social disadvantage, with higher rates of poverty, un- and underemployment, and housing instability than the general population.2 These disparities appear to be consistent across countries and social contexts. Certain subgroups of the LGBTQ+ community, including LGBTQ+ people of color, LGBTQ+ people with disabilities, and LGBTQ+ immigrants and refugees, experience even greater inequities. Perceived and enacted stigma are to blame, including that of nurses who may lack basic knowledge about LGBTQ+ culture and health needs and may harbor implicit or explicit bias.3 To fight injustice, we need to educate ourselves, have hard conversations about our own privilege and power, and consider how our actions and attitudes may contribute to both lessening and perpetuating health inequities. Although the Stonewall Riots occurred 50 years ago, there is still work to be done. It is illegal to be LGBTQ+ in approximately 70 countries; in over a dozen, being LGBTQ+ is a crime punishable by death.4 And even in relatively socially progressive countries, including much of Europe, Canada, and the United States, LGBTQ+ people continue to face significant discrimination in areas such as housing, employment, and health care. We are only beginning to understand how social inequity influence the health of LGBTQ+ populations and their encounters with health care professionals. As nurses who pride ourselves on expertly caring for diverse populations, we need to hold each other accountable to learn the history of struggle and resilience of marginalized groups and to thoughtfully consider how stigma and discrimination continue to impact the health and well-being of many of us. As the largest health care profession in the world, nurses are in the perfect position to advocate for LGBTQ+ persons and lessen health inequities in this vulnerable population. But first we need to talk. We need to talk about how LGBTQ+ marginalization impacts the communities we serve and members of our profession. We need to talk about Stonewall. —Caroline Dorsen, PhD, RN, FNP-BC Assistant Professor NYU Meyers College of Nursing New York Nursing Chair GLMA: Health Professionals Advancing LGBT Equality —Billy Caceres, PhD, RN, AGPCNP-BC Postdoctoral Research Fellow Columbia University School of Nursing and the Program for the Study of LGBT Health, New York City, New York

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