Between 1989-1996, multiple agencies both domestic (American Medical Association) and international (World Health Organization) began a campaign to end violence against women, because it was a “public health problem” and health care’s “silent epidemic” (document WHO/EHA/SPI.POA.2; Schornstein 1997). What resulted is an ever-increasing body of literature on the negative health outcomes of (mostly) physical and sexual IPV on women abused (mostly) by men. This body of literature exposes a grim reality: victims of physical and sexual intimate partner violence suffer higher levels of both acute and chronic physical health problems than those who are not abused (Campbell and Wasco 2005; Coker et al. 2002a; Fischbach and Herbert 1997; Plichta 2004; Porcerelli et al. 2003; Wolkenstein and Sterman 1998).
Among the negative health outcomes studied are increased mortality, injury and disability, problems with general health, chronic pain, obesity, substance abuse, reproductive disorders, sexually transmitted diseases, vaginal bleeding, and poorer pregnancy outcomes (Campbell 2002; Huang, Yang, and Omaye 2011; Kovach 2004; McCauley et al. 1995; McFarlane et al. 2005; Plichta 2004). Moreover, women physically and sexually abused by men are more likely to sustain acute injuries to the head, face, neck, breasts, or abdomen, which can lead to chronic conditions such as headaches, migraine, and constant pain (Campbell 2002; Kovach 2004). In terms of psychological health and emotional well-being, studies have found higher than expected levels of depression and post-traumatic stress disorder (PTSD) (Campbell 2002; Coker, et al. 2002; Dienemann et al. 2000; Dutton et al. 2006; Houry, Kaslow and Thompson 2005; Jones, Hughes and Unterstaller 2001; Stein and Kennedy 2001).
Studies conclude: these health outcomes mean women abused by men constitute a significant proportion of female patients seeking emergency medical services, obstetric care, and primary medical care (Abbott, Johnson, Koziol-McLain and Lowenstein 1995; Koziol-McLain et al. 2004). In quantifiable terms, this equates to approximately $8.3 billion a year for medical care, mental health services, and lost time from work due to injury and death (Max, Rice, Finkelstein, Bardwell and Leadbetter 2004); and while half of the women abused by men report a physical injury, only around 4 in 10 of these women seek care (Rennison and Welchans 2000).
For men who are victims of IPV and for women abused by women, the health-related outcomes of violence have not been well documented. For example, even though the California Health Interview Survey (2007 and 2009; see Zahnd et al. 2010 and Golberg and Meyer, 2013) and the Centers for Disease Control and Prevention’s (CDC) National Intimate Partner and Sexual Violence Survey (NISVS 2013; see Walters, Chen and Breiding 2013) released detailed reports on same-sex victimization, this data has yet to be used to examine health disparities related to violence in relationships. It would appear to still hold true that “The medical model of IPV has historically been limited to male perpetration of IPV against female victims in heterosexual relationships” (Cronholm, 2006).
The awareness of IPV as a “public health problem” for same-sex relationships or LGBT individuals is stymied (Klostermann, Kelley, Milletich and Mignone, 2011; Lehavot, Walters and Simoni, 2010). One influential study very early on claimed that IPV is the third most severe health problem among gay men, after AIDS and substance abuse, and may affect 15–20% of both gay and lesbian men and women (Island and Letellier, 1991).Recently research on same-sex IPV has discovered a number of negative health outcomes stemming from victimization (see Messinger, 2014). These outcomes include substance abuse (Kelly et al., 2011; McClennen et al., 2002; Stall et al., 2003), mental health issues and psychological trauma (Stall et al., 2003; Gillum and DiFulvio, 2014), and physical injuries (Dolan-Soto, 2000; NCAVP, 2012). Although rarely compared, one study did find that lesbian and bisexual victims were more likely to report negative outcomes than heterosexual victims (Walters et al., 2013). Potentially compounding these issues are some negative health outcomes that are unique to LGBT individuals generally, such as general substance abuse (see Kelly et al., 2011; Lewis et al., 2012) and suicidal ideation (Massachusetts Department of Education, 2006; National Transgender Discrimination Survey, 2010).
Moreover, because of the continued social stigma associated with being LGBT, many LGBT youth and adults do not openly disclose their sexual orientation to others publically or privately. Findings from discussions with advocates and healthcare professionals in the city of New York showed that the healthcare environment is heterosexist and gender-normative; providers lack knowledge about health disparities affecting LGBT people; LGBT individuals experience hostility and discrimination in care; and concerns about homophobia and transphobia keep LGBT individuals from using healthcare services (Grant, Mottet and Tanis, 2010).
From a public health perspective, unlike the adverse effects of smoking or alcoholism (a popular focus for LGBT health researchers)—or other commonly cited general health issues like obesity, cancer, or depression—same-sex and LGBTQ+ intimate partner violence remains a seemingly controversial issue. More than individual vices or diseases, intimate partner violence seems to threaten the social and moral fabric of relationships and families. While the public health sector has been able to admit, officially since 1989 in the U.S. and 1996 globally, that violence against women by men is a social problem and that ending it should be a priority, it has been reticent to admit the same is true for those abused by a same-sex partner or who identify as LGBTQ+.
This paper critiques the current model of IPV detection and prevention (e.g. as rooted in patriarchy, gendered power, and physical violence exclusively; and as entrenched in the medical-industrial complex) and, using quantitative analyses (from the NISVS) and focus group narratives (from work in NYC), highlights the specific concerns of LGBTQ+ victims/survivors: such as, power along other axes – race, class, age, etc.; the increasing use of emotional/verbal abuse and control; the need for alternative definitions of rape; issues in “outing,” HIV status, and minority stress; biphobia/binegativity in intimate relationships; and the heterosexism, homophobia, and transphobia present within the health care system and the need for more extensive cultural competency/humility training or alternatives to the traditional system, such as community-based organizations.