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Sexual Orientation Research Phase 1: A Review of Methodological Approaches

5. Policy and subject areas

5.1 Overview of key policy and subject areas in sexual orientation research

There have been several attempts to survey subject specific areas of the sexual orientation research and literature; in particular within lesbian and gay studies, but also of the work addressing bisexual and transgender issues. ²⁸ Emphasis in this Chapter is not on summarising what the research has found in these areas, but rather to review the methodological issues specific to particular fields, assess the range of existing research and identify broad areas where there is a clear lack. Both methodologically sound, and less than sound, research is included, as well as both studies where LGBT issues are the focus of research and where they are addressed within the context of a wider research project. For details of projects in each subject area, please refer to the methodological summaries accompanying this report.

5.1.1 Alcohol and drug use

There has been little research into problematic alcohol and drug use amongst LGBT people living in Scotland. A considerable amount has been done outside Scotland over the past fifteen years, although this work has focused primarily on gay men and MSM (men who have sex with men), and on the impact of alcohol and drug use on practising safer sex behaviours.

Extent of alcohol and drug use

In a recent review of published research on alcohol and drug use amongst MSM, Stall (2001) identified studies which have found non-intravenous drug and alcohol use to be high among this population, and heavy drinking to be linked to AIDS loss; lower self-esteem; negative affect of anti-gay discrimination; and employment in service and sales occupations. One problem with much of this literature, however, is that samples were frequently recruited from bars and clubs, and so likely to be skewed towards the LGBT people with a higher alcohol and drug intake.

Population-based surveys in the US have found fewer differences in drinking patterns and frequency of drug misuse between homosexual and heterosexual men.

Comparisons of lesbian and heterosexual women have shown no differences in alcohol consumption. However the 1990 National Household Survey on Drug Abuse did find that lesbians and bisexual women reported much higher rates of smoking in the previous month.(Lee, 2000)

The Drug Prevalence Survey in England asked the sexual orientation of male respondents, but not female respondents, as it was felt that that could not be justified on health promotion grounds. (Kelly, 1996). Bridget, in her study of the treatment of lesbians with alcohol problems in alcohol services in north west England, argues that while there has been research about alcohol and gay men, that there has been little research in Britain regarding lesbians and alcohol.(1996) In identifying areas for future research O'Connor and Molloy state that the preponderance of drug use amongst their sample of homeless lesbian and gay youth suggests that there are reasons related to their sexuality that contribute to such behaviour and that this is an area yet to be explored in a UK context.(2001)

Alcohol and drug use and sexual behaviour

Contrary to much of the previous literature, Weatherburn et al. found no link between alcohol use and unsafe sexual behaviour.(1996) They critique why most of the other studies may have found a link, arguing that it stems from a number of major conceptual and methodological limitations, including:

1. "The widespread assumption that there is, or could be, only one straightforward relationship between alcohol use and sexual behaviour, irrespective of factors such as culture, gender or sexual orientation." Thus results from samples of LGBT and straight men and women are frequently considered together.

2. Alcohol is sometimes conflated with other drugs in one global measure, implying that all drugs are used in similar circumstances and to obtain similar effects.

3. Past sexual behaviour is often compared with gross measures of previous alcohol consumption (typically drinking sessions per time period). Since both variables represent gross measures of past behaviour any association tells us little about the actual relationship.

Weatherburn et al. suggest 'critical incident' or diary techniques are more appropriate methods for testing any association between alcohol use and unsafe sex.

5.1.2 Community and social support

Several reports include a theoretical discussion of what is meant by the concept of a gay or LGBT community/communities, for example Morrison and Mackay (2000) who draw on Scottish literature in their review. Others have tried to quantitatively measure community involvement and social support. Use of standardised scales, such as that developed by Kippax ²⁹, do provide some measure of comparability across studies, but the nature of local communities and the form of community involvement is likely to vary greatly. A qualitative oral history approach was successfully used by Kennedy and Davis in their detailed exploration of memories of a lesbian community in Buffalo, USA.(1993)

Grossman and Kerner acknowledge that their study of the support networks of gay and lesbian youth was limited by the fact that they recruited their sample from young people who were actively involved in LGBT organisations.(1998) Given Waldo's finding that gay community involvement predicts social support for and self-acceptance of gay identity, it is clear that the support networks of young LGBT people not in contact with such organisations is likely to be very different. Similarly, use of snowballing techniques would also be likely to overestimate the level of community and social support most LGBT people experience.

Considerable work has been undertaken in Brighton and Hove around the topic of community and social support, including an assessment of LGBT community needs (Webb and Wright, 2001) and a survey of volunteering among the LGBT community (GLAM, 2002).

5.1.3 Domestic abuse

A recent study of domestic abuse against men in Scotland included abuse perpetuated by both male and female partners, enabling comparisons to be made.(Gadd et al., 2002) The multi-modal study made use of secondary analysis of the Scottish Crime Survey and administrative statistics to assess issues of the prevalence of domestic abuse against men, as well as conducting more exploratory qualitative analysis. Because the qualitative sample was drawn from a random probability general population survey sample, respondents could be selected independent of the extent of any gay community involvement, being 'on scene', or being in contact with services. ³⁰ The multi-modal approach of the study also enabled misinterpretation of survey questions by respondents to be exposed, and illustrated the problems of relying on crime statistics given both men's reluctance to report and the police's reluctance to record incidents of domestic abuse of men in same sex relationships.

Domestic abuse within lesbian partnerships was one of the issues covered in Henderson's recent analysis of two surveys of lesbian and bisexual women and health.(2002) Only a tiny proportion of the sample (less than 1%) resided in Scotland however.

Renzelti and Miley (1996) edited a collection of articles in Violence in Gay and Lesbian Domestic Partnerships. Most of the studies cited in this collection, like much of the work in this field, is theoretical and lacks an empirical basis. Burke and Follingstad (1999) note in their review of research into same sex domestic abuse that using personal networks to recruit participants may lead to inflated estimates of abuse, as LGBT people who have been abused might also be likely to have friends who have experienced abuse. Another methodological design flaw they identify is that when asking about abuse in previous relationships, some studies conflate previous same-sex violence and violence by an opposite sex partner, leading to exaggerated prevalences. Vickers argues that LGBT community reluctance to admit that domestic abuse occurs within same sex partnerships is inhibiting further research being done.(1996)

5.1.4 Education

In the consultation with Scottish LGBT organisations, which constituted the second phase of this research, education was identified by LGBT representatives as a key area for research priority. This included assessments of teaching on equality and sexual orientation; investigation of the training needs of teachers; and exploration of the impact of bullying and homophobia in schools.

Schools-based research on sexual orientation amongst young people has been inhibited, however, by the requirements of some ethical committees (e.g. to insist on parental permission for participation) and by Section 28 which has restricted even discussion about homosexuality in schools. More than half of teachers in a survey in England and Wales said that Section 28 had caused them difficulty in addressing the needs of lesbian, gay and bisexual pupils.(Douglas et al., 1997) Attitudes towards Section 28 in Scotland have been addressed by various general population polls (e.g. MORI Scotland, 2000; Gallup, 2000; NOP, 2000) and amongst LGBT respondents (Jarvis, 2001).

Different aspects of education have been addressed as sections of several broader Scottish studies. Bullying and violence in educational settings are included in Morrison and Mackay (2000); experience of sex education is addressed in Arrested Development (Stonewall); and much of the work of the MRC Unit at Glasgow University explores peer and health education projects (e.g. Hart et al., 2001).

5.1.5 Employment and training

There are a variety of issues addressed by research on employment. Some areas identified by LGBT representatives as priorities for research included researching the career paths of LGBT people to understand patterns of discrimination, the exclusion of LGBT from certain types of work, and identification of public sector workers training needs with regard LGBT issues. Including a question on sexual orientation in cohort or longitudinal studies would be an ideal way to explore career paths.

Studies of employment issues have tended to use one of two sample types; surveys of employers (and their awareness and implementation of equal opportunities policies and practices), and studies of employees. The Commission for Racial Equality Scotland recently published Equal Opportunities and Private Sector Employment in Scotland: A summary of research into equal opportunities policies and practices, which found that fewer employers had policies relating to sexual orientation than to other discrimination criteria such as sex, disability, ethnicity and age.(CRE, 2000) This survey was also interesting because previous studies of employers regarding sexual orientation issues have tended to address the public sector rather than private sector labour market. While this survey was useful for being able to compare sexual orientation and other policies, LGBT issues were not otherwise explored.

A recent survey of employees that also enabled comparison of sexual orientation (and transgender identity) with other discrimination criteria is the Civil Service-Wide Diversity Survey, which included about 800 Scottish respondents.(ORC International, 2002) The reporting for this survey emphasised the crucial need for respondents to feel confident of complete confidentiality, if LGBT people do fear discrimination in the workplace they will be particularly likely to not disclose their sexual orientation in a workplace survey.

There has been little recent research focusing specifically on LGBT respondents and their experience of employment issues. Palmer's 1993 survey remains a significant study, in particular as it includes issues to do with seeking work.

5.1.6 Families, partnerships and parenting

In Same sex intimacies: families of choice and other life experiments Weeks et al. argue that "because there has been very little systematic empirical research on [LGBT families] in Britain… we had no existing baseline from which to work."(Weeks et al, 2001) Their qualitative study explores the nature of and meanings attached to various LGBT families. In terms of quantitative research, as discussed in Chapter 4, there is currently some opportunity to examine same sex partnerships and family units through analysis of survey and Census data, although this approach has not yet been used in the UK to the extent it could be. As discussed in Chapter 3, this has partly been because of concerns about the approach leading to an undercount. ONS has stated that such analysis of Census data is planned, although they do not yet have a date for when this will be available. Black et al. have done work of this nature with various data sources, including the Census, in the US. Their concern is that "because gays and lesbians constitute a relatively small fraction of the population, modest measurement problems could lead to serious errors in inference."(Black et al., 2000)

Much work on families overlaps with that on partnerships, with, for example, Weeks et al. (2001) interviewing some couples together. The same researchers have also published a methodological review of researching non-heterosexual relationships.

Reviews of research into gay parenting have identified some, usually small scale, studies particularly in the psychological literature and mainly in the US. The American Psychological Association state that "less is known about children of gay fathers than about children of lesbian mothers. Little is known about development of the offspring of gay or lesbian parents during adolescence or adulthood. Sources of heterogeneity have yet to be systematically investigated. Longitudinal studies that follow lesbian and gay families over time are badly needed."(APA, 2002)

A few studies have emerged exploring aspects of lesbian motherhood and self-insemination (e.g. Griffins and Mulholland, 1997; Saffron, 1994), while these studies function well as informative guidebooks, more empirically rooted work in this area is lacking.

While the consultation with LGBT representatives highlighted the legal status of co-parenting, custody, partnership ³¹ and registration rights to be issues of great policy concern, it was also argued that these issues of basic human rights required action before research. It was felt that any research undertaken in this area should be focused on informing the development of future policy, and not impede the implication of swift changes in policy.

'Coming out' to heterosexual families, and how parents respond to the disclosure of their child's sexual orientation, is an area that a number of US studies have addressed, several of which include reviews of this literature (e.g. D'Augelli et al. (1998), Savin-Williams (1998), Gray (1999), Martin, (1996)). A key research issue discussed in these regards the difficulty of identifying young people for the research, by virtue of the fact that they may still be in the process of 'coming out'. Because of this and ethical consent reasons, much of the research explores the issue retrospectively with adult samples, which is subject to problems of recall. Caused by the Clause is one piece of recent empirical research in Scotland which specifically addressed the issue of disclosure to family.(Jarvis, 2001)

5.1.7 Health

Health has been a major area in sexual orientation research, but the vast majority of this substantial work has focused on MSM, sexual health transmission risk factors and service use. This important body of work includes various Scottish studies into HIV awareness and testing (e.g. Flower, forthcoming); sexual health promotion and intervention evaluations (e.g. Hart, 2001); sexual health needs assessments (e.g. Ross, 2002); and measuring sexual behaviour in order to predict the current and likely future spread of HIV/AIDS and other STIs (e.g. Reid, forthcoming).

There are various methodological issues attached to conducting research in this area. For instance, Ross in his study of MSM in the Grampian areas notes that it is difficult to rigorously evaluate interventions to promote safer sex because of: overlapping initiatives, long time scales and complex influential factors, the fact that many interventions may be effective despite identifiable evidence not being found, and a reluctance to publish findings that aren't positive about the intervention.(Ross, 2000) Yet again, identifying those who do not identify as gay or bisexual also presents a real problem.

Despite there being a significant amount of excellent and important research on health, there are some key areas that have not been tackled to the same extent, in Scotland or elsewhere.

Firstly, despite significant research into sexual physiology and sexual function in the heterosexual male, the prevalence of sexual disorders in homosexual and bisexual men has been largely ignored. There is a lack of well-conducted studies on the type, severity and prevalence of sexual disorders in gay men.(SPIGS, 2002)

Secondly, because of the predominance of the medical model of sexual health in LGBT research, lesbians and bisexual women have been largely absent. Henderson et al. argue that there is more to sexual health than avoidance of infection and unintended conceptions.(2002) The focus of research with lesbians needs to broaden the definition of sexual health to include "enforced celibacy, absence of sexual fulfilment, unequal and abusive sexual relationships, difficult sex and painful sex, relationship disruption, and feelings of low self-worth and sexual disgust."(Henderson, 2002) In addition, Richters argues that HIV and AIDS are also of major concern to lesbian women because although the main HIV transmission mode for women is through 'heterosexual' sex; non-heterosexual women are more likely to be injecting drug users and if they did have sex with a man, it was more likely to be with a man who identified as gay or bisexual. For these reasons sexual research is crucial for lesbian women too.(Richters, 1998)

Thirdly, general health and service use issues have been largely overshadowed by the emphasis in sexual orientation research into sexual health. Bradford notes the increased emphasis beginning to be placed on research into lesbian health and service use issues.(2001) Lee conducted a substantive MEDLINE search of general health issues relevant to particular groups, and found some work on lesbians and cervical cancer, breast and endometrial cancer (which the contraceptive oral pill protects many heterosexual women against) and STIs.(2000) Her review of research focusing on gay male health issues located studies addressing eating disorders, STIs and anal cancer. Though she had a section exploring transgender health, she found very little relevant research to report.

Lee found that many LGBT people may not "seek health care (and are therefore excluded from health studies) because of prior negative experience. As many as two thirds of physicians never ask patients about their sexual orientation. Some health care professionals assume that their patients are heterosexual. Others may be homophobic and hostile and prefer to avoid the issue."(Lee, 2000) Coia et al.'s study 'Something to tell you': A health needs assessment of young gay, lesbian and bisexual people in Glasgow is a start on addressing the lack of general health research amongst LGBT respondents in Scotland. By recruiting respondents from a variety of sources, Cois et al. aim to avoid excluding LGBT people not in contact with health services.

5.1.8 Housing and homelessness

In Outright Scotland's published response to Better Homes for Scotland's Communities Consultation, Brian Dempsey stated that "the housing needs of people from the LGBT communities are not currently known. As far as we know, there has not been any detailed and thorough research or monitoring of the needs of those in our communities with respect to different types of housing." ³² The range of issues in this field includes: being evicted from the family home or rented accommodation; homelessness; co-habitation and succession rights; and discrimination in housing from neighbours or housing providers. Smailes defined homelessness as a continuum ranging from sleeping rough through hostels to various insecure and temporary arrangements.(1994) Plant et al.'s survey of violence in Edinburgh identified respondents who had been denied a mortgage or insurance, faced eviction or were denied housing because of discriminatory attitudes towards their sexuality. Others reported ill treatment by Housing Association staff or from mortgage lenders or having been assaulted in their own home. Morrison and Mackay found that gay men in Edinburgh were more likely to rent their home privately and less likely to rent from a housing association, suggesting that their needs are not being met by housing providers.(2000)

A few recent research studies have addressed these issues in Scotland, particularly amongst younger LGBT people. Stonewall's Out in the Cold: an action report on the housing needs of LGBT youth in south east Scotland used a variety of approaches and intervention evaluations to conduct a needs assessment amongst young LGBT people living in south east Scotland.(Watterson et al., 2000) The authors identified as a major problem: "the lack of research done on LGBT housing issues (four reports produced in London only) and the lack of other workers who specialise in this field (no one else in Scotland)."(2000)

O'Connor and Molloy's 2001 qualitative research project, 'Out' of Home: Exploring Homelessness Amongst Lesbian and Gay Youth, was the "first study to explore fully the experiences of homeless lesbian and gay youth in Britain." They suggest that an essential direction in which further research in this field should develop is towards "the inclusion of sexuality as a consideration within mainstream, locally based, evaluations of housing and homelessness services [which] would help develop further awareness of how young lesbians and gay men fare in these services. Equally, evaluative work with agencies dedicated to the needs of young lesbians and gay men would assist in greater understanding of the delivery and impact of these services." They discuss the methodological difficulties of attempting to recruit a sample of LGBT people who are either homeless or in insecure accommodation, both in terms of finding a sample and in terms of successfully meeting up with them. Kruks used administrative data to inform his US study of youth and homelessness, drawn from the Youth Services Department of the Los Angeles Gay and Lesbian Community Service Centre and from the Children's Hospital Los Angeles (CHLA).(1991)

While research in the UK specifically amongst young LGBT people on housing is quite new there has been previous work with older respondents, for example The North British Housing Association published their report of a study of the housing needs of older lesbians and gay men in the north east of England in 1999.

5.1.9 Mental distress and suicide

Mental distress is one area of health research that the consultation with LGBT representatives identified as a priority. MIND has argued that "there is a paucity of research into the needs of lesbians, gay men and bisexual men and women who are involved in mental health - as users, carers, professionals; in community and institutional settings; in voluntary, statutory and private provision. Most studies come from the USA. A couple of reports have been produced in England recently but there remains a great need for further research in the area."(Mind Information Unit, 2001) Research is also still needed to reveal and repudiate the assumption that sexual identity itself is either a cause or symptom of mental distress.(Fergusson, 1999 & Waldo, 1998) But as the consultation with LGBT representatives suggested, there is still a need to explore any relationship between the discrimination faced because of a person's sexual orientation or gender identity, and their vulnerability to experiences of mental distress or instability (e.g. Mays & Cochran, 2001).

Diagnosis: Homophobic was the first qualitative research study carried out in Britain which looked at the experiences of lesbians, gay men and bisexual people in mental health services.(McFarlane, 1998) Little recent work has focused on mental health amongst LGBT respondents in Scotland, though this area has been covered in broader Scottish studies focusing on other issues (e.g. Coia, 2002). A number of studies carried out abroad have addressed mental distress issues recently, and have sought to use the same standardised measures of mental health to facilitate international comparisons (e.g. Sandfort, 2001; Welsch et al., 2000; D'Augelli and Grossman, 2001). For a recent international review of literature exploring suicide and LGBT individuals, see Lee, 2000.

5.1.10 Paying for sex

The National Survey of Sexual Attitudes and Lifestyles (Natsal, Johnson et al., 2001) asked all male respondents if they had ever paid a man or a woman for sex, allowing comparison across a general population sample. It is perhaps a shame that the question was not asked of female respondents however, as women are only addressed in this literature as sellers and not buyers of sex. Whether respondents had ever sold sex would also have been interesting from the perspective of targeting health promotion campaigns.

Davies and Feldman argue that research into male prostitution published before the 1980s "lacks methodological validity and empirical basis and…betrays a moralistic and patronising attitude towards its 'objects of study.'"(1997) Prostitution is assumed to be negative, an option forced on individuals rather than chosen, and has sometimes been associated by researchers with child sexual abuse. Even after the advent of AIDS, Davies and Feldman go on to argue, "male sex work rarely, if ever, emerged as an issue of importance in HIV prevention campaigns." A major reason for this being the "multiple marginality of male sex work." This marginality and the stigma associated with sex work can make samples for research difficult to locate and recruit. This has lead to studies of paying for sex that have focused only on GBT men and MSM who are currently living on the streets (e.g. Tremble, 1993).

In a review of research into male (youth) prostitution, Foster found little literature on the subject in Britain but considerably more in America. Davies and Feldman's qualitative study in 1992 targeted interviews with male sex workers in South Wales to address the previous urban bias in the literature. Subsequent research has primarily focused on young people in prostitution as a particularly vulnerable group (e.g. PHACE in Scotland, 1998).

5.1.11 Sexual assault

Same sex sexual assault is a difficult area to research for various reasons; the legal definition of rape and lack of police sympathy may lead to few LGBT people reporting incidents or seeking help, and the sensitivity of the crime may make it a particularly difficult subject for respondents to talk about and the LGBT community to acknowledge. Much of the existing work has focused on male sexual assaults in prisons, correctional institutions, or other institutions such as the military or else has been recorded as incest where the perpetrator is a relative. Hickson, in Gay Men as Victims of Non-consensual Sex , notes that the sample for Mezey and King's British study differed from many of the US studies in that "recruitment… included advertisements in the gay press, whereas the American studies recruited from police and hospital departments."(1994) As with other subjects, the profile of same sex sexual assault is likely to vary depending on the population studied. Most of the existing studies are based on small sample sizes.

O'Connor and Molloy (2001) identify research into the incidence and experience of sexual abuse among young lesbians and young men, and their needs, as key areas in need of further research. Likewise, very little has been done with LGBT women, or in Scotland (although reference is sometimes made to it, e.g. in Gadd et al., 2002).

5.1.12 Sexual orientation: origins, prevalence and behaviour

Origins of sexual orientation

There is still work going on looking at the 'origins' of (non-heterosexual) sexual orientation. Although there is not the same level of psychological research as there was in the sixties and seventies (King, 1999) there is now new genetic and neurobiological work being carried out. Harrison et al. (1994) reviewed work on brain structure and the origins of sexual orientation which has only become 'viable' to do since AIDS related deaths have allowed for the availability of 'heterosexual' and 'homosexual' brains for scientific study. They argue that "the search for neurobiological explanations for human behaviours is in full flow…[and] homosexuality is no exception, with recent studies reporting on its possible genetic basis (Hamer et al., 1993) and biological correlates (Byne & Parsons, 1993). One area of research that has received much attention concerns neuroanatomical differences in homosexual compared to heterosexual men."(Harrison et al., 1994)

Prevalence of different sexual orientations and behaviours

As discussed in the sampling section of Chapter 3, any attempt to measure the prevalence of different sexual orientations or behaviours requires a large-scale, random probability general population sample in order to make reliable estimates. The National Survey of Sexual Attitudes and Lifestyles (Natsal, Johnson et al., 2001) is the primary source of such data in Britain, and with 856 Scottish respondents it has been able to: make reliable estimates for Scotland, compare Scotland with rates for England and Wales and assess change in behaviour in Scotland since the study was first conducted a decade ago. The survey did not ask about sexual orientation however, only measures of same-sex behaviour and attraction. Inclusion of a self-perceived sexual orientation question on other general population surveys or the Census may become more likely in Scotland in the future.

5.1.13 Social inclusion and poverty

There exists little research in Britain on how social exclusion impacts upon the economic circumstances of lesbians and gay men. A report on poverty and social exclusion among gay men and lesbians in Glasgow has been carried out by the Glasgow Women's Library (1999), and similar work has been undertaken in Ireland by the Combat Poverty Agency, Dublin (1995). There is a substantial amount of research literature discussing what is meant by social inclusion and the multiple indicators that can be used to measure it. Some of this debate is covered by Atrill et al. in Social Exclusion and HIV (2001), and by Weatherburn in A Class Apart (1999) which also focuses on the relationship between social exclusion and patterns of HIV infection amongst homosexually active men.

5.1.14 Transgender issues

A review by TransAlba, a transsexual support group, states that there "is a real need for serious research into numbers of men and women undergoing treatment for Gender Dysphoria in Scotland."(1999) While there has been an increase in public and professional knowledge in recent years through some highly publicised legal and clinical cases, very little research, particularly on prevalence, is available. The only data on UK prevalence is from a survey of general practitioners in Scotland, reported in a paper by Wilson et al. (1999)

Wilson et al.'s Scottish study, The prevalence of gender dysphoria in Scotland: a primary care study, is unusual amongst (and more inclusive than) the other sparse international literature on medical perspectives of transsexualism (e.g. Tsoi, 1988; Van Kesteren et al., 1996, Weizte and Osburg, 1996). This is because Wilson et al. surveyed general practitioners rather than psychiatric consultants as the previous research had done. They argue that "there are conflicting data on the prevalence of transsexuality and gender dysphoria. Although data on surgical gender reassignment exist from the Netherlands, England and Wales, Singapore, Germany and Australia and New Zealand, we have been unable to identify publications dealing with gender identity problems in a community-based medical setting."(Wilson et al., 1999) Dr Susan Carr, who was a part of the research team, has also done significant further work in this field in Scotland.

In the field of transsexual research, due to that fact that there is so little being done, close international collaboration amongst those working in the field has become inevitable, including one split site project comparing Sweden and Australia. However, the different administrative, ethical and financial set-up in each country has lead to enormous variation in nationally appropriate methodologies. As Ross et al. (1981) point out, the difficulties in calculating a national prevalence of transsexualism are such that the study of differences between societies might be viewed with even more caution, particularly given this unavoidable variation in methodology.

While more community based sexual orientation research is starting to focus more broadly on transgender and gender identify issues (rather than just medical transsexualism) and is embracing the language of the 'LGBT' umbrella, putting into action the inclusion of transgender respondents is more methodologically problematic. This is for a number of reasons, including their low prevalence in the general population and because of the hegemony of the polarised model of gender, which makes the almost standard question 'what is your sex?' exclusionary and problematic. Some studies have begun to include a separate question on transgender identity, for example, in Webb and Wright (2002) and the Civil Service-Wide Diversity Study (2002). Asking about transgender identity is discussed more fully in Chapter 2.

The consultation work with LGBT representatives highlighted that the lack of basic baseline data on transgender issues makes prioritising areas for research difficult; research amongst transgender people is needed across all of the specific topics described in this Chapter. Because there has been very little published research in this area the abstracts of a recent transgender conference are reproduced in the methodological summaries accompanying this report, as an indication of the type of research that is likely to be emerging over the next few years. Issues associated with research with transgender respondents are also explored in the next Chapter on inclusiveness in the research process.

5.1.15 Violence and victimisation

Violence and victimisation cover a wide umbrella of related concepts including hate crime; victimisation; harassment; abuse; bullying; assault and other forms of violence, encompassing a spectrum of events including verbal, physical and sexual attacks. All, and the attempts to avoid them all, have been argued to have an enormous impact on the lives and well being of LGBT people. In their review of the literature on violence Pilkington and D'Augelli argue that "research has consistently demonstrated that victimisation based on known or presumed lesbian or gay sexual orientation is the most common form of bias related violence."(1995) The word 'presumed' is significant here, as research into levels of hate crime should not be restricted to people who self-identify as LGBT, but also include those who have been assumed and targeted by others for being LGBT. This can be achieved by amending the response options of surveys which ask about experience of hate crime from on the basis of 'sexual orientation' to 'perceived sexual orientation'.

The recent Scottish studies by Morrison and Mackay (2000), Plant et al. (1999) and Ramsey (2001) have greatly expanded the level of knowledge available on the experience of violence amongst LGBT people in Scotland. Two of the studies focused exclusively on men and two on Edinburgh, so there is clearly scope for further work in Scotland with women and in rural areas. Von Schulthess, in 'Violence in the Streets: Anti-Lesbian Assault and Harassment in San Francisco' argues that internationally there have been few studies focusing specifically on lesbians and that because of gender, violence will be experienced differently by lesbians and gay men.(1992)

Von Schulthess' study found high reports of harassment, though it could be argued that the self-selecting survey sample was most likely to attract respondents who felt they had relevant experiences to report. Mason and Palmer discuss this risk in their report of Stonewall's national 1996 survey of hate crimes against lesbians and gay men, Queer Bashing. While they recognise that a self-selecting sample "may run the risk of over-representing those who have suffered problems. We put at the top of our questionnaire 'Whether you have experienced violence or not, we need YOU to fill in this questionnaire' in an attempt to minimise this risk."(Mason and Palmer, 1996) They cite the fact that two-thirds of the survey respondents reported never having been harassed.

Herek and Berrill (1992) took a lead in research of violence towards and harassment of, in particular, gay men. Morrison and Mackay (2000) write that an important starting point for Herek and Berrill has been to explore the "social context" in which violence and harassment occurs, and to define the ideology which underpins the conditions which foster the hatred of gay men. In particular to explore the definitions, meanings and distinction between homophobia and heterosexism (see Section 2.3 of this review). Mason and Palmer (1996) in part to highlight similarities between homophobic violence and racist crimes and violence used the "generic" term 'hate crime'. They argue that "in their motivation, pattern of attack and effect on their victims we believe all hate crimes have much in common."(1996)

5.1.16 Voting and representation

Disaggregated data profiling the situation of LGBT groups needs to be systematically carried out with respect to representation within decision-making systems. This, Barry argues, is key given that disadvantaged groups are likely to be under-represented within the middle and upper layers of the decision-making and policy-making systems and structures of society. (Barry, 2000)

5.2 Conclusion

This Chapter should be regarded as a companion to the more detailed listings of research contained in the separate methodological summaries. This Chapter has sought to outline the various key policy and subject areas covered by current and recent existing research into sexual orientation; to mention some of the methodological issues that impact on this subject specific research; and to highlight some of the areas where there is a particular lack of research. As the phase two consultation with LGBT community representatives illustrated, given the lack of research into most LGBT issues in Scotland, establishing priorities is problematic: "when groups were ask to construct priority, the general view expressed was that all the policy issues outlined were of equal priority." ³³

There is also the matter of identifying particular subject areas as being a priority for particular sub-groups within the LGBT community. For example, sexual health research, including intervention evaluations, has been relatively well funded, and a large amount of good quality work has focused on the sexual behaviour, HIV transmission risk factors, and service use, of gay and bisexual men and men who have sex with men. This same attention, however, has not been given to lesbian and bisexual women or transgender people's health. Likewise much of the recent work on violence in Scotland has focused on male respondents in urban areas.

While in some areas there is a quite substantial international literature, the evidence base is usually much more limited in Scotland. Sometimes it is restricted to British surveys with sufficient Scottish respondents to report on the regional sub-sample. In recent years, however, several of these national studies have either begun reporting on Scotland separately and in greater detail, or have initiated an independent Scottish project (e.g. Vital Statistics Scotland, (forthcoming); Natsal, (Scottish level analysis forthcoming); and Scottish Social Attitudes). The last few years have also witnessed the publication of several key new Scottish-specific studies with LGBT respondents. These have tackled issues such as homophobic hate crime (Plant et al., 1999; Morrison and Mackay, 2000; Ramsay, 2001); health and sexual health (Coia et al., 2002; Ross, 2000; Hart et al., 2001); social inclusion and housing (John & Patrick, 1999; Watterson, 2000), Section 28 (Jarvis, 2001), and transsexualism (Wilson et al., 1999). As with the sexual orientation research conducted elsewhere, this work has tended to focus on particular subject areas, and with a bias towards younger men in urban environments (particularly Edinburgh and Glasgow). There is a particular lack of baseline data on transgender people across all areas of sexual orientation research.

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