LGBT Older Adults at a Crossroads in Mainland China: The Intersections of Stigma,Cultural Values,and Structural Changes Within a Shifting Context

Abstract

In this article, we explore the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults in mainland China, with an emphasis on the shifting nature of the cultural context. Based on a culturally informed perspective, the intersection of LGBT stigma with cultural values (familial responsibility, filial piety, and loss of face) and larger structural changes (the aftermath of the one-child policy, economic reforms and globalization, LGBT human rights, and HIV policies) are creating dramatic shifts in Chinese society and impacting the lives of LGBT older adults. The increasing prevalence of HIV among gay and bisexual older men, although rarely acknowledged, is also contributing to challenges facing LGBT older adults and their families. These changes render LGBT older adults and those living with HIV and their caregivers at risk of economic insecurity. Resilience and resistance of LGBT older adults in China must be considered in both practice and policy to strengthen LGBT human rights globally.

Keywords

lesbian gay bisexual transgender China HIV global human rights

Introduction

China, one of the most populous countries in the world, has an estimated 1.4 billion people (United Nations, Department of Economic and Social Affairs, Population Division, 2017) and thus is home to many lesbian, gay, bisexual, and transgender (LGBT) older adults. Over a decade ago, Xinhua news, the official state-run press in mainland China, estimated that the population of LGBT people in China was approximately 30 million (Liu, 2013; United Nations Development Programme [UNDP] China, 2016). By the year 2050, it is estimated that more than 350 million people in China will be 65 and older (United Nations, Department of Economic and Social Affairs, Population Division, 2017); these changing demographics suggest that the numbers of LGBT older adults will increase significantly as well.

To date, lesbian, gay, and bisexual (sometimes referred to as 同志, tongzhi, meaning “same purpose or will”) and transgender (变性者, bianxingzhe, meaning “person who changes forms”) older adults in mainland China remain largely invisible, and research and literature on their experiences is nearly nonexistent. Due to differences in government oversight and censorship, Chinese LGBT research and experiences have been more accessible from Hong Kong and Taiwan rather than mainland China. Yet, LGBT people in China consistently report experiencing substantial legal, social, and economic barriers in society (Burki, 2017; UNDP China, 2016).

In this article, we explore the context of the lives of LGBT older adults in mainland China by way of a cultural lens. Specifically, we examine the confluence of cultural values (including familial responsibility, filial piety, and loss of face) and structural changes (including the aftermath of the one-child policy, LGBT human rights, and HIV and economic policies), highlighting the compounding effects of stigma from a uniquely Chinese perspective as it impacts the future of LGBT older adults and their families.

LGBT Stigma in China: Past and Present

Stigma, rooted within power structures, is subject to culturally specific expressions (Yang, 2007). Applying Western theories of stigma to a traditionally collectivist society such as China’s is problematic because it centers processes within individuals and ignores the greater influence of familial and social structures. When we consider the experience of stigma as historical, social, interpretive, and moral in nature, we can better assess its influence in inequalities within specific cultures (Yang et al., 2007). Although stigma theory in China was largely developed in the context of mental illness, many of the same sociocultural considerations are relevant to the lives of other marginalized groups in China (Phillips, Pearson, Li, Xu, & Yang, 2002; Yang & Kleinman, 2008), including LGBT older adults.

Although stigma continues to support the inequalities that Chinese LGBT older adults experience, it is rarely overtly described in research. The English word “stigma” has its origins in Latin and Greek words describing a mark, puncture, or brand and was founded on Western ideas (Goffman, 1963). Within a Chinese context, stigma as a threat to identity posits that people assess their positionality through collective representations of cultural stereotypes for cues of devaluation (Yang, 2007; Yang et al., 2007). Thus, stigma, defined as socially constructed, influences such phenomena as stereotyping, labeling, and “othering,” creating status loss as well as supporting discrimination and limiting opportunities available to individuals and groups within a society (Yang, 2007). The layering of multiple stigmatized identities, for example, double or triple stigma by sexual orientation, gender expression and identity, and older age, places LGBT older adults in China at risk of experiencing overwhelming trauma, social exclusion, invisibility, and barriers to accessing social resources. LGBT stigma further undermines the respect and authority older adults traditionally held in communities.

Historically, there was a tradition of acceptance of homosexuality in China. However, in the wake of the 1949 Chinese Revolution, a significant shift occurred in cultural attitudes with same-sex relationships increasingly characterized as socially deviant, which has now been reinforced by the People’s Republic of China for decades (Lixian, 2014). During the Communist Cultural Revolution (1966 to 1976), homosexuality was heavily persecuted, regarded as both “disgraceful” and “undesirable.” Exposed homosexual individuals underwent public denunciation, examination, and in some cases were beaten to death (Li, 1998).

From 1979 to 1997, the Chinese government enacted an antihooliganism law, criminalizing any male who conducted ji jian (sodomy) with a male. This law was used to persecute gay and bisexual men in China (UNDP China, 2016), many of whom were arrested by police in gay-related sociability spaces (Li, 1998). While decriminalization occurred in 1997, the complex trauma of such laws and practices on the lives of LGBT older adults has not faded away. Historically sexual activity between women has not been criminalized, however society has heavily stigmatized lesbians. For instance, the Chinese government’s Health Examination Criteria of Blood Donors, enacted in 1998, prohibited lesbians from donating blood until 2012.

In the past, prior to the popularization of the Internet, most gay men only talked about their sexual desires with “strangers” they met in secret sociability spaces for gay men, including specific parks, bathhouses, and teahouses in urban areas (X. Chen, 2014). For example, Mr. Li, a 75-year-old gay man who was arrested three times on the basis of the “antihooliganism law,” talked about a famous “gay park” in Beijing. He shared, “Anything you could not talk to your family, your children, and your colleagues could be discussed here” (X. Chen, 2014). Meanwhile, Chinese lesbians have had even lower social visibility than gay men. Most lesbians choose to conceal their sexual orientation from their family (Fan, 2017), which is even more pronounced given their lower socioeconomic status. Yu Shi, an LGBT activist who spent 6 years conducting an oral history of old lesbians in China, stated,

Chinese women are in a weak position in the family, which doesn’t allow them to speak out for themselves. Among the 30 lesbians I have interviewed, only one person came out to their family. Most of them did not divorce even after they found a female partner. (Fan, 2017)

Although the Chinese Society of Psychiatry removed homosexuality as a mental disorder in 2001 and standards of care were developed, the enactment of stigma and prejudice remains strong. For example, instances of “conversion therapy” (p. 1286) continue to be reported (Burki, 2017; Cen, 2017). Furthermore, in 2016, the Chinese government cracked down on gay materials in the media, actively removing numerous websites and web-series on the allegation of “immoral content” (Cao & Guo, 2016, p. 505). At the height of this restrictive campaign, the Chinese government proposed to ban all gay content from Weibo, a popular social media platform. Due to the outrage of many Chinese citizens, this effort was retracted, but the public and private censorship of LGBT materials is ongoing (Ullah, Doherty, & Westcott, 2018; Yang, 2018).

Cultural Values

In contrast to a more westernized individualistic approach, present-day China has a relational and collectivist culture based in values informed by Confucianism (Huang, Bedford, & Zhang, 2017; Sundararajan, 2015; Yang, 1995). From Confucian values emerges the concept of Five Relationships (无论, wu-lun), which are principles that govern an individual’s sense of self, duty, and responsibility. Wu-lun are defined as relationships between government and citizens, parents and children, husband and wife, siblings, and friends. It is through the lens of these connections that family values, filial piety (孝, xiao), and brotherly respect (悌, ti) are emphasized as the foundation of humanity (jen). Integration of these principal relationships have shaped, and continue to influence, the order of present-day Chinese society, the organization of social institutions, and the protocols around interpersonal interactions (guanxi). Therefore, LGBT people in China generally consider relational consequences via such cultural values as familial responsibility, filial piety, and loss of face.

Familial Responsibility and Filial Piety

Given the strong familial orientation in Chinese society, there is a reliance on interpersonal relations as the basis of social status. Such relations are ritualistic and formal, and individuals rarely make decisions without considering the impact on the family (Huang et al., 2017; Li et al., 2007). Filial piety is considered as the core virtue in the Chinese society governing the parent–child relationship. It denotes children’s reverence, attentiveness, and material support to ones’ parents for their love and nurturance (Ikels, 2004; Yang, 1995).

Such Chinese cultural values influence a person’s moral standing and not creating a family nor having a child to maintain the continuity of heritage is regarded as unfilial. To meet the cultural expectations, most LGBT older adults consider creating family as an imperative and responsibility they must fulfill (Jing, Wang, & Zhang, 2014). For instance, Bizhi Qu, a 72-year-old gay man, has been married to his wife for more than 30 years (Li, 2015). Although Bizhi was not attracted to women, he met his wife in 1984 via matchmaking and quickly got married due to social pressure (Li, 2015).

Loss of Face

In Chinese society, a person’s moral standing is dependent on upholding such social obligations and values. The loss of social standing or weakening of social ties as a result of LGBT stigma is inseparable from Chinese experiences of shame, humiliation, and despair (Yang et al., 2007). Arguably the most critical threat of LGBT stigma in China’s collectivist society is the loss of social connection through interpersonal separation, from within (families) and without (communities). The importance of “face” is reflected in two common Mandarin phrases for stigma: 污名(wuming), “dirtied name,” and 病耻感 (bingchigan), the perception and feelings of shame. To lose moral face represents the community’s condemnation of immoral behavior and signifies a serious breach of the moral code of society. Anger and rage toward those who do not fulfill social norms are socially accepted aspects of shaming, and shame is a group rather than an individual concern or experience (Li, Wang, & Fischer, 2004; Yang & Kleinman, 2008).

In Chinese society, both families and communities are diligent in their protection of the established system of social obligations and networks. “Coming out” as LGBT to one’s family and community has the potential effect of separating oneself from the group as “deviant”; the act itself may be perceived as a selfish, individualistic action directly in opposition to the collective’s best interests. Both same-sex behavior and gender diversity can result in an immediate loss of face and isolation within families as well as the isolation of the larger family by the greater community. Such a loss of face is very painful (physically and psychologically), especially if it results in community ostracizing, immediate shame, and “social death” (Yang & Kleinman, 2008, p. 402).

Structural Changes

Just as cultural values reinforce the importance of heteronormativity, structural changes including the historic one-child policy, the ongoing HIV/AIDS epidemic, globalization, and economic reform affect the state of LGBT human rights and the barriers faced by LGBT older adults in China.

One-Child Policy and its Aftermath

The invisibility and erasure of LGBT older adults in China has been further complicated by the legacy of the one-child policy. In 1979, the Chinese government enacted a family planning policy allowing only one child per family to limit population growth (Brandon, 2009; French, 2007). As a result, the parents invested heavily in a single child, knowing that in their old age, they will rely on the child to provide material and emotional support. In November 2013, the Chinese government made the policy less restrictive and eventually, in 2015, lifted the one-child policy altogether (Leng, 2018). The one-child policy was changed in large part due to the overall aging population within China and the increasing difficulty for a single child to meet expectations within traditional family structures - to support increasing numbers of aging parents and in-laws with longer life expectancies (Zheng & Hesketh, 2016). Some have surmised that the legacy of population control shifted China toward a nuclear family structure, prioritizing a single person or conjugal couple over extended family (Xu, Lin, Chen, Liu, & Liu, 2018; Yuesheng, 2006).

The ramifications of familial responsibility, filial piety, and the one-child policy have had a tremendous impact on the lives on LGBT older adults. Such cultural values and structural mandates created pressure on LGBT older adults to marry and produce offspring with opposite sex partners (Kong, 2017). Thus, it is not surprising that 70% of gay men in China reported having married women (Burki, 2017). Many of these marriages were created through the practice of Xinghun, a formality marriage, with lesbians in some cases satisfying familial obligations and filial duties of childbearing with gay men (Liu, 2013). Such familial and societal expectations combined with the cultural stigma attached to sexual and gender minority identities create a social responsibility that many Chinese LGBT older adults have had to navigate throughout their lives.

LGBT Aging, Economics, and the Workforce

Through decentralization and the privatization of enterprise, mainland China has been undergoing tremendous economic and structural changes. There has been a shift from communist ideology and a socialist economy toward an increasingly promarket economy, though still under vast governmental oversight (Ning, 2018). Although China is now a major force in the global economy, various economic transitions have resulted in increased income gaps and job insecurity for some segments of the population (Sharma, 2014). Conflating such issues are the additional barriers that result from stigma, limiting opportunities for economic success for LGBT people. Despite a few notable legal victories, existing laws make it difficult for LGBT employees to counter discrimination (Parkin, 2017; Smith, 2017; UNDP China, 2016). Such was the case for a transgender man whose lawsuit against unfair employment termination received national and international coverage, but for whom the courts ruled out discrimination based on the grounds of being transgender despite compelling evidence (Parkin, 2017). With little protection against such discrimination, LGBT people are at elevated risk of economic insecurity and limited opportunities (UNDP China, 2016). In addition, the consideration of older age brings additional threats to economic solvency in China, especially for LGBT older adults, some of whom do not have children or other family members to provide support in later life.

The existing governmental and public support systems in China are strained given the overall aging of the population. While the average age of retirement in China is younger than 55 years of age (Zhou, 2016), the ratio of working to retired persons is projected to decrease significantly from six to one in 2007 to two to one by 2040 (French, 2007). Social security pensions in China differ between provinces and sometimes even municipalities, though most workers in government-owned organizations participate in a two-part plan, one for self-contributions and the second based on a percentage of the regional average wage for those who have worked 40 years or more (Feldstein, 2018). Yet, only 5% to 8% of older adults can live on the pensions provided, and most depend on supplemental income or family support received from working children (Wang, 2006). Furthermore, access to pension plans are especially limited for older adults living in rural areas, with rural hukou (residency) status ranging from 41.5% to 58.8% of older Chinese adults (Wee, 2012) and those who cannot work to retirement age due to disability or chronic illness, including HIV. For LGBT older adults who are estranged from family as a result of social stigma, without adult children to support them, or isolated from community supports, an inadequate pension may be their only source of income, which puts them at greater risk for poverty, social isolation, and adverse health outcomes.

HIV and LGBT Older Adults in China

The HIV/AIDS epidemic in China is in a critical phase. Since 2015, the primary mode of HIV transmission shifted to men who have sex with men (MSM), including gay and bisexual men and others who do not openly identify as a sexual minority (Zheng, 2018). The cases of infection among MSM continue to increase, from approximately 2.5% in 2006 to more than one quarter of the cases by 2014 (Zheng, 2018). Furthermore, there has been a steady increase in HIV infections among China’s older adults, aged 50 years or older (Xing et al., 2014), with the largest increase among men aged 60 years and older, which increased 136% in 5 years (L. Chen, 2018). In addition, older adults in China are more likely to receive a late-stage HIV diagnoses and experience higher likelihood of comorbidity and mortality when compared with younger adults (Hu et al., 2017).

Liu et al. (2006) argue that as a collectivist culture, Chinese persons living with HIV/AIDS are stigmatized because their value to the group is seen as diminished (Yang, 2007). Stigma related to HIV status was initially promulgated via misleading propaganda, suggesting that HIV/AIDS was a foreign disease, unlikely to exist or spread in China (Kleinman & Guo, 2011). Presently, gay and bisexual men, MSM, and transgender women are especially singled out, their identities linked falsely as root causes of HIV infection by the public, with little destigmatization efforts by the government to combat discrimination (UNDP China, 2016). A gay man living with HIV reports,

In China, a patient always needs to take a blood test before their surgery. And once the doctor found that I had infected with HIV, they refused to care for me. Refusing a patient is not legal in China, but nowadays almost every hospital is doing the same thing. There are only two hospitals that are willing to conduct surgeries for HIV patients and the cost is very pricey. (Hua, 2016)

Those living with HIV continue to experience discrimination based on their HIV status, and even within safer gay spaces, HIV status is stigmatized and consequently difficult to disclose (Hua, 2016; Kong, 2017).

The Chinese government has taken several steps to constrain the HIV epidemic, even as far as extending a pledge to end AIDS by 2030 (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2016). While there are policies intended to provide HIV care, utilization continues to be a challenge for persons living with HIV and their caregivers and families (Fredriksen-Goldsen et al., 2008; Fredriksen-Goldsen et al., 2011). Contributing factors include ongoing stigma associated with HIV and diverse sexualities and genders, lack of LGBT friendly and age-responsive specialty services, and the differing availability and use of services across regions (Starks et al., 2008; Zhang et al., 2016). Invisibility and stigma related to sexuality among older adults has reigned, concomitant with the lack of education, attention to safe sexual practices (Xing et al., 2014) and prevention efforts geared at older adults in China.

LGBT identities were placed in the crossfire of this moral separation, painted with the brush of “deviancy” and linked with the AIDS epidemic, creating additional barriers to services for LGBT older adults living with HIV. Despite the increasing prevalence of HIV among gay and bisexual older men, the future direction of China’s HIV policies overwhelmingly focus on supporting women and children, with an implicit assumption that people with HIV are heterosexual (National Health and Family Planning Commission of the People’s Republic of China, 2015; UNAIDS, 2018a, 2018b). Even though the overt stigma of LGBT identities was intensified via the AIDS pandemic, it has also provided an important platform for community engagement and resistance to support the lives of those living with HIV/AIDS. For many LGBT organizations in mainland China, HIV treatment and education services continue to provide the primary avenue for receiving public funding (Cao & Guo, 2016; Hildebrandt, 2012).

Conclusion: Moving Forward

Those who live at the intersection of multiple stigmatized identities in mainland China—sexual and gender minorities, those who are older, or HIV-positive—find themselves confronting severe stigma that continues to threaten their health and well-being. With family as the reflection of the government and procreation values, maintaining the relational connections becomes a critical responsibility of all family members (Burki, 2017; Ren, Howe, & Zhang, 2018). Given the shifting context, such traditional cultural values can at times collide with structural changes in the larger society. Stigma as well as structural changes render LGBT older adults and those living with HIV and their caregivers at risk of economic insecurity with a constricting safety net for their own health and old age.

In China, targeted services and policies are needed that honor the strengths of LGBT older adults as well as address their distinct social and health risks. However, to date, the limited supports available for LGBT people have most often been tailored to younger generations likely as a result of both ageism and the invisibility of LGBT older adults. For example, while the effectiveness of HIV medications is now reducing mortality and leading to increased age among persons living with HIV, additional challenges exist for LGBT older adults, including an increased risk of comorbidities; higher levels of functional dependence; increased psychiatric and neuropsychiatric symptoms; weakened immune systems; faster disease progression; and greater mortality rates (Hu et al., 2017; Tang et al., 2018; Zhang, Fuller-Thomson, Mitchell, & Zhang, 2013). The enactment of policies that ignore LGBT older adult lives fosters an environment of ignorance that ultimately threatens population health.

LGBT rights continue to be in flux within China, wavering between some acceptance and criminalization in both political and public domains. A National Study on Social Attitudes towards Sexual Orientation, Gender Identity and Gender Expression by the United Nations (2016) found that younger Chinese compared with older adults were significantly less likely to hold a pathological view of homosexuality and were significantly more likely to complete a survey and disclose a sexual or gender minority identity status. Such differences by age likely reflect the shifting context in China, including changes from the lack of awareness to fear of reprisal to increasing acceptance. Some have advanced that the common sentiment in present-day China is that of tolerance of same-sex sexuality, as long as it is not within one’s own family (Cao & Guo, 2016). More than 60% of transgender people reported having family members that were not accepting of them, while 50% reported that they had at least some support from one or more family members (Smith, 2017).

LGBT older adults’ experiences of stigma in China likely differ from younger generations simply by not having access to language to describe their experiences as well as more limited opportunities to explore their sexualities, although it is essential to recognize the resilience and resistance of some LGBT older adults in China, who banded together to resist the prevailing norms to build community and created the foundation for the modern day LGBT movement in China.

Despite the recent efforts of Chinese people in confronting oppressive laws and systems, serious human rights abuses continue. There is a critical need for more openness and an intensified program to stop discrimination and prejudice against LGBT people in China, including older adults and people living with HIV/AIDS (Gu & Renwick, 2008; Yeo & Chu, 2017). Lifting government censorship on LGBT media and materials would be an important step to increasing visibility of LGBT lives in China. Developing campaigns that embrace LGBT concerns and lives, such as the 2008 national HIV program targeting MSM and gay men, in conjunction with education denouncing discriminatory moral discourses and policies are needed to address stigma-related barriers and foster change in Chinese society (Hildebrandt, 2012; UNAIDS, 2009).

The degree of tolerance by the Chinese government for LGBT activism and rights remains tenuous and limited, fluctuating according to differing political agendas (Cao & Guo, 2016). In addition, local policies related to the funding of LGBT programs tend to resist more progressive agendas, with increasingly more oversight by government entities. Rather than requesting governmental funding in China, some nongovernmental organizations receive funding to conduct work on LGBT issues from Western countries, an avenue that has recently seen more restrictions imposed by the Chinese government as well (Hua, 2017). Stigma embedded in the development and translation of policies has to date seen limited research and attention to the lived lives of LGBT older adults and their families in mainland China.

One exception is the timely and innovative research emerging from Hong Kong, chronicling the experiences of local older gay men (Kong, 2004, 2012, 2017). Kong’s (2004, 2012, 2017) work incorporating storytelling and narratives of gay men born before 1950 incorporates the impact of British colonization and criminalization of homosexuality on LGBT communities in Hong Kong and details the historic and present ways in which gay men there have resisted homophobia and heteronormativity. Contrasting Western LGBT movements of liberation, which are deeply rooted in political movements and demonstrations, Kong (2004) describes the nonconfrontational nature of resistance in Hong Kong as a deliberate avoidance of political activism, shaped in large part by national politics and Chinese values. For these older men, their sacrifices of individual identity for heterosexual family highlight a different battle from Western gay experiences, one that is less about political institutions and more about one’s “willingness [or] refusal to play one’s traditional family and gender role” (Kong, 2017, p. 264). In fact, for many, the exploration of their gay identity only began after their 50s, after they had fulfilled filial obligations of having children and providing for family (Kong, 2017).

Though “cultural resistance is political resistance” (Kong, 2004, p. 18), both class and age have become exclusionary factors in the modern gay scenes of Hong Kong. Historically, older generations of gay men in Hong Kong used methods such as Mahjong references and “fishing” in public spaces such as toilets and bathhouses to realize same-sex love, sex, and community (Kong, 2012). The influx of technology, disappearance of public spaces, and appearance of commercial spaces emphasizing youth and money is making the tongzhi identity less accessible and less inclusive of older and lower income gay and bisexual men.

The UNDP series of Being LGBT in Asia report emphasized the necessity of understanding unique sociocultural and historical contexts when addressing barriers to LGBT well-being in countries across Asia. Although mainland China shares cultural values with Hong Kong, it has greater levels of censorship than Hong Kong. Therefore, future research with LGBT older adults must also be conducted referencing local knowledge and benchmarks created based on mainland Chinese experiences. While there is limited knowledge about gay and bisexual men in China, there is dearth of material detailing the lives of lesbian, bisexual, and transgender older adults. Further research must also be conducted to understand the lives of those living in poverty and across regions who are marginalized within modern tongzhi communities. Narrative-focused research based within China is needed to give voice to LGBT older adults. Through participatory research, we can begin creating spaces that support and shed light on the diverse experiences of LGBT older adults in mainland China.

Based on impressions informed largely by Western perspectives, one runs the risk of viewing the lives of LGBT older adults in overly simplistic terms. The circumstances of LGBT older adults in mainland China are far more complex and varied, often encompassing multilevel oppression as well as subversion and liberation through covert and overt practices of resistance. The resilience of LGBT older adults who are aging well must be considered as we move forward to enhance both practice and policy to strengthen LGBT human rights, aging, and HIV/AIDS responses in China.

When an individual is viewed as one small plank on a bridge that extends in a timeless way through the past and into the future, the social stigma attached to their lives may be perceived as “warping” their place in time, increasing their risk of marginalization. Change is needed that reconceptualizes the lives of LGBT older adults in China, as their strengths create a timeless way through the past into the future to solidify their rightful place in history creating communities and a movement that not only supports their lives but expands the bridge for all LGBT people of all ages.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Boya Hua, MSW, is a Chinese LGBT activist who founded a sexual diversity education workshop called LGBT Free Talk and co-organized Shanghai Pride. She is author of a book called Voices of LGBT in Shanghai based on interviews with 20 queer local folks in Shanghai. Currently, she provides culturally-sensitive mental health services at Seattle Counseling Service, an LGBT-specialized community mental health agency.

Vickie F. Yang is a Master's of Social Work student at the University of Washington, graduating class of 2019. Her areas of interest include Chinese and Chinese American LGBTQ+ experiences, Asian immigrant experiences of belonging, storytelling, sexual health, and harm reduction. Vickie plans to pursue clinical social work licensure and future PhD studies in the United States.

Karen Fredriksen Goldsen, PhD, is Professor and Director of Healthy Generations at the University of Washington. Dr. Goldsen is a nationally and internationally recognized scholar addressing equity and the intersections of aging, health, and well-being in resilient, at-risk communities. She is Principal Investigator of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NIH/NIA, R01), the first national longitudinal study of LGBTQ midlife and older adult health assessing trajectories; Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action) (NIH/NIA, R01) the first federally-funded study of cognitive impairment in LGBTQ communities; Socially Isolated Older Adults Living with Dementia (P30); Sexual and Gender Minority Health Disparities; and Investigator of Rainbow Ageing: The 1st National Survey of the Health and Well-Being of LGBTI Older Australians. Dr. Goldsen is the author of more than 100 publications, three books, and numerous invitational presentations including U.S. White House conferences and Congressional Briefings. Her research has been cited by the New York Times, U.S. News & World Report, NBC News, Washington Post, and more than 50 international news outlets.

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