Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

ABSTRACT

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.

Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.

Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.

Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.

Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

HIGHLIGHTS

• Despite their increased vulnerability, relatively few prevention strategies that specifically aim to reduce sexual violence among sexual and gender diverse (SOGD) communities and existing packaged programmes are less effective for preventing victimization among SOGD than for cisgender, heterosexual groups.

• Packaged prevention programmes should continue adapting with the specific aims to reduce these SOGD-based disparities.

• Broader changes at the outer layer of the social-ecological model (e.g. anti-discrimination, anti-bullying, inclusive sex-education) are critical primary prevention approaches to reduce SOGD-based sexual violence disparities.

Antecedentes: Los miembros de las comunidades de lesbianas, gays, bisexuales, transgénero, queer y otras orientaciones y diversidades de género (OODG) se encuentran en un riesgo desproporcionalmente alto de violencia sexual en comparación con personas cisgénero heterosexuales. Pese a este elevado riesgo, se han realizado muy pocos esfuerzos en la prevención de la violencia sexual para reducir de forma efectiva esta inequidad en la victimización basada en la identidad u orientación de género.

Objetivo: Esta revisión narrativa brinda una perspectiva general de la prevalencia de la violencia sexual en la comunidad de OODG, delimita los factores de riesgo para la victimización sexual en miembros de la comunidad de OOGD, evalúa y revisa los esfuerzos de prevención existentes para la comunidad OOGD. Se estructuran recomendaciones específicas para garantizar que los esfuerzos de prevención satisfagan las necesidades de la comunidad de OOGD.

Métodos: Recurriendo a la teoría de sistemas ecológicos y a enfoques de salud pública en materia de prevención de violencia sexual, se estructuran los enfoques y oportunidades actuales para personas que las dedicadas a la prevención y a la academia impulsen este ámbito.

Resultados: Se encuentran programas de prevención prometedores diseñados para ser implementados específicamente dentro de las comunidades de OOGD; sin embargo, es importante que los programas generales de prevención primaria se proyecten a abordar específicamente la violencia sexual perpetrada en contra de personas OOGD. Si bien muchos programas que se esfuerzan por prevenir la violencia sexual en todas las identidades de género y orientaciones sexuales son inclusivos para personas de la comunidad OOGD y se encuentran llenos de actividades, se requiere mayor programación que integre el entrenamiento contra la opresión enfocado contra las normas sociales que perpetúan los mitos relacionados con violaciones sexuales a personas de la comunidad OOGD y que normalizan la violencia contra sus miembros.

Conclusión: Las estrategias de prevención ecológicas, alineadas con un enfoque de salud pública para la prevención primaria, pueden ser particularmente valiosas para reducir la disparidad en la victimización basada en el estatus y la identidad de la comunidad OOGD. Una educación sexual integral y políticas en contra de la discriminación deben ser consideradas de primera línea en la programación de medidas preventivas. Para evaluar si estas estrategias son efectivas, se necesita implementar estudios de monitorización que incluyan evaluaciones integrales de la orientación sexual, identidad de género y agresiones sexuales y se encuentren cimentados en la teoría.

KEYWORDS:

• Sexual violence
• prevention
• LGBTQ
• sexual orientation
• gender identity
• sexual assault

PALABRAS CLAVE:

• Violencia sexual
• prevención
• LGBTQ
• orientación sexual
• identidad de género
• agresión sexual

1. Introduction

Sexual violence – which is an umbrella term that includes non-consensual sexual experiences, including sexual assault and rape – is a pervasive public health concern within the United States and across the world (Dworkin et al., 2021). Survivors of sexual violence face an array of deleterious mental health, physical health, and economic outcomes (Black et al., 2020; Dworkin et al., 2017; Smith et al., 2018). Sexual orientation and gender diverse people (SOGD) – defined as individuals who identify as lesbian, gay, bisexual, transgender, queer, or another sexual identity or gender expansive identity and individuals who engage in sexual behaviours with people of the same gender/sex – experience high rates of sexual violence across the lifespan (Blackburn et al., 2023; Garthe et al., 2021; Rothman et al., 2011), with transgender and gender diverse people at potentially higher risk for victimization (Langenderfer-Magruder et al., 2016). Despite the increased vulnerability for sexual violence, relatively few effective strategies exist to prevent sexual violence perpetrated against SOGD people. Accordingly, the current paper seeks to advance sexual violence prevention programming for sexual orientation and gender diverse communities in the United States by (1) briefly reviewing the prevalence of sexual violence in the SOGD community; (2) delineating vulnerability for sexual victimization among the SOGD community (Bronfenbrenner, 1979; CDC, 2020); (3) reviewing existing prevention efforts for the SOGD community; and (4) proposing a set of recommendations for sexual violence prevention efforts targeting risk and protective factors for harm across the social ecology with the goal of reducing SOGD-based sexual violence disparities. Violence against SOGD people is a global concern (Madrigal-Borloz, 2019). In the current paper, however, we focus on violence prevention strategies within the United States considering the unique socio-cultural and political context that informs the mixed climate regarding both sexual violence and SOGD communities within this region of the world.

2. Sexual violence prevalence in the SOGD communities

Cisgender sexual minority individuals (e.g. lesbian, gay, bisexual, queer, and other non-heterosexual individuals who do not identify as transgender) are consistently found to be at disproportionate risk for sexual violence across the lifespan compared to their cisgender heterosexual counterparts. The 2010 National Intimate Partner and Sexual Violence Survey (NISVS) found that adult sexual minority women and men were at increased risk for sexual violence compared to their heterosexual countparts (Walters et al., 2013). Adult bisexual women reported astounding rates of rape, specifically, with 46.1% reporting lifetime rape (compared to 13.1% of lesbian and 17.4% of heterosexual women) (Walters et al., 2013). Additionally, adult lesbian and bisexual women reported elevated rates of other forms of sexual violence (including, being made to penetrate someone else, sexual coercion, and other unwanted sexual experiences) compared to their heterosexual counter parts, with 74.9% of bisexual women reporting sexual violence, 46.4% of lesbians reporting sexual violence, and 43.3% of heterosexual women reporting these experiences (Walters et al., 2013). Adult gay men and bisexual men also reported considerably higher rates than their heterosexual counterparts, with 47.4% of bisexual men and 40.2% of gay men reporting sexual violence compared to 20.8% of heterosexual men. Disparities in victimization rates begin early, with sexual minority adolescent girls at disproportionate risk for experiencing unwanted sexual touching (17%) unwanted sexual intercourse (9%) compared to heterosexual girls (8% and 4% respectively) (Norris & Orchowski, 2020).

Within sexual minority communities, victimization vulnerabilities are heterogenous. Bisexuals, particularly bisexual women, have been consistently significantly more likely to report sexual assault victimization than both sexual minority men and lesbians (Chen et al., 2020). An analysis of the NISVS data found that bisexual women had significantly higher likelihood of experiencing sexual violence compared to lesbian women. Whereas bisexual men were at increased risk of victimization compared to their heterosexual counterparts, their risk was not higher than that of gay men (and both gay and bisexual men reported lower rates of sexual victimization compared to sexual minority women) (Chen et al., 2020). Although victimization rates among both gay and bisexual men were lower in this particular study, the victimization experiences of gay and bisexual men are nonetheless unique and warrant special attention in the context of prevention and response (Oesterle et al., 2023).

Although individuals across gender identities can and do perpetrate sexual violence, the vast majority of bisexual and lesbian women reported that their assaults were perpetrated exclusively by men (with rates ranging between 85.2%−98.3%) (Walters et al., 2013). Gay and bisexual men also reported that their experiences of sexual violence were also disproportionately perpetrated by other men, with 78.6% of gay men and 65.8% of bisexual men reporting exclusively male perpetrators (Walters et al., 2013). Few studies have examined the sexual orientation of reported perpetrators of sexual violence or perpetration prevalence rates among sexual minorities. To fully understand how prevention programming can be most effective, more research using validated assessments of sexual violence perpetration and assessing for more contextual information on sexual violence experiences and perpetrator characteristics is needed.

Transgender and gender diverse people may be at even greater vulnerability for sexual violence in comparison to their cisgender counterparts, although more research is needed to understand the potentially heterogenous risk among transgender people (Langenderfer-Magruder et al., 2016). Initial estimates from the U.S. Transgender Survey indicate that 47% of participants reported experiencing a sexual assault at some point over the course of their lives, with 10% reporting sexual violence within the past year (James et al., 2016). Initial studies have found that transgender adults experience sexual violence as much as twice as frequently as cisgender LGBQ individuals (Langenderfer-Magruder et al., 2016; Ybarra et al., 2022). Among youth, one online study found that transgender youth had greater than twice the odds of experiencing sexual violence, but they were not more likely to perpetrate sexual violence (Ybarra et al., 2022). Moreover, disproportionate rates are observed within college student samples. In a study using data from the National College Health Assessment-II, transgender college students reported greater odds of all forms of sexual victimization measured when compared to cisgender college students (Griner et al., 2020). More research, however, is needed to understand which transgender and gender diverse people (e.g. transgender women vs. genderqueer people) or at which intersections of identity transgender people might be at risk (e.g. sexual minority transgender people vs. heterosexual transgender people). The alarming rates of harm underscore the increased vulnerability to sexual violence faced by transgender people.

2.1. Theoretical frameworks to characterize vulnerability

Several theoretical models have been developed to better characterize the risk of sexual victimization among SOGD. Using analyses from a mixed-method’s study of sexual victimization disparities, Flanders and colleagues developed an integrated model on the determinants of sexual victimization of sexual minorities. Flanders and colleagues incorporated the psychological mediation framework (Flanders et al., 2023; Hatzenbuehler, 2009) the socioecological model, and intersectionality theory to understand how context shapes vulnerabilities (Bronfenbrenner, 1979; CDC, 2020; Crenshaw, 1989). More specifically, Flanders and colleagues (2023) outline the synergistic role of general and group-specific vulnerability factors across the socioecological levels including individual, interpersonal, and societal. General vulnerability factors include societal (e.g. expectations for sex and relationships), interpersonal (e.g. exposure to cisgender men), and individual (e.g. substance use). Group-specific vulnerability factors include lack of queer-specific sex and relationship knowledge, intra-community violence, and sexuality stigma. Flanders and colleagues (2023) further propose that these socioecological levels mutually influence one another, consistent with Bronfenbrenner (1979)’s initial conceptualization (Bronfenbrenner, 1979). Finally, Flanders and colleagues (2023) emphasize the role of intersectional marginalization contributing to sexual victimization vulnerability. For example, a Black woman who identifies as bisexual faces experiences of misogynoir or racialized sexual harassment (Bailey M, 2018; Buchanan, 2005) as well as antibisexual discrimination (Brewster & Moradi, 2010; Dyar et al., 2019), and may experience unique risks for violence (both general and specific) due to her experiences with interlocking systems of oppression that exacerbate vulnerability across the SEM (Rieger et al., 2022). Following victimization, survivors with intersecting marginalized identities also face differential treatment on the basis of the marginalized identities they hold (Bryant-Davis et al., 2010; Hamby, 2008; Kennedy et al., 2012; Sokoloff & Dupont, 2016; Tillman et al., 2010), which then, in turn, can prevent survivors from seeking and attaining support (Bedera et al., 2023; Edwards et al., 2022; Grocott et al., 2023), may contribute to worse outcomes following assault (Salim et al., 2023), and create risk for further victimization (Mason et al., 2009). Below, we briefly review additional risk factors for sexual violence victimization among SOGD people at each of the levels of the SEM, but note that previous reviews on SOGD sexual violence risk have also summarized this research (Blayney et al., 2023; Flanders et al., 2023; McCauley et al., 2018).

2.2. General and group-specific correlates of sexual violence among SOGD

SOGD people are at increased risk for general sexual violence vulnerability factors such as alcohol (Hequembourg et al., 2015; Kirwan et al., 2023) and substance use (Champion et al., 2022), which may place SOGD people at risk for incapacitated assault, specifically. For example, a study conducted among a sample of 75,192 college students within the United States indicated that, when compared to their cisgender peers, both transgender men and transgender women who were college students had significantly higher odds of experiencing past-year alcohol-related sexual assault (Coulter et al., 2015). SOGD are also at elevated for general vulnerability factors associated with sexual assault victimization compared to their cisgender, heterosexual counterparts, including, internalizing psychopathology (Tyler, 2008), and prior history of childhood sexual abuse (Blackburn et al., 2023). In addition to these general vulnerability factors, group-specific factors (that only impact SOGD and not their cisgender-heterosexual counterparts) such as internalized homophobia (Hequembourg et al., 2015; Murchison et al., 2017), identity concealment (Watson et al., 2021), are all associated with increased risk for experiencing sexual assault among SOGD individuals.

At the relationships level, general vulnerability factors such as sexual encounters involving substance or alcohol use (Flack et al., 2015; Tyler et al., 2017), and affiliation with deviant peer groups (Bhochhibhoya et al., 2021), have been associated with increased risk for violence among SOGD. Group-specific factors at the relationship level have also been identified including discordance in outness (Balsam & Szymanski, 2005), and experiencing social prejudice and discrimination based on sexual orientation (Grove & Johnson, 2022). For instance, results from a cross-sectional study conducted among 133 bisexual women found that women experiencing hostile sexism or biphobia from their peers were more likely to report prior sexual victimization (Grove & Johnson, 2022). Some relationships risk factors which are general might be especially elevated among specific SOGD groups. For example, bisexual women may be at increased risk for sexual violence exposure compared to lesbians given their increased exposure to cisgender heterosexual men (Flanders et al., 2023; 2020; 2019).

Outer layer (e.g. community and societal-level) victimization correlates which are both general and group-specific have been established (McCauley et al., 2018). Outer layer general vulnerability factors such as experiencing homelessness (Ormiston, 2022) and trading sex (Tyler & Schmitz, 2018) have been found to be associated with increased risk for victimization among SOGD. As an example, one study examining sexual assault vulnerability among a sample of 595 gay and bisexual community men found that men with a history of having traded sex for money or drugs were more likely to report prior unwanted sexual experiences (Kalichman et al., 2001). Availability of comprehensive sex education (a general vulnerability factor) which is not LGBTQ inclusive (a group-specific vulnerability factor) might be especially influential for SOGD communities. One mixed method study of SOGD undergraduates found that SOGD reported that their sexual education programming was not helpful in navigating sexual interactions and that they more often relied on media to learn sexual scripts, which fostered increased risk for victimization (Bloom et al., 2022). Group-specific outer layer factors, such as locker room and bathroom restrictions based on sex assigned at birth have been found to be associated with increased risk for sexual assault among transgender and gender expansive youth as compared to environments with fewer restrictions (Murchison et al., 2019).

3. Current sexual violence prevention efforts for SOGD communities

It is important to note that reducing the prevalence of sexual violence across gender and sexual orientations is challenging and programmes/efforts to broadly reduce sexual violence are often difficult to evaluate (DeGue et al., 2014). While some programmes and efforts have shown some success, more funding and research is needed across the board to determine the long-term effectiveness in primary prevention programmes and strategies that aim to reduce sexual violence risk across gender identities and sexual orientations. However, as prevention strategies are being developed and evaluated, it is critical that programme developers and evaluators examine the effectiveness for SOGD and other marginalized communities.

3.1. Intervening at the individual and relationship-level

When considering current individual- and relationship- level sexual assault prevention approaches for SOGD communities, it is first essential to ask whether existing programmes are preventing sexual assault victimization and perpetration among SOGD. Although numerous interventions seeking to prevent sexual violence have been developed, particularly for use among high school and college students, few of these programmes include content specific to SOGD people (DeGue et al., 2014; Oesterle et al., 2022). This might be particularly true of packaged prevention programmes like bystander programmes which aim to reduce general, relationship-level vulnerability (through individual behaviours, i.e. by training peers to intervene when they see potential sexual assault risks) while also targeting individuals to change climates and social norms that foster and tolerate violence (an individual level intervention aiming to diffuse out to an outer layer, general risk factor). In fact, a review conducted by Kirk and colleagues found that only 10% of existing bystander intervention programmes aiming to reduce sexual violence among college students included content specific to sexual and gender minorities (Kirk-Provencher et al., 2023).

A second critical question is whether existing universal programming efforts, administered regardless of sexual orientation or gender identity and targeting exclusively general (and not group-specific) sexual violence risk factors, can be inclusive of the SOGD community, and meet the specific needs of the population. Some work has begun to adapt protocols to be inclusive of SOGD communities and target group-specific risk factors. As an example, one qualitative developmental study assessing for potential required adaptations to a college rape prevention programme (Define It! – an individual-level programme delivered to undergraduates), reported that SOGD participants and stakeholders requested adaptations to include SOGD-specific rape myths in their prevention programming (an individual-level programme targeting an outer layer group specific factor); however, data on intervention effectiveness data for these potential adaptations are not available (Johnson et al., 2019). Other studies, however, suggest that prevention initiatives are not equally effective in reducing violence against SOGD people. For example, one study found that a universally-delivered bystander-focused violence prevention programmes (Green Dot) was associated with reductions in sexual violence perpetration and victimization among sexual majority youth but not among sexual minority youth (Coker et al., 2020). Another study found that a packaged programme (Bringing in the Bystander) was more effective in reducing 12-month sexual harassment and stalking outcomes for sexual majority youth than for sexual minority youth (Waterman et al., 2022). It is possible that these interventions do not attend to group-specific vulnerability factors that might foster risk. As an example, a bystander’s attitude or biases about or towards a group might prevent them from intervening, thus reinforcing a group-specific relationship-level vulnerability factor. Research has found that victim and bystander racial identity can impact a bystander’s likelihood to intervene, with one lab-based study finding that White women are less likely to intervene in a potential sexual assault when they perceive that the victim to be a Black woman (whose name is LaToya, compared to a woman whose name is Laura) (Katz et al., 2017). More research is needed to understand what informs willingness to intervene when, for example, the potential victim/perpetrator appear to hold the same gender identity, or the potential victim holds an identity that carries specific rape myths (e.g. that bisexual women or sexual minority men are hypersexual and thus cannot be raped). It is possible that programmes that specifically tailored to the unique needs and experiences of sexual orientation and gender diverse people are warranted. Moreover, research has focused on characterizing sexual victimization experiences among sexual minority youth and adults, however examination with transgender or gender non-conforming communities is warranted.

To date, a limited number of prevention programmes exist that are tailored to address the needs of the SOGD population. To our knowledge, only one integrated alcohol and sexual assault prevention programme – +Change (Positive Change) – has been specifically developed to simultaneously target theoretically and empirically derived individual-level risk factors for sexual victimization among SOGD college students (Gilmore et al., 2022). Given the high co-occurrence between alcohol use and sexual assault in some settings (Abbey, 2011), programmes that integrate alcohol use and sexual assault prevention together show considerable promise in preventing both sexual victimization and perpetration (Gilmore et al., 2022; Orchowski, Barnett, et al., 2018). Notably, +Change targets general risk factors at the individual (e.g. alcohol use), relationship (e.g. sexual risk behaviours), and community (e.g. alcohol contexts) levels, while being grounded in a minority stress framework and simultaneously targeting group-specific risk factors. Results from an open pilot trial of +Change demonstrate acceptability and efficacy in preventing sexual victimization among SOGD college students (Gilmore et al., 2022), which provides preliminary support for prevention efforts that are developed to simultaneously target multiple risk factors across the social ecology for diverse SOGD populations. Indeed, numerous researchers have suggested that risk for victimization among SOGD individuals is multiplicative among individuals holding more than one marginalized identity (Coulter et al., 2017; Gyamerah et al., 2021; Reisner et al., 2014; Ussher et al., 2022). Therefore, it is prudent that prevention programmes adopt intersectional approaches to address broader systemic and institutional risk factors that disproportionately increase risk for vulnerable subpopulations within the SOGD community.

It is also important to acknowledge that we are aware of several research studies that are underway that will close this gap in prevention by specifically developing and evaluating individual-level sexual assault prevention programmes for SOGD populations. For instance, efforts to develop an empowerment self-defense programme that aims to decrease sexual victimization among transwomen specifically through increasing sexual assertiveness and physical resistance are currently in progress (targeting general individual vulnerability factors that may be especially meaningful for transgender women) (Hotchkiss et al., 2022; Smith et al., 2023). Programmatic efforts that integrate numerous salient individual-level general and group-specific risk factors for sexual revictimization among bisexual women, including alcohol use and psychological distress, are also currently being developed (Orchowski, 2023). Further, the development and evaluation of an integrated alcohol and violence prevention intervention seeking to curb rates of dating violence among SOGD teens more broadly are underway (Edwards, 2023). Although promising, given that each of the aforementioned programmes addresses established group-specific and general risk factors associated with sexual victimization among SOGD people, the effectiveness and ability of these efforts in reducing rates of sexual violence among individuals with minoritized sexual and/or gender identities has yet to be established.

3.2. Integrating outer layer primary prevention programming

Whereas individual- and relationship-level sexual violence prevention efforts are crucial for reducing sexual violence perpetration and victimization, they are only one part of a comprehensive, multi-pronged approach to prevention. Although targeting individual-level risk factors might reduce individual-level vulnerabilities, this approach to prevention may be inefficient for broadly reducing risk and may not be entirely effective in promoting widespread and long-lasting change. Perpetration of violence is upheld through deeply ingrained societal norms, and reducing perpetration of violence will require intensive and synergistic prevention approaches that extend beyond programmes that address general individual risk and protective factors. It is vital that these efforts address the ways that violence is rooted in systems of identity-based oppression, particularly as many sexual orientation and gender diverse people report that their perpetrators are cisgender/heterosexual men (Hequembourg et al., 2015; 2013; Morris & Balsam, 2003; Sutton et al., 2022).

Notably, the CDC’s Rape Prevention and Education (RPE; a large funding mechanism for state-wide sexual and gender-based violence prevention since the inception of the Violence Against Women Act) (Dahlberg & Mercy, 2009) mandates that at least half of all prevention strategies occur at the ‘outer layers’ of the SEM, meaning that prevention strategies should take place at the ‘community’ or ‘societal’ level, rather than at the individual- (e.g. individual-level consent education) or relational-level (e.g. bystander training) (Banyard, 2011; Basile et al., 2016; Kirk-Provencher et al., 2023). Community (e.g. whole-school approaches, school- and organizational- policies aiming to change community norms, improve organizational climates, and enforce existing policies) (Edwards et al., 2023; Orchowski et al., 2023a; Orchowski et al., 2023b) and societal approaches (international statements, task forces, and legislation aiming to reduce violence, change broader social norms, reduce gender-pay gaps, promote gender equity) target common sexual violence risk factors, promote protective factors, and root causes of sexual violence (e.g. oppression and gender inequity) in line with a public health primary prevention approach to efficiently prevent violence from ever occurring (Basile et al., 2016; Campbell et al., 1998; DeGue et al., 2011; 2012; Lehrner & Allen, 2008). These approaches often target interrelated forms of violence (e.g. aiming to reduce both sexual and dating violence, childhood sexual abuse, and bullying), with the understanding that these forms of violence share an underlying root cause (Hamby, 2014; Hamby & Grych, 2012; Hong, 2017). Outer layer prevention approaches are often conceptualized as tools to efficiently target individual-level and relationship-level risk and protective factors (McCauley et al., 2019; McMahon, 2015; McMahon & Seabrook, 2019; Moylan et al., 2021; Moylan & Javorka, 2020). These approaches map on well to Flanders’ and colleagues’ conceptualization for the increased vulnerability for sexual violence among SOGD, and the importance of interventions that target both general and group-specific factors. For example, having school or organizational policies that bar SOGD discrimination can reduce sexual violence against SOGD in at least two ways. The first is that by preventing discrimination, universities can change climates which tolerate violence against SOGD people (an outer layer intervention targeting an outer layer group-specific risk factor). Additionally, policies that reduce the discrimination that SOGD people experience (Black et al., 2012; Fields & Wotipka, 2022), which in turn reduces SOGD individuals likelihood of problematic alcohol use (Hatzenbuehler et al., 2011; McConnell & Messman-Moore, 2019), which can in turn reduce likelihood for experiencing or perpetrating assault (Abbey, 2011; Blayney et al., 2016) (an outer layer intervention targeting an individual level, general vulnerability factor for perpetration and victimization).

Whereas outer layer approaches (including whole school approaches, state-wide anti-discrimination or anti-bullying policies) offer promise, they can be challenging for preventionists to implement, as they are often hired and trained to provide individual-level programming (often within schools) and may perceive themselves to have inadequate training (Rieger et al., 2023). Additionally, outer layer interventions – such as policy implementation – can be challenging to effectively evaluate, despite having a strong theoretical rationale (DeGue et al., 2011). Even with their challenges, outer layer prevention strategies offer promise for reducing victimization disparities for minority populations, particularly SOGD populations, by broadly targeting anti-SOGD climates and rape myths (outer layer group-specific risk factors), implementing anti-bullying and harassment policies that explicitly protect SOGD (an outer layer intervention targeting group-specific risk factors), and advocating for legislation and policies that promotes gender equity, across genders and sexual orientations. Programmes which aim to dispel stigmatizing attitudes, stereotypes, or rape myths (e.g. that sexual orientation or gender identity can be ‘corrected;’ that some SOGD people, like bisexuals, are inherently promiscuous and unassailable), and fostering respect for people’s identities can both prevent climates that tolerate sexual violence towards SOGD people (an outer layer group specific vulnerability factor) (Schulze & Koon-Magnin, 2017) and reduce minority stressors that exacerbate psychopathology following victimization (Murchison et al., 2017).

Many outer layer interventions – such as policies that address violence – are implemented in schools, colleges, and universities (Ali, 2011). Whereas little research has been conducted to evaluate how sexual violence policies are associated with sexual violence prevalence, large climate data demonstrated that state-level policies requiring that schools develop clear and specific anti-violence policies have lower rates of violence among their students (Hatzenbuehler et al., 2015). Comprehensive bullying policies are associated not just with bullying prevalence but also with reduced disparities in bullying, with one study finding high compliance with the U.S. Department of Education anti-bullying practices contributing to reduced sex-based disparities in bullying (Hatzenbuehler et al., 2017). Notably, the implementation of policies that specifically prohibit anti-SOGD bullying (targeting a group-specific risk factor) is associated with less bias-based incidents and promote climates in which SOGD youth trust teachers to intervene and disclose these experiences. A study of four Chilean high schools with 572 students found that when youth reported having an anti-bullying policy that specifically bars bullying based on gender identity and sexual orientation, they were less likely to hear teachers or staff making homophobic remarks (a setting-level group-specific risk factor) and were more likely to see teachers intervening when other students perpetrated bias-based bullying (a setting-level group-specific protective factor). This study also found that teachers intervening when they saw peer-perpetrated bias-based bullying was associated with increased trust in teachers and staff (a setting-level group-specific protective factor), which then contributed to youth being more likely to disclose and report victimization experiences (Berger et al., 2019). Although bullying and sexual violence are distinct forms of violence, perpetration of biased-based bullying is associated with later sexual violence perpetration, and preventing bullying is an important part of comprehensive sexual violence prevention (Espelage et al., 2018).

4. Recommendations for enhancing SOGD sexual violence prevention

4.1. Accurately tracking sexual violence prevalence

In alignment with the first step-public health approach, we must invest in the consistent implementation of wide-scale climate assessments to effectively document the prevalence of various forms of harm across individuals with varying sexual and gender identities. Whereas large-scale climate and surveillance assessments have been consistently implemented for some populations (e.g. the Youth Risk Behavior Surveillance System) (Centers for Disease Control and Prevention (CDC) 2019), large-scale, nationally representative surveys for adults are lacking, with the last iteration of National Intimate Partner and Sexual Violence Survey (NIPSVS) having collected data in 2017. Surveillance surveys can use inclusive and specific language to properly assess for sexual orientation and gender identity, such as implementing a two-step gender identification process (Fraser, 2018), to understand the heterogenous vulnerability within the SOGD community (Chen et al., 2020; Langenderfer-Magruder et al., 2016). Additionally, efforts currently being made to ensure that the gold-standard sexual assault assessments (such as the Sexual Experiences Survey) (Koss et al., 2007) are inclusive and adequately assessing for sexual violence across SOGD communities must also translate to large-scale climate assessments as well (Koss et al., 2022). Finally, it is critical to assess not only the prevalence of victimization experiences, but also the context of how those experiences occurred and who perpetrates them as well. Little research has been done both to assess perpetration among SOGD communities and who is targeting SOGD for sexual violence. Understanding who is perpetrating sexual violence against SOGD community members is critical for preventing perpetration against this community.

4.2. Integrating anti-oppression programming into existing, widely adopted sexual violence prevention efforts

Programme creators should push beyond inclusion alone and explicitly integrate anti-oppression training and education about the unique risks for SOGD people and how stigmatizing homophobic, bi-phobic, queer-phobic, ace-phobic, and transphobic attitudes might foster individual-attitudes and broader climates that condones sexual violence towards the SOGD community (group-specific and relationship-level vulnerability factors). Scholars have made calls for preventionists and programme developers to centre marginalized voices and broader social justice efforts into programming (Bonomi, 2019; Brush & Miller, 2022; Klein et al., 2021; Rothman, 2019), in response to research demonstrating that SOGD communities tend to understand their increased risk for victimization as being attributed broader queerphobic/bi-phobic/homophobic/transphobic climate, want sexual prevention efforts to integrate social justice training into their programming (Flanders et al., 2023; Johnson et al., 2019; McMahon et al., 2020; Potter et al., 2012). Scholars have noted how gender transformative paradigms in prevention programmes (which aim to levy social norms approaches to challenge gender inequity that contributes to violence risk) (Brush & Miller, 2019; Orchowski, 2019) may be particularly helpful in considering strategies to change attitudes and perceptions of SOGD youth as deviant or dangerous, and promote attitudes that disavow violence against SOGD people (Miller, 2022). Explicitly challenging stigmatizing attitudes for sexual minorities that are specifically at risk (e.g. bisexual people), may be especially important to reduce SOGD specific-rape myths and reduce sexual violence disparities within SOGD communities.

While few evidence-based sexual violence programmes have explicitly integrated anti-homophobia or anti-transphobia, many anti-transphobia and anti-homophobia programmes do exist (Cruz, 2015; Domínguez-Martínez & Robles, 2019; Goldstein et al., 2007). Given that some evidence-based packaged sexual violence programmes are less effective for SOGD communities (Coker et al., 2020), and that heterosexual/cisgender people do perpetrate sexual assault against SOGD people, integrating education aiming to reduce anti-SOGD attitudes, and provide education about SOGD rape myths is essential. Bystander intervention programmes, like Green Dot, that also aim to change social norms/individual attitudes have demonstrated initial success in reducing attitudes that contribute to perpetration risk (like ambivalent sexism) among programme recipients (Coker et al., 2022; Miller et al., 2016), and – if adapted and expanded – might be particularly well suited to also reduce oppressive and stigmatizing attitudes about SOGD and promote environments that do not tolerate violence against them.

4.3. Attending to risk for victimization and perpetration

It is essential that violence prevention efforts address risk for victimization, risk for perpetration, and engage all members of a community as taking an active role to prevent harm among their peers. Sexual violence perpetration broadly is under assessed, which is particularly true among LGBTQ people. One formative study has found that sexual minority youth are at increased risk of perpetration and that transgender youth are less likely to perpetrate sexual violence (Ybarra et al., 2022). Given that SOGD people can and do perpetrate sexual violence within the community (Edwards & Sylaska, 2013), it is also vital that programmes address risk for both victimization and perpetration proclivity among SOGD people. Given that some programmes are demonstrating promise in preventing harm among SOGD people (Gilmore et al., 2022; Johnson et al., 2019), the implementation of evidence-based programmes should be also prioritized.

4.4. Addressing the barriers to implementation of prevention programming

Although preventionists must first be tasked with creating effective programming to prevent sexual assault within SOGD communities, the ability for these interventions to create meaningful and sustained change is ultimately a result of effective implementation. Although challenges in programme implementation are not necessarily specific to sexual assault and violence, several unique challenges to implementing a wide range of programmatic efforts exist for those within SOGD communities. For instance, factors such as limited ability to provide safe learning spaces, difficulties promoting student awareness and acceptance of diversity, and heteronormative policies and procedures have been found to be prohibitive of effective implementation among school-based programmes geared towards SOGD youth (Steck & Perry, 2018). Another potential barrier to implementing programming specific to SOGD communities is that individuals may be reluctant to participate in these efforts due to concerns of ‘coming out by proxy’ (Williams et al., 2020). Perceptions of interventionists’ lack of cultural competency or likelihood of stigmatizing those participating in prevention efforts may also limit participation from those within SOGD communities, particularly in regions where experiencing society stigma is heightened (Glasgow et al., 2013).

Despite these challenges, Implementation Science, which represents a broad field of study concerned with applying and integrating research evidence into practice and policy, may offer important insights into ensuring effective and successful implementation of programmatic efforts. The Consolidated Framework for Implementation Research (CFIR) is an evidence-based tool that provides a conceptual framework to assess ecological, systemic, and institutional factors that both facilitate and impede intervention uptake (Damschroder et al., 2009; 2022). Large-scale implementations of prevention programmes often have multiple contextual factors that can hinder effective implementation and diffusion of innovation, and demonstrate the importance of considering and engaging with the implementation context, as recommended by CFIR (Cox et al., 2010; Rieger et al., 2023). Although the constructs and domains assessed by CFIR may provide critical insights into factors that influence successful implementation of SOGD sexual violence prevention programmes, it is both possible and likely that the tool’s neutrality toward sexuality- and gender-specific influences on the implementation process may hinder researchers’ ability to assess these specific systemic and ecological factors. Promisingly, researchers seeking to implement a programme to prevent race-based discrimination among school-aged youth created a race/racism-conscious adaption of CFIR; this innovative approach may provide a useful roadmap for preventionists seeking to apply the CFIR framework to promote successful implementation of prevention programming for SOGD individuals at risk for experiencing sexual assault (Allen et al., 2021).

4.5. Promoting policies that advance protective environments

Promoting safe and affirming climates that do not condone sexual assault against SOGD communities requires intervention from state and federal lawmakers. Statewide policies that mandate the inclusion of SOGD history in social studies curricula and policies that specifically protect SOGD communities from discrimination, harassment, and peer victimization are critical to foster protective environments that do not tolerate violence and reduce group-specific sexual violence risk factors (Russell et al., 2021; Snapp et al., 2015). Previous research has demonstrated that anti-SOGD laws and policies can increase SOGD people’s experiences with violence (e.g. Proposition 8) (Hatzenbuehler et al., 2019) current anti-SOGD legislation being implemented nationwide (e.g. Florida’s ‘Don’t Say Gay,’ multiple state’s bans on gender affirming medical interventions and care) (Kline et al., 2022) may further exacerbate the extraordinary sexual orientation- and gender identity- based disparities. Laws that mandate the inclusion of SOGD history in social studies (e.g. Inclusive Curriculum in Illinois) (Illinois General Assembly - Full Text of Public Act 101-0227, 2023; Public Act 101-0227, 2020), may be particularly meaningful for promoting climates that do not tolerate violence perpetrated toward SOGD people. Anti-bullying and anti-discrimination policies are associated with SOGD well-being broadly (Hatzenbuehler et al., 2017; 2015; 2009; Hatzenbuehler & Keyes, 2013), but more research is needed to determine if one mechanism that might explain this is the reduction of sexual violence experienced by SOGD communities.

Comprehensive sex education that is inclusive of sexual assault perpetration prevention has proposed by scholars as a unique opportunity to see meaningful reductions in sexual violence and should be considered an important primary prevention strategy (Schneider & Hirsch, 2020). Integrating programming aiming to foster acceptance and provide comprehensive education on the experiences of SOGD communities may be particularly effective for preventing sexual violence against SOGD (Bloom et al., 2022). Previous studies have found that comprehensive sex education that is inclusive of SOGD communities can promote willingness to intervene when SOGD youth are targeted for violence broadly, and can reduce the prevalence of homophobic name calling (Baams et al., 2017). Thus, ensuring that affirming and SOGD-inclusive consent education programming is integrated into comprehensive sex education might be valuable in reducing SOGD-based sexual violence disparities.

5. Conclusions

Sexual violence is a public health crisis in the United States, and SOGD-based disparities in sexual violence victimization both reflects and contributes to larger disparities and oppression faced by SOGD communities. Within the current paper the prevalence of sexual violence in the SOGD community, victimization risk factors across the socio-ecological model, existing prevention efforts for SOGD community are reviewed. Further, the current manuscript provides recommendations for preventing sexual violence against SOGD populations across their social-ecology, taking up calls for scholars to push beyond documenting risk factors and disparities and conduct research and programming endeavouring to mitigate them (see Table 1) (Mustanski & Macapagal, 2023). Prevention programmes should be inclusive of SOGD communities, and target both general and group-specific sexual violence risk factors. By intervening across a social ecological context, we move the onus from preventing violence from the individual to the broader community, which is especially impactful for marginalized communities (Blackburn and Todd, 2022). Intervening at the level of and with attention to context can more efficiently reduce victimization disparities and avoid further harming SOGD community members.

Table 1. Recommendations for preventing sexual violence of SOGD at each layer of the socioecological model (SEM).

SEM Layer	Specific Prevention Recommendation
Societal/Policy	Mandate inclusive coverage of SOGD history to promote safety for SOGD youth (e.g. Inclusive Curriculum in Illinois). Implement and enforce policies that protect SOGD communities from harm (e.g. anti-discrimination policies, SOGD specific anti-bullying policies) and challenge policies that endeavour to foster hostile environments for SOGD people (e.g. Don’t Say Gay laws).
Community	Ensure that sexual violence surveillance surveys are using inclusive assessment strategies for gender identity (e.g. a two-step approach), sexual orientation, and sexual victimization. Inclusive contextual information about sexual violence victimization and perpetration should be collected. Sex education should be comprehensive and integrate sexual SOGD-inclusive content (particularly related to sexual violence and sexual health). Adapt and expand bystander intervention programmes (e.g. Green Dot) to challenge participants to promote safe environments for SOGD people that do not tolerate violence against SOGD people. Explicitly integrate anti-oppression training and education about unique risks among SOGD people.
Relationship	Ensure that bystander intervention programmes include programming on recognizing violence between SOGD people and provide training about how personal biases can contribute to likelihood to intervene.
Individual	Adopt gender transformative paradigms within prevention programming that using social norms approaches that can reduce SOGD victimization disparities. Ensure that consent education programming contains inclusive information about SOGD victimization disparities.

Disclosure statement

No potential conflict of interest was reported by the author(s).