Capital accumulation

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https://en.wikipedia.org/wiki/Capital_accumulation

 

Capital accumulation is the dynamic that motivates the pursuit of profit, involving the investment of money or any financial asset with the goal of increasing the initial monetary value of said asset as a financial return whether in the form of profit, rent, interest, royalties or capital gains. The aim of capital accumulation is to create new fixed and working capitals, broaden and modernize the existing ones, grow the material basis of social-cultural activities, as well as constituting the necessary resource for reserve and insurance. The process of capital accumulation forms the basis of capitalism, and is one of the defining characteristics of a capitalist economic system.

Definition

The definition of capital accumulation is subject to controversy and ambiguities, because it could refer to:

• A net addition to existing wealth
• A redistribution of wealth.

Most often, capital accumulation involves both a net addition and a redistribution of wealth, which may raise the question of who really benefits from it most. If more wealth is produced than there was before, a society becomes richer; the total stock of wealth increases. But if some accumulate capital only at the expense of others, wealth is merely shifted from A to B. It is also possible that some accumulate capital much faster than others.^{[citation needed]} When one person is enriched at the expense of another in circumstances that the law sees as unjust it is called unjust enrichment. In principle, it is possible that a few people or organisations accumulate capital and grow richer, although the total stock of wealth of society decreases.

In economics and accounting, capital accumulation is often equated with investment of profit income or savings, especially in real capital goods. The concentration and centralisation of capital are two of the results of such accumulation (see below).

Capital accumulation refers ordinarily to:

• Real investment in tangible means of production, such as acquisitions, research and development, etc. that can increase the capital flow.
• Investment in financial assets represented on paper, yielding profit, interest, rent, royalties, fees or capital gains.
• Investment in non-productive physical assets such as residential real estate or works of art that appreciate in value.

and by extension to:

• Human capital, i.e., new education and training increasing the skills of the (potential) labour force which can increase earnings from work.
• Social capital, i.e. the wealth and productive capacity that the people in a society hold in common, rather than as individuals or corporations.

Both non-financial and financial capital accumulation is usually needed for economic growth, since additional production usually requires additional funds to enlarge the scale of production. Smarter and more productive organization of production can also increase production without increased capital. Capital can be created without increased investment by inventions or improved organization that increase productivity, discoveries of new assets (oil, gold, minerals, etc.), the sale of property, etc.

In modern macroeconomics and econometrics the term capital formation is often used in preference to "accumulation", though the United Nations Conference on Trade and Development (UNCTAD) refers nowadays to "accumulation". The term is occasionally used in national accounts.

Measurement of accumulation

Accumulation can be measured as the monetary value of investments, the amount of income that is reinvested, or as the change in the value of assets owned (the increase in the value of the capital stock). Using company balance sheets, tax data and direct surveys as a basis, government statisticians estimate total investments and assets for the purpose of national accounts, national balance of payments and flow of funds statistics. Usually, the reserve banks and the Treasury provide interpretations and analysis of this data. Standard indicators include capital formation, gross fixed capital formation, fixed capital, household asset wealth, and foreign direct investment.

Organisations such as the International Monetary Fund, UNCTAD, the World Bank Group, the OECD, and the Bank for International Settlements used national investment data to estimate world trends. The Bureau of Economic Analysis, Eurostat and the Japan Statistical Office provide data on the US, Europe and Japan respectively.

Other useful sources of investment information are business magazines such as Fortune, Forbes, The Economist, Business Week, etc., and various corporate "watchdog" organisations and non-governmental organization publications. A reputable scientific journal is the Review of Income and Wealth. In the case of the US, the "Analytical Perspectives" document (an annex to the yearly budget) provides useful wealth and capital estimates applying to the whole country.

Demand-led growth models

In macroeconomics, following the Harrod–Domar model, the savings ratio (${\displaystyle s}$) and the capital coefficient (${\displaystyle k}$) are regarded as critical factors for accumulation and growth, assuming that all saving is used to finance fixed investment. The rate of growth of the real stock of fixed capital (${\displaystyle K}$) is:

${\displaystyle \frac{\mathrm{\Delta }K}{K}=\frac{\frac{\mathrm{\Delta }K}{Y}}{\frac{K}{Y}}=\frac{s}{k}}$

where ${\displaystyle Y}$ is the real national income. If the capital-output ratio or capital coefficient (${\displaystyle k=\frac{K}{Y}}$) is constant, the rate of growth of ${\displaystyle Y}$ is equal to the rate of growth of ${\displaystyle K}$. This is determined by ${\displaystyle s}$ (the ratio of net fixed investment or saving to ${\displaystyle Y}$) and ${\displaystyle k}$.

A country might, for example, save and invest 12% of its national income, and then if the capital coefficient is 4:1 (i.e. $4 billion must be invested to increase the national income by 1 billion) the rate of growth of the national income might be 3% annually. However, as Keynesian economics points out, savings do not automatically mean investment (as liquid funds may be hoarded for example). Investment may also not be investment in fixed capital (see above).

Assuming that the turnover of total production capital invested remains constant, the proportion of total investment which just maintains the stock of total capital, rather than enlarging it, will typically increase as the total stock increases. The growth rate of incomes and net new investments must then also increase, in order to accelerate the growth of the capital stock. Simply put, the bigger capital grows, the more capital it takes to keep it growing and the more markets must expand.

The Harrodian model has a problem of unstable static equilibrium, since if the growth rate is not equal to the Harrodian warranted rate, the production will tend to extreme points (infinite or zero production). The Neo-Kaleckians models do not suffer from the Harrodian instability but fails to deliver a convergence dynamic of the effective capacity utilization to the planned capacity utilization. For its turn, the model of the Sraffian Supermultiplier grants a static stable equilibrium and a convergence to the planned capacity utilization. The Sraffian Supermultiplier model diverges from the Harrodian model since it takes the investment as induced and not as autonomous. The autonomous components in this model are the Autonomous Non-Capacity Creating Expenditures, such as exports, credit led consumption and public spending. The growth rate of these expenditures determines the long run rate of capital accumulation and product growth.

Marxist concept

Marx borrowed the idea of capital accumulation or the concentration of capital from early socialist writers such as Charles Fourier, Louis Blanc, Victor Considerant, and Constantin Pecqueur. In Karl Marx's critique of political economy, capital accumulation is the operation whereby profits are reinvested into the economy, increasing the total quantity of capital. Capital was understood by Marx to be expanding value, that is, in other terms, as a sum of capital, usually expressed in money, that is transformed through human labor into a larger value and extracted as profits. Here, capital is defined essentially as economic or commercial asset value that is used by capitalists to obtain additional value (surplus-value). This requires property relations which enable objects of value to be appropriated and owned, and trading rights to be established.

Over-accumulation and crisis

The Marxist analysis of capital accumulation and the development of capitalism identifies systemic issues with the process that arise with expansion of the productive forces. A crisis of overaccumulation of capital occurs when the rate of profit is greater than the rate of new profitable investment outlets in the economy, arising from increasing productivity from a rising organic composition of capital (higher capital input to labor input ratio). This depresses the wage bill, leading to stagnant wages and high rates of unemployment for the working class while excess profits search for new profitable investment opportunities. Marx believed that this cyclical process would be the fundamental cause for the dissolution of capitalism and its replacement by socialism, which would operate according to a different economic dynamic.

In Marxist thought, socialism would succeed capitalism as the dominant mode of production when the accumulation of capital can no longer sustain itself due to falling rates of profit in real production relative to increasing productivity. A socialist economy would not base production on the accumulation of capital, instead basing production on the criteria of satisfying human needs and directly producing use-values. This concept is encapsulated in the principle of production for use.

Concentration and centralization

According to Marx, capital has the tendency for concentration and centralization in the hands of richest capitalists. Marx explains:

"It is concentration of capitals already formed, destruction of their individual independence, expropriation of capitalist by capitalist, transformation of many small into few large capitals.... Capital grows in one place to a huge mass in a single hand, because it has in another place been lost by many.... The battle of competition is fought by cheapening of commodities. The cheapness of commodities demands, ceteris paribus, on the productiveness of labour, and this again on the scale of production. Therefore, the larger capitals beat the smaller. It will further be remembered that, with the development of the capitalist mode of production, there is an increase in the minimum amount of individual capital necessary to carry on a business under its normal conditions. The smaller capitals, therefore, crowd into spheres of production which Modern Industry has only sporadically or incompletely got hold of. Here competition rages.... It always ends in the ruin of many small capitalists, whose capitals partly pass into the hands of their conquerors, partly vanish."

Rate of accumulation

In Marxian economics, the rate of accumulation is defined as (1) the value of the real net increase in the stock of capital in an accounting period, (2) the proportion of realized surplus-value or profit-income which is reinvested, rather than consumed. This rate can be expressed by means of various ratios between the original capital outlay, the realized turnover, surplus-value or profit and reinvestment's (see, e.g., the writings of the economist Michał Kalecki).

Other things being equal, the greater the amount of profit-income that is disbursed as personal earnings and used for consumption purposes, the lower the savings rate and the lower the rate of accumulation is likely to be. However, earnings spent on consumption can also stimulate market demand and higher investment. This is the cause of endless controversies in economic theory about "how much to spend, and how much to save".

In a boom period of capitalism, the growth of investments is cumulative, i.e. one investment leads to another, leading to a constantly expanding market, an expanding labor force, and an increase in the standard of living for the majority of the people.

In a stagnating, decadent capitalism, the accumulation process is increasingly oriented towards investment on military and security forces, real estate, financial speculation, and luxury consumption. In that case, income from value-adding production will decline in favour of interest, rent and tax income, with as a corollary an increase in the level of permanent unemployment.

As a rule, the larger the total sum of capital invested, the higher the return on investment will be. The more capital one owns, the more capital one can also borrow and reinvest at a higher rate of profit or interest. The inverse is also true, and this is one factor in the widening gap between the rich and the poor.

Ernest Mandel emphasized that the rhythm of capital accumulation and growth depended critically on (1) the division of a society's social product between necessary product and surplus product, and (2) the division of the surplus product between investment and consumption. In turn, this allocation pattern reflected the outcome of competition among capitalists, competition between capitalists and workers, and competition between workers. The pattern of capital accumulation can therefore never be simply explained by commercial factors, it also involved social factors and power relationships.

Circuit of capital accumulation from production

Strictly speaking, capital has accumulated only when realized profit income has been reinvested in capital assets. But the process of capital accumulation in production has, as suggested in the first volume of Marx's Das Kapital, at least seven distinct but linked moments:

• The initial investment of capital (which could be borrowed capital) in means of production and labor power.
• The command over surplus labour and its appropriation.
• The valorisation (increase in value) of capital through production of new outputs.
• The appropriation of the new output produced by employees, containing the added value.
• The realisation of surplus-value through output sales.
• The appropriation of realised surplus-value as (profit) income after deduction of costs.
• The reinvestment of profit income in production.

All of these moments do not refer simply to an economic or commercial process. Rather, they assume the existence of legal, social, cultural and economic power conditions, without which creation, distribution and circulation of the new wealth could not occur. This becomes especially clear when the attempt is made to create a market where none exists, or where people refuse to trade.

In fact Marx argues that the original or primitive accumulation of capital often occurs through violence, plunder, slavery, robbery, extortion and theft. He argues that the capitalist mode of production requires that people be forced to work in value-adding production for someone else, and for this purpose, they must be cut off from sources of income other than selling their labor power.

Simple and expanded reproduction

In volume 2 of Das Kapital, Marx continues the story and shows that, with the aid of bank credit, capital in search of growth can more or less smoothly mutate from one form to another, alternately taking the form of money capital (liquid deposits, securities, etc.), commodity capital (tradeable products, real estate etc.), or production capital (means of production and labor power).

His discussion of the simple and expanded reproduction of the conditions of production offers a more sophisticated model of the parameters of the accumulation process as a whole. At simple reproduction, a sufficient amount is produced to sustain society at the given living standard; the stock of capital stays constant. At expanded reproduction, more product-value is produced than is necessary to sustain society at a given living standard (a surplus product); the additional product-value is available for investments which enlarge the scale and variety of production.

The bourgeois claim there is no economic law according to which capital is necessarily re-invested in the expansion of production, that such depends on anticipated profitability, market expectations and perceptions of investment risk. Such statements only explain the subjective experiences of investors and ignore the objective realities which would influence such opinions. As Marx states in Vol.2, simple reproduction only exists if the variable and surplus capital realized by Dept. 1—producers of means of production—exactly equals that of the constant capital of Dept. 2, producers of articles of consumption (p. 524). Such equilibrium rests on various assumptions, such as a constant labor supply (no population growth). Accumulation does not imply a necessary change in total magnitude of value produced but can simply refer to a change in the composition of an industry (p. 514).

Ernest Mandel introduced the additional concept of contracted economic reproduction, i.e. reduced accumulation where business operating at a loss outnumbers growing business, or economic reproduction on a decreasing scale, for example due to wars, natural disasters or devalorisation.

Balanced economic growth requires that different factors in the accumulation process expand in appropriate proportions. But markets themselves cannot spontaneously create that balance, in fact what drives business activity is precisely the imbalances between supply and demand: inequality is the motor of growth. This partly explains why the worldwide pattern of economic growth is very uneven and unequal, even although markets have existed almost everywhere for a very long time. Some people argue that it also explains government regulation of market trade and protectionism.

Origins

According to Marx, capital accumulation has a double origin, namely in trade and in expropriation, both of a legal or illegal kind. The reason is that a stock of capital can be increased through a process of exchange or "trading up" but also through directly taking an asset or resource from someone else, without compensation. David Harvey calls this accumulation by dispossession. Marx does not discuss gifts and grants as a source of capital accumulation, nor does he analyze taxation in detail (he could not, as he died even before completing his major book, Das Kapital).

The continuation and progress of capital accumulation depends on the removal of obstacles to the expansion of trade, and this has historically often been a violent process. As markets expand, more and more new opportunities develop for accumulating capital, because more and more types of goods and services can be traded in. But capital accumulation may also confront resistance, when people refuse to sell, or refuse to buy (for example a strike by investors or workers, or consumer resistance).

Capital accumulation as social relation

This section contains too many or overly lengthy quotations. Please help summarize the quotations. Consider transferring direct quotations to Wikiquote or excerpts to Wikisource. (December 2017)

"Accumulation of capital" sometimes also refers in Marxist writings to the reproduction of capitalist social relations (institutions) on a larger scale over time, i.e., the expansion of the size of the proletariat and of the wealth owned by the bourgeoisie.

This interpretation emphasizes that capital ownership, predicated on command over labor, is a social relation: the growth of capital implies the growth of the working class (a "law of accumulation"). In the first volume of Das Kapital Marx had illustrated this idea with reference to Edward Gibbon Wakefield's theory of colonisation:

...Wakefield discovered that in the Colonies, property in money, means of subsistence, machines, and other means of production, does not as yet stamp a man as a capitalist if there be wanting the correlative — the wage-worker, the other man who is compelled to sell himself of his own free-will. He discovered that capital is not a thing, but a social relation between persons, established by the instrumentality of things. Mr. Peel, he moans, took with him from England to Swan River, West Australia, means of subsistence and of production to the amount of £50,000. Mr. Peel had the foresight to bring with him, besides, 3,000 persons of the working-class, men, women, and children. Once arrived at his destination, “Mr. Peel was left without a servant to make his bed or fetch him water from the river.” Unhappy Mr. Peel, who provided for everything except the export of English modes of production to Swan River!

— Das Kapital, vol. 1, ch. 33

In the third volume of Das Kapital, Marx refers to the "fetishism of capital" reaching its highest point with interest-bearing capital, because now capital seems to grow of its own accord without anybody doing anything. In this case,

The relations of capital assume their most externalised and most fetish-like form in interest-bearing capital. We have here ${\displaystyle M-M^{\prime }}$, money creating more money, self-expanding value, without the process that effectuates these two extremes. In merchant's capital, ${\displaystyle M-C-M^{\prime }}$, there is at least the general form of the capitalistic movement, although it confines itself solely to the sphere of circulation, so that profit appears merely as profit derived from alienation; but it is at least seen to be the product of a social relation, not the product of a mere thing. (...) This is obliterated in ${\displaystyle M-M^{\prime }}$, the form of interest-bearing capital. (...) The thing (money, commodity, value) is now capital even as a mere thing, and capital appears as a mere thing. The result of the entire process of reproduction appears as a property inherent in the thing itself. It depends on the owner of the money, i.e., of the commodity in its continually exchangeable form, whether he wants to spend it as money or loan it out as capital. In interest-bearing capital, therefore, this automatic fetish, self-expanding value, money generating money, are brought out in their pure state and in this form it no longer bears the birth-marks of its origin. The social relation is consummated in the relation of a thing, of money, to itself.—Instead of the actual transformation of money into capital, we see here only form without content.

— "Das Kapital", vol.3, ch. 24

Markets with social influence

Product recommendations and information about past purchases have been shown to influence consumers choices significantly whether it is for music, movie, book, technological, and other type of products. Social influence often induces a rich-get-richer phenomenon (Matthew effect) where popular products tend to become even more popular.

Disability and LGBTQ identities

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Disability_and_LGBTQ_identities

Disability and LGBTQ identity both can play significant roles in the life of an individual. Disability and sexuality can intersect in compounding ways, and, for many people, being both disabled and LGBTQ can result in double marginizalization. The two identities, either by themselves or in tandem, can complicate questions of discrimination (in the workplaces, schools, or otherwise) and access to resources like accommodations, support groups, and elder care.

LGBTQ identity and its relationship to disability has also been analyzed by academics. LGBTQ identities have been pathologized as mental disorders by some groups, both historically and in the present. Alternatively, some activists, scholars, and researchers have suggested that under the social model of disability, society's failures to accommodate and include LGBTQ people makes such an identity function as a disability.

Rates of disability

In general, studies have found that LGBTQ populations report higher rates of disability than the general population.

In studies looking at populations in the United States, LGBTQ populations report higher rates of disability compared to the heterosexual and cisgender majorities. According to the Movement Advance Project in 2019, an estimated 3 to 5 million lesbian, gay, bisexual and transgender people in the United States have a disability.

In a 2020 study of Australian LGBTQ people, 38% of respondents reported having at least one disability.

In China, a rough estimate of cantong, or LGBTQ people with disabilities, is about 5 million people.

Academic theory

Academics writing about queer theory and disability studies have drawn from one another's work, as both examine what society deems as normal and how those people outside of that definition are treated. For example, theorist Robert McRuer has used Adrienne Rich's idea of compulsory heterosexuality to examine how society might also perpetuate "compulsory able-bodiness". In Feminist, Queer, Crip Alison Kafer's "engagement with the intersections of gender and cripping time is never stronger than in the instances where she makes explicit the mainstream responses to gendered disability narratives".

History

Until 1990, the World Health Organization classified homosexuality as a mental disorder. In 2019, the organization also removed "gender identity disorder", referring to transgender people, from the International Statistical Classification of Diseases and Related Health Problems.

United States

Street Transvestite Action Revolutionaries (STAR), a group founded by Marsha P. Johnson and Sylvia Rivera, worked both to support trans and gay people and disabled people. STAR called for the end of non-consensual psychiatric incarcerations of LGBTQ individuals, something Johnson had experienced in her life.

Other activists in the United States involved in both the gay rights and the disability rights movements include Kenny Fries, Barbara Jordan, and Connie Panzarino.

In the late 1970s, disabled attendees and groups were recorded at San Francisco Pride.

In the 1980s and early 1990s, the case of Sharon Kowalski was taken up by both disability and gay rights activists. Kowalski, a lesbian, had become disabled after a car accident, and her father had been awarded custody of her. Her father then moved Kowalski to a nursing home five hours away from her partner, Karen Thompson, and prevented Thompson from visiting Kowalski. In a victory for both groups of activists, the Minnesota Court of Appeals ruled that Thompson be made Kowalski's legal guardian, in line with Kowalski's wishes.

Disability Pride Month was founded in 1990, inspired by both gay and Black pride.

In June 2014, the White House hosted a panel on LGBT issues and disability.

Medical care

Until 1973, homosexuality was included in the Diagnostic and Statistical Manual of Mental Disorders. Although many gay liberation activists celebrated its removal, others were blase or wary about aligning the wider community with psychiatric associations or providers. Before its removal, both anti-psychiatric and gay liberation activists had used homosexuality's inclusion in the DSM as leverage to criticize psychiatry as a whole.

In the late 1970s, Bobbie Lea Bennett became the first trans woman to have her gender-affirming surgery covered by Medicare. Bennett, as a wheelchair user with osteogenesis imperfecta, was already covered by the policy, which forced the courts to decide whether the surgery was considered a "legitimate medical treatment"; up until this point, transgender activists trying to have their surgeries covered under the policy had to argue that being transgender, in and of itself, was a disability.

The Americans with Disabilities Act of 1990 (ADA) made disability a protected class in the United States. However, the law purposefully excluded homosexuality, bisexuality, and "[t]ransvestitism, transsexualism...[and] gender identity disorders not resulting from physical impairments" from the act's definition of disability. This exclusion has led to some cases in which prosecutors have argued that gender dysphoria is a "gender identity disorder" that therefore cannot be accommodated under the ADA. In 1998, Bragdon v. Abbott confirmed that HIV was considered a protected disability under the ADA, which has been used to protect HIV-positive individuals in years since, many of whom are members of the LGBT community.

In 2017, Kate Lynn Blatt became the first trans woman who was allowed to sue her employer under the ADA for not accommodating her gender dysphoria.

Challenges

LGBTQ individuals with disabilities are subject to higher rates of childhood bullying and lack of comprehensive sex education.

LGBTQ individuals with disabilities who are assisted by family or caregivers may have more difficulty finding time to be intimate with or have sex with their partners. Those who live in group homes might similarly have difficulties with maintaining privacy within relationships. People who cannot drive or require assistance while traveling may have more limited opportunities to attend LGBTQ support groups, community spaces, or events.

Limited travel opportunities may lead some disabled LGBTQ people, especially those living in socially conservative areas, to pursue online or long-distance relationships.

Discrimination

Medical care

In some cases, medical providers or other authorities will use a transgender person's disability status to deny them gender-affirming care, using the argument that the person is not capable enough to give informed consent for such care. Similarly, people may deny LGBTQ self-identification on the basis of someone's disability, particularly intellectual disability.

Alternatively, LGBTQ individuals may avoid seeking needed medical care, such as STI testing, or accessing disability services because of prejudiced comments or treatment by their healthcare providers. Those who do seek medical care, but do not disclose their identity, may have adverse health consequences when their identity is not taken into account by their physicians.

LGBTQ individuals with disabilities that need in-home care may be especially vulnerable, as they may be less likely to have family that can care for them, and nurses or other hired caregivers may make prejudiced or uneducated statements to their patients. Some individuals may choose to change their appearance or behavior so as to appear straight or cisgender to caregivers. For people who are unsure of their sexual or gender identity, caregivers or assistants may be unwilling to discuss the topic with their client.

Interpersonal relationships

Both LGBTQ people and people with disabilities face high rates of sexual assault compared to the general population; for people who are both LGBTQ and disabled, the statistics are even higher.

Employment

Limited opportunities for employment may drive some disabled LGBTQ people to remained closeted at work, to avoid being fired. For disabled individuals who are out, their disability and LGBTQ identity may further limit job opportunities.

A 2020 study of American lawyers found that nearly 60% of respondents who were both LGBTQ and disabled reported having experienced discrimination in the workplace related to their identities.

Intercommunity issues

A common complaint among disabled LGBTQ people is that the LGBTQ community does not discuss disability, and the disabled community does not discuss queer identities. This is particularly an issue among the LGBTQ movements in countries such as China and Nepal.

Within the LGBTQ community, accessibility remains an important issue. Not all LGBTQ community spaces, for example, have accessible buildings or parking, sign language interpretation, Braille signage, or TTY services. LGBTQ events, such as Pride events and marches, may have routes which are difficult to navigate for those in wheelchairs or using mobility devices, or spaces that are too overwhelming for those with sensory sensitivities. Lectures, gatherings, or film screenings may lack sign language interpretation or closed captions. This may be further complicated by limited budgets that organizations or groups have, leaving little funding to better cater to disabled people.

Ableism more widely is also an issue within the LGBTQ community. LGBTQ people with disabilities have also expressed that a focus in the community on appearance can lead to disabled people feeling excluded or undesirable as partners. Attitudes that disabled people are inherently asexual are also still prevalent.

Within disabled communities, homophobia and transphobia remain as important issues.

Related organizations

Multiple organizations have been founded that specifically aim to serve those in the LGBTQ community with disabilities. International organizations include Blind LGBT Pride International.

In the U.S., these include Services & Advocacy for GLBT Elders (SAGE). In the U.K., these include Brownton Abbey, Deaf Rainbow UK, ParaPride, and Regard. In Australia there is Inclusive Rainbow Voices (IRV) and Rainbow Rights & Advocacy.

In media

Disabled LGBTQ characters in movies and television tend to be rare; a 2021 report by GLAAD found zero such characters in any major American movie releases that year. Their 2022 report found only 27 characters - 4.5% of all counted LGBTQ characters - who were also disabled. However, some movies and television shows featured disabled and LGBTQ characters do exist, such as Margarita with a Straw (2014), about a bisexual student with cerebral palsy, Queer as Folk (2022), which features a wheelchair-using side character, and Special (2019), a series about a gay man with cerebral palsy. Such characters have also been included in some children's shows, including The Dragon Prince (2018), which has a recurring Deaf lesbian character, and Dead End: Paranormal Park (2022), which has an autistic bisexual protagonist.

Some LGBTQ magazines have specifically addressed a disabled audience, such as the magazine Dykes, Disability & Stuff, from Madison, Wisconsin, which was founded in the late 1980s and was published until 2001. More general LGBTQ magazines have also addressed disability; lesbian magazine Sinister Wisdom, for example, made "On Disability" the theme of their Winter 1989/1990 issue.

Sexuality and disability

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Sexuality_and_disability

Caressing between people with Down syndrome

Sexuality and disability is a topic regarding the sexual behavior and practices of people with disabilities. Like the general population, these individuals exhibit a wide range of sexual desires and adopt diverse methods of expressing their sexuality. It is a widespread concern, however, that many people with disabilities do not receive comprehensive sex education, which could otherwise positively contribute to their sexual lives. This stems from the idea that people with disabilities are asexual in nature and are not sexually active. Although some people with disabilities identify as asexual, generalizing this label to all such individuals is a misconception. Many people with disabilities lack rights and privileges that would enable them to have intimacy and relationships. When it comes to sexuality and disability there is a sexual discourse that surrounds it. The intersection of sexuality and disability is often associated with victimization, abuse, and purity, although having a disability does not change someone's sexuality, nor does it change their desire to express it.

For physical disabilities that change a person's sexual functioning, such as spinal cord injury, there are methods that assist where needed. An individual with disabilities may enjoy sex with the help of and physical aids (such as bed modifications), by finding suitable sex positions, or through the services provided by a sex worker.

History

Much of the sexual biases in the United States are traced back to Puritan ethics. Issues on the acceptance of sexuality and disability root back to 2000 years. The review of history on sexuality in philosophy, religion, and science leads to the modern day views on sexuality and disability. Religious institutions were the first entities to combat sexuality. They believed that sex was a sin and should not be practiced unless it was done with intents of reproducing. Then doctors began developing medical views on sex. Sexual pleasure was deemed a sickness. The taboo around sexuality being a disease and sin restricted many people from expressing their sexuality, especially people with disabilities.

After much groundbreaking research, it was not until the 20th century that sex and pleasure became normalized. With the normalization of sex, pleasure became the main focus. Healthy sex meant a good performance that led into an orgasm. If a person was not able to orgasm during sex they were seen as inadequate for sexual intercourse. With this a sex therapist would help the individual explore oral sex, and clitoral orgasm. When a person with a disability is not able to achieve an orgasm it was not seen as problematic, because they did not have sexual desires. The neglect on the sexual lives of people with disabilities roots from the idea that they are child like and asexual. Because people with disabilities do not fall under the category of being sexual, there were no resources for them to seek sexual assistance.

Over the years sexually disenfranchised groups were working towards sexual acceptance for all people, including queer and disabled communities. The work of these groups began to open doors for people with disabilities to become more expressive of their sexuality. Even with these new found opportunities, sexual pleasure for people with disabilities remained unspoken of.

Self-image

Having a disability may sometimes create an emotional or psychological burden for the individual with disabilities. They may feel inhibition about pursuing relationships, fearing rejection on the basis that they have a disability. Self-image may suffer as a result of disfigurement, or lack of confidence. A New York disabled dating service manager explains, "Sexuality, travel, mobility, pain: Everything takes on a different dimension." In The Ultimate Guide to Sex and Disability, Miriam Kaufman points out that attempting to hide a disability or minimize its existence is ultimately an added burden, encouraging readers to "come out" to themselves as having a disability, to accept their disability.

There is often fear associated with the intersection of sexuality and disability. Many people with disabilities embody a fear of being rejected due to the way they look. This hypersensitivity causes the individual with disabilities to keep interactions platonic. Author of Sex and Disability Robert McRuer studied a man with disabilities. McRuer gave insight on the individuals sexual and non-sexual encounters. This man had a belief that crossing the line into sexual encounters meant it would cause severe bodily harm for him. During a sexual encounter, the man felt very uncomfortable and could not cross the sexual boundary. This was due to his fear of being judged. This is an issue common in some people with disabilities. The "evaluative gaze" coming from others causes people with disabilities to feel judged and uncomfortable in their own bodies.

It is a common misconception that people with disabilities are insecure and have a negative self-image. A study was done on 7 adolescents with cerebral palsy, to assess their self-image. Of the group there were 3 girls and 4 boys, ranging between 12 and 17 years old. A personality inventory was conducted and the results came out to be positive. The group of adolescents with disabilities viewed themselves very positively, rating their self-image higher than norm groups. After the inventory, the interviewer Lena Adamson wrote this conclusion in her "Brief report—Self-image, Adolescence and Disability", published in the American Journal of Occupational Therapy:

The following conclusions are made: Further studies on self-image and the psychosocial development of adolescents with disabilities should (a) focus on the social interaction outside their immediate families, and (b) continue to use and develop methods where these adolescents can give voice to their own experiences and opinions.

In contemporary society

Individuals with disabilities are rarely regarded in society as sexy or believed to be sexually active. When sex and disability are linked, it is common for marginalization to occur. Many people shy away from the idea that individuals with disabilities can have sex. This is due to a lack of information on the subject. Popular scholarly texts on disability rarely discuss sex, conversely disability is rarely discussed in the field of sexuality studies. Disability studies is a new field, it is just recently beginning to have a voice in the scholarly communities. Cultural theory on HIV and AIDS is one area of study that has broadly considered disability and sex. Since the AIDS epidemic, the queer community have been including physically and intellectually disabled individuals in their activist interventions. Even with these efforts, the correlation between sexuality and disability are not discussed in disability studies.

In society, it is widely believed that women with disabilities are asexual. One reason for this belief is that Individuals with disabilities are seen as eternal children. Others see the intertwine of sex and disability as an acrobatic act. It is difficult for many people to imagine an individual with a disability having sex, because of the restricting impairments. Viewing women with disabilities as asexual has issues. In contemporary United States, women with disabilities are not viewed as physically attractive because society does not view them as sexually desirable. This results in women with disabilities to be limited and constrained in their capacity to love and be loved.

In the United States, pleasure and sex have been largely ignored, especially when it comes to individuals with disabilities. Medical facilities, public schools, and religious groups have created a "don't ask don't tell" policy when it comes to sex education. The United States government has spent over 500 million dollars funding a program that restricts public schools from teaching sex in the classroom.

The idea that sex is meant for reproduction can be damaging to the sexual lives of individuals with disabilities. Because some disabilities restrict an individual from having children, the idea of this person having sex is eliminated. Additionally, the hereditary nature of certain disabilities may make caregivers of disabled adults uncomfortable allowing them to engage in sexual activity. There also exists a history of forced sterilization of disabled people, such as the Buck v. Bell case legalizing the practice in the US and the Law for the Prevention of Hereditarily Diseased Offspring mandating disabled people be sterilized in Nazi Germany.

Sexual activity

General

The mechanics of sex may be daunting, and communication, experimentation, medication and manual devices have been cited as important factors for sexual activity where disability is involved. Additionally, recognition of the pleasure that is derived from sexual activity beyond penetration and intercourse is also highlighted. For example, changes may take place in a person's sexuality after spinal cord injury; sensitivity to touch can increase above the lesion location in someone with a spinal injury. From research undertaken by the Christopher and Dana Reeve Foundation, orgasm was achievable for 79% of men with incomplete spinal cord injuries and 28% of men with complete injuries.

Oral sex and manual sex are other alternatives where penetration is not possible or not wanted, and wedge devices can be used to aid with positioning—wedges can be used as an aid in sex generally. Sex toys may be used as assistive devices as well; for example, vibrators can be used to provide extra stimulation and in circumstances where hand mobility is impaired. Other supportive devices include manual stimulation pumps, for erection promotion and maintenance, and "sex furniture", whereby rail or clamp enhancements, or specialised designs facilitate sexual activity.

Writer Faiza Siddiqui sustained a serious brain injury that led to a decrease in her sexual drive and the loss of her ability to orgasm, with the latter most likely the result of damage to Siddiqui's hypothalamus. Siddiqui explained her learning process in relation to sexual activity following the accident in a 2013 article:

I had to clear away all the thoughts I had about my imperfect body ... Since then, I've started to feel less shame about my unresponsive body ... My brain can't concentrate on as many things anymore, so I have to focus more on every little twinge and the lightest of touches. Surely that's going to mean better sex? I can't say that the sex is exactly better – I can't be on top anymore – but I'm learning that it doesn't really matter ... I had to grow up. Growing up is something that we're all having to do.

Some people with a spinal cord injury are able to "transfer their orgasm" using sexual energy to any part of the body that has sensation. For example, Rafe Biggs acquired a spinal cord injury in 2004. Through his work with a sexologist he discovered during a massage that when his thumb was being massaged; it felt very similar to his penis. It was through this experience that he learned that he could transfer his orgasm, using tantric energy, to his penis. Kenneth Ray Stubbs also has a spinal cord injury and is able to use tantric bodywork to obtain an "orgasmic feeling".^[16] If a person is able to use sexual energy correctly then they would be able to experience an orgasm in any part of the body that is capable of feeling sensation.

Fetishes and BDSM

Sexuality for people with disabilities is often linked to fetishes and "freakish excess".

• Abasiophilia is when an individual's sexual arousal is dependent on a sexual partner with a disability. The obsession is most common for people with disabilities who wear leg braces.
• Apotemnophilia is self demanded amputation.

Apotemnophilia is when an individual amputates their own limb for sexual pleasure. A case research done in the Journal of Sex Research states "Apotemnophillia is related to erotization of the stump and to overachievement despite a handicap." Little is known about the relationship between sexual pleasure and amputated limbs. This is due to the fetish being fairly new. Apotemnophilia was first introduced to the public in the magazine Penthouse in late 1972. The fetish was brought up by a young man with a disability who practices this fetish. After reading his accounts some editors of the magazine related with this feelings and published his story.

Some individuals who have this fetish, have made successful amputation attempts. For those who want to be amputated but do not have the means or strength to do so, are able to get professional assistance.

• Devotism is the sexual attraction someone has for a person with disabilities

Sex and disability does not only have an unattractive connotation. Sex and Disability writer Robert McRuer found that Devotism had renewed self-assurance in a group of women with disabilities. He writes "Women who had felt profound shame about their bodies reported significant gains in their self-confidence after discovering devotees." This empowerment has led to positive changes in the women's behavior. It has been reported by Robert McRuer that because of this some women with disabilities are more confident in their self-image and do not hide their disabilities as they previously have.

People who have a devotism fetish are referred to as Devotees. Robert McRuer argues that devoteeism relies on disgust and desire. The description of the devotees' desire come from an ableist assumption that disabled bodies are disgusting. It is typical for a devotees to view themselves as the only people who are sexually attracted to amputees. This belief establishes a ground for Devotees exceptionalism.

BDSM is a topic in the sex and disability culture. It has been described as empowering for people with disabilities because of their acceptance of non-normative bodies. BDSM could be used as a way to control pain for people with chronic pain. Bob Flanagan used BDSM to help him cope with his Cystic Fibrosis. His ability to control his own pain excited him as he was known to push himself as far as he could. "I was making a mockery out of something serious that had happened to me," said Flanagan when making light of his pain related to Cystic Fibrosis. Flanagan was an artist. He was a writer, an actor, and also created a traveling museum exhibit called "Visiting Hours" that showed the intersectionality of Cystic Fibrosis and sadism and masochism. In the exhibit, "Visiting Hours", museumgoers would experience an environment that was a combination of a children's residential hospital and a BDSM torture chamber. The purpose of this exhibit was to portray Flanagan's pain through a pleasurable lens showing that BDSM could offer some sexual healing.

Women and girls with disabilities are a common focus in fetishism due to their immobility. This makes them especially vulnerable to sexual abuse.

Sex work

In February 2013, it was reported that citizens with disabilities in the Netherlands were eligible for a government-funded scheme that provided funds to cover up to 12 occasions of sexual service per year. During the same period, Chris Fulton, a campaigner in the UK with cerebral palsy and muscular dystrophy, called upon the UK government to also provide financial support for sexual services for people with disabilities. Fulton explained:

The idea is to give people with disabilities more of a choice. There's still a lot of stigma attached [to people with disabilities having relationships] from research I've done and experiences I've had. I think it would be good to bring the Dutch scheme over here to take away that stigma about people with disabilities having sex. But it's not just about that. It's about people with disabilities being accepted when they have relationships ... It needs to be brought out into the open in a managed and constructive way.

In early 2013, former brothel owner Becky Adams spoke with the media about her intention to open a non-profit brothel exclusively for people with disabilities in the UK, which, if launched in 2014, will be the nation's first legal initiative of this nature. Adams stated that she will invest £60,000 into the brothel following a stroke in 2009—Adams explained that after the stroke, her "eyes were suddenly opened. I was utterly unaware that such a big group was suffering so enormously." If she is approved for a permit, Adams plans to open a two-room service in Milton Keynes, near London, that will be staffed by sex workers and assistants.

Adams also founded the Para-Doxies service in 2012, which connects people with disabilities throughout the UK with sex workers—at the time, Adams ran the service on a completely voluntary, non-profit basis. In April 2013, the service was receiving over 500 enquiries a week from men, women and couples, and was struggling to cope with the demand.

A 2011 Australian documentary directed by Catherine Scott, Scarlet Road, explores another aspect of sexuality and disabilities through the life of a sex worker who has specialized for 18 years in a clientele who have disabilities. In 2012, the topic was highlighted in a fictional film based on the real life experience of writer Mark O'Brien. The Sessions portrays the relationship between O'Brien, who survived polio as a child, and a "sexual surrogate" to whom he loses his virginity. A member of the British Polio Fellowship states that post-polio syndrome, which affects polio survivors later in life, is a little-known condition that could have been explored in the film.

A survey conducted by the Disability Now magazine in 2005 found that 19% of female participants would see trained sex workers, compared with 63% of the male respondents. Tuppy Owens, sex therapist and disability professional, explained in 2013 that disabled women "don't trust male sex workers to be honourable".

LGBT

Main article: Disability and LGBT identities

LGBT people with disabilities face double marginalization. Individuals with disabilities are often either viewed as nonsexual or hypersexual. Because of these misconceptions it is hard to find queer people with disabilities portrayed in healthy sexual lives. During the recent decades, scholars have been working to include disabilities studies into queer theory, with the intentions of normalizing disability in queer and LGBT spaces. Queer and disabled liberation starts with the rejection of historic ideas on sexuality and disability.

It is also rare to have a queer person with disabilities portrayed in media. Some movies and literature do exist for the queer disabled communities such as:

• Akers, Michael D. (director). 2012. Morgan (film). United Gay Network

This movie is about a bicyclist who gets in an accident and becomes paraplegic. After the bicyclist recovers from his injuries, he comes to terms with his sexuality and falls in love with a man.

• Alland, Sandra (filmmaker). 2013–2014. I'm Not Your Inspiration (documentary film series)

This is a short documentary series documenting the lives of queer and trans people with disabilities.

• Bose, Shonali (director). 2014. Margarita, With a Straw (film).

This is a film about a young Indian woman with cerebral palsy who relocates to America for her undergraduate education. The movie follows her complex romantic relationship with a blind woman.

Relationships

Individuals with disabilities access to sexual and emotional partners is restricted by societies de-eroticization of their sexuality. The experiences of individuals with disabilities has shown that the basic human need to form close relationships is as relevant for individuals with disabilities as it is for humans without a disability. Furthermore, the social networks of people with disabilities can be small and this restricts the ability to form new relationships. Society's view of disability also puts pressure of individuals with disabilities in finding relationships. Even though our society has made great strides with creating a more accepting world, individuals with disabilities are still seen as outsiders. Parents prevent their children from asking individuals with disabilities questions which results in them viewing people with disabilities as "other". While the majority of non-disabled people meet other people in public spaces there are many physical and social barriers. The lack of access to public spaces, whether it be stairs; an absence of menus written in braille; or no ASL interpreters; could make it difficult and almost impossible for an individual with disabilities to go out. Individuals with disabilities also participate in online dating. Not only are there websites that are for online dating, but there are also websites that are solely for people with disabilities finding someone that is also disabled or someone that wants to date an individual with disabilities.

Disability stereotypes add to the difficulty and stigma experienced by individuals with disabilities. The following myths about individuals with disabilities have been identified:

• Individuals with disabilities do not need sex to be happy.
• Individuals with disabilities are not sexually attractive.
• Individuals with disabilities are "oversexed".
• Individuals with disabilities have more important needs than sex.
• Individuals with disabilities do not need sex education.
• Individuals with disabilities cannot have real sex.
• Individuals with disabilities, particularly those with intellectual disabilities, should not have children and should not be allowed to have children.

According to one survey, up to 50% of adults with disabilities are not in any sexual relationship at all. Online dating sites specifically aimed at individuals with disabilities have been founded to fill this void.

Misperceptions from the broader community has been raised as a prominent issue for individuals with disabilities in terms of their own relationships. The head of a disabled dating service explained in 2010: "Like anyone else, people with disabilities have different preferences. Someone with good mobility may prefer someone also mobile; others don't limit at all." In a 2012 Sydney Morning Herald, the mother of a man with cerebral palsy explained, "It's hard being a parent and this [sexuality] comes up. People see them sitting in their wheelchair think, that's it. They don't see what's going on in their lives and Mark [son] would dearly love a relationship."

Oppression

There is a long history of seclusion and segregation that has affected society's view of people with disabilities. For years people with disabilities have been segregated from society. People with disabilities were often put in institutions against their will because they were deemed "weak" and "feeble minded". While they were in the institutions they would often experience compulsory sterilization a.k.a. forced sterilization. The types of sterilization would include vasectomies, salpingectomy, and other types as well. None of these were considered dangerous to the person in the institution. In 1927, the United States Supreme Court case of Buck v. Bell stated that it was permissible to sterilize some people with disabilities against their will. It also stated in the decision that that did not violate the Fourteenth Amendment to the United States Constitution. However, in Olmstead v. L.C., 527 U.S. 581 (1999), the Supreme Court of the United States held that under the Americans with Disabilities Act, individuals with mental disabilities have the right to live in the community rather than in institutions if, in the words of the opinion of the Court, "the State's treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities."

According to a series of interviews taken place in Malta investigating the sexual lives of men and women with intellectual disabilities, most individuals reported that they felt oppressed by the expectations from families and caretakers to not engage in sexual activity or a relationship. As a result of the study, almost all individuals expressed a desire to be able to talk openly about their relationships and spend more time away from the family. And while all people's sexualities are controlled and limited by social norms, people with disabilities feel that they are limited by further factors. Another study in Texas explored the beliefs of the families and caretakers of people with intellectual disabilities on their sexualities. The results revealed that the majority of families and caretakers of those with intellectual disabilities believed that those with disabilities should not engage in sexual activity because of the fear that they will be taken advantage of. A resolution to the oppression that people with disabilities face when it comes to sexuality is educating families on these findings and educating disabled people on their own sexualities and life options.

Sexual harassment, assault, and domestic violence

People with disabilities are no less vulnerable than people without disabilities to harassment, assault, and domestic violence. People with disabilities are more vulnerable to sexual assault than the general public, being targeted due to the physical or mental impairments that they have. The American Journal of Preventive Medicine has published results of a survey that found that males with disabilities are 4 times more likely to be sexually abused. Other studies have shown that for women with disabilities, "regardless of age, race, ethnicity, sexual orientation, or class [they] are assaulted, raped, and abused at a rate two times greater than women without disabilities [... the] risk of being physically assaulted for an adult with developmental disabilities is 4–10 times higher than for other adults".

It is estimated that 25% of both girls and boys with disabilities will experience sexual abuse before the age of 18. It is also estimated that 20% of these incidents are reported. These rates are much higher than sexual abuse incidents pertaining to nondisabled children. There is a 1 in 4 chance that a girl with developmental disabilities will be molested before the age of 18. This is 10 times higher than the nondisabled population. During the California Committee on Abuse of Person with Disabilities, national statistics estimate the sexual abuse on people with disabilities as such:

By combining national statistics with specific studies, estimate ranges are as follows: between 39% and 83% of girls with developmental disabilities, and between 16% and 32% of boys with developmental disabilities will be subjected to sexual abuse before the age of 18 years. Incidence of sexual abuse among the population of persons with developmental disabilities was estimated in 1985 by the California State Department of Developmental Services to be 70%.

A majority of the predators are documented to be the father or stepfather of the victim. This is especially true for females with developmental disabilities. It is estimated that 10% of girls with intellectual disabilities are victims of incest. Females are most likely to be victims of sexual abuse. Studies show 50% of disabled females have experience multiple incidents of sexual abuse and 80% of disabled males experienced 1 incident. The numbers for sexual abuse are so high because the perpetrators are well known to the individual, such as a parent, uncle, aunt, cousin, friend, caretaker or sibling.

The statistics on sexual abuse for people with disabilities are also high because staff and dependent parents are not adequately trained in identifying sexual abuse. Many staff believe that sexual abuse must be proven before it is reported. The issue with this is that certain disabilities restrict the individual from expressing the experience. Adults with training in identifying abuse are more effective in protecting the child. Most programs focus on "stranger danger", which is not effective because most sexual abuse assaults come from the individual's inner circle.

Prevention

Several prevention programs against sexual abuse for people with disabilities exist in the United States.

• Seattle

In Seattle, United States a program called Seattle Project trains individuals with developmental disabilities to prevent sexual assault.

• Minnesota

In Minnesota, the Department of Corrections created a prevention program where children and adults with disabilities are trained in all aspects of abuse prevention.

• California

In California, there is the Waters Child Abuse Prevention Training Act (WCBTA). This program attempts to provide all children with abuse prevention. Each program caters to the child's age and learning level. In Contra Costa County, California, the WCBTA focuses on the needs of various disabilities and sexual abuse prevention. In Los Angeles County Office of Education they have created a Preschool Abuse Prevention Program for Children with disabilities. In this, teachers are instructed to train students with disabilities on physical, emotional, and sexual abuse.

Organizations

Australia

The subject of the Scarlet Road documentary, Rachel Wotton, also co-founded and helps run Touching Base, an organization based in New South Wales, Australia that provides information, education and support for clients with disabilities, sex workers and Disability Service Providers. The organization has been active since October 2000 following the formation of the founding committee that consisted of disability and health organization representatives. Wotton explains, "I am a sex worker and I make my money from clients seeing me. Some clients just happen to have a disability." Initially, the organization was receiving around one weekly phone call, but by 2012, inquiries were daily.

In March 2014, former Australian High Court judge Michael Kirby became a patron of the organization, joining four other inaugural patrons: Eva Cox, Professor Basil Donovan, Associate Professor Helen Meekosha, and NSW Local Government elder statesman Peter Woods. Following his appointment, Kirby stated: "If you deny sexual expression to human beings, cut them off from that aspect of their personalities and of their happiness, then you end up with a lot of very frustrated and very unhappy people", and he praised Touching Base for recognising that people with disabilities need "to have opportunities for sexual expression".

People with Disability Australia has developed a sex and relationship education workshop for people with intellectual disabilities.

United Kingdom

• TLC Trust

The TLC Trust provides a web-based service that facilitates the provision of sexual services—sex workers, therapists, and teachers—for people with disabilities, including a phone call appointment-booking service for those people with speech impairments or care workers who are unable to organize such services for clients due to the policy of their employer. The TLC Trust was founded in 2000 at a Sexual Freedom Coalition Conference and the website was initially run by James Palmer, a man with disabilities. The organization has garnered praise from sex educator and performance artist Annie Sprinkle, and academic and writer A.C. Grayling.

• Outsiders

Founded by Owens, Outsiders is primarily an international social club for people with disabilities, but the organization also runs the Sex and Disability Helpline, a telephone support service for people with disabilities that is staffed by both people with disabilities and health professionals. Outsiders is supported by the Outsiders Trust, which consists of a board of trustees that assists with the management of matters such as finances and projects.

• Sexual Health and Disability Alliance (SHADA)

The Sexual Health and Disability Alliance, also founded by Owens, was first started to provide a forum in which all of the UK's disability helpline operators, and others, could meet and discuss their work. The individuals who were initially involved state that they were "eager to improve the sex-positive work we do" and the Alliance was eventually formalized in 2008 with a mission to "bring together health professionals who work with people with disabilities to empower and support them in their sex and relationship needs." The Alliance does not charge a fee for those interested in becoming members and meets biannually in London. It held its first conference in 2009 at the Royal Society of Medicine.

• The Disabilities Trust

The Disabilities Trust is over 30 years old and is a leading charitable organization in the UK. It states that it provides "residential and day services to meet the needs of individuals with Autism, Brain Injury, Physical Disability and Learning Disability", as well as helping people to live at home in the community. The Trust has produced written information on sexuality and disability, which are freely available on the Internet.

United States

• Reach Out USA

Reach out USA is an advocacy organization that focuses on the relationship between disability and LGBT (gay, lesbian, bisexual, and transgender) concerns. The group's goal is to influence disabled communities to be more aware of the LGBT communities, and LGBT communities and organizations to be more accountable and welcoming of disabled communities. Reach Out USA also helps out with other topics such as mental illness, suicide, depression and much more.

• Queerability

Queerability is an LGBT and disabled rights advocacy group that is run by LGBT people with disabilities who hope to increase visibility to the community. The goal of this group is to ensure that the voices of LGBT people with disabilities are heard. The organization gives them a large social platform to express themselves. Queerability does not only advocate for the rights of LGBT disabled communities, but also provides educational sources pertaining to the individuals sexuality and disability. Some of the sources they provide include: How to Meet, Date, and Have Sex When You're Disabled, Practical Sex Tips for people with disabilities, Good Sex Positions for Disabled Sex, Talking About Sensitive Topics and more.

France

The idea of sexual support emerged in 2007, when a conference on "Physical dependence: intimacy and sexuality" was organised by Marcel Nuss. The Strasbourg conference is co-organised by Handicap International, the Association des Paralyés de France (APF), the French Muscular Dystrophy Association (AFM) and the Coordination Handicap et Autonomie (CHA).

In France there are several structures that now provide training for sex assistants: the Swiss association Sexualité et Handicap Pluriels (SEHP), the Association for the Promotion of Sexual Support (APPAS), founded by Marcel Nuss, which is organising its first training cycle in 2015, and the association Corps Solidaires, which brings together certified sex assistants.