Introduction
The inclusion of LGBT+ people – lesbian, gay, bisexual, transgender, and others outside of the cisgender and heterosexual mainstream – has been increasingly integrated in the global human rights agenda of the United Nations Human Rights Committee, among the most influential international human rights organisations in the world (Gerber and Gory, Reference Gerber and Gory2014; Mulé et al., Reference Mulé, McKenzie and Khan2016). Notably influenced by the Yogyakarta Principles (2006, 2017), developed in 2006 by a group of international LGBT+ legal scholars and advocates, and expanded in 2017, inclusion aims to realise freedom and equality for LGBT+ people through the ‘full enjoyment of all human rights’. While the concept and implementation of LGBT+ inclusion has continued to evolve amid ongoing sociocultural and political constraints in various societies (Easton, Reference Easton2023; Mulé et al., Reference Mulé, McKenzie and Khan2016), empirical research has increasingly documented the salubrious effects of LGBT+ inclusion measures and policies on the health and well-being of sexually and gender diverse communities (Solazzo et al., Reference Solazzo, Brown and Gorman2018; Hatzenbuehler et al., Reference Hatzenbuehler, Lattanner, McKetta and Pachankis2024). Despite global calls for action, however, and accumulating evidence, LGBT+ people in many jurisdictions continue to face structural discrimination and exclusion, as evidenced by persistent disparities in physical security, educational opportunities and achievement, income and financial status, and overall health (Newman et al., Reference Newman, Reid, Tepjan and Akkakanjanasupar2021; Chakrapani et al., Reference Chakrapani, Newman, Shunmugam, Rawat, Mohan, Baruah and Tepjan2023; Hatzenbuehler et al., Reference Hatzenbuehler, Lattanner, McKetta and Pachankis2024; Reid et al., Reference Reid, Newman, Lau, Tepjan and Akkakanjanasupar2022; Wong et al., Reference Wong, Suen, Chan, Tepjan and Newman2025).
Taiwan provides a unique site to observe and track the progress of inclusion policies in Asia. As the first jurisdiction to legally recognise same-sex marriage in Asia, in 2019, Taiwan is regarded as a pioneer in marriage equality (Hsu and Yen, Reference Hsu and Yen2017). In contrast to neighbouring countries and jurisdictions, Taiwan has also passed laws and policies to prevent gender- and sexuality-based discrimination, driven by persistent social activism and policy advocacy. In 2004, the Gender Equity Education Act (GEEA) was passed, signifying the government’s commitment to eradicating gender- and sexuality-based bullying (Sinacore et al., Reference Sinacore, Chao and Ho2019). The primary aims of this Act are to educate students about gender and sexual diversity, foster discrimination-free school environments, and prevent gender-based or homophobic and transphobic violence within educational institutions. The Act of Gender Equality in Employment was passed in 2001 to address and prohibit sexual harassment and discrimination based on gender and sexual orientation. The recent revision of the Domestic Violence Prevention Act in 2023 expanded its coverage to include individuals in same-sex partnerships, promising legal protections for all victims of domestic violence, regardless of their sexual orientation.
Despite progress in the legal domain, poll and survey data demonstrate persistent social stigma and exclusion of LGBT+ communities in Taiwan. The discrepancy between legal actions and Taiwanese societal perceptions of LGBT+ individuals is strikingly evident from the results of a 2018 referendum: the public overwhelmingly rejected the expansion of marriage to include same-sex couples and the incorporation of sexual diversity content in primary school curricula (Chen et al., Reference Chen, Ko, Huang, Hu, Lu and Yen2021b). Moreover, school bullying and microaggressions against LGBT+ students, and discrimination in the workplace are observed to be rampant (Chen et al., Reference Chen, Huang, Lin, Yen, Griffiths and Pakpour2021a; Au, Reference Au2022). An increase in public acceptance of same-sex sexuality was identified from 1995 to 2012, largely attributed to cohort succession, increases in education, and shifts towards more liberal societal values; however, these attitudes may fluctuate over time, with dynamic tensions between moralistic vs. civil rights dimensions of LGBT+ inclusion (Cheng et al., Reference Cheng, Wu and Adamczyk2016). Indeed, the daily experiences among LGBT+ individuals in various domains are still characterised by multifaceted exclusion and rejection. These findings underscore the need for sustained efforts to examine and assess the status of LGBT+ inclusion, along with the impact of measures to advance inclusion of diverse LGBT+ people in Taiwanese society.
This scoping review aims to provide an overview of the research literature focused on LGBT+ people in Taiwan. The primary objectives are to appraise the status of research concerning LGBT+ inclusion in Taiwan, identify gaps in research, and propose future directions for research and policy.
Methods
Conceptual framework
The LGBTI Inclusion Index developed by Badgett and Sell (Reference Badgett and Sell2019) was used as a conceptual framework to guide our analysis. Based on evidence derived from rigorous reviews of LGBT+ research conducted in other Asian jurisdictions (Newman et al., Reference Newman, Reid, Tepjan and Akkakanjanasupar2021; Wong et al., Reference Wong, Suen, Chan, Tepjan and Newman2025), we added a family domain to the five dimensions initially conceptualised in the LGBTI Inclusion Index: political and civic participation, education, personal security and violence, economic well-being, and health.
Methodology
We conducted a scoping review in accordance with the Joanna Briggs Institute guidelines (2015), based on the framework originally developed by Arksey and O’Malley (Reference Arksey and O’Malley2005). The main steps consisted of (1) identifying the research questions; (2) defining a search strategy; (3) developing a priori inclusion and exclusion criteria; (4) charting the data; and (5) collating, summarising, and reporting the results. This scoping review was guided by the question: How does the literature describe the inclusion of LGBT+ individuals in Taiwanese society in the following six domains: political and civic participation, family, education, employment, personal security and violence, and health?
Information sources and search strategy
With the assistance of a specialist librarian, a literature search was conducted using the following databases: Medline, APA PsycInfo, Embase (via Ovid); Bibliography of Asian Studies, Child and Adolescent Development, EconLit, Education Source, Gender Studies, LGBT Life, Social Work Abstracts (via EBSCO); Applied Social Sciences Index and Abstracts [ASSIA], Education Resources Information Centre [ERIC], ProQuest Thesis, Public Affairs Information Service Index [PAIS Index], Sociological Abstracts, PsycInfo, Worldwide Political Science Abstracts (via ProQuest); and HeinOnline. To identify relevant articles, we used modified versions of a search string previously validated for LGBT+ populations (Lee et al., Reference Lee, Ylioja and Lackey2016). We added Taiwanese LGBT+ terminology (i.e., ‘Tongzhi’, an umbrella term for gender and sexual minorities used in Taiwan, Macau, and Hong Kong) and the term ‘Taiwan’ to restrict search results geographically. Search strings were tailored to account for the unique syntax of each database (Supplement 1).
Study selection criteria
Studies were selected based on a priori inclusion and exclusion criteria. Included publications had to be: (1) published between January 1, 2000 and May 2024; (2) peer-reviewed; (3) focused on LGBT+ individuals or communities; (4) focused on people residing in Taiwan, including non-citizens and/or refugees; (5) written in English; and (6) based on primary (quantitative or qualitative) research data or original historical/policy analysis on inclusion, marginalisation, discrimination, human rights, or comparative well-being of LGBT+ populations. We chose the timeframe starting in 2000 based on events heralding the onset of the modern LGBT+ rights era in Taiwan: the first national registration of an LGBT+ organisation (Taiwan Tongzhi Hotline Association) in June 2000 and the first Taiwan Pride held in 2003, now the largest in Asia.
Study selection process
Search results were collated into Covidence systematic review software (Veritas Health Innovation, Melbourne, Australia), and duplicates removed. For the initial screening, pairs of reviewers (LC, YTH, DD, ST, CY) independently evaluated titles and abstracts for inclusion. We held team discussions to ensure consistent application of inclusion/exclusion criteria, with subsequent agreement 83 per cent of the time (Cohen’s kappa = .65, substantial agreement) (Landis and Koch, Reference Landis and Koch1977). Groups of two reviewers then independently screened full-text articles for inclusion. All discrepancies were resolved by a third reviewer (PN or ST).
Data extraction and synthesis
Three authors (LC, DD, CY) extracted the following data for analysis: publication characteristics (i.e., author(s), year), methods (i.e., qualitative, quantitative, mixed methods, or historical/policy analysis), focal populations, terminology, and key study findings pertinent to LGBT+ inclusion or human rights. Publications were then categorised by focal domain(s) of LGBT+ inclusion. We synthesised findings using quantitative (i.e., frequency) analysis of the publication year, methods, focal populations and inclusion domains, and qualitative (i.e., thematic content) analysis of key findings. Results are reported in accordance with PRISMA-ScR guidelines (Tricco et al., Reference Tricco, Lillie, Zarin, O’Brien, Colquhoun and Levac2018).
Results
The search identified 1544 unduplicated titles and abstracts, with 244 full-texts evaluated and 109 articles included in this review (see Figure 1).
PRISMA flow diagram of study selection process and results.
Description of peer-reviewed articles
Peer-reviewed articles on LGBT+ inclusion in Taiwan increased substantially since 2000, with the majority (62.4 per cent; n = sixty-eight) published since 2020 (see Figure 2). The majority (55.0 per cent, n = sixty) were quantitative, 38.5 per cent (n = forty-two) qualitative, four (3.7 per cent) mixed methods, and three (2.8 per cent) historical/policy analyses (see Table 1). A plurality of articles (33.6 per cent, n = thirty-eight) addressed gay and bisexual men, twenty-one (18.6 per cent) LGBT+ people overall, ten (8.8 per cent) lesbians and bisexual women, and two (1.8 per cent) transgender and gender diverse people; nineteen articles (16.8 per cent) addressed general population attitudes, fourteen (12.4 per cent) healthcare/social/public service providers, six (5.3 per cent) parents and their LGBT+ children, and three (2.7 per cent) LGBT+/queer families (see Figure 3).
Distribution of peer-reviewed articles by year of publication (n = 109).
Study characteristics and domains of inclusion (n = 109)
Terminologies for focal populations are derived from original sources.
LGBT: lesbian, gay, bisexual, transgender; LGBTQ: lesbian, gay, bisexual, transgender, and queer or questioning; MSM: men who have sex with men.
POL: Political and civic participation; EDUC: Education; VIOL: Personal security and violence; ECON: Economic well-being; HLTH: Health; FAM Family.
Distribution of peer-reviewed articles by focal populations.
Articles addressing multiple focal populations were counted more than once; of the 109 articles, 3.7 per cent (n = 4) addressed more than one focal population (total count of populations N = 113).
Across the six domains of inclusion, seventy-nine articles (55.2 per cent) focused on one domain, twenty-seven (37.8 per cent) on two domains, two (4.2 per cent) on three domains, and one article (2.8 per cent) on four domains. The predominant focus was on the health domain (n = fifty-eight, 40.6 per cent), followed by political and civic participation (n = thirty-three, 23.1 per cent), family (n = twenty-six, 18.2 per cent), personal security and violence (n = fifteen, 10.5 per cent), economic well-being (n = six, 4.2 per cent), and education (n = five, 3.5 per cent) (see Figure 4).
Distribution of peer-reviewed articles by domain of LGBT+ inclusion.
Articles addressing multiple domains were counted more than once; of the 109 articles, 28 per cent (n = 30) addressed more than one domain (total count of domains N = 143).
Political and civic participation
Thirty-three articles addressed political and civic participation, revealing that LGBT+ communities faced challenges in affirming their gender and sexual minority identities, accessing basic rights, and obtaining policy protections and recognition in areas such as partnership, marriage, family formation, adoption, and parenting. Several studies emphasised the agency of LGBT+ people and how they navigate heteronormative social and legal systems, and the strategic mobilization of Taiwan’s democratization as an integral factor in LGBT+ advocacy movements.
LGBT+ identity and activism
Six studies explored the construction of collective and individual LGBT+ identity within the cultural and social context of Taiwan. LGBT+ people were described as facing obstacles in affirming their identities and obtaining basic rights, such as access to housing ownership, due to cis-heteronormative systems and pervasive institutional barriers (Chao, Reference Chao2002). However, they established a sense of community by connecting their Taiwanese citizenship with their LGBT+ identity, which played a crucial role in mobilising grassroots movements for LGBT+ activism in Taiwan (Chao, Reference Chao2002; Wang, Reference Wang2005; Kong, Reference Kong2019; Wang and Sun, Reference Wang and Sun2024). Kong’s (Reference Kong2019) study situated in the context of the democratisation of Taiwan found that gay men were proud of being a beacon of LGBT+ rights. In Hsieh’s (Reference Hsieh2019) analysis, the Red House District, a local district in Taiwan, was seen as a symbol of LGBT+ activism and community support. This line of research highlighted the roles of grassroots NGOs, social workers, and advocates in creating a space of care and inclusivity for the LGBT+ community.
LGBT+ activism was evoked in the use of the concept of ‘comrade’ (tongzhi) by Taiwanese queer communities. Tongzhi can be seen as a rhetorical device that calls attention to the revolutionary nature of embracing diversity, and advocates for unity among all people with diverse (non-mainstream) sexual and gender identities (Chao, Reference Chao2002). Kao (Reference Kao2018) describes how Taiwanese tongzhi movements allocated considerable resources and discursive space to address other minority issues beyond the scope of marriage equality, including the sexuality of people with disabilities, rights of people living with HIV/AIDS, anti-discrimination in schools, diverse family formations, non-monogamous relationships, BDSM and fetishism, and other sexual minorities and stigmatised sexualities.
Public attitudes towards LGBT+ communities
Eighteen studies investigated public attitudes towards LGBT+ populations in Taiwan and their impact on the community. Damm (Reference Damm2005) depicted changing public attitudes toward same-sex desire in Taiwan during the twentieth century, influenced by traditional views and Confucian values, medical and psychological discourses, democratisation, and the AIDS pandemic. Subsequent studies indicated that younger individuals and those with higher educational attainment tended to be more accepting of same-sex sexuality (Hsu, Reference Hsu2009; Feng et al., Reference Feng, Lou, Gao, Tu, Cheng, Emerson and Zabin2012). Feng and colleagues (Reference Feng, Lou, Gao, Tu, Cheng, Emerson and Zabin2012) suggested that Taipei had higher public acceptance towards ‘homosexuality’ than Hanoi or Shanghai. This does not, however, indicate the absence of conflicts within the Taiwanese public. Su’s (Reference Su2023) discourse analysis of the distinct attitudes towards legalisation of same-sex marriage of two mothers who were online bloggers illustrated multifaceted tensions between supporters and opponents of equal marriage.
Researchers observed that despite the legalisation of same-sex marriage, the Taiwanese public still holds discriminatory attitudes toward LGBT+ communities. For instance, the general public expressed support for LGBT+ rights, while opposing the extension of welfare benefits to LGBT+ families and communities (Hsu, Reference Hsu2022), and expressed discomfort with the idea of having an immediate family member who is lesbian or gay (Hsu, Reference Hsu2009). Even as certain queer images were normalised among the general public, others were stigmatised, such as gay men living with HIV (Huang, Reference Huang2024). Two studies explored shared homophobic attitudes and anti-Tongzhi discourses of U.S. and Taiwanese transnational and highly strategic Christian conservative ‘pro-family’ movements (Kao, Reference Kao2018; Liao, Reference Liao2020). Emerging studies also revealed attitudes indicating strong rejection of transgender identities among the majority of the general public (Chang et al., Reference Chang, Kerdsomboon and Haynes2023; Chao et al., Reference Chao, Chou, Chen and Cheng2024).
Notably, the same-sex marriage referendum in Taiwan had a profoundly detrimental impact on friendships, family relationships, and mental-wellbeing of LGBT+ people compared to their heterosexual counterparts (Lin, Chen, et al., Reference Lin, Chen, Ko, Chang, Lu and Yen2020). LGBT+ individuals’ perception of lower public acceptance towards ‘homosexuality’ was significantly associated with poorer mental health (Lin, Chen, et al., Reference Lin, Chen, Ko, Chang, Lu and Yen2021), with a significant increase in suicidal ideation among LGB (but not heterosexual) people after passage of the same-sex marriage referendum (Lin et al., Reference Lin, Ko, Huang, Chen, Lu and Yen2019). Moreover, the perception of unfavourable public attitudes toward homosexuality and same-sex marriage was associated with suicidal ideation among LGB-friendly heterosexual people, but not among heterosexuals with unfavorable attitudes toward LGB people (Ko et al., Reference Ko, Lin, Huang, Chen, Lu and Yen2020).
Multiple factors (i.e., gender, age, sexual orientation, perceived attitudes of peers and family members toward legalising same-sex marriage, and endorsement of filial piety) were associated with attitudes toward sexual minority people and same-sex relationships (Hsu, Reference Hsu2009; Yen et al., Reference Yen, Ko, Huang, Chen, Lin and Lu2020). Importantly, the quality of face-to-face contact experiences with sexual minorities was a significant factor in reducing stereotypes against same-sex families (Hsu, Reference Hsu2009; Yang et al., Reference Yang, Lin, Hsieh, Tsai and Strong2023).
Legal recognition
Six studies in the political domain indicated insufficient policy protections and formal recognition concerning partnerships, marriage, family formation, adoption, and parenting within LGBT+ communities in Taiwan (Chang, Reference Chang2017; Tang et al., Reference Tang, Khor and Chen2020; Chung, Reference Chung2021; Friedman and Chen, Reference Friedman and Chen2021; Chang et al., Reference Chang, Lu, Chang, Tsai and Yen2022; Tang, Reference Tang2022). In the absence of social and public recognition, especially before the legalisation of same-sex marriage in 2019, same-sex desires and relationships had been suppressed (Tang, Reference Tang2022). However, LGBT+ people contested heteronormativity and dismantled marriage as an exclusively heterosexual institution by normalising same-sex intimacy, planning same-sex wedding ceremonies, and participating in same-sex marriage. These actions disrupted gender and sexual hierarchies, extended kinship ties, and added new and expanded meaning to the family system (Tang, Reference Tang2022; Tang et al., Reference Tang, Khor and Chen2020).
Other studies explored the tensions between family rights and same-sex partnerships in the context of Taiwan’s marriage equality movement and the efforts of LGBT+ parents (including adoptive LGBT+ parents) to secure legal protections and recognition of parental status (Chang, Reference Chang2017; Friedman and Chen, Reference Friedman and Chen2021; Chung, Reference Chung2021; Chen, Reference Chen2023; Friedman and Chen, Reference Friedman and Chen2023). Chung (Reference Chung2021) noted that although the Taiwanese government provided near-full legal recognition of same-sex partnerships, the relationships between couples and their extended families were not fully recognised. Moreover, at the inception of same-sex marriage legalisation in May 2019, Taiwan denied same-sex couples’ access to joint adoption, reinforcing the stigmatisation of LGBT+ parenthood and adoption (Friedman and Chen, Reference Friedman and Chen2023). The only pathway was limited to those whose same-sex partner had biological children, in which case the other partner could adopt them, with many couples reporting challenges in accessing reproductive rights (Chung, Reference Chung2021; Chen, Reference Chen2023).
Taiwanese lesbian mothers shared experiences of navigating heteronormative legal frameworks, both domestically and internationally, for adoption, childbearing, and obtaining formal recognition of parental status; some reported conceiving via cooperative marriage, and domestic or international Assisted Reproductive Technology (ART) (Chang, Reference Chang2017; Friedman and Chen, Reference Friedman and Chen2021). With ART not yet approved outside of heterosexual couples in Taiwan as of June 2025, and surrogacy currently illegal, this poses barriers to same-sex couples in accessing their reproductive rights, particularly those of lower socioeconomic status (Chen, Reference Chen2023).
Family
Twenty-six studies focused on family-related issues within LGBT+ communities. Several studies focused on LGBT+ people’s coming-out processes and a range of family responses. Other studies explored the desires of LGBT+ people to form a family and raise children, with a few examining intimate relationships among LGBT+ people.
Coming out and family response
Nine studies investigated LGBT+ people’s coming out process and family responses with a focus on the Taiwanese context. One study used the Chinese translation ‘Chugui’ (出櫃), literally meaning ‘coming out of the closet’ rather than ‘coming out’, to accentuate differences between Western and Taiwanese understanding of the term (Jhang, Reference Jhang2019). Brainer (Reference Brainer2018) argued that the process of coming out to family involves a relational strategy connected to family practices, norms, and expectations. Due to high familial expectations and significance of engaging in heterosexual marriage in Chinese culture, the decision of LGBT+ people to come out is subject to perceptions of their parents’ attitudes towards same-sex sexuality, with many striving to minimise negative impacts on the family (Wang et al., Reference Wang, Bih and Brennan2009). Some LGBT+ participants chose to come out to their parents, almost exclusively their mothers, in order to seek openness, support, and acceptance; interestingly, this support included helping to protect their ‘secret’ from fathers and other relatives (Brainer, Reference Brainer2017b).
Coming out was a challenging and often stigmatising process for LGBT+ people and their family members. LGBT+ participants reported experiencing parental rejection, surveillance, and identity-based harassment (Brainer, Reference Brainer2017b; Lin et al., Reference Lin, Chen, Ko, Chang, Lu and Yen2020; Tang et al., Reference Tang, Khor and Chen2020). Parental responses to their child’s coming out were dominated by emotional unrest and shock, with some reporting gradual acceptance of their child’s sexual orientation and identity (Lin and Hudley, Reference Lin and Hudley2009; Wang, Reference Wang2013), seeking information and support, emotional connection with their child, and broader social and legal changes (Huang, Reference Huang2023). It was recommended that counselors guide LGBT+ people and their family members in exploring the benefits and costs of coming out, and solutions that mitigate negative impacts on family relationships (Lin and Hudley, Reference Lin and Hudley2009; Huang, Reference Huang2023).
LGBT+ family formation and parenting
Five studies explored LGBT+ people’s family formation and parenting, with inchoate data revealing possible differences by gender and socioeconomic status. One study of gay and bisexual men suggested that those who were bisexual or in a stable or open relationship, and those who had better psychosocial wellbeing and endorsed filial piety, were more likely to have parenting intentions (Chan et al., Reference Chan, Huang, So, Leung, Forth and Lo2023). A study of queer women indicated that those with limited financial resources had stronger intentions to enter heterosexual/opposite-sex marriage to have a child (Brainer, Reference Brainer2017a). LGBT+ people adopted various strategies to pursue parenthood, such as cooperative or transactional marriages to have children or seek ART (Chang, Reference Chang2017; Brainer, Reference Brainer2021; Friedman and Chen, Reference Friedman and Chen2021). However, class disparities among LGBT+ people stratified their pathways to parenthood given that co-adoption and ART remained legally and financially out of reach (Brainer, Reference Brainer2021). Gay men reported a small but significant decrease in perceived importance of parenthood after legalisation of same-sex marriage, potentially attributable to lack of access to family-formation options and the COVID-19 pandemic (Lau et al., Reference Lau, Huang, Forth and Gietel-Basten2023).
Other studies explored LGBT+ parenting in response to heteronormativity and heteropatriarchy. Beyond traditional motivations, such as lesbian parents expecting their children to take care of them later in life, parenting also served as a form of resistance by redefining family structures and challenging the necessity of a father’s role (Chang, Reference Chang2017). For example, some lesbian parents openly discussed with their young children how their families were formed, including the process of their children’s birth, to reinforce the validity of having two mothers (Chang, Reference Chang2017). Lesbian couples also reported a desire to send their children to public schools, hoping their offspring would grow up with students from more diverse backgrounds and not embrace the oppression of minorities (Friedman and Chen, Reference Friedman and Chen2021).
Intimate relationships
Four studies explored LGBT+ people’s intimate relationships. Among gay men, relationship satisfaction with same-sex partners among gay men was found to be negatively associated with internalised homophobia and depressive symptoms (Liang and Huang, Reference Liang and Huang2022). Some Taiwanese queer women reported experiences of intimate partner violence (IPV), and partner betrayal and infidelities (Brainer, Reference Brainer2017a). In one study, a thirty-five-year-old transgender woman shared how her sense of body uneasiness and gender dysphoria caused anxiety, which created challenges for her intimate relationships and romantic pursuits (Shen and Shen, Reference Shen and Shen2023). The impact of same-sex marriage legalisation on LGB people’s intimate relationships included changing their expectations of romantic relationships, concerns about partners’ intentions to marry, and subtly shifting their sense of entitlements and responsibilities within relationships (Huang and Hang, Reference Huang and Hang2024).
Education
Five articles addressed LGBT+ issues in education settings, four of which examined college students’ attitudes towards LGBT+ people and same-sex adoption (Hsu, Reference Hsu2009; Gutierrez, Reference Gutierrez2021; Chang et al., Reference Chang, Kerdsomboon and Haynes2023; Wang and Lee, Reference Wang and Lee2023). While most students showed high levels of acceptance towards LGB people and same-sex adoption, they reported the lowest acceptance toward transgender people. Students who were women, non-heterosexual, non-Christian, and social work majors showed more positive attitudes toward LGBT+ people (Wang and Lee, Reference Wang and Lee2023). Chen (Reference Chen2013) identified loneliness among gay high school students, which was greater among those with feminine than ‘hyper-masculine’ gender roles.
Personal security and violence
Fifteen studies addressed personal security and violence at different stages in the life course, including online and in-person experiences among adults and youth. Online platforms were described as safe spaces for married bisexual men, enabling them to manage their sexual identity and intimate relationships, solicit peer support, and make friends (Hou and Lu, Reference Hou and Lu2013). Sending or receiving sexually suggestive or sexually explicit text messages (i.e., sexting) was a sensation-fulfilling activity for some MSM (Currin and Hubach, Reference Currin and Hubach2017) with others vulnerable to negative psychological outcomes due to involuntarily receiving sexual text messages (Chan and Wu-Ouyang, Reference Chan and Wu-Ouyang2023).
Victimisation experiences among adults also included IPV and sexual orientation microaggressions. One study examined queer women’s experiences of IPV (Brainer, Reference Brainer2017a), while three focused on experiences of sexual orientation microaggressions among LGB people (Tsai et al., Reference Tsai, Huang and Yen2021; Reference Huang, Chang, Lu and YenHuang et al., Reference Huang, Chang, Lu and Yen2022; Huang et al., Reference Huang, Chou, Hang and Yen2023), with cisgender men experiencing higher levels of microaggressions than cisgender women. Sexual orientation microaggressions were significantly associated with greater mental distress, such as depression, anxiety, and suicidality, with coping measures ranging from active responses to no response.
Among young people, several studies focused on the consequences and determinants of traditional school-based and cyber-bullying victimisation (Wang, Lin, et al., Reference Wang, Lin, Chen, Ko, Chang, Lin and Yen2018; Li et al., Reference Li, Chen and Yen2019; Wang, Hsiao, et al., Reference Wang, Hsiao and Yen2019; Lu et al., Reference Lu, Chang, Lin and Yen2019; Li, Chang, et al., Reference Li, Chang, Chen and Yen2020a, Reference Li, Chang, Chen and Yen2020b; Li, Chen, et al., Reference Li, Chen, Chang and Yen2020). Being bullied or victimised as LGBT+ was associated with numerous deleterious outcomes: higher likelihood of engaging in problematic Internet/smartphone use, substance use, anxiety, suicidality, physical pain, and lower levels of quality of life. In one study, early identification of sexual orientation, low self-rated masculinity, and low family support were significantly associated with traditional bullying victimisation (Wang, Hsiao, et al., Reference Wang, Hsiao and Yen2019).
Economic well-being
Six studies explored economic well-being, largely indicating LGBT+ individuals’ struggles in mainstream cis-heteronormative working environments. This traversed-perceived stigma related to self-image and gender identity, experiences of microaggressions, and lack of supportive legislation regarding the workplace (Chao, Reference Chao2002; Chen, Reference Chen2018; Achyldurdyyeva et al., Reference Achyldurdyyeva, Wu and Datova2023; Shen and Shen, Reference Shen and Shen2023). Moreover, LGB employees’ job effectiveness was negatively impacted by disclosure of sexual minority status, perceived consequences of disclosure in the workplace, and lack of social support (Tsai et al., Reference Tsai, Joe, Liu, Lin, Chiu and Tang2015). Some LGBT+ employees received steady social support from their LGBT+ network, but faced challenges nevertheless in gaining acceptance from coworkers (Achyldurdyyeva et al., Reference Achyldurdyyeva, Wu and Datova2023).
In studies identifying specific demographics, Brainer (Reference Brainer2017a) indicated that queer women faced significant economic pressures and injustice within a patriarchal family system, such as unpaid family work, inequitable family resource redistribution, property loss, and housing insecurity. A lesbian woman shared facing constant questions in the workplace about her ‘true’ gender identity, with this harassment preventing her from maintaining long-term employment (Chao, Reference Chao2002). A transgender woman shared that her body incongruence prevented her from retaining long-term employment, rendering her unable to afford national health insurance (Shen and Shen, Reference Shen and Shen2023). Some gay massage workers, though employed legally and out as gay men, nevertheless reported anti-gay stigma from their families exacerbated by their work identity, and stigma from within the gay community (Chen, Reference Chen2018).
Some LGBT+ individuals reported operating or working in unlicensed businesses in order to avoid stigma and harassment in the mainstream economy. This included selling merchandise in night markets, street food vending, or running small shops. However, this resulted in their status as a non-taxpayer, which in turn denied them recognition as having ‘sufficient citizenship’ and excluded them from accessing social welfare programmes (Chao, Reference Chao2002: p.371).
Health
Fifty-eight articles addressed LGBT+ inclusion in the health domain. Topical focuses included mental health issues; behavioural and physical health; and knowledge and experiences of accessing healthcare services.
Mental health
Thirty studies examined mental health and minority stress among LGBT+ people in Taiwan. Notably, in a 2013 nationally representative sample of Taiwanese adults aged 40+ years, a threefold higher prevalence of mental health issues (10.8 per cent) was identified among LGBT+ adults compared to the general population (3.3 per cent) (Wang, Chang, et al., Reference Wang, Chang and Miao2021). Internalised homophobia and perceived sexual stigma from families and peers were associated with higher levels of depression, loneliness, suicidal ideation, and increased likelihood of substance use (Chang et al., Reference Chang, Lu, Chang, Tsai and Yen2022; Chuang et al., Reference Chuang, Newman, Fang and Lai2022; Lin, Chang, et al., Reference Lin, Chang, Chang, Chen and Yen2022; Huang, Chang, et al., Reference Chang, Lu, Chang, Tsai and Yen2022; Lin Y-J et al., Reference Lin, Chang, Chou and Yen2023). Victimisation and identity-based microaggressions were associated with adverse mental health outcomes (Wang et al., Reference Wang, Griffiths and Grande2018; Li et al., Reference Li, Chen and Yen2019; Wang, Chang, et al., Reference Wang, Chang, Yang, Hu and Yen2019; Wang, Ko, et al., Reference Wang, Ko, Hsiao, Chen, Lin, Yen, Wang, Ko, Chen, Lin and Yen2019; Li et al., Reference Li, Chang, Chen and Yen2020a, Reference Li, Chang, Chen and Yen2020b; Li, Chen, et al., Reference Li, Chen, Chang and Yen2020; Chen et al., Reference Chen, Huang, Lin, Yen, Griffiths and Pakpour2021a; Tsai et al., Reference Tsai, Huang and Yen2021). Two studies identified associations between harassment and bullying experiences, and quality of life (QOL) among gay and bisexual emerging adults (Hu et al., Reference Hu, Chang, Lin and Yen2019; Lu et al., Reference Lu, Chang, Lin and Yen2019). Importantly, several studies reported protective factors for LGBT+ people’s mental health, including satisfying relationships, and social support from family and peers, that promoted prevention as well as coping with victimisation (Wang et al., Reference Wang, Griffiths and Grande2018; Wang et al., Reference Wang, Hsiao and Yen2019; Li, Chang, et al., Reference Li, Chang, Chen and Yen2020b; Wang et al., Reference Wang, Miao and Chang2021; Liang and Huang, Reference Liang and Huang2022; Wang et al., Reference Wang, Chang and Miao2022).
Behavioural and physical health
Nine studies explored physical health status and health behaviours, including self-rated health, obesity, physical pain, breast health, HIV infection and condomless anal sex, and COVID-19 vaccination (Wang, Reference Wang2015; Wang et al., Reference Wang, Griffiths and Grande2018; Li and Huang, Reference Li and Huang2018; Chuang et al., Reference Chuang, Newman, Fang and Lai2021; Tseng, Reference Tseng2021; Wang, Chang et al., Reference Wang, Chang and Miao2021; Wu and Lee, Reference Wu and Lee2021; Huang, Liang, et al., Reference Huang, Liang and Emery2022; Lin et al., Reference Lin, Chang and Yen2023). Overall self-rated health and health-related self-efficacy of LGBT+ individuals were identified as lower compared to the general public (Wu and Lee, Reference Wu and Lee2021), with childhood sexual abuse, sexual minority stress, and/or homophobic bullying associated with increased risk of obesity and physical pain among gay and bisexual men (Wang et al., Reference Wang, Griffiths and Grande2018; Huang, Liang, et al., Reference Huang, Liang and Emery2022).
Four publications identified psychosocial factors, such as sexual stigma, internalised homophobia, syndemic conditions, and social support, associated with HIV serostatus, HIV status disclosure, healthcare seeking, and medication practices among MSM in Taiwan (Li and Huang, Reference Li and Huang2018; Chuang et al., Reference Chuang, Newman, Fang and Lai2021; Tseng, Reference Tseng2021; Yao et al., Reference Yao, Liou, Chien and Wu2024).
Healthcare services
Six studies explored healthcare service needs and utilisation intentions of LGBT+ people (Wang, Reference Wang2015; Huang et al., Reference Huang, Wu, Strong, Jan, Mao, Ko, Li, Cheng and Ku2019; Huang, Reference Huang2020; Wu and Lee, Reference Wu and Lee2021; Chiou et al., Reference Chiou, Vincent, Chen, Li, Chou, Tsao, Yu and Hsu2024; Hong, Reference Hong2024). Although LGBT+ people reported higher rates of recent and lifetime suicidal ideation, prior suicide attempts, and depressive symptoms compared to the general population, they were less likely to seek professional healthcare services, yet more likely to disclose to informal networks (Wu and Lee, Reference Wu and Lee2021). Similarly, older gay men indicated high awareness of long-term care services; however, they expressed concerns about accessing LGBT+ friendly services and fear of discrimination based on their sexual orientation by service providers (Hong, Reference Hong2024).
LGBT+ people reported an array of challenges in accessing healthcare services, such as affordability, lack of regular income, lack of access to HIV testing and results, lack of sensitivity from healthcare providers, concerns about stigma related to HIV medications (Wang, Reference Wang2015; Huang et al., Reference Huang, Wu, Strong, Jan, Mao, Ko, Li, Cheng and Ku2019; Chiou et al., Reference Chiou, Vincent, Chen, Li, Chou, Tsao, Yu and Hsu2024; Hong, Reference Hong2024;), and concerns around the confidentiality of record-keeping and surveillance in the healthcare system (Huang, Reference Huang2020). Transgender women reported low intentions to seek healthcare services to avoid encountering stigma from healthcare providers, and insufficient access to HIV preventive information within transgender communities (Chiou et al., Reference Chiou, Vincent, Chen, Li, Chou, Tsao, Yu and Hsu2024).
Finally, seven studies with healthcare professionals, including nurses, student nurses, and nursing educators, revealed limited knowledge about LGBT+ people and lack of LGBT+ inclusive health services (Hou et al., Reference Hou, Pan, Ko, Liu, Wu, Yang, Yang, Shieh, Chuang and Yen2006; Yen et al., Reference Yen, Pan, Hou, Liu, Wu, Yang and Yang2007; Lin et al., Reference Lin, Ko, Huang, Chen, Lu and Yen2019; Lin, Lin, et al., Reference Lin, Lin, Chang, Lu and Yen2021; Lu et al., Reference Lu, Hsu, Green and Tsai2022; Reference Wang, Miao and YouWang, Miao, and You, Reference Wang, Miao, Wang and Chang2022; Wang, Miao, Wang, et al., Reference Wang, Miao, Wang and Chang2022;), with recommendations to increase healthcare workers’ competencies and sensitivity in working with LGBT+ people (Hong, Reference Hong2024).
Discussion
Taiwan has been regarded as the vanguard of LGBT+ rights in Asia (Hsu and Yen, Reference Hsu and Yen2017), notably the first Asian jurisdiction to legalise same-sex marriage. However, this scoping review of over two decades of research—the first comprehensive review of LGBT+ inclusion in Taiwan—reveals that LGBT+ people continue to face marginalisation, discrimination, and victimisation across multiple domains of life. Discriminatory forces are manifested in a cis-heteronormative sociocultural environment with limited acceptance towards LGBT+ communities. This is evinced in a lack of policy protections and recognition of LGBT+ partnerships and family formation, and denial of access to reproductive rights; a family system that largely excludes LGBT+ people; an education system that perpetuates victimisation and discrimination against LGBT+ young people; an economic system that constrains LGBT+ people’s opportunities to achieve equitable employment; and a healthcare system that lacks sensitivity and competence in working with LGBT+ people.
Emblematic of the systematic lack of inclusion in multiple sectors of Taiwanese society, LGBT+ individuals report a high prevalence of victimisation and exclusion, which negatively impacts their physical and mental health. Notably, reflecting an antithetical social and policy climate, and the low availability of LGBT-competent healthcare, the prevalence of mental health problems was three times higher among the LGBT+ community than among the general population in Taiwan (Wang et al., Reference Wang, Miao and Chang2021).
This review also highlights the agency and strategic resilience of LGBT+ people in coping with and resisting cis-heteronormativity and transgressing social and gender hierarchies. LGBT+ individuals and communities enacted various approaches and tactics to navigate pathways towards inclusion, such as the development and mobilisation of collective Taiwanese queer identities; strategically connecting pride in advocating for the rights of LGBT+ people with rights movements for other marginalised identities and the democratisation of Taiwan more broadly; and engaging in same-sex family formation, adoption, and parenting. Nevertheless, social policies and legislation remain vital instruments to redress the systemic exclusion and marginalisation of LGBT+ individuals in Taiwan, whereas governmental inaction and neglect perpetuate stigma and entrench systemic hardships even in the presence of legislative advances.
While Taiwan has enacted significant steps in advancing marriage equality, sustained efforts and advocacy are imperative to ensure equity and inclusion across life domains, including education, economic, and healthcare sectors, as demonstrated by the ongoing exclusion and discrimination evidenced in the present review. This requires broadening the scope of social policy to explicitly address sexual and gender diversity. Gregory and Matthews (Reference Gregory and Matthews2022) argue that the discipline of social policy often overlooks the experiences of LGBT+ individuals and the unique challenges they face in accessing welfare services. Through a content analysis of online communications among LGBT+ individuals in Taiwan, Lo (Reference Lo2024) revealed that the legalisation of same-sex marriage has sparked critical discussions around other fundamental social welfare issues, such as cross-border partnerships, inclusive parental leave, and access to parenthood via assisted reproductive technologies, which continue to be constrained by heteronormative ideologies and policy frameworks. However, these realities and social welfare needs are largely not yet addressed by scholars and policymakers, and they risk being rendered invisible to the extent that heterosexist and cis-normative policies go unchallenged. This comprehensive review of Taiwanese LGBT+ people’s experiences across six key domains underscores the urgent need for more inclusive policy responses and greater public attention to the adversities faced by LGBT+ communities in Taiwan.
Policy implications
Specific policy recommendations identified in the literature on political and civic participation focused on the family domain and to a lesser extent the health domain. These include the need for protection of same-sex family units, legal recognition for LGBT+ parents, and increased access to reproductive health rights, particularly in the aftermath of equal marriage legislation. More broadly, recommendations in the political domain emphasised the importance of greater representation of LGBT+ people in legislation and policymaking processes across all sectors to articulate and respond to specific community needs, and to address experiences of systemic discrimination and exclusion.
Family emerged as a crucial domain for LGBT+ inclusion in Taiwan, where cultural values of familism, filial piety, and ‘face concerns’ permeate identity development, social relationships, and individuals’ daily lives. The legislation of marriage equality since 2019 has highlighted the need for complementary policy advances to actualise LGBT+ inclusion in the family domain. In contrast to what has been termed a defamilisation approach to social welfare, which lends support to individuals independent of family relationships (Lohman and Zagel, Reference Lohmann and Zagel2016), Taiwan’s approach to means-tested benefits and employment support is predicated on reliance on families as primary providers of basic needs and a social safety net (Zhao and Wang, Reference Zhao and Wang2025). This policy framework based on familisation not only reinforces the centrality of family in everyday life but also exacerbates vulnerabilities among LGBT+ individuals who face familial rejection or expulsion. A study published in Chinese with 270 gay men in Taiwan (mean age = 27 years) highlighted persistent experiences of family exclusion, including being forced to leave home, with higher rates of both social and economic exclusion among gay men who had come out to family and friends (Chung and Lee, Reference Chung and Lee2017). However, a later study reveals that some parents of LGBT+ people in Taiwan served as vital allies, consistently advocating for social and legal reforms to promote LGBT+ equity and inclusion (Huang, Reference Huang2023).
Collectively, these findings underscore the dynamic tensions between what are in essence psychologically and developmentally beneficial disclosures of one’s identity, countervailed by heightened risks for financial precarity, housing and employment insecurity owing to family rejection, and a social welfare system predicated on familisation. These tensions transpire in a context that provides legalisation of same-sex marriage amid a fraught and incrementally changing policy landscape for family formation, adoption, reproductive healthcare options, legal parenthood, and equal treatment in employment policies, such as parental leave. Together, these highlight the family domain as a fulcrum for LGBT+ inclusion in Taiwan.
Social policy interventions to advance LGBT+ inclusion include trainings for social service providers, equipping them to provide culturally sensitive guidance to parents and family members of LGBT+ people, incorporating relationship-focused approaches to encourage parents to support the needs of their LGBT+ children and to foster positive parent-child relationships (Huang, 2020, Reference Huang2023). Second, lawmakers should reform Taiwanese laws that create barriers to same-sex couples’ family formation, such as laws restricting assisted reproductive services to heterosexual couples, and restrictions on surrogacy that create additional barriers for gay male couples (Chen, Reference Chen2024). Third, policymakers should reform Taiwan’s parental leave policies to be more inclusive of diverse family forms, such as LGBT+ families, as they currently provide greater parental leave support to biological parents versus same-sex parents (Wong et al., Reference Wong, Jou, Raub and Heymann2020; Lo, Reference Lo2024); these policies should also combat the gendered social construction of parenting, such as by expanding paid paternity leave and ensuring that fathers have access to parenting facilities such as infant-changing tables (Lau, Reference Lau2016).
Inclusion in the education domain is crucial, not only for improving the lived experiences of LGBT+ students—with evidence of negative health impacts of bullying victimisation concurrently and later in life (e.g., Li, Chen, et al., Reference Li, Chen, Chang and Yen2020)—but also because education (re)produces norms that emanate outward, increasing social acceptance of LGBT+ people in society (Cheng et al., Reference Cheng, Wu and Adamczyk2016). While Taiwan has been a global leader in LGBT+ inclusive education policies (i.e., GEEA), systemic approaches are needed to achieve implementation of LGBT-positive school climates (Fantus and Newman, Reference Fantus and Newman2021), including training for school staff (Shen, Reference Shen2021; Chiao and Chang, Reference Chiao, Chang, Chiao and Chang2023), and mainstreaming LGBT+ people in the curriculum, rather than a narrow focus on sexual health and discrimination (Chiao and Chang, Reference Chiao, Chang, Chiao and Chang2023; Brown, Reference Brown2025).
In the domain of personal security and violence, this review highlights prevalent cyberbullying and harassment against LGBT+ individuals, underscoring the need for explicit legal prohibitions against such behaviour, as seen in Canada and the United States (Chang, Reference Chang2022). Although amendments to Taiwan’s Domestic Violence Act have extended protections to same-sex partners, specific training and guidelines for professionals working with same-sex couples are needed (Santoniccolo et al., Reference Santoniccolo, Trombetta and Rollè2023).
In terms of economic wellbeing, this review indicates that LGBT+ employees and job seekers in Taiwan face both overt and subtle forms of exclusion. The current Gender Equality in Employment Act does not adequately address microaggressions or discrimination specifically targeting LGBT+ individuals. Policy interventions to safeguard the economic well-being of LGBT+ individuals must include clear mandates that prevent discrimination in both workplace environments and hiring and advancement practices.
Amid pervasive disparities in health and mental health among LGBT+ people promulgated by stigma and marginalisation, and extensive service gaps, there is a critical need to develop and implement provider training and institutional policies in the health domain to advance sensitivity and competence in working with LGBT+ individuals. These comprise use of inclusive language with LGBT+ patients, healthcare issues particularly important to discuss with LGBT+ patients, ensuring that LGBT+ patients can be visited by same-sex (even unmarried) partners, and developing mechanisms for LGBT+ patients to report and receive remedies for discrimination in healthcare contexts (Lim et al., Reference Lim, Brown and Justin Kim2014).
Despite limited but evolving social and legal support for broader LGBT+ rights in Taiwan, various forms of individual and collective action were identified in this review that challenge heteronormative institutions and discourses traversing domains, and advance LGBT+ inclusion. Targeted resources to support and promote research and data on LGBT+ communities, and the activities of LGBT+ nongovernmental and community-based organisations, represent strategic investments in achieving equity and inclusion for LGBT+ people.
Gaps in the literature
Amid the increasing focus on LGBT+ inclusion demonstrated in over twenty years of published research in Taiwan, this scoping review reveals significant gaps in the literature. First, the preponderance of research was in the health domain, with scant attention to education and economic well-being, despite documentation of negative sequelae of stigma and bullying victimisation in schools, and economic disparities, stigma, and microaggressions in the workplace, absent adequate or effective protections for LGBT+ children or adults. A second substantial gap is the lack of disaggregated data on and within LGBT+ populations, with an overrepresentation of research with gay men and other MSM (n = 38 studies), and LGBT+ people as a whole the second most researched population (n = 21 studies). Lesbian and bisexual women are underrepresented (n = 10 studies), with only two studies (<2 per cent) focused on experiences of transgender women (Shen and Shen, Reference Shen and Shen2023; Chao et al., Reference Chao, Chou, Chen and Cheng2024). Third, the extremely limited research with transgender, nonbinary, and other gender-diverse people, and intersex people, reflect their largescale invisibility in Taiwanese society, and extensive and entrenched stigma and marginalisation of gender and sexual minority populations.
Finally, several factors identified by the UNDP and World Bank as central to LGBT+ inclusion (Badgett and Sell, Reference Badgett and Sell2019; UNDP, 2024) require additional focus in Taiwan. Largely unexplored are topics related to legal gender recognition, LGBT+ representation in politics, the presence and breadth of LGBT + NGOs, and access to justice for LGBT+ people. Increased data and evidence on LGBT+ people’s access to education and school non-discrimination policies, and on income sufficiency, income disparities, workplace microaggressions and protections are sorely needed, particularly at the population level.
Limitations
First, while including peer-reviewed articles helped to ensure the rigor of the studies reviewed, this may overlook grey literature that could provide relevant data. Nevertheless, as the first systematic review of LGBT+ research in Taiwan, our aim was to provide a comprehensive overview of existing scholarship; future studies should assess contributions and insights from nongovernmental organisations and community-based LGBT+ organisations. Second, we included only publications in English; however, the lack of inclusion of Taiwanese journals in recognised international scholarly databases delimit the Chinese-language literature available. Third, although the review aimed to comprise the breadth of LGBT+ populations in Taiwan, few studies focused on lesbian and bisexual women, or transgender people, with an absence of non-binary, genderqueer, genderfluid, and other gender minority individuals. We highlighted articles focused on under-represented demographics, with evidence documenting these gaps important for guiding future research.
Conclusion
This comprehensive scoping review of research on LGBT+ inclusion in Taiwan indicates a predominant focus on the health domain with scant research on challenges in education and economic well-being. Substantial research in the family domain documents its central importance to LGBT+ inclusion in the Taiwanese context. Given Taiwan’s pivotal role as a pioneer in LGBT+ inclusion in Asia, the continuing marginalisation of Taiwanese LGBT+ individuals requires ongoing and progressive advocacy. This review offers evidence-based recommendations for advancing future research and policymaking to ensure that LGBT+ people in Taiwan enjoy the full measure of dignity and human rights.
Supplementary material
The supplementary material for this article can be found at https://doi.org/10.1017/S1474746425101176
Acknowledgements
Special thanks to Taiwan Tongzhi Hotline Association for their expert input on the history, progress, and current landscape of LGBT+ inclusion in Taiwan.
Author Contributions: CRediT Taxonomy
Yu-Te Huang Conceptualization, Formal analysis, Supervision, Writing – original draft.
Chenxi Yang Formal analysis, Writing - original draft, Writing – review & editing.
Leo Chow Formal analysis.
Suchon Tepjan Data curation, Project administration, Writing – review & editing.
Holning Lau Writing - review & editing.
Duy A. Dinh Formal analysis.
Peter A. Newman Conceptualization, Funding acquisition, Methodology, Supervision, Writing – review & editing
Funding statement
The study was supported in part by a grant from Social Sciences and Humanities Research Council of Canada, 895–2019-1020, PI: Newman [MFARR-Asia].
Competing interests
The author(s) declare none.
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