Lesbian, Gay, Bisexual, and Transgender Health: A Neglected Issue
Lesbian, Gay, Bisexual, and Transgender (LGBT) communities have existed in all cultures throughout recorded history; however, it is only in the last two decades that the health of sexual and gender minorities has emerged as an important discipline within public health practice. Before an accurate assessment can be made of the health issues facing the LGBT population, it is important to first determine what is meant when we refer to these groups. Sexual orientation refers to the inclination or capacity to develop emotionally and sexually intimate relationships with people of the same gender, other gender, or either gender. A woman who is primarily oriented to other women is lesbian; a man primarily oriented to other men is gay, while bisexuals are oriented toward both women and men.
Determination of gender is complex. While a person may have a combination of genetic and anatomic traits that define them as male, female, or intersexed at birth, gender is the self-identification with the social, psychological, and emotional traits associated with masculinity or femininity. Transgender individuals are those with gender identities that do not fully conform to their assigned sex at birth. Individuals determined to be female at birth (natal females) may identify as men (transgender men, transmen), while natal males may identify as women (transgender women, transwomen). Some transgender individuals do not fully embrace either male or female roles, preferring to define themselves outside of traditional definitions. It is important to recognize that there is considerable fluidity in how people define their sexual orientation and gender identity depending on their life experience, ethnicity, culture, and stage in the “coming out” process.
It became clear in the early years of the AIDS epidemic that both HIV and other sexually transmitted infections (STIs) were clustered within the communities of men who have sex with men (MSM).
It was evident that public health officials did not have the necessary expertise to undertake effective health promotion activities among MSM or other members of the LGBT community. The reasons for this were many and included a lack of population-based research conducted in the LGBT community, lack of political will to target a socially stigmatized group, andthe difficulty of reaching members of a community often reticent of declaring their sexual identity to government officials.
Amid the AIDS-hysteria of the early 1980s, and refusal of some clinicians to provide care to people with HIV or perceived to be at risk for HIV, several clinics led the way in providing sensitive and nonjudgmental care to gay and bisexual men. The Community Health Project in New York, New York (now Callen Lorde Community Health Center), the Fenway Community Health Center in Boston, Massachusetts, and the Howard Brown Clinic in Chicago, Illinois, are a few examples. The inclusion of HIV/AIDS as a disability under the Americans with Disabilities Act in 1998 was an important milestone in securing rights for people with HIV, many of whom were also gay or bisexual men.
An important outcome of the devastating effect that HIV/AIDS had on the LGBT community was the recognition that disparities exist in other areas not related to HIV or sexual health issues. The reasons for these disparities are complex and related to both historic and contemporary factors. Social stigma and systemic discrimination based on sexual orientation and gender identity have resulted in multilevel barriers to health care for the LGBT population. Although population-based research has been limited, the Health and Human Services Secretary’s Advisory Committee on Healthy People 2020 has recognized the LGBT community as a “special” population. The Healthy People 2010 companion document highlighted the fact that the community suffers disproportionately from higher rates of health disorders such as substance and tobacco use, eating disorders, obesity, depression, infectious diseases, and reduced uptake of preventive health services.
Why Is LGBT Health Important?
Eliminating LGBT health disparities and enhancing efforts to improve LGBT health are necessary to ensure that LGBT individuals can lead long, healthy lives. The many benefits of addressing health concerns and reducing disparities include:
* Reductions in disease transmission and progression
* Increased mental and physical well-being
* Reduced health care costs
* Increased longevity
Efforts to improve LGBT health include:
* Curbing human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) with interventions that work.
* Implementing antibullying policies in schools.
* Providing supportive social services to reduce suicide and homelessness risk among youth.
* Appropriately inquiring about and being supportive of a patient’s sexual orientation to enhance the patient-provider interaction and regular use of care.
* Providing medical students with access to LGBT patients to increase provision of culturally competent care.
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Anita Radix, MD, MPhil, MPH, and Gal Mayer, MD, MS
Anita Radix, MD, MPhil, MPH, Director of Research and Education, Callen-Lorde Community Health Center
Dr. Gal Mayer MD practices internal medicine in New York, New York. Callen Lorde Community Health Center
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REFERENCES
- The Gay and Lesbian Medical Association. Healthy People 2010 companion document for LGBT Health.
- Solarz AL, Institute of Medicine, eds. Lesbian Health: Current Assessment and Directions for the Future. 1st ed. Washington, DC: National Academies Press; 1999.
- Dean L, Meyer I, Robinson K, Sell R, et al. Lesbian, gay, bisexual, and transgender health: findings and concerns. J Gay Lesbian Med Assoc. 2000;4(3):101-151.
- Laumann E, Gagnon J, Michael R, Michaels S. The Social Organization of Sex: Sexual Practices in the United States. Chicago, IL: University of Chicago Press; 1994.
- Pathela P, Hajat A, Schillinger J, Blank S, Sell R, Mostashari F. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City. Men Ann Intern Med. 2006;145:416-425.
- Mosher W, Chandra A, Jones J. Sexual behavior and selected health measures: men and women 15-44 years of age, United States, 2002. Vital Health Stat. 2005;362:21-26.
- Goodenow C, Szalacha L, Rubin L, Westheimer K. Dimensions of sexual orientation and HIV-related risk among adolescent females: evidence from a statewide survey. Am J Pub Health. 2008;98(6):1051-1058.