IOM Tackles Disparities in LGBT Health Care, Research

Lesbian, gay, bisexual, and transgender individuals face disparities in health care and health status, compared with their heterosexual counterparts, caused in part by social stigmatization and exacerbated by limited data and research on the unique medical needs of the LGBT community, according to a report released by the Institute of Medicine.

The report, "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding," was requested by the National Institutes of Health (NIH). It was designed to assess current knowledge of the health status of the LGBT population, to identify research gaps and opportunities, and to propose specific research goals for NIH to implement in future.

The authors proposed seven specific recommendations, with the long-term goal of improving the status of health care in the LGBT community:

• NIH should implement a research agenda designed to advance knowledge of LGBT health.

• Data on sexual orientation and gender identity should be collected in federally funded surveys administered by the Department of Health and Human Services and other relevant federally funded surveys.

• Data on sexual orientation and gender identity should be collected in electronic health records.

• NIH should support the development and standardization of sexual orientation and gender identity measures.

• NIH should support methodological research that relates to LGBT health issues.

• A comprehensive research training approach should be created to strengthen LGBT health research at NIH.

• NIH should encourage grant applicants to explicitly address the inclusion or exclusion of sexual and gender minorities in their samples.

To back up these recommendations, the report detailed the broad historical and current difficulties faced by the LGBT community with regard to health care, citing small studies and anecdotal evidence of specific known issues for different age groups.

In childhood and adolescence, "LGB youth are at increased risk for suicidal ideation and attempts as well as depression. Small studies suggest the same may be true for transgender youth," according to the report. In addition, rates of smoking, alcohol consumption, and substance abuse may be higher among LGB youth, and the homeless youth population comprises a disproportionate number of LGB youth and transgender women. There are also increased levels of violence, victimization, and harassment reported by LGBT youth, compared with heterosexual and non–gender-variant youth.

Importantly, "the burden of HIV falls disproportionately on young men, particularly young black men who have sex with men."

These issues were found to continue throughout the lifetimes of LGBT individuals. The report is careful to point out that the disparities in mental and physical health seen in LGBT youth, compared with their heterosexual counterparts, "are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity throughout the life course."

In early/middle adulthood, LGB individuals "appear to experience more mood and anxiety disorders, more depression, and an elevated risk for suicidal ideation and attempts, compared with heterosexual adults," the report noted.

Adult lesbian and bisexual women might use preventative health services less, be at greater risk of obesity, have higher rates of smoking and alcohol use, and have higher rates of breast cancer than do heterosexual women.

Compared with their heterosexual peers, gay and lesbian individuals are less likely to be parents, "although children of gay and lesbian parents are well adjusted and developmentally similar to children of heterosexual parents."

In this age group, "HIV/AIDS continues to enact a severe toll on men who have sex with men, with black men and Latino men being disproportionately affected."

Only limited studies look at this population in later adulthood. Transgender elders may experience negative health outcomes from long-term hormone use. HIV/AIDS is also a growing problem for older individuals, although there are few prevention programs targeting elder adults.

The report was frank in its approach, pointing out that many of the current medical difficulties faced by the LGBT community (and problems faced by researchers of that community) were brought about by social stigmatization in part created by the medical profession itself, which provided ostensible scientific rationales for social prejudice and punitive legislation and attempted to "cure" so-called sexual deviants through methods ranging from psychotherapy to shock treatments to castration and lobotomy.

This created a climate of mistrust that inhibits individual disclosure in studies already impeded by the statistical and recruitment difficulties intrinsic to minority studies.

Today, it still is difficult to accurately assess the percentage of lesbian, gay, bisexual, and transgender individuals in the general population, according to the report. The 2010 National Survey of Sexual Health and Behavior, the most recent large study cited in the report, found that 6.8% of men and 4.5% of women identify themselves as homosexual, gay, lesbian, or bisexual.

But relying on self-identification is problematic and might impede research. For example, in the 2008 General Social Survey, only 2.2% of men identified themselves as gay and 0.7% as bisexual, despite the fact that about 10% of men reported same-sex sexual behavior as adults. Most nonwhite men appear to be far less likely to self-identify as gay or bisexual than do white men, despite reporting that they have sex with men.

Data on the proportion of transgendered individuals are based almost exclusively on those who have sought medical intervention, whether instigated by their parents in their youth or by themselves as adults, according to the report.

A full prepublication copy of the report is available online.

The IOM Board on the Health of Select Populations, which was responsible for the report, indicated no financial disclosures; however, several of the participants had associations with or were employed by organizations that might benefit by increased monies for LGBT research, either from direct client service or increased grant funding.

Lesbian, gay, bisexual, and transgender individuals face disparities in health care and health status, compared with their heterosexual counterparts, caused in part by social stigmatization and exacerbated by limited data and research on the unique medical needs of the LGBT community, according to a report released by the Institute of Medicine.

The report, "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding," was requested by the National Institutes of Health (NIH). It was designed to assess current knowledge of the health status of the LGBT population, to identify research gaps and opportunities, and to propose specific research goals for NIH to implement in future.

The authors proposed seven specific recommendations, with the long-term goal of improving the status of health care in the LGBT community:

• NIH should implement a research agenda designed to advance knowledge of LGBT health.

• Data on sexual orientation and gender identity should be collected in federally funded surveys administered by the Department of Health and Human Services and other relevant federally funded surveys.

• Data on sexual orientation and gender identity should be collected in electronic health records.

• NIH should support the development and standardization of sexual orientation and gender identity measures.

• NIH should support methodological research that relates to LGBT health issues.

• A comprehensive research training approach should be created to strengthen LGBT health research at NIH.

• NIH should encourage grant applicants to explicitly address the inclusion or exclusion of sexual and gender minorities in their samples.

To back up these recommendations, the report detailed the broad historical and current difficulties faced by the LGBT community with regard to health care, citing small studies and anecdotal evidence of specific known issues for different age groups.

In childhood and adolescence, "LGB youth are at increased risk for suicidal ideation and attempts as well as depression. Small studies suggest the same may be true for transgender youth," according to the report. In addition, rates of smoking, alcohol consumption, and substance abuse may be higher among LGB youth, and the homeless youth population comprises a disproportionate number of LGB youth and transgender women. There are also increased levels of violence, victimization, and harassment reported by LGBT youth, compared with heterosexual and non–gender-variant youth.

Importantly, "the burden of HIV falls disproportionately on young men, particularly young black men who have sex with men."

These issues were found to continue throughout the lifetimes of LGBT individuals. The report is careful to point out that the disparities in mental and physical health seen in LGBT youth, compared with their heterosexual counterparts, "are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity throughout the life course."

In early/middle adulthood, LGB individuals "appear to experience more mood and anxiety disorders, more depression, and an elevated risk for suicidal ideation and attempts, compared with heterosexual adults," the report noted.

Adult lesbian and bisexual women might use preventative health services less, be at greater risk of obesity, have higher rates of smoking and alcohol use, and have higher rates of breast cancer than do heterosexual women.

Compared with their heterosexual peers, gay and lesbian individuals are less likely to be parents, "although children of gay and lesbian parents are well adjusted and developmentally similar to children of heterosexual parents."

In this age group, "HIV/AIDS continues to enact a severe toll on men who have sex with men, with black men and Latino men being disproportionately affected."

Only limited studies look at this population in later adulthood. Transgender elders may experience negative health outcomes from long-term hormone use. HIV/AIDS is also a growing problem for older individuals, although there are few prevention programs targeting elder adults.

The report was frank in its approach, pointing out that many of the current medical difficulties faced by the LGBT community (and problems faced by researchers of that community) were brought about by social stigmatization in part created by the medical profession itself, which provided ostensible scientific rationales for social prejudice and punitive legislation and attempted to "cure" so-called sexual deviants through methods ranging from psychotherapy to shock treatments to castration and lobotomy.

This created a climate of mistrust that inhibits individual disclosure in studies already impeded by the statistical and recruitment difficulties intrinsic to minority studies.

Today, it still is difficult to accurately assess the percentage of lesbian, gay, bisexual, and transgender individuals in the general population, according to the report. The 2010 National Survey of Sexual Health and Behavior, the most recent large study cited in the report, found that 6.8% of men and 4.5% of women identify themselves as homosexual, gay, lesbian, or bisexual.

But relying on self-identification is problematic and might impede research. For example, in the 2008 General Social Survey, only 2.2% of men identified themselves as gay and 0.7% as bisexual, despite the fact that about 10% of men reported same-sex sexual behavior as adults. Most nonwhite men appear to be far less likely to self-identify as gay or bisexual than do white men, despite reporting that they have sex with men.

Data on the proportion of transgendered individuals are based almost exclusively on those who have sought medical intervention, whether instigated by their parents in their youth or by themselves as adults, according to the report.

A full prepublication copy of the report is available online.

The IOM Board on the Health of Select Populations, which was responsible for the report, indicated no financial disclosures; however, several of the participants had associations with or were employed by organizations that might benefit by increased monies for LGBT research, either from direct client service or increased grant funding.

Lesbian, gay, bisexual, and transgender individuals face disparities in health care and health status, compared with their heterosexual counterparts, caused in part by social stigmatization and exacerbated by limited data and research on the unique medical needs of the LGBT community, according to a report released by the Institute of Medicine.

The report, "The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding," was requested by the National Institutes of Health (NIH). It was designed to assess current knowledge of the health status of the LGBT population, to identify research gaps and opportunities, and to propose specific research goals for NIH to implement in future.

The authors proposed seven specific recommendations, with the long-term goal of improving the status of health care in the LGBT community:

• NIH should implement a research agenda designed to advance knowledge of LGBT health.

• Data on sexual orientation and gender identity should be collected in federally funded surveys administered by the Department of Health and Human Services and other relevant federally funded surveys.

• Data on sexual orientation and gender identity should be collected in electronic health records.

• NIH should support the development and standardization of sexual orientation and gender identity measures.

• NIH should support methodological research that relates to LGBT health issues.

• A comprehensive research training approach should be created to strengthen LGBT health research at NIH.

• NIH should encourage grant applicants to explicitly address the inclusion or exclusion of sexual and gender minorities in their samples.

To back up these recommendations, the report detailed the broad historical and current difficulties faced by the LGBT community with regard to health care, citing small studies and anecdotal evidence of specific known issues for different age groups.

In childhood and adolescence, "LGB youth are at increased risk for suicidal ideation and attempts as well as depression. Small studies suggest the same may be true for transgender youth," according to the report. In addition, rates of smoking, alcohol consumption, and substance abuse may be higher among LGB youth, and the homeless youth population comprises a disproportionate number of LGB youth and transgender women. There are also increased levels of violence, victimization, and harassment reported by LGBT youth, compared with heterosexual and non–gender-variant youth.

Importantly, "the burden of HIV falls disproportionately on young men, particularly young black men who have sex with men."

These issues were found to continue throughout the lifetimes of LGBT individuals. The report is careful to point out that the disparities in mental and physical health seen in LGBT youth, compared with their heterosexual counterparts, "are influenced largely by their experiences of stigma and discrimination during the development of their sexual orientation and gender identity throughout the life course."

In early/middle adulthood, LGB individuals "appear to experience more mood and anxiety disorders, more depression, and an elevated risk for suicidal ideation and attempts, compared with heterosexual adults," the report noted.

Adult lesbian and bisexual women might use preventative health services less, be at greater risk of obesity, have higher rates of smoking and alcohol use, and have higher rates of breast cancer than do heterosexual women.

Compared with their heterosexual peers, gay and lesbian individuals are less likely to be parents, "although children of gay and lesbian parents are well adjusted and developmentally similar to children of heterosexual parents."

In this age group, "HIV/AIDS continues to enact a severe toll on men who have sex with men, with black men and Latino men being disproportionately affected."

Only limited studies look at this population in later adulthood. Transgender elders may experience negative health outcomes from long-term hormone use. HIV/AIDS is also a growing problem for older individuals, although there are few prevention programs targeting elder adults.

The report was frank in its approach, pointing out that many of the current medical difficulties faced by the LGBT community (and problems faced by researchers of that community) were brought about by social stigmatization in part created by the medical profession itself, which provided ostensible scientific rationales for social prejudice and punitive legislation and attempted to "cure" so-called sexual deviants through methods ranging from psychotherapy to shock treatments to castration and lobotomy.

This created a climate of mistrust that inhibits individual disclosure in studies already impeded by the statistical and recruitment difficulties intrinsic to minority studies.

Today, it still is difficult to accurately assess the percentage of lesbian, gay, bisexual, and transgender individuals in the general population, according to the report. The 2010 National Survey of Sexual Health and Behavior, the most recent large study cited in the report, found that 6.8% of men and 4.5% of women identify themselves as homosexual, gay, lesbian, or bisexual.

But relying on self-identification is problematic and might impede research. For example, in the 2008 General Social Survey, only 2.2% of men identified themselves as gay and 0.7% as bisexual, despite the fact that about 10% of men reported same-sex sexual behavior as adults. Most nonwhite men appear to be far less likely to self-identify as gay or bisexual than do white men, despite reporting that they have sex with men.

Data on the proportion of transgendered individuals are based almost exclusively on those who have sought medical intervention, whether instigated by their parents in their youth or by themselves as adults, according to the report.

A full prepublication copy of the report is available online.

The IOM Board on the Health of Select Populations, which was responsible for the report, indicated no financial disclosures; however, several of the participants had associations with or were employed by organizations that might benefit by increased monies for LGBT research, either from direct client service or increased grant funding.