Two weeks ago, Secretary of Health and Human Services Kathleen Sebelius headlined the first of several White House-sponsored LGBT conferences, this one focusing on health care issues facing the community. Some of the issues that Sebelius spoke to included the following:
- access to employment-based insurance coverage;
- hospital visitation rights for LGBT partners;
- cultural competency standards for health care professionals;
- reinvigorating domestic HIV/AIDS prevention efforts (particularly among gay men and African-Americans);
- issues of aging;
- transgender health;
- and health issues among LGBT youth.
An impressive and comprehensive list, some would say.
But where are the women?
Of course, most of the items Sebelius noted in her speech are relevant to women. But none of them are specific to women. And this, I think, is an opportunity to examine what happens to people with “double minority” status – lesbian women being a good example of this. The phrase “LGBT health” often is associated with HIV/AIDS prevention and treatment – traditionally seen as a “gay men’s issue” (even though, of course, sexually active women are absolutely at risk for HIV/AIDS). The phrase “women’s health,” on the other hand, is often associated with reproductive health -the right to safe, effective, and affordable family planning options; the right to choose reproductive health care options, rather than have them be chosen for her; and the right to health care services that ensure a woman’s safety through pregnancy and childbirth. While these issues may be relevant for some lesbian and bisexual women, the reality is that this form of “women’s health” really refers to “heterosexual women’s health.” As a result, the LGBT health agenda and the women’s health agenda are two entirely separate spheres, with little overlap. And lesbians end up falling through the cracks.
Clearly, if you’re a double minority (or multiple minority), only one element of your minority status gets focused on at a time. Rarely is the intersection of both aspects of identity considered.
So let’s shift our focus. What would a “lesbian health agenda” look like?
Heart disease would be at the top of the list. Compared to heterosexual women, lesbian and bisexual women are at a higher risk for obesity, smoking, and stress, all of which contribute to heart disease and type 2 diabetes. Add age, poor health, less education, sedentary lifestyle, and being African American or Latina, and the risk increases substantially. Of course, smoking also raises the risk of lung cancer for lesbian and bisexual women.
Next might be breast cancer and reproductive diseases. Because lesbians are less likely than heterosexual women to have had a full-term pregnancy, they may be at higher risk for breast cancer, endometrial cancer, and ovarian cancer – largely because hormones released during pregnancy and breastfeeding are thought to protect women against these cancers. Lesbians and bisexual women are also at higher risk for polycystic ovary syndrome (PCOS), possibly for the same reason. Lesbians and bisexual women are less likely to get routine screenings, such as a Pap test, which can prevent or detect cervical cancer. Lesbian and bisexual women are also less likely to get routine mammograms and clinical breast exams, which means that they may not detect cancer early enough for treatments to be effective. Lack of health insurance, fear of discrimination, and/or bad experiences with health care providers may be why lesbian and bisexual women aren’t seeking out these forms of preventative care.
Our lesbian health agenda wouldn’t be complete if we didn’t include mental health issues. Lesbians report higher rates of depression and anxiety than their heterosexual counterparts, and bisexual women have even higher rates than lesbians. Many factors likely contribute to this, including internalized homophobia (negative feelings about oneself due to homophobia in society, stress from hiding one’s sexual orientation), interpersonal homophobia (rejection and unfair treatment by family, friends, and/or colleagues), and institutional homophobia (lack of civil rights and protections, including health insurance). In addition, heavy alcohol and drug use is more common among lesbians than heterosexual women. Bisexual women are at a higher risk for injecting drugs, putting them at higher risk for HIV and other STIs.
And let’s not forget domestic violence (also known as intimate partner violence). Obviously, domestic violence can happen within same-sex relationships, as it does in heterosexual relationships. However, lesbian victims are much more likely than heterosexual women to stay silent about the violence, in many cases because of internalized homophobia and institutional barriers (see my earlier blog post titled “Under the radar”).
March is Women’s History Month. Let’s not forget the “L” in “LGBT.”