Experts bemoan lack of data on LGBT health disparities

The first panel at Harvard Law School's 4th annual Harvard Lambda Legal Advocacy (HaLLA) Conference was tasked with answering the question, is there an LGBT health gap? Without fail all four panelists answered in the affirmative; Fenway Health population research expert Judy Bradford came equipped with a PowerPoint presentation to solidify her case.

Bradford, addressing the crowd at Harvard Law's Langdell Hall on Feb. 27, the first day of the two-day conference, explained that there is precious little population survey data on the LGBT community, but what data there is shows that segments of the LGBT community are generally at higher risk than the rest of the population for health threats such as obesity and cardiovascular disease, tobacco and substance use and abuse, and injury and violence.

Bradford said despite these initial findings, population research leaves more questions than answers when it comes to LGBT health. She said none of the major national population research surveys include questions that would identify transgender respondents, and only a handful ask about sexual orientation. The surveys that do measure the LGB population often have such a small sample of respondents who identify as LGB that they present a woefully inadequate picture of LGBT health overall.

"The reliance on these data sets as benchmarks ... is really insufficient. This is just to say it's good when you hear these things to know they have value where the data demonstrates that there are disparities in our population groups because that's useful at the policy level," said Bradford, the director of the Fenway Institute's Center for Population Research in LGBT Health. "But for really understanding what's happening with us I think they're lacking."

Analysis of data on same-sex couples recorded on the U.S. Census, said Bradford, shows that health and other disparities exist for LGB people of color compared to white LGB people. Same-sex couples of color reported higher rates of disability and disparities in education and income, and on these measures same-sex couples of color closely resembled other respondents of their racial or ethnic background. Most studies of LGBT health have historically focused on white gay men, said Bradford, but the analysis of the Census data shows the flaws to that approach.

Another panelist, Jason Villarreal, said his own experience working with HIV-positive clients as a health promoter for Partners in Health, bears that out. Villarreal said he works with people who for one reason or another are having trouble taking medication for their HIV, and most of them are people of color and low income.

"The picture of a privileged white gay male is not at all what any of the patients that I serve are living through," said Villarreal.

He believes the LGBT health gap is closing, particularly in cities like Boston that have a range of LGBT-friendly healthcare providers; Villarreal said he gets his primary care at Fenway Health. But those services are often seen as inaccessible to LGBT people in communities of color whose families and social circles may be less accepting, said Villarreal.

"I've seen people that I serve that are so hesitant to go and access the services that are out there to help them have better healthcare outcomes because they don't feel comfortable there or they're afraid to be seen going into those places," said Villarreal.

The HaLLA conference was organized by HLS Lambda, the law school's LGBT student group, and the conference focused on the LGBT health gap. Another panel discussion later in the afternoon on Feb. 27 focused on disability issues and the law. Attorney Jennifer Levi of Gay and Lesbian Advocates and Defenders (GLAD), who serves as director of the advocacy law firm's Transgender Rights Project, said over the years she has found that making a disability claim has been an effective strategy to help transgender clients overcome discrimination.

Yet Levi said some within the transgender community oppose making the disability argument, and she believes much of that opposition comes from fear of the stigma associated with disability. Levi said the resistance to using disability claims in the courts ignores the profound impact of gender dysphoria on many transgender people.

"For many people within the trans community ... the experience of having gender dysphoria is real, is legitimate, is serious, is not a social condition, and would exist regardless of the external perceptions and understandings of gender. ... If as a community we at least agree that there are people for whom that is a real and legitimate experience, then to disavow that experience because of the stigma associated with mental heath conditions I think is to leave behind a very real and important part of our community," said Levi.