Monday, 20 October 2014

Fat Lesbians need more NIH funding

The usual suspects are going after NIH funding in light of Francis Collins' political own goal on ebola research. As a non US citizen, despite being paid out of an R01 NIH grant, I often feel like my voice is not the most useful in these debates. But as a gay man living in rural Ohio, I can tell you this. Contrary to what fair and balanced news coverage may have you believe, fat lesbians need more NIH funding, not less.
LBGT people are an understudied population in all aspects of clinical intervention, yet what research we have clearly indicates that, as a group, gay and lesbian people have worse health then straight people when you control for income and socio-economic group. Compared to straight men in their thirties, I am more likely to smoke, binge drink, and show signs of psychological distress. Although I am less likely to be overweight, lesbian women are more likely to be so than their straight counterparts. (data from CDC survey of health differences among gay and lesbians).
Crucially, that survey was conducted in 2013, and its results only published this year. It was the first of its kind. We have almost no population wide, systematic data on differences in the health of gay and lesbian individuals. What is more, we know they are less likely to have medical coverage (in part owing to problems with spousal coverage), less likely to have a regular healthcare provider, less likely to seek out medical help regularly and less likely to discuss LBGT specific issues with their healthcare providers.
Conversely, we know that most physicians receive almost no education in LBGT specific healthcare issues in four years od med school. I have a couple of gay doctor friends, and I have watched them advocate tirelessly for years to get LBGT health issues on the medical school radar. It is tough going and change is slow. The medical profession in the US is surprisingly conservative on these matters. LBGT men and women have long known that they have to be their own advocates in the doctor's office. Ask any gay friends you may have, and you're bound to hear some cringe worthy stories. But patient advocacy requires privilege. With my PhD and middle class background and white maleness, I can talk back to a doctor (especially when it comes to anatomy). I can demand treatment. I can argue. A latina teen lesbian who'se been kicked out of her house has no such recourse. A closeted twenty something gay farm boy visiting the same family doctor his whole family and town sees isn't going to be comfortable asking for an HIV test.
The HIV crisis fundamentally damaged the (already shaky) relationship between LBGT people and the medical profession. Not helped by the fact that homosexuality was considered a disease until 1973. Many gay men and lesbian women in big cities set up parallel networks of healthcare providers, because they neither trusted the medical establishment, nor had access to insurers. These voluntary outfits do amazing work for outreach, education and testing, but they do not provide the follow through a established family doctor does. And in the rural areas of the US, these services are few and far between. I know this first hand. In my old city, I could get free HIV tests several times a week at several locations. Here in Ohio, my family doctor seems surprised when I order one, and my other options are a monthly clinic half an hour away, or planned parenthood, which my insurance will not cover.  And again, I am an out, educated, financially independent male. I'm not afraid of my doctor's looks, or the village gossips, or who sees me come in and out of the planned parenthood offices. I don't think that experience generalises to my LBGT friends who grew up here.
When Fox news goes after the paltry amount of money NIH is willing to give to investigating LBGT health issues, they are attacking vulnerable men and women in precisely the place where they are most exposed: their relationship with their healthcare provider. It is low and callous even by their standards. Fat lesbians and gay men who drink too much deserve NIH money. And remember, one day you may be grateful on behalf of your son or daughter that they got it.
PS: Hat tip to drungmonkey for alerting me to this.

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