LGBT health inequity persists; NIH research lags

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The National Institutes of Health funded only a negligible number of studies researching the health of lesbian, gay, bisexual and transgender people over more than two decades, according to an analysis led by the University of Pittsburgh Graduate School of Public Health.

Because of that, health inequities in that population continued unabated, according to the study published Wednesday in the February issue of the American Journal of Public Health.

The findings showed there were 628 NIH-funded studies of LGBT health between 1989 and 2011, representing only one-half of 1 percent of all NIH-funded studies. The majority of the LGBT studies focused on HIV/AIDS and other sexual health matters. When those studies were excluded, there were only 113 LGBT-related studies, or 0.1 percent of NIH-funded studies during the time period.

The study notes more research is clearly needed because, in general, LGBT people experience disproportionate behavioral risks and psychosocial health problems, and higher chronic disease risk factors than their non-LGBT counterparts.

"I can't say what number [of LGBT-related studies] there should be, but we should have research until disparities dissipate or are eliminated," said Robert W.S. Coulter, the study's lead author and a doctoral student in Pitt Public Health's Department of Behavioral and Community Health Sciences.

About 3.5 percent of the U.S. adult population is estimated to be gay, lesbian or bisexual, according to recent research based on national- and state-level population surveys, according to Mr. Coulter.

He noted that LGBT people suffer stigma associated with their sexual and gender minority status. Additionally, some subgroups use alcohol and tobacco and suffer obesity at higher rates than non-LGBT people; experience more violence among youths, including bullying and cyberbullying; have more mental health problems; and have higher rates of chronic disease such as cardiovascular disease and cancer. Moreover, they experience more stress from being a minority and can experience and internalize more victimization, he said.

The study found that during the time frame examined there were 202 NIH-funded projects on the development, implementation or evaluation of interventions for LGBT health issues. When intervention studies concerning HIV and other sexual health matters were removed, the number of projects dropped to 21.

"I think it's important to note the lack of funding for LGBT issues perpetuates these health inequities," Mr. Coulter said. "NIH is the world's largest funder of health research. Without them on our side, I don't think it's possible to eliminate these health disparities."

The paper notes that the "political climate" has had a chilling effect on such research, particularly after Republican members of Congress questioned in 2003 nearly 200 projects involving LGBT or other marginalized populations. More than half of the researchers in those studies removed words from proposals such as "gay," "lesbian," "bisexual" and "AIDS" while others completely dropped their projects and NIH funding for such projects declined.

"The political climate does have an effect. The NIH should be promoting, encouraging and stimulating research on LGBT issues," the paper said.

Betty Hill, executive director of the Persad Center, a human service organization serving the region's LGBT community, said the lack of NIH-funded research for LGBT people wasn't surprising to her.

"While there are a multitude of health problems, the only one that gets attention, albeit miniscule, is the HIV-AIDS issue. This is certainly a population whose health inequities should be studied to determine what to do to help," she said. "You don't know the right thing to do to help if you don't know what's happening.

"But in spite of the fact there are significant health disparities, it gets so little attention. What can account for that besides homophobia? What else could it be?"

The study suggests the NIH more efficiently stimulate research projects on LGBT health issues by doing the following:

• Establish policies that designate LGBT people as priority populations for research that goes beyond HIV/AIDS and sexual health issues.

• Increase evidence-based intervention research to improve LGBT and reduce health inequities.

• Explore new strategies to increase the amount of LGBT health research, including support for diversity among researchers.

• Support efforts to expand the pool of trained researchers prepared to propose LGBT research projects through training grants, fellowships, career awards and the establishment of LGBT Centers of Excellence.

"That certainly would be my wish list as well," Ms. Hill said. "This is a very important study. I hope it brings great awareness to the issue and puts pressure on the powers that be to invest in LGBT-related research."

Michael A. Fuoco: mfuoco@post-gazette.com or 412-263-1968.


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