Research Article: Lesbian, gay, bisexual, and transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape

Date Published: July 10, 2017

Publisher: Public Library of Science

Author(s): Alexander J. Martos, Patrick A. Wilson, Ilan H. Meyer, Garrett Prestage.

http://doi.org/10.1371/journal.pone.0180544

Abstract

LGBT community organizations in the United States have been providing health services since at least the 1970s. However, available explanations for the origins of LGBT health services do not sufficiently explain why health in particular has been so closely and consistently linked to LGBT activism. Little is also known regarding how LGBT health services may have evolved over time with the growing scientific understanding of LGBT health needs.

This study begins with a review of the early intersections of sexuality and health that led to an LGBT health movement in the United States, as well as the evolution of LGBT health services over time. Informed by this, an asset map displaying the location and types of services provided by “LGBT community health centers” today in relation to the population density of LGBT people was explored. An online search of LGBT community health centers was conducted between September–December, 2015. Organizational details, including physical addresses and the services provided, were confirmed via an online database of federally-registered non-profit organizations and organizational websites. The locations and types of services provided were analyzed and presented alongside county-level census data of same-sex households using geographic information system (GIS) software ArcGIS for Desktop.

LGBT community health centers are concentrated within urban hubs and coastal states, and are more likely to be present in areas with a high density of same-sex couples. LGBT community health centers do not operate in 13 states. The most common health services provided are wellness programs, HIV/STI services, and counseling services.

LGBT community health centers have adapted over time to meet the needs of LGBT people. However, significant gaps in service remain in the United States, and LGBT community health centers may require significant transformations going forward in order to continue serving LGBT people.

Partial Text

The LGBT health movement in the United States can be defined in terms of LGBT people providing for themselves a safe space for accessing healthcare services [1–6]. LGBT health services, or health services offered through LGBT community organizations, have been available since at least the 1970s [7]. Available explanations for the origins of LGBT health services, such as the increased community mobilization and explicit rejection of homophobia following the Stonewall Riots of 1969 [5], do not sufficiently explain why health in particular has been so closely and consistently linked to LGBT activism. Little is also known regarding how LGBT health services may have evolved over time with the growing scientific understanding of LGBT health needs. LGBT community organizations provided health services to at least 300,000 clients in 2015 [8], suggesting that they still constitute a significant proportion of the healthcare landscape for LGBT people today.

Michel Foucault’s The History of Sexuality [19] explores how notions of sexuality have been constructed, and how the boundaries of “legitimate” sexuality have been contested, historically. There is no clear beginning to the relationships between sexuality, social and political movements, and health. But the interplay of these factors in the formation of LGBT identities in the United States has origins in the mid-20th Century [16]. Prior to adopting more consolidated identities of lesbian, gay, bisexual, and transgender, unorganized and isolated individuals first sought to identify and connect with each other in the politically and socially hostile climate following World War II [20]. In the midst of 1950s McCarthyism, two organizations formed that would greatly influence the trajectory of what would ultimately become “LGBT” people in the United States: The Mattachine Society [20] and the Daughters of Bilitis [21]. Both groups organized in secrecy, regularly published and distributed magazines and newsletters to subscribing members that debated the meaning of homosexuality, and provided medical professionals’ perspectives on homosexuality [16, 20, 21]. Both groups came to promote the notion that sexuality was constitutional to one’s identity, and that subscribing members were a discriminated minority [20]. These moves toward self-acceptance and identity development would ultimately encourage public advocacy for the rights and social acceptance of a broader community.

The infrastructure for community-based health services was being established with the proliferation of LGB community centers throughout the country. However, lessons learned within the women’s health movement introduced the idea of uniquely “LGB” health issues. In 1973, the Boston Women’s Health Book Collective published the second edition of Our Bodies, Ourselves [35, 36]. As a part of recognizing women’s unique healthcare needs, one chapter focused specifically on lesbian health issues and the shortcomings of medicine and healthcare in meeting their needs. LGB community centers and activists began to consider the possibility of unique health issues and disparities in need of specialized attention.

The history of the LGBT health movement in the United States is inextricably linked to long-running political, social, and scientific associations between LGBT people and health. Consistent with Foucault’s understanding of the relationship between sexuality and power, efforts to gain social and legal recognition as a minority group required LGBT people to also challenge notions of “normal” and “healthy” sexuality [19]. Early efforts to protect LGBT people against societal stigma and prejudice motivated LGBT communities to provide themselves with better health services than they could not obtain in general population settings. In their earliest form these health services consisted predominantly of general medical, mental health, and sexual health services at LGBT organizations operating small health clinics [5, 37, 38]. These organizations soon included such specialized services as hospice, grief counseling, cancer prevention, peer support groups, and 12-step programs in the era of HIV, the stigma from which left many without access to care in the general population healthcare settings [1, 2].

 

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http://doi.org/10.1371/journal.pone.0180544

 

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