National Coming Out Day Shines Spotlight on UCSF Lesbian Health & Research Center

One of the biggest challenges lesbians face when seeking health care is the complexity of talking openly about health issues with a clinician without the stigma of judgment, disapproval, and condemnation or the fear of having care withheld. It is a concern that is represented in the theme of this year's National Coming Out Day: "Talk About It." This nationally recognized day takes place every October 11 to help all people - gay, lesbian, bisexual, transgender and straight - talk openly about their support for equality. The UCSF Lesbian Health & Research Center (LHRC) was founded in 1999 to address these issues and to support research and education for what an Institute of Medicine (IOM) report that year named as an "underserved and overlooked community" as it relates to health matters. "There is a great need for more information on the health care status of lesbians, bisexual women and transgender people," said Diane Sabin, DC, executive director of LHRC. "This is still a new field of study and we're only starting to see the results of evidence-based research. That any information exists at all, given the paucity of funding and non-existent federal government support is a testament to the vision and tenacity of those who have come before us." Vision and Leadership The leadership at LHRC has recently expanded to include two new members. Sabin, named as the new LHRC executive director in July, is also the associate director of the UCSF National Center of Excellence in Women's Health (CoE). Ellen Haller, MD has been appointed as a new co-director. Haller, an adjunct professor of psychiatry and director of the Adult Psychiatry Clinic at Langley Porter Psychiatric Institute, also serves as the chair of the UCSF Chancellor's Advisory Committee on Gay, Lesbian, Bisexual and Transgender (GLBT) issues. "The work that has been accomplished to date is incredibly significant," said Sabin. "LHRC is the only center located in a premier health sciences institution in the United States and internationally. Our mission is to enhance clinical practice and inform public policy about the health needs of, and delivery of services to: lesbians, bisexual women, transgender people and our families. Our ability to directly work on these issues as well as collaborate with others is essential to improving the health of our community." LHRC was created by Suzanne Dibble, RN, DNSc, and Dixie Horning, executive director of the CoE. Dibble, an adjunct professor in the UCSF Institute of Health and Aging, has served as the center's co-director since its onset. "She has really worked tirelessly to expand research on lesbian health," said Sabin. Teaming with Dibble has been co-director Patty Robertson, MD, a professor in the department of Obstetrics, Gynecology and Reproductive Sciences, who teaches widely on LGBT health and is renowned in the field. Robertson successfully changed the medical school curriculum to include health care needs of LGBT people. A two-hour course was created to teach second-year students such nuances as how to comfortably interview patients, ways that bias adversely affects the health of LGBT people and specific health care needs. "This course speaks to Patty's vision as well as the 'power of students,' since two students actually petitioned to have curriculum that would address the health care issues of gay men, lesbians, bisexuals and transgender people," said Haller. "We'd like to eventually branch out to offer seminars and training to front line and emergency room staff and to have the other UCSF schools also have inclusive curriculum. There's a need for this type of outreach and education, which is one of our primary goals." LHRC is a collaboration of the School of Nursing, School of Medicine and the National Center of Excellence in Women's Health. According to Sabin, since funding has been limited by the federal government under the Bush administration, the center has relied on private donors as well as grants from the California Endowment, Dorian Fund, Folsom Street Events, Fountaingrove Lodge, Horizons Foundation, Lesbian Health Fund, and the San Francisco Foundation. One of the most common questions asked of the LHRC is the difference between lesbians and heterosexual women with regard to health care. It is a question that receives a direct response. "Ours is a population that has been hidden and not sufficiently studied scientifically, so there is little evidence-based research on lesbian health," said Haller. "Some data does exist though, and it suggests that lesbians have slightly higher rates of smoking, substance abuse, obesity and depression compared to heterosexual women. For many other aspects of health, we actually don't know yet what the differences are, if there are any." To illustrate her point, Haller described a scenario where a 70-year-old lesbian probably has more in common with respect to her health to a 70-year-old heterosexual woman than she would to a 30-year-old lesbian. The 30-year-old may have had difficulty finding and accessing knowledgeable clinicians, paying for her health care, and avoiding discrimination. "To alleviate the anxiety and discomfort lesbians face in a doctor's office, especially when asked if they're on birth control or who their husband is, it would be beneficial to have certain data in advance," said Haller. Haller said there should be a standard practice to have questions about sexual orientation and gender identity on patient information forms just as one is asked about age and race. "We are very interested in furthering this area by working in coalition with others with regard to issues of cultural effectiveness. We want what is commonplace in San Francisco to become commonplace everywhere," added Sabin. Research Opportunities Research studies are currently taking place that relate to mood, parenting, smoking cessation, same-sex couples and breast cancer. In addition, LHRC has been asked to serve on a national advisory committee for a CDC funded grant on lesbian health, will review the curriculum, and design the evaluation tools for this research project. "We want to foster research that explores resiliency," Sabin explained. "That is to say, in the face of so many obstacles, why is it that many of us not only function, but thrive? We want this information to increase the health of our community. We need this information for all groups that experience health disparities." For the LHRC, opportunities for research projects are endless. "For researchers, this is essentially an untapped segment of the population that has many precedent-setting opportunities," said Sabin. "This is an appreciative and cooperative community that welcomes attention and is hungry for more knowledge. There are so many areas to explore, whether it pertains to specific medical conditions, lack of health insurance, or domestic partnership benefits and legal status. In fact, what good are our legal rights if we don't have our health?" The LHRC maintains a small staff with one program coordinator, Lisabeth Castro-Smyth, and several interns. They handle everything from calls seeking referrals for lesbian doctors around the country, to maintaining a web site that receives more than 800,000 hits from around the world, to coordination of educational programs - including the upcoming Lesbian Health Institute. The Lesbian Health Institute takes place on Wednesday, Oct. 11 from 1 to 5:30 p.m. at the Renaissance Parc 55 Hotel in San Francisco. This half-day presentation of speakers is an official pre-conference institute that takes place as part of the Gay and Lesbian Medical Association's 24th annual conference. At this forum, experts from across the country will present research findings on a variety of lesbian health topics that include cancer risk, tobacco and alcohol use, two-spirit identity and sexuality. Both Sabin and Haller agree that there is much work ahead. "It's an educational process," said Haller. "If you grow up hearing negative messages about gay people, you may end up internalizing those messages and feeling badly about yourself for being a lesbian. As a result of the stigma in society against women who love women, many lesbians may avoid taking good care of their health. The bottom line is that we simply don't know enough yet about lesbian health to completely and adequately guide both patients and clinicians - and we are dedicated to finding these answers." On October 11, UCSF will hold a celebration of National Coming Out Day. All LGBT staff, students, post-docs, faculty and their allies are welcome. Related Links: Lesbian Health Resource Center Gay & Lesbian Medical Association National Coming Out Day Celebration at UCSF Parnassus Campus UCSF Lesbian, Gay, Bisexual and Transgender Resources