50 Years After Stonewall, the LGBTQ Health Movement Embodies Empowerment, Expertise, and Energy

The Stonewall riots in June 1969 unleashed a torrent of gay activism, and the arena of lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) health grew from a tiny seed into an essential aspect of the emerging queer communities. There is no escaping that the audacity of gays, lesbians, bisexuals, and drag queens (labeled as such at the time, but likely inclusive of people we call “transgender” today) who fought the police at the Stonewall lit a fire of empowerment among LGBTQ people across the United States and around the world.

GAY IS NOT A DISEASE

Initially, for those interested in promoting a message that being gay could be healthy, there was a one-point program: overturn the diagnosis of homosexuality as a mental disorder within the field of psychiatry. In 1973, the American Psychiatric Association (APA), following years of lobbying by gay activists, asked members attending its annual convention to vote on whether they believed homosexuality was an illness. If it was not an illness, the APA would have to remove the diagnosis of “homosexuality” from the Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II)¹; 5854 psychiatrists voted to remove homosexuality from the DSM, and 3810 to retain it. At the time, APA implemented a compromise, removing homosexuality from the DSM-II but replacing it with “sexual orientation disturbance” for people “in conflict with” their sexual orientation. It took until 1987 for homosexuality to be completely removed from the DSM.²

EARLY ORGANIZATION

The concept of LGBTQ health did not exist before Stonewall, and only began to emerge in the late ’70s through the formation of the National Lesbian and Gay Health Foundation in 1977,³ which later became the National Lesbian and Gay Health Association. During this period, there was a growing body of work on the topic coming less from medicine than from queer political theory, psychology, social science, sociology, and education. It was modeled on other liberation movements including the women’s liberation movement, which generated the self-empowerment book Our Bodies, Ourselves in 1970—women speaking directly to other women about their bodies and their physical, mental, and spiritual health.⁴

Another phenomenon of the 1970s was the growing Community Health Center Movement, sometimes called the Free Clinic Movement. These were medical clinics created on a model of self-empowerment—physicians volunteered their time, sometimes occupying unused or underutilized spaces in parts of the United States where people lacked access to quality health care. Fenway Health, originally known as Fenway Community Health Center, was founded in 1971 in the Fenway neighborhood of Boston, Massachusetts, to provide services to elderly residents and soon to provide sexually transmitted infection screening and treatment to gay men. It soon became the first community health center to develop expertise in lesbian, gay, and bisexual (LGB) health services in response to the demographic needs of its own staff and clients.⁵ Other community centers expanded to address gay and lesbian health concerns in Los Angeles, California; New York, New York; Chicago, Illinois; and Philadelphia, Pennsylvania.⁶

THE ’80s: CATASTROPHE AND TRANSFORMATION

In the early ’80s, lesbians were concerned about the paucity of information available about the physical and mental health of lesbians. A few young researchers, public health professionals, and health care professionals organized the first National Lesbian Health Care Survey. From 1984 to 1985, the survey organizers utilized grassroots methods to circulate the survey to lesbians around the country, such as mailing information about the project to organizations identified as serving or working with lesbians, traveling to various parts of the country to promote the survey, and relying on word of mouth.⁷

In the 1980s, AIDS was first identified, and the gay community—barely a decade after Stonewall—had to face the emergence of a deadly illness that was spreading quickly, had no treatment or cure, and for which transmission vectors were only partly understood. As pointed out by Halkitis in his editorial (p. 851), HIV and AIDS forced the LGBTQ community to focus its resources on pushing the health care system to care for and attend to the needs of many gay men, bisexual men, and transgender women, with lesbians, bisexual women, and transgender men frequently at their side as caregivers. The LGBTQ community built its response to the epidemic by embracing self-determination concepts such as The Denver Principles (http://data.unaids.org/pub/externaldocument/2007/gipa1983denverprinciples_en.pdf) which codified the concept of “nothing about us, without us” and substituted the term “people with AIDS” for “AIDS victim.”

THE POWER OF POPULATION-BASED DATA

In the 1990s, there were successful attempts in some state and local jurisdictions to include questions about sexual orientation on health surveys such as the federally supported Behavioral Risk Factor Surveillance System and the Youth Risk Behavior Surveillance System. These questions provided, for the first time, scientifically valid data on LGB respondents, enabling public health workers to identify health disparities between LGB people and their heterosexual counterparts.

At the end of the second Clinton administration, with valid measure of health disparities available for the first time, the Department of Health and Human Services published its Healthy People 2010 document, which included 29 health disparities faced by LGB persons. In addition, they awarded funding to support the first ever Companion Document for LGBT Health to Healthy People 2010, released in 2000 (http://www.nalgap.org/PDF/Resources/HP2010CDLGBTHealth.pdf). The Healthy People series is the federal framework for identifying and addressing objectives to improve the nation’s health. Previously, there had been companion documents focused on the disparities faced by women and racial/ethnic minorities, and the Companion Document for LGBT Health expanded greatly upon the identified disparities and explored other areas in which research had indicated that other disparities might exist.

Thus, activists across the country set out to identify reliable and valid measures to identify LGBT people. Two notable efforts included a study of best practices related to measuring sexual orientation (https://williamsinstitute.law.ucla.edu/wp-content/uploads/SMART-FINAL-Nov-2009.pdf) and another to identify best practices for asking questions about gender identity (https://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf).

However, as recently as 2017, the Department of Health and Human Services proposed eliminating questions about sexual orientation and transgender status from the annual National Survey of Older Americans Act Participants. Successful lobbying by the LGBTQ community succeeded in reversing the decision with respect to sexual orientation, but did not succeed in maintaining the questions about transgender status (https://www.publichealthpost.org/research/if-they-dont-count-us-we-dont-count). As Bockting points out in his editorial (p. 852), transgender health issues have diverged from the health concerns of LGB people, with significantly different approaches to educating and transforming both the private health professions and government public health programs.

In June 2001, this journal would feature its first-ever theme issue on LGBT health—perhaps the first of its kind in a mainstream health or public health journal. Today, many scientific journals publish articles on LGBTQ health and specialized study of LGBTQ health can be conducted at the graduate level at several universities. Of necessity, health care providers and public health program planners look at the health and social needs of gay and bisexual men in a holistic way rather than address only HIV disease. The underlying infrastructure to address the health issues of LGBTQ people continues to grow, fueled along the way by the Stonewall notions of empowerment and activism. As a result, the LGBTQ community is more prepared than ever to monitor and address its health challenges.