Q. Can you point me to specific resources that I can use to prepare an inservice to campus health services regarding lgbt health concerns?

A. The GLBT Health Access Project has developed a set of standards of practice for provision of health care services to GLBT clients and their families. They're fairly comprehensive (covering personnel, clients' rights, intake and assessment policies, service planning and delivery, confidentiality, and health promotion/community outreach). You can take a look at the standards at their website, http://www.glbthealth.org. The site provides concise reports on GLBT Health about these specific issues, (including helpful statistics): Specific Concerns and Barriers to Care, Substance Abuse, Violence, Mental Health, Youth, and Health Concerns of the Transgender Community. The Project has also produced a series of health care access posters with the theme "Homophobia in Health Care is Unhealthy." You can request copies from them at

GLBT Health Access Project
100 Boylston Street, Suite 860
Boston, MA 02116
617.988.2605, ext. 201
or email Mary Clark at: maclark@jrihealth.org

The Community Standards of Practice For Provision of Quality Health Care Services For Gay, Lesbian, Bisexual And Transgendered Clients from the GLBT Health Access Project are excellent, and have been required of state-contracted providers in Massachusetts and Tucson. The Health Access Project also has co-authored an excellent, ground-breaking study of the health access needs of transgendered persons (not yet posted on the web, but available from them in print or by e-mail).

The Health Access Project works with Fenway Community Health in Boston to provide trainings and resources to help Massachusetts providers identify and address barriers to care. They are willing to offer trainings or technical assistance to folks working with campus health services.

The Gay and Lesbian Medical Association offers guidelines for health care of gay and bisexual men . Guidelines for sexual risk assessment and cultural competence in treating gay and bisexual men that help create an environment which enables patients to talk openly and honestly with their doctors so that they can receive appropriate treatment. The first set of recommendations, called "Creating a Safe Clinical Environment for Men Who Have Sex With Men (MSM)," cover every aspect of the patient-provider relationship, beginning with the office and waiting room environment and ending with the patient interview. The second set of guidelines, titled "MSM: Clinician's Guide to Incorporating Sexual Risk Assessment in Routine Visits," focuses on the specific HIV and STD risk factors faced by gay and bisexual men. In addition to addressing barriers to appropriate health care treatment stemming from sexual orientation, the guidelines also examine such other impediments as racial, ethnic, and economic concerns. The guidelines were developed by GLMA member Jason Schneider, MD. The full guidelines can be seen on the GLMA Web site at http://www.glma.org/medical/clinical/msm.guidelines.html.

Willa Young, Director of Student Gender and Sexuality Services at The Ohio State Univ, teaches several courses in their College of Medicine each year. She reports that she has learned that the students, as well as health professionals with whom she has contacts, respond best to reading materials drawn from credentialed medical sources. She relies as much as possible on those and supplement in the lectures with my sociologically informed perspective. She has also learned to pair medical citations with citations from other disciplines, which then garners greater respect for the scholarship from non-medical authorities.

Margaret Cook, Program Coordinator for Lesbian, Gay, Bisexual, Transgender Programs at Northern Illinois University, notes that when I did an inservice for hercampus health service, one strategy she used was trying to give them actual feedback from students. She got statements from students about their experiences at the health service, both positive and negative. She typed them up so they were anonymous, and then as part of the workshop had volunteers from among the health service staff read them aloud. It had a huge impact. It made all of the other information very, very real to them, so when we got to brainstorming strategies for being more LGBT friendly, they had concrete examples to fuel their thinking. The positive examples gave them models of what LGBT sensitive health care could look like. The negative statements really helped them focus in on things they could improve.

Here are some materials that might be useful preparing the didactic portion of such a presentation or for sharing with the audience:

Bagley C, & D'Augelli A.R. Suicidal behaviour in gay, lesbian, and bisexual youth. BMJ 2000; 320: 1617-1618 (17 June.)

Bradford, J. & Ryan, C. The national lesbian health care survey: Final report. Washington, DC: National Lesbian and Gay Health Foundation (PO Box 65472, Washington, DC 20035). 1988.

Cabaj,, R.P.& Stein, T.S.. (Eds.) Textbook of Homosexuality and Mental Health. 1996. Philadelphia: AGLP.

Cochran, S.D. & Mays, V.M. Disclosure of sexual preference to physicians by black lesbian and bisexual women. The Western Journal of Medicine, 1988, 49 (5), 616-619.

Collings, S. C. D. & Welch, S. Doctors must be more aware of problems of gay, lesbian, and bisexual youth. BMJ 2000; 321: 767.

Douglas, C.J., Kalman, C.M., & Kalman, T.P. Homophobia among physicians and nurses: An empirical study. Hospital and Community Psychiatry, 1985, 36(12), 1309-1311.

Edelman, D. (1986). University health services sponsoring lesbian health workshops: Implications and accessibility. Journal of American College Health, 35(1) Ð, 44-45.

Finnegan, D. & McNally, E.. Dual Identities: Counselling Chemically Dependent Gays and Lesbians, Center City, Minn, Hazelden, 1987.

Friedman, D. C. Alcoholism in the Gay and Lesbian Community , Evanston, Il: National College of Education, 1989.

Gillow, K.E. & Davis, L.L. Lesbian stress and coping methods. Journal of Psychosocial Nursing, 1987, 25(9), 28-32.

Hall, J. An exploration of lesbians' images of recovery from alcohol problems. Health Care of Women International, 1991, 13(2), 181-198.

Harrison AE. Primary care of lesbian and gay patients: educating ourselves and our students [see comments]. Fam Med 1996 Jan;28(1):10-23

Hitchcock, J.M. & Wilson, H.S. Personal risking: Lesbian self-disclosure of sexual orientation to professional health care providers. Nursing Research, 1992, 41(3), 178-183.

Irish, A. Straight talk about gay patients. American Journal of Nursing, August, 1983,1168-70.

Johnson, S.R. & Guenther, S.M. The role of "coming out" by lesbians in the physician-patient relationship. Women & Therapy, 1987, 6(1-2), 231-38.

Johnson, S.R., Smith, E.M., & Guenther, S.M. Comparison of gynecological health care problems between lesbians and bisexual women: A survey of 2345 women. Journal of Reproductive Medicine, 1987, 32(11), 805-11.

Lapsley H. Mental health issues for lesbians. In: Romans S, (Ed). Folding back the shadows: a perspective on women's mental health. Dunedin: University of Otago Press, 1998:137-146.

Leiblum S.R.; Palmer M.G.; & Spector I.P. Non-traditional mothers: single heterosexual/lesbian women and lesbian couples electing motherhood via donor insemination. J Psychosom Obstet Gynaecol 1995 Mar;16(1):11-20

McFarlane, E. Diagnosis homophobicthe experiences of lesbians, gay men and bisexuals in mental health services. London: Project for Advocacy, Counselling and Education, 1997.

McKee M.B., Hayes S.F., & Axiotis I.R. Challenging heterosexism in college health service delivery. J Am Coll Health 1994 Mar;42(5):211-6

Moran N. Lesbian health care needs. Can Fam Physician 1996 May;42:879-84

Perrin , E.C. "Pediatricians and Gay and Lesbian Youth," Pediatrics in Review, v. 17, no. 9: pp. 311-318.

Remafedi, G. (ed.) Death by denial: Studies of suicide in gay and lesbian teenagers. Boston: Alyson. 1994

Shernoff, M. & Scott, W. A. The sourcebook on lesbian/gay health care (2nd edition). Washington, D.C.: National Lesbian and Gay Health Foundation. 1988

Solarz, A. L. (Ed.) Lesbian Health: Current Assessment & Directions For The Future. Institute of Medicine of the National Academy of Science. 1999. Available from the National Academy Press. You can purchase it from their website or read it on-line for free.

Stevens, P., Tatum, N., & White, J. "Optimal care for lesbian patients." Patient Care, March 15, 1996

Stevens, P.E. & Hall, J.M. Stigma, health beliefs, and experiences with health care in lesbian women. Image, 1988, 20(2 ), 69-73.

Swetnam, A. Inside The Invisible Minority: Addressing the Special Issues of the Addicted Patient is Gay or Lesbian, Park Ridge, Il, Parkside Publishing.

Taylor I & Robertson A. The health needs of gay men: a discussion of the literature and implications for nursing. J Adv Nurs 1994 Sep;20(3):560-6

Trippet, S.E. & Bain, J. Reasons American lesbians fail to seek traditional health care. Health Care for Women International, 1992, 13(2), 145-154.

Welch S, Collings S, Howden-Chapman P. Lesbians in New Zealand: their mental health and satisfaction with mental health services. Aust NZ J Psychiatry 2000; 34: 256-263.

White, J. & Martinez, M.C. The Lesbian Health Book: Caring for Ourselves. Seattle: Seal Press. 1997

Kaiser Permanente has also just released a Provider's Handbook on Culturally Competent Care for LGBT people. It's much longer than the Community Standards, with text, numerous references, and model intake form. Thus, it is also very effective with a provider audience. It's not available electronically; but print copies can be obtained from Kaiser's National Diversity Department at 510-271-6485.

The Journal of the Gay and Lesbian Medical Association also has articles which may be useful in preparing your presentation.

Here are some other websites that can provide useful information:

Association of Gay and Lesbian Psychiatrists (AGLP). Their site offers an LGB parenting bibliography and Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients.

Gay and Lesbian Medical Association: This site includes the GLMA-Columbia University White Paper on LGBT Health.

Gay Men's Health Project (United Kingdom): Their site includes two guides for general practitioners and general practice staff: One Small Step is a brief guide to working with gay and bisexual men; Small Effort, Big Change is their exhastive booklet about the subject. Both are downloadable.

Lesbian Community Cancer Project (Chicago). This site offers their breast self-exam animation -- the first of its kind to be offered on the Web.

Lesbian Gay and Bisexual People in Medicine (LGBPM AMSA): The site includes a down-loadable PowerPoint presentation of Homosexuality in Adolescents: Risk factors and Co-morbidities.

Mautner Project for Lesbians with Cancer (New York) offers Removing the Barriers to Accessing Health Care for Lesbians -- a special project aimed at building the skills of health care providers and promoting change in health care institutions through training and technical assistance. See their website for more information. You can also order materials from them (the order form can be downloaded as a PDF file from their website), including “Tools for Caring About Lesbian Health” Training Package (MP-004) for $25.00 plus $6 shipping and handling. The also have other materials that a campus health center might want to purchase for distribution to students.

Transgender Education Network: Their site includes the Gender Continuum of Terms and The Standards of Care For Gender Identity Disorders. They also have the New England Guide to Transgender Resources which includes a bibliography of transgender materials.

Check out this related FAQ: 
Where can I find inexpensive (or better yet, free) resources on health issues for LGBT folks?

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