The Gay and Lesbian Medical Association (GLMA) is a national nonprofit organization based in San Francisco. GLMA’s mission is to make the health care environment “a place of empathy, justice and equity.” The organization began in 1981 as the American Association of Physicians for Human Rights. It became the Gay and Lesbian Medical Association in 1994 to broaden its visibility, leadership, education and advocacy.
GLMA aims to increase the visibility of the specific health concerns of lesbian, gay, bisexual and transgender (LGBT) patients. Although HIV has been the focus of gay health care activism in the past, GLMA addresses a broad spectrum of health issues affecting the gay community, including disparities in treatment and growing difficulties in acquiring funding for research that addresses these issues. According to GLMA President Kenneth Haller, MD, health care providers often assume that their patients are straight, thus missing questions or considerations that might apply to gay patients. Meanwhile, the Bush administration’s prohibition of language referencing homosexuality in grant proposals has restricted the amount and quality of research being conducted on gay health issues.
GLMA says its members provide expertise and credibility in its policy advocacy efforts, which are especially dedicated to expand access to high-quality health care. GLMA members represent the interests of thousands of LGBT physicians, medical students, and increasingly other health care professionals, as well as millions of patients throughout North America who seek equality in health care access and delivery.
To accomplish its goals in these areas, GLMA holds conferences and seminars to provide continuing medical education to health providers, researchers, policy makers and students. The Lesbian Health Fund was established in 1992 to fund research in several areas specifically affecting lesbians, including what GLMA calls “dangerously indequate medical care,” high rates of suicide, increased incidence of stress-related chronic illnesses, and avoidance of preventative health services.
GLMA also mobilizes its membership on policy issues through its email alert system, called GLMA*PAN. The organization uses the listserv to encourage its membership to advocate for administrative and legislative changes to promote health and civil rights. Another tech tool offered by GLMA is its online health referral service, which helps patients find gay-friendly physicians and other health care professionals who are GLMA members. In an interview with DAHC, President Kenneth Haller talked about GLMA’s challenges as an organization, common problems faced by LGBT patients, and his hopes for the future.
How did GLMA evolve from an association for physicians to one that now includes other health care workers in its membership?
“GLMA has been in existence as a freestanding association dedicated to eliminating homophobia in health care for more than 20 years. During that time, no other health care profession has been able to create a similar freestanding LGBT organization for themselves. Over the years many people in other health care professions approached GLMA about broadening our scope to include professionals other than physicians. We did so two years ago, and we have been very gratified that membership in the non-physician category has grown steadily. We feel strongly that the more providers we have in our association, the more credibility we will have with government policy makers, and we feel we are beginning to see that come to fruition.”
What is the biggest challenge facing GLMA today?
“The climate in Washington has made it difficult for researchers to focus on LGBT health issues. Earlier this year, for example, there were reports from many researchers that their project directors were telling them to avoid words and phrases like ‘gay,’ ‘transgendered,’ ‘men who have sex with men,’ among others, when they submitted grantproposals to the National Institute for Health (NIH) or Center for Disease Control (CDC). This sort of censorship makes it difficult for researchers to communicate with one another and to communicate their work to health care providers taking care of patients. GLMA connected some of these researchers to the media, resulting in coverage in various outlets including The New York Times, and we created a sign-on letter at our Web site protesting these actions that was signed by 650 GLMA members. The letter was sent to the White House, the CDC, the NIH, and the Department of Health and Human Services, putting them on notice that we wouldn’t take this sort of treatment lying down.”
You’ve just been re-elected for a second one-year term as president of GLMA. Why do you believe this organization is worth such a high level of commitment?
“Two influences really. I did my residency in New York City in the early 1980s, so I came of age as a doctor in the midst of the AIDS crisis. I also grew up in a very liberal Catholic tradition of social justice and have always worked in underserved communities. As I, like so many others, saw how AIDS affected our community, I began to realize how invisible the gay and lesbian community had been to the medical community for years. It’s a matter of simple justice, and I feel that GLMA is best equipped to bring these issues to light and make a difference.”
How can students and young professionals participate in GLMA’s work?
“GLMA has reduced rates for student members, and students make up a significant portion of our volunteer base. Students can be a very important part of GLMA’s advocacy function by signing up for GLMA*PAN alerts, which are emails sent out to alert our members to pending legislation that will impact LGBT health. They can also serve on GLMA committees. Further information is available at our Web site at www.glma.org.
What are some examples of disparities in health care for gay and lesbian patients?
“Well, beyond HIV, there are differences in how gay men contract sexually transmitted diseases. Lesbian women have rates of breast and gynecological cancers that are very different from straight women. Both gay men and lesbians smoke at rates about twice that of their straight counterparts. Rates of substance abuse and risk behaviors seem to be higher among gay and lesbian youth than among the general adolescent population.
“Beyond that, though, is the very issue I touched on earlier—we often have only a vague idea of the particular health concerns of gay and lesbian persons because of how difficult it is to get funding for research into our health issues. This leads to a Catch-22: Without the evidence you don’t get the funding, but without the funding you don’t get the evidence. Obviously, this has got to stop, and GLMA is adamant about the need for increased funding to investigate the state of LGBT health.”
Why do you think it has taken so long for physicians to become aware of these issues? How is GLMA working to make this change?
“I don’t think most health care providers are actively homophobic; these sorts of issues have just never occurred to them. The problem is, when you don’t know to ask the right questions, you may not get the right diagnosis. For example, men who have sex with men and are sexually active may not know that they may have an elevated PSA level after anal sex. The PSA is a test done to see if the prostate is inflamed, and if you have an elevated level, the doctor will often recommend a prostate biopsy. If a patient isn’t comfortable telling his doctor that he’s gay, he may end up getting this procedure—which is painful, expensive, and does have some risk—for no reason.
“GLMA is working on education, not just of LGBT health care providers, but of all providers through materials such as our “Top Ten Health Concerns of Lesbians and Gay Men” and “Guidelines for Creating a Safe Clinical Environment for LGBTI Patients.” These and other instructional materials are available at our Web site at www.glma.org. We are also trying to get funding to distribute these materials more widely. In any case there’s still a lot to do. The need for GLMA is not going to disappear soon, and we intend to be here to keep doing that work.”
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