A study by the Boston University School of Public Health has found a need to create health programs specifically promoting the well-being of lesbian, gay, and bisexual cancer survivors. The research was lead by Ulrike Boehmer, associate professor of community health sciences.
The results found that gay men were 1.9 times more likely to report a cancer diagnosis than heterosexual men. Though there were no significant differences in cancer prevalence among women with varied sexual orientation, the study showed that lesbian and bisexual cancer survivors were respectively two and 2.3 times more likely to report fair or poor health than heterosexual cancer survivors.
In a BU Today article, Boehmer says the differences in the prevalence of cancer survivorship raises questions about possible differences in the cancer rates by sexual orientation. She also says they can only speculate that HIV status may have contributed to the higher cancer prevalence in gay men, but they were unable to address this in the study since they didn’t have data on the participants’ HIV status.
The significance of the study, according to Boehmer, is the finding that sexual orientation may be a factor in cancer incidence and outcomes. The study concludes saying lesbian and bisexual cancer survivors need to be targeted by programs and services to better assist them in improving their health perceptions. The study also suggests health care providers and public health agencies need to be made aware of the higher prevalence of cancer in gay men through increased screening and primary prevention.
The study was published online in Cancer, a peer-reviewed journal of the American Cancer Society, and included data from the California Health Interview Survey.
Lesbian, gay, bisexual and transgender (LGBT) persons are 50% to 200% more likely to smoke than the rest of the population, according to the National LGBT Tobacco Control Network. That’s one of the highest smoking rates of any minority group in the U.S. In 2005, the American Cancer Society estimated that over 300,000 LGBT people die each year from tobacco-related diseases. Given the tobacco industry’s well-documented history of aggressively marketing its products to racial/ethnic minorities and women, it’s no surprise that Big Tobacco targets this community, too—e.g., by offering financial support to LGBT festivals, bars, media and local organizations.
Still another factor contributing to LGBT smoking disparities is a lack of anti-smoking interventions that are culturally tailored to this population. To help close that information gap, the Boston-based National LGBT Tobacco Control Network offers a wealth of culturally competent resources for both smokers and health care professionals. For example:
- Fact sheets on topics like LGBT people and tobacco, smoking and HIV, and anti-tobacco community organizing.
- Smoking cessation strategies and tips for smokers and clinicians.
- A national directory of LGBT tobacco control professionals and projects.
- An online resource library with links to LGBT tobacco control events, publications, research, Web sites and downloadable LGBT-friendly anti-smoking materials.
- An annual LGBT Tobacco Summit that brings together tobacco control leaders from across the country to share solutions and best practices. This year’s summit will be held on June 9 in Phoenix, Arizona.
To further promote the sharing of information about what’s working in LGBT tobacco control efforts, the network publishes a quarterly newsletter, Sharing Our Lessons, that showcases successful model programs. A recent issue featured an in-depth case study of a Minnesota project that helped make the state’s tobacco quitlines more accessible to LGBT people.
For more information, visit www.lgbttobacco.org.
How do gay, lesbian, bisexual and transgender (GLBT) nurses handle the issue of their sexuality in the nursing workplace? Are they “out” at work? Do they encounter discrimination from patients and co-workers, and if so, how do they deal with it? Is their sexuality an asset, a liability or a non-issue when it comes to being a nurse?
As a gay man who is also a nurse, I am very interested in exploring these issues. I recently spent some time searching Internet nursing forums and came across a very enlightening thread. I’d like to share some of the posts with you.
The discussion began with a gay nurse asking other gay nurses for advice on how they deal with questions from patients about their home life, such as “Are you married?” The conversation quickly turned to more general comments on the broader issues of acceptance of gays in the workplace and being “out” versus “in the closet” at work.
From a nursing assistant and Army medic: “There is NOTHING wrong with keeping your personal life (whatever that may be) COMPLETELY apart from your work life. That’s what professionals do.”
A nurse in Texas responds: “That’s not the real world, professional or not. Keeping my personal life completely apart from my work life is what I attempted to do many times over, but. . .it only leads to more questions, more probing and just as much if not more gossip and stories about you. Not that gossip in the workplace should rule how you react to it, but in my experience it just ends up making things worse when you act vague and mysterious about your personal life.
“For me, it has always been a struggle between [how to deal with] the ‘if you’re gay I don’t want to know about it’ straight co-workers and the ‘inquiring minds want to know’ types,” the post continues. “For the latter types, fine. Here’s my oh-so-interesting gay life. Pretty ordinary and not much different from yours. For the former types, I’ve always found it interesting that the same nurses who fall into the ‘keep your private life to yourself’ category tend to be the same ones who constantly talk about their [spouses] and children at the nurses’ station all day.
“Can all of you [nurses] out there who insist that your private lives are completely separate from your professional lives honestly say that you never make any mention of a spouse or love interest to your co-workers, whether voluntarily or [in response to] questions from your peers? [Or that you] only discuss professional work-related issues with them?”
Another poster argues, “When I am at work, I am a nurse. I leave my personal life where it belongs— at home, not work! I would never engage in discussions about my personal life at work, because I am there solely to ensure that my patients receive the best quality care.”
A critical care nurse in Texas comments at some length: “I disagree that you can work in such close environs and not share some personal information with your co-workers. Establishing professional relationships requires some personal disclosure. [People] don’t live in compartments— professional here, personal there. If you withhold all [information about] personal relationships, you will have a problem with being considered aloof or cold—and that would affect your professional relationships.
“It has been my experience that most nurses’ stations are literal Peyton Places of personal information. I couldn’t see how you could hide who you are for long. The effort to do so would seem to me to just cause too much dang stress—. “Will some people be comfortable with [your sexuality] and others uncomfortable? Of course. You have to read each individual and [then decide to give or not give] details of your life based on [how accepting you think that person would be]. That’s not the same as saying that you should remain ‘in the closet’ to co-workers who would have a problem [with your being gay], but you can certainly de-emphasize your conversation [about that aspect of your life when you’re working with them]. The bottom line is: as co-workers we have to work together, which means some give and take on lots of issues, including this one.
“I would think that [in this day and age] most of your co-workers would have come to terms with this issue anyway. It is my experience that there is either a higher percentage of gays in nursing [than in other professions] or at the least, a higher percentage of gay nurses who are willing to be ‘out’ about it. As such, most of your co-workers should have had ample opportunity to ‘get [used to] it.’
“As far as patients go, your relationship with them is far more temporary. I would think it would be, if not appropriate, then certainly more convenient to not bring it up and only disclose that information rarely, [especially if you are working with older patients]. The older generation is much more fixed in their [biases and stereotypes], and a few days’ exposure to a challenge of those stereotypes is not going to change them, [especially if] they are sick enough to be in the hospital or a family member who is stressed over their loved one being in the hospital.”
What an interesting and revealing conversation! These posts shed light on some important issues that are all too often overlooked in discussions about the need for more diversity in the nursing workforce. Above all, they show that while GLBT nurses face many of the same biases and barriers to acceptance as racial and ethnic minority nurses, we must also deal with a whole set of other challenges that are uniquely our own.
To Thine Own Self Be True
As a gay RN who is now in his 40s, I have seen the incidence of homophobia in the workplace decline quite a bit in recent years. Of course, that’s partly because I moved from Georgia to more liberal California to escape some of that. But all in all, it’s a more accepting workplace.
Like other groups who are perceived as “different” by the majority population, GLBT people have had a tough time as a minority in society. I remember when I was in my 20s and saw my first gay bashing. Then, when [21-year-old gay college student] Matthew Shepard was beaten to death [in Wyoming in 1998], it put homophobia in the national spotlight.
Since then, many states and organizations have taken action to protect GLBT people from various kinds of discrimination, including employment discrimination. While it’s still legal in 26 states to fire someone because of his or her sexuality, another 25 states have laws on the books protecting homosexuals from workplace discrimination. Some of the gay participants in the abovementioned Internet nursing forum say they rely on their hospital’s code of ethics to protect them from harassment in the workplace.
As for myself, I’m out at work. I have a partner of six years and I find (some) men attractive. That’s who I am. I have a sexuality and while it’s not really part of my work life, I am not going to hide it in fear. It is just as beautiful and worthy of respect as any other part of me or anyone else. We owe it to the next generation to leave this world in better shape than we found it. I do that, in part, by fighting homophobia and promoting tolerance. I perform my nursing care in a nonjudgmental fashion and I don’t expect to be judged if my sexuality is revealed in casual conversation.
Nursing is, by its nature, a very personal profession. We perform embarrassing and sometimes painful procedures on people, and so our patients sometimes want to know a little bit about us. Accepting who I am allows me to better accept other human beings for who they are. Some people are in a mindset that requires some personal growth before they can be accepting of gays— or blacks, or Indians or any other minority. It’s not for me to shelter them from my sexuality and stunt their growth nor to judge them. I owe it to the world to be a good person and a worthy nurse who, among many other things, is an unashamed homosexual. I don’t accept intolerance and I point it out when I see it.
Based on those Internet forum posts, it would appear that the main concerns on the minds of today’s GLBT nurses are about disclosure— whether to hide or downplay their sexuality at work or to stand up for their right to be accepted as who they are. That this is still an issue clearly shows how laws against equality for gay people—such as the recent Proposition 8 in California, which took away same-sex couples’ right to marry—can be passed in this modern age. If gays are afraid to stand up and be counted in the workplace, then people who are on the fence regarding GLBT rights will never know who we are and what great people we are. They will never know what positive role models we are as nurses and as minorities fighting for acceptance in society. And most importantly, they will never know about the unique qualities, knowledge and insights we bring to the nursing profession and to patient care.
We bring compassion and a special advocacy for the underdog. We have known discrimination and the fear that comes from being different. GLBT nurses turn this into an ability to strive harder to meet the needs of minority patients and the underserved. We know what it’s like to have to work twice as hard as other people to reach the same goals. We cherish the things it takes us more effort to achieve, such as marriage, children and equal rights under the law. We respect people for who they are as individuals, regardless of skin color, gender, age or affliction. That’s what GLBT nurses bring to the nursing workplace. Now it’s time for us to step up and be recognized for those contributions. I urge all GLBT nurses to bring one more very important thing to the work we do: the willingness to stand up and be proud of who we are.
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.”
The U.S. pharmaceutical industry has been in a five-year hiring frenzy. IMS Health, a leading source of market information for the pharmaceutical industry, forecasts that both pharmaceutical and biotechnology companies will continue to experience growth that outpaces that of the overall economy for the foreseeable future. This steep growth curve spells opportunity for new college graduates considering a career in pharmaceuticals. The industry has recognized the value of attracting and retaining a diverse workforce and is actively pursuing graduates from many different backgrounds. Within many organizations, the workforce diversity they embrace not only encompasses race, gender and disability status, but also has been expanded to include lesbian, gay, bisexual and transgender (LGBT) employees.
What do you do if you are a gay man or lesbian looking for a job in the pharmaceutical or biotechnology industry? How do you know which potential employers have a demonstrated commitment to diversity and especially to their LGBT employees? An excellent place to start is the Corporate Equality Index published annually by the Human Rights Campaign (HRC) Foundation. HRC is an organization that works to advance equality based on sexual orientation and gender expression and identity. In 2003 the index rated 250 employers that can be found on either the Fortune 500 list of the largest publicly traded companies or the Forbes 200 list of the largest privately held firms. An additional 112 employers with at least 500 employees were also included. Companies were surveyed and rated on a scale of 0% to 100% based on seven factors that demonstrate how the companies treat LGBT employees, consumers and investors. Nineteen pharmaceutical and biotechnology companies were rated in this year’s index. Sixteen had scores of 57% or higher, indicating positive responses on at least four of the seven factors, with Bausch & Lomb Inc. scoring a perfect 100%. (To see how other pharmaceutical and biotech employers scored, see the chart below.)
Gaining the Support of Your Employer
One of the seven factors on the HRC survey is whether the companies “officially recognize and support a gay, lesbian, bisexual and transgender employee resource group; or would support employees’ forming a LGBT employee resource group if some expressed interest by providing space and other resources; or have a firm-wide diversity council or working group whose mission specifically includes LGBT diversity.”
Employee resource groups (also known as affinity groups) are expanding in number as more and more companies focus on diversity for a competitive advantage. However, groups often develop at the grassroots level, before formal diversity initiatives are in place. As corporate sponsorship increases, the groups can help spread diversity messages to the rest of the company. Resource groups are usually formed around what are known as the “primary dimensions of diversity”: age, race, physical disability, gender, ethnicity and sexual orientation.
Genentech, a biotechnology leader headquartered in South San Francisco, Calif., is a strong supporter of employee resource groups and offers one that focuses on LGBT issues. (See sidebar “Genentech’s Out & Equal Diversity Network Association”.) Sandra Manning, co-chair of Genentech’s Out & Equal (GO&E), states that “at Genentech, it is truly believed that when an employee can arrive at work free of inhibitions or worries, then that person will contribute fully to their work and to the company’s goals. That is what is so great about a corporate culture that embraces diversity.”
Resource groups work to support their companies’ business in four common ways:
Education. An educational forum is one of the most useful benefits a resource group can provide to both its members and the company. For instance, busy employees may not know all of the details surrounding the domestic partnership benefits that the company offers. (Lobbying to get them is often the first goal of a LGBT resource group if they are not already available.) The same holds true for benefits available to registered domestic partners in the states where the company does business, and updating members on pending legislative issues such as the Employment Non-Discrimination Act (ENDA). More ambitious projects include educating and increasing the awareness of all employees about their gay and lesbian colleagues.
Educational programs need not, indeed should not, be limited to LGBT issues. A powerful way to align the resource group’s objectives with those of the company is to sponsor lectures open to all staff members on professional development and corporate issues. For example, invite a senior manager from research, manufacturing or sales to speak about what their departments do and what their greatest challenges are. Other educational offerings can include maintaining a library of current books and publications relevant to LGBT professional issues, and facilitating a book club that covers general business and leadership related topics from a LGBT perspective.
Networking. Social events provide an excellent opportunity to meet with people from across the organization, which is good for exchanging information and developing professional contacts. Networking is an informal way to learn how different parts of the company contribute to the organization’s overall goals. Such knowledge is useful if you want to make a lateral move within the company, and it also becomes increasingly valuable as your career advances.
Genentech’s Manning says, “Since GO&E meets monthly to plan activities throughout the year, people attending the meetings make an impact on each other simply by introducing themselves. We meet new members who are from various departments in the company, we learn a little about our different roles, and how we each contribute to the goals of Genentech.”
Meeting gay and lesbian colleagues at higher levels in the organization also fosters mentoring opportunities. In addition, resource groups often have sponsors who are high-ranking employees within the company that offer advice and guidance on group activities. Membership in a resource group, and especially holding a leadership position, can provide access and visibility that might not normally be available in your job.
Networking opportunities can expand well beyond the company. Community outreach activities allow members to interact with LGBT philanthropic organizations. Connecting with other corporate LGBT resource groups in the same city and across your industry can infuse your group with new ideas and energy. Two formal programs provide a structured way for gay and lesbian professionals to come together: The Out & Equal Workplace Summit is an annual three-day event culminating in the Outie Awards Gala and the LGBT Leadership Institute sponsored by the Anderson School at UCLA offers a week-long symposium covering a full range of gay and lesbian employment and career issues.
Recruitment and Retention. Finding talented and highly skilled employees is a constant challenge for pharmaceutical companies. Once they find the right employees, companies want to keep them. Manning adds, “Genentech’s GO&E group works to help accomplish the goals of the company and, in turn, Genentech supports GO&E in order to retain its highly valued human resources.”
The presence of an LGBT resource group is a strong indicator of the corporate culture’s attitude toward and acceptance of gay and lesbian employees. The groups foster a sense of community within the company, and make a gay or lesbian employee more likely to stay. Often, personnel who have been hired recently are not only new to the company, but also new to the city. A resource group provides an immediate social circle and can help smooth the transition to the new area—this reduces stress and makes a new employee more productive, faster.
As the workplace becomes more open for gay and lesbian employees, and candidates become more comfortable addressing GBLT issues before they are hired, the demand for information on diversity policies and corporate attitudes will increase. Resource groups can assist on this front in several ways. They can help the company identify talent pools by providing the human resources department with recruitment contacts for LGBT professional societies and college or university alumni associations. Group members can serve on panels for human resources during the interview process. A savvy candidate may request an informational interview with a gay or lesbian employee before accepting an offer. New hire orientation packets should include contact information for all corporate diversity groups along with listings of local organizations and community events.
Community Outreach. Resource groups can do good deeds while also building the company’s image through community outreach programs. Activities can take the form of directed giving, volunteerism and corporate sponsorship. Directed giving involves identifying worthwhile charitable organizations that the group can support by combining individual member contributions. Corporate foundations may offer matching funds in addition to employee contributions. Volunteerism can be as simple as forming a corporate team for an AIDS walk or as complex as staffing an entire fundraising event.
Pharmaceutical and biotechnology companies have a vested interest in building strong science skills in school-age children. Mentoring high school students or sponsoring a science fair develops both goodwill and future employees. Finally, corporate sponsorship of gay and lesbian events sends a strong message of support to the community. Both Amgen(a global biotechnology company headquartered in Southern California) and Genentech have sponsored their local LGBT Pride events.
Opportunities to contribute can come from a variety of sources. The Amgen Network for Gay & Lesbian Employees (ANGLE) recently had an unexpected, but welcome, request. “A local elementary school asked for donations of age-appropriate books from each of Amgen’s affinity groups for their school library. The experience made me realize that our group can help shape positive attitudes toward gays and lesbians not only within the company but also in the communities where we do business,” states Durk Hubel, president of ANGLE. (See sidebar “Amgen: Lessons Learned From a Start-up”.)
Your Next Step
The HRC’s Corporate Equality Index is a unique and helpful resource, but it surveys only the largest U.S.-based companies. Don’t let a potential employer’s absence from the index hold you back. Check out the company’s Web site; it may have information on their commitment to diversity. Also, try calling the human resources department. Ask if they have an active LGBT resource group, and if so, whether you can have the group’s contact information. Employment prospects in the new millennium for both the pharmaceutical industry and LGBT professionals are looking very bright indeed.