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HP 2010 Companion Document-Title Page Coordinated and co-written by the Gay and Lesbian Medical Association (GLMA) w w w. g l m a . o r g With experts from across the field and the National Coalition for LGBT Health www.lgbthealth.net. Technical assistance and editing provided by IQ Solutions, Inc. April, 2001 The development of this document received partial funding support from the Health Resources and Services Administration of the U.S. Department of Health and Human Services under purchase orders 00-0048 (P) and 01- 0145 (P). The opinions expressed herein are those of the authors and do not necessarily reflect the official positions of the U.S. Department of Health and Human Services. Suggested Citation: Gay and Lesbian Medical Association and LGBT health experts. Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender (LGBT) Health. San Francisco, CA: Gay and Lesbian Medical Association, 2001. For further information, or to order additional copies of the Healthy People 2010 Companion Document for LGBT Health, contact: The Gay and Lesbian Medical Association 459 Fulton Street, Suite 107 San Francisco, CA 94102 Phone: 415-255-4547 Email: [email protected] Web: Http://www.glma.org The HP2010 Companion Document for LGBT Health is available for downloading or printing at the GLMA and National Coalition for LGBT Health Web sites. An order form for hard copies is available at the GLMA web site. Co n t e n t s Ac k n o w l e d g m e n t s . i In t r o d u c t i o n . 1 Access to Quality Health Services. 27 Ca n c e r . 97 Educational and Community-Based Programs. 112 Health Communication. 15 1 HI V / A I D S . 17 2 Immunization and Infectious Diseases. 19 7 Mental Health and Mental Disorders . 20 5 Nutrition and Wei g h t . 24 0 Public Health Infrastructure . 25 8 Sexually Transmitted Diseases (Infections) . 29 8 Substance Ab u s e . 33 0 Tobacco Use . 35 2 Violence Prevention. 37 6 Ap p e n d i c e s Appendix A: Recommendations . 417 Appendix B: Acronyms. 435 Appendix C: LGBT Definitions . 443 Appendix D: Resources . 451 Appendix E: Contributors . 477 Ac k n o w l e d g m e n t s The Healthy People 2010 Companion Document for LGBT Health is the product of a national collaborative effort that involved nearly 200 individuals, organizations, and agencies. The full list of contributors may be found in Appendix E: Contributors. In addition, several individuals and organizations provided strategic leadership and contributed significant time and resources. IQ Solutions, Inc. drafted the document and provided editorial, design, and production services throughout the document development process. Nancy Kennedy of the Substance Abuse and Mental Health Services Administration (SAMHSA), DHHS, contributed immeasurably in editing and writing the document. The collaborative process was organized, planned, and coordinated by the Gay and Lesbian Medical Association. An outgrowth of this process was the formation of the National Coalition for LGBT Health by many of the contributing organizations. The National Coalition will continue to be a partner in the dissemination and implementation of the document. Other organizations that provided staff and logistical support for the process include: Boston Public Health Commission; Columbia University Center for LGBT Health and the Lesbian Health Research Institute; Fenway Community Health; LLEGO, The National Latina/o Lesbian, Gay, Bisexual, and Transgender Organization; National Association for Lesbian and Gay Addiction Professionals; National Coalition for LGBT Health; National Gay and Lesbian Task Force; University of Pittsburgh Center for Research on Health and Sexual Orientation; and Virginia Commonwealth University Survey and Evaluation Research Laboratory. The document could not have been written without the notable contributions of the following individuals: Deborah J. Aaron, Clinton Anderson, Sandi J. Armstrong, John Auerbach, Cornelius Baker, Valerie Bassett, Rodger L. Beatty, Deborah J. Bowen, Judy Bradford, Sean Camargo, Darren Carter, Bianca Cody Murphy, Blake Cornish, Patricia Dunn, L. Michael Gipson, Henia Handler, Irene Anne Jillson, Nancy Kennedy, Stewart Landers, Anne Lawrence, Jean Flatley McGuire, Alejandro Marcel, Nina Markovic, Kenneth H. Mayer, Marshall Miller, Craig Packer, Gerard Passannante, Fred D. Rachman, Marty Rouse, Lauretta A. Safford, Scout, Randall Sell, Anthony J. Silvestre, Jessica M. Xavier, and Frank Y. Wong. i A Healthy People 2010 Companion Document for Lesbian, Gay, Bisexual, and Transgender Health In t ro d u c t i o n Healthy People 2010 is the prevention agenda for the Nation. It is designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century. (More information is available online at www.health.gov/healthypeople.) Like the preceding Healthy People 2000 initiative—which was driven by an ambitious, yet achievable, 10-year strategy for improving the Nation’s health by the end of the 20th century—Healthy People 2010 is committed to a single, overarching purpose: promoting health and preventing illness, disability, and premature death. Federal program planners and health care policymakers recognize that all population groups neither share the same health status, nor have equal access to quality health care and related services. Vulnerable or underserved populations—people who, for a variety of reasons, do not have access to needed health care—face many barriers to health care. These barriers include having no health insurance, having inadequate health insurance coverage, having low income, living in isolated areas or in crowded inner cities where there may be a shortage of needed health care providers, facing discrimination, experiencing stigma, and encountering cultural barriers such as a lack of literacy and few culturally competent providers or culturally accessible health promotional or educational materials. The ability of health professionals and health plans to provide necessary and appropriate services in areas with the greatest need Healthy People 2010 is grounded in depends, to a large extent, on good information about the health science, built through needs of people served within communities as well as overall public consensus, health status. Lesbian, gay, bisexual, and transgender (LGBT) and designed to populations have been among those for whom little or no measure progress. national-level health data exist.1, 2, 3, 4, 5 Some State-level data from CDC’s Youth Risk Behavioral Surveillance System, a few household-based studies, many studies using convenience samples, and anecdotal information have indicated that LGBT populations, in addition to having the same basic health needs as the general population, have health disparities related to sexual orientation or gender identity. This Healthy People 2010 Companion Document contains most of the existing quantitative and qualitative research and information specific to LGBT health in the areas defined and Healthy People 2010: Lesbian,Gay, Bisexual,and Transgender Health 1 Introduction discusses the overall health status of LGBT people. Making the best use of available data, this document describes the barriers and recommends changes that will facilitate success in overcoming them. Healthy People 2010 Companion Documents Although Healthy People 2010 outlines the health goals for the Nation over the next 10 years and serves as a benchmark and guide for community-based program planning, such a document cannot meet the diverse needs of all people, especially of minority populations for whom adequate data are lacking. Healthy People 2010 Companion Documents, therefore, are intended to highlight or identify the objectives most relevant to selected populations or groups and to focus on practical strategic steps to improve the health of the population or to better manage chronic disease conditions. Companion Documents also are designed to make Healthy People 2010 and the information pertaining to targeted populations more useful to consumers, community health planners, health educators, people in health professions training, academics, and practicing health professionals at all levels of health care delivery. Over the next decade, a series of Healthy People 2010 Companion Documents on a broad range of health issues or focused on the health needs of selected populations are expected to be available. The History Behind the Healthy People 2010 Initiative Healthy People 2010 builds on other national health promotion and disease prevention initiatives pursued for more than two decades. Of the most recent, in 1979, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention provided national goals for reducing premature deaths and preserving independence for older adults. In 1980, another report, Promoting Health/Preventing Disease: Objectives for the Nation, set forth 226 targeted health objectives for the Nation to achieve over the next 10 years. Healthy People 2000: National Health Promotion and Disease Prevention Objectives, released in 1990, identified health improvement goals and objectives to be reached by the year 2000. The Healthy People 2010 initiative continues in the tradition and looks ahead to improve the overall health of the Nation for the first decade of the 21st century. Healthy People 2010 represents the ideas and expertise of a diverse range of individuals, health professionals, and organizations concerned about the Nation’s health. The Healthy People Consortium—an alliance of more than 350 national
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