Healthways are means by which a folk group may foster wellness among its members. In the LGBTQ community, healthways encompass medical issues that have particular application to sexual orientation, gender identification, and the body that have not been addressed by the broader institution of medicine.
In general, the health issues of Lesbians are no different from those of other women, but the politics of equal treatment for women in the clinic and hospital continues to be of great concern to the Lesbian community. There is also evidence that risk of breast cancer may be higher for Lesbians than for Straight women. In an article for the National LGBT Cancer Network, Liz Margolies says the following:
[S]ome people currently believe that lesbians have an increased risk of developing breast cancer, based on a “cluster of risk factors” theory… Each of these behaviors [cigarette smoking, alcohol use, obesity, not bearing a child before 30] carries with it an increased risk of cancer. Taken together, as a cluster, they could more than double a lesbian’s chance of getting cancer.
Margolies believes that “increased risks are a result of behaviors that are a result of the stress and stigma of living with homophobia and discrimination,” which also leads to lower numbers of Lesbians seeking medical screening:
In every location surveyed, lesbians reported lower rates of mammography, colonoscopy and pap smears than their heterosexual counterparts, due to a combination of limited financial access and perceived unwelcome… lesbians are less likely to have adequate health insurance coverage than heterosexual women, as most employers do not offer coverage for unmarried domestic partners. Even when cost is not a factor, previous or feared negative responses from health care providers keep too many lesbians from seeking routine screenings… Sometimes, I imagine a lesbian who has just been diagnosed with cancer and is living in a small town in Utah or Iowa, not in one of the few cities with lesbian cancer programs. I wonder if it is safe for her to be out to her oncologist. This woman doesn’t have the option of joining a lesbian cancer support group. Will she go to a group that is comprised of heterosexual women? Will she feel safe being out there? Her partner can’t go to a caregiver group for lesbians… I picture the two of them using the internet to learn more about their cancer and survivorship issues. Whenever I visit a website, I pretend I am this couple and type the word “lesbian” in the search box. More often than not, the search produces no results. Invisible still.
The AIDS crisis was initially focused primarily on men having sex with men, and members of the Gay community worked together to help those who were infected and to honor the dead. In the days before the medical community at large was willing to deal with the crisis, different factions in the Gay collective came together, and many Lesbians helped men and transwomen who were afflicted with AIDS. In the public sphere, the Gay community demanded access to testing and treatment when others were avoiding the issue entirely, and in conjunction with some medical institutions, developed its own safer-sex programs. As general concern for public safety began slowly to override a cultural reluctance to talk about sex, safer-sex programs were selectively adopted in society at large. Organizations such as the Gay Men’s Health Crisis (GMHC) in New York City, a grassroots organization formed in the earliest days of the AIDS crisis, continue to provide a range of services around AIDS prevention and support for those who test positive for HIV., such organizations can be found across the globe today with the worldwide spread of AIDS and AIDS awareness. Leaders in several countries realized that facing up to the challenges presented by AIDS should be a national priority.
The ethics of the LGBTQ community have been affected by those living with AIDS who chose to end their lives when their bodies deteriorated and their suffering became too much for them to bear. As a result, there is greater tolerance among LGBTQ people than the public at large for assisted suicide. Although not a healthway per se, this practice nevertheless marks a boundary for what constitutes health and a life worth living in terms of personal choice rather than religious or legal definitions.
In the early days of the AIDS crisis, some HIV+ men used steroids to prevent loss of muscle mass. The success of steroids led to the image of the ideal Gay male physique as an elaborately sculpted muscular body rather than simply physically fit, engendering health risks due to steroid cycles (weeks or months in which a schedule of steroids would be taken) and effects of steroids on temperament and internal organs. Preoccupation with physique became especially pronounced in weekend-long Circuit parties where men dance with their shirts off. Since the muscular male body in the Gay male community may be accompanied by disdain for the less physically perfect, the term body fascist was coined to condemn such behavior, and there is very little tolerance for aggression associated with steroid use, whether in the Circuit community or the Gay male community at large.
To foster AIDS awareness and reduce problems associated with irresponsible drug use, the Circuit community also began programs promoting safer sex and informing people about the effects of certain recreational drugs, the most problematic being GHB and crystal methamphetamine. In keeping with the harm-reduction principle that education and substance-abuse treatment are more effective than incarceration, advertisements and brochures featuring attractive men and humorous themes were designed for distribution at parties. At some events, particularly those in Canada, this tradition continues today. Groups promoting harm reduction include MedEvent, an organization of volunteers that goes to Circuit events and helps those who have overdosed, the AIDS Committee of Toronto (ACT), and the commercial-oriented Radical 5 artist collective in Montreal. Harm-reduction campaigns have also been used in men’s bathhouses with the aim of informing rather than condemning those who use recreational drugs and engage in sex on the premises.
Gender Reassignment and Trans Health Issues
Information about gender reassignment treatments for transmen and transwomen as well as health issues that arise from such treatments was initially sparse after Gay liberation. In India, communities of male-to-female hijras have traditionally employed ancient, medically risky folk forms of surgery for the removal of male genitalia, often suffering infection or death. But the growing visibility of the Trans community worldwide means greater access to more information about the treatments, surgeries, and long-term effects, shifting from isolated folkways and medical procedures to standard medical practice.
Diversity within the Trans community concerning what constitutes the desired body gives its members more options for determining how their bodies will look and function erotically. In addition to physical health, the community takes into account the mental well-being and sexual health of transpeople, who are free to determine which surgeries and treatments are appropriate for them.
Lack of choice concerning their bodies while still in the infancy has led the Intersex community to speak out against forced surgeries before an appropriate age of consent. Health issues for intersex people resulting from medical treatments (whether desired or otherwise) are poorly understood within the LGBTQ community and the general public.
Goldstein, Diane. Once Upon a Virus: AIDS Legends and Vernacular Risk Perception. Logan: Utah State University, 2004.
Makadon, Harvey, and the American College of Physicians. The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians, 2008.
Margolies, Liz. “Lesbians and Breast Cancer Risk.” National LGBT Cancer Network, www.cancer-network.org/cancer_information/lesbians_and_cancer/lesbians_and_breast_cancer.php, February 2012.
Rosario, Vernon A. Homosexuality and Science: A Guide to the Debates. Santa
Barbara, CA: ABC-CLIO, 2002.