Ah, June! That magical time of year when the weather finally warms and we celebrate lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Pride Month. In June, LGBTQ+ communities and allies commemorate how far we’ve come and look ahead to the next steps for advancing equity and justice for LGBTQ+ people. In the field of Health Services Research (HSR), it’s also an opportunity to highlight new resources, research, and revelations in LGBTQ+ health that are appearing every day.
A Brief History of LGBTQ Health Research
It's worthwhile to take a pause to look back at some of the history of how we got here in LGBTQ+ health research. In 2011, the Institute of Medicine (now the National Academy of Medicine) released a report that promised a comprehensive overview of existing research in LGBT population health. Due to decades of neglect of LGBT health by researchers, policymakers, and funders, however, the report mostly identified research gaps, particularly around topics aside from HIV among cisgender men who have sex with men.
In 2015, the National Institutes of Health (NIH) responded by establishing the NIH Sexual and Gender Minority Research Office, and in 2016 the directors of NIH and the Agency for Healthcare Research and Quality (AHRQ) officially designated the sexual and gender minority (SGM) population as a health disparity population.
Since then, interest in LGBTQ+ patient and population health research has exploded. The National Academy of Sciences published major reports in 2020 and 2022 laying out a research agenda for the health and well-being of sexual and gender diverse populations and establishing standards for the collection of data on sex, gender identity, and sexual orientation, and new research in understudied areas such as transgender health is increasingly being funded and published.
LGBTQ+ Health Research at Whitman-Walker
As a health services researcher, I am proud to head the Whitman-Walker Institute, the research, policy, and education arm of Whitman-Walker, a community health system in Washington, D.C. Whitman-Walker also includes Whitman-Walker Health, a Federally Qualified Community Health Center (FQHC) with almost 50 years of expertise serving LGBTQ+ patients and people living with HIV.
As an FQHC, Whitman-Walker Health is a unique clinical environment that is recognized as a Patient-Centered Medical Home (PCMH) by the National Committee on Quality Assurance (NCQA) and serves 20,000 patients annually from across D.C., Maryland, and Virginia. Approximately half of our patients identify as lesbian, gay, or bisexual, and 15 percent are transgender. Our payer mix has a high proportion of Medicaid patients, as well as Medicare and a variety of private insurers, including plans sold on the Health Insurance Marketplaces established under the Affordable Care Act. Reflecting the racial diversity of the D.C. area, 40 percent of our patients are Black or African American, and 20 percent are Latinx. In June 2023, Whitman-Walker will open a major new facility at the St. Elizabeth’s campus in D.C.’s Ward 8, bringing greater access to cutting-edge research and clinical care to communities that have historically experienced high levels of disinvestment.
Whitman-Walker has contributed to the testing of almost every HIV medication since the beginning of the epidemic, and the Institute’s current research portfolio includes more than 20 clinical and applied studies. Our research and related policy and education work in LGBTQ+ health and health equity spans the entirety of the Quintuple Aim, from improving access to gender-affirming care for transgender people to training health care providers in LGBTQ+ cultural competency to exploring structural stigma as a driver of HIV risk. We aim to provide the patients and communities we serve with access to breakthroughs in biomedicine, clinical practice, and policy that can help achieve goals such as preventing new HIV infections, successfully managing HIV as a chronic disease, and addressing disparities among LGBTQ+ populations that include higher rates of certain cancers and mental and behavioral health conditions.
Guidance for LGBTQ+ Community-Engaged and Equity-Focused Research
The Institute invites inquiries from potential research collaborators who can help us advance Whitman-Walker’s care mission and research agenda by conducting clinical, implementation, and applied research at the local and national levels to advance intersectional health equity. Whitman-Walker Institute has developed the following guidance for potential research partners, drawing from models for community engagement that center equity and benefits to communities experiencing marginalization and oppression:
- Health equity – Does the proposed project have a meaningful focus on and significant potential to promote health equity?
- Community engagement – Does the proposed project meaningfully engage the communities we serve and significantly reflect community-driven health and research needs?
- Relevance and contribution – How the proposed project contribute to the research portfolio and clinical practice at a community health system like Whitman-Walker? If involving patients or their data, does the project propose a benefit to the patients?
- Feasibility – Will the proposed scope of work, timeline, and budget allow a community health system like Whitman-Walker to thrive as a productive partner in the proposed research?
- Collaboration and involvement – Does the proposed research meaningfully integrate relevant teams and stakeholders at a community health system like Whitman-Walker and provide involvement at multiple levels or stages of the research process? Are there bi-directional benefits of the collaboration? Is there evidence of equitable budgeting across institutions?
- Research methods and ethics – Do the proposed research methods meet all ethical standards? Are the methods reflective of best practices, and is their use well-justified? Are any risks of the study outweighed by its direct or indirect benefits?
This June and beyond, we hope partners across the field of HSR will continue to advance the scope and sophistication of research into LGBTQ+ health, particularly in partnership with the clinics that historically have welcomed LGBTQ+ patients with affirming, culturally competent, and high-quality care. We look forward to working with you!