The most recent issue of the Journal of the American Medical Association (JAMA) included a research paper that surveyed American and Canadian medical schools on their Lesbian, Gay, Bisexual, and Transgender (LGBT) curricula. Though the results suggested a slight increase in coverage of LGBT related topics in the past decade, the statistics were still abysmal. The median reported total time dedicated to LGBT topics in all four years of medical school was five hours. 76 percent of programs self-rated their curriculum as “fair” or worse.
None of this is actually surprising. What’s surprising is that we’ve progressed so little in the past decade that it’s still worth talking about in a major journal like JAMA. And while I’ve squirreled away these statistics for future use in a cathartic, but probably only marginally-productive, rant on the modern-day soapbox (AKA personal blog), the data from this study probes into deeper issues than a low allocation of curriculum time.
The study also measured the frequency of institutional instruction on different LGBT health topics. Four of the top five most common are related to sex. Most might think that this focus on sexual behavior is appropriate for a population that is seemingly defined by sex. However, in reality, the non-LGBT population engages in the same sexual behaviors that the LGBT population does. Though each particular behavior might be practiced at different rates, “HIV,” “Safer Sex,” and “Sexually Transmitted Infections” are important for all people. Those were three of the LGBT-related topics.
The focus on sexual topics demonstrates our tendency to hyper-sexualize the LGBT population. This not only perpetuates stereotypes, but also is a health disservice to LGBT and non-LGBT alike. While sexual health is obviously important, the LGBT population is also plagued by disproportional rates of depression, substance abuse, addiction, and smoking. Multiple studies over the past ten years have found that LGBT youth are up to 5 times more likely than their heterosexual counterparts to be homeless and 2-5 times more likely to commit or attempt suicide. By overemphasizing issues of sexual health, those issues are overlooked. Furthermore, the association of certain sexual behaviors with only the LGBT population neglects necessary screening for a significant portion of the heterosexual population.
The US Department of Health and Human Services defines health disparities as differences in “the overall rate of disease incidence, prevalence, morbidity, and mortality or survival rates.” Continuing to intimate that the LGBT population is limited to the single dimension of sex is disrespectful, inaccurate, and unproductive. Though a sexual health disparity does exist, it is only one of many contributors to the overall picture. Ultimately, the poorer health outcomes stem from a broader environment of prejudice. Until we broaden the scope of our curricula and teach all of the relevant topics in the context of social stigma, the disparities will remain.
Jessica Guh is in her final year at University of Michigan Medical School and posts on her blog, On Race, Privilege, and Medicine. You can contact her at firstname.lastname@example.org