June 15, 2023 – Amid a recent wave of policies targeting LGBTQ populations across the U.S., a Harvard collaborative focused on LGBTQ health is doubling down on its work—studying the health impacts of the new policies, churning out hundreds of studies, developing mentoring programs to support up-and-coming trainees, creating a new reproductive health seminar series, and engaging in advocacy work.
For members of the Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative, a partnership of more than 125 Harvard-affiliated researchers, “it’s been a tumultuous year,” acknowledged Brittany Charlton, an associate professor in the Department of Epidemiology who co-directs Harvard SOGIE with Sabra Katz-Wise, an associate professor in the Department of Social and Behavioral Sciences. She cited, for example, pediatricians who have been threatened and harassed for providing gender-affirming care to transgender youth in Boston and across the country. But, as she put it in her keynote address at the October 2022 GLMA Annual Conference on LGBTQ Health, “The time is now to stand up, speak out, and fight back.”
Quantifying the health implications of LGBTQ-targeted policies—particularly the impact on young people’s mental health—is a top priority, said Charlton. She and her colleagues are applying for various grants to support this research.
“There has been a completely unprecedented number of policies in the U.S. that target LGBTQ populations,” she said. “In the first half of 2023, we’ve already seen more than 500 bills introduced into state legislatures.” A record 70 anti-LGBTQ laws have been enacted so far this year, according to the Human Rights Campaign. Some of the laws ban gender-affirming care for children and teens. Others ban books that address LGBTQ topics, or criminalize teachers “for even discussing the existence of LGBTQ people,” Charlton said.
Such policies exasperate an already dire situation, she said. “LGBTQ people experience widespread discrimination that leads to adverse health,” she said. “Discriminatory policies will continue to widen those disparities.”
Charlton and colleagues are also part of a coalition working to pass the Healthy Youth Act in Massachusetts, which would help sex education curricula across the state be medically accurate and LGBTQ-inclusive. In March, Charlton co-authored a viewpoint article published on the Boston University School of Public Health website that made a case for the legislation. In late May, the coalition held a lobby day at the Massachusetts State House, speaking with lawmakers to advocate for the bill’s passage.
“This bill is popular, and yet, it has gone 11 years without passage,” said Charlton. “Our team has documented that LGBTQ teens are being excluded from sex education, and now we need the political will to enact this policy solution.”
The importance of mentoring
Another focus for Charlton and her team is mentorship, which she said is critical to mitigating the impact of discrimination that LGBTQ trainees face within public health.
“LGBTQ trainees have to navigate unique issues like potentially disclosing their sexual orientation or gender identity in a job interview,” Charlton said. Most research on lack of mentorship focuses on how women and people of color are affected, she noted, but much less so on how LGBTQ people are affected. So, her team identified best mentoring practices and existing evidence-based curricula and adapted them into the Harvard Sexual and Gender Minority Health Mentoring Program. The goal is to teach faculty how to mentor and meet the unique needs of trainees—both LGBTQ-identified trainees, as well as those focused on LGBTQ health. A series of six professional development sessions were held this past spring. “The curriculum was well received and faculty changed their mentoring as a result,” she said. Charlton also received one of the inaugural NIH awards for excellence in DEI-focused mentorship and a mentoring award from Harvard Chan School. In addition, at the invitation of the American Association for the Advancement of Science, she recently spoke to officials at federal agencies and the White House about the importance of mentorship for LGBTQ trainees.
Addressing health disparities
Harvard SOGIE members continue to chronicle and analyze the numerous health disparities facing LGBTQ people. For instance, compared to heterosexual women, sexual minority women are more likely to have sex at a younger age and with more partners, and they’re twice as likely to have sexually transmitted infections. LGBTQ people are at higher risk of unintended pregnancy and are more likely to have an abortion than their cisgender peers. They also are more likely to be unemployed, uninsured, lack access to care, and delay care. In addition, early studies suggest that sexual minority women experience twice the number of pregnancies ending in miscarriage and stillbirth and twice the number of children born extremely preterm and low birthweight compared to heterosexual women.
Ten Harvard SOGIE members presented their research at the Society for Epidemiologic Research Annual Meeting in Portland, Oregon, held in mid-June. Topics included sexual orientation and gender identity-related disparities in: fetal and neonatal outcomes (presented by Payal Chakraborty), assisted reproductive technology (Kodiak Soled), endometriosis (Tabor Hoatson, featuring work led by Ari Tabaac), abortion (Sarah McKetta), and cancer (Aimee Huang). Other team members discussed cutting-edge research methods (Colleen Reynolds) and elucidated how to turn research into policy change (Ariel Beccia). Charlton led several sessions at the meeting, including a workshop on mentor training and a symposium on measuring sex, gender, and sexual orientation in epidemiologic research.
On the Harvard Chan campus, Harvard SOGIE rolled out a new seminar series last fall on reproductive health. The series included eight lectures featuring experts from universities nationwide and drew more than 100 people to each event.
The path forward
Charlton outlined how LGBTQ health is central to the mission of Harvard Chan School. “A core value of the School is to improve and protect the health of all populations, especially the most vulnerable, which includes LGBTQ populations,” she said. Noting the opportunities to invest in teaching, research, and dissemination, she added “The School has the opportunity to uphold its core values by helping to create a diverse, inclusive, and equitable home for LGBTQ health scholarship and members of our School community.”
For Charlton, the bottom line is that it’s more important than ever to meaningfully invest in LGBTQ health. She noted that research has shifted in recent years, from simply documenting that LGBTQ-related disparities exist to exploring the underlying mechanisms behind those disparities. “We are at a turning point where we can design interventions, advocate for policy change, and cultivate a more just world,” she said.
Photo: Andrew Flamang