San Francisco Chronicle - Tuesday, November 23, 1993
David Tuller, Chronicle Staff Writer

So last spring, O'Hanlan, an associate director of Stanford University's gynecological cancer service, and other lesbian rights advocates began a lobbying and letter-writing campaign. In October, the NIH reversed its decision and agreed to ask the more than 100,000 women in the study about their sexual orientation.

The change will enable researchers to determine whether some lesbians are at increased risk for breast cancer -- a possibility raised by a study released in February -- or colon cancer, osteoporosis and other life-threatening illnesses.

"The researchers thought that if they asked about homosexuality, people were going to be worried that the government was trying to root them out," said O'Hanlan, who is president of the American Association of Physicians for Human Rights, an organization of gay and lesbian doctors.

"But I said, `Please, we're taxpaying Americans, and we'd like to get our fair share of the health research dollars.' "

The NIH reversal marked a significant victory for the lesbian health movement, which is burgeoning at the same time that the scientific and political establishment has turned increased attention to the overall health needs of women.

Several large cities now have health clinics focusing specifically on lesbians, such as Lyon-Martin Women's Health Services in San Francisco. The National Gay and Lesbian Task Force this year appointed a woman to be a key lobbyist on health care issues, and the American Association of Physicians for Human Rights has raised tens of thousands of dollars through its Lesbian Health Foundation to pay for research into lesbians' medical concerns.

LACK OF RESEARCH DECRIED

The movement has successfully sought allies among heterosexuals, too. At its annual conference several weeks ago, the American Medical Women's Association, which has 13,000 members, decried the "lack of research on lesbian health issues" and issued a ringing call for laws barring discrimination based on sexual orientation.

"Homophobia is a health hazard to all individuals and compromises the delivery of our highest standard of medical care," according to the association's lengthy and wide-ranging statement.

Anti-gay prejudice is a direct cause of many of the health problems facing both gays and lesbians, say health care providers.

Lesbian and gay youth account for one-third of all teenage suicides, according to a U.S. government study, and violent attacks on gays of both sexes are on the rise. Some studies also indicate that homosexuals suffer from higher rates of drug and alcohol abuse.

Access to health care is also a major concern. Women are more likely than men to be uninsured, and many receive better coverage through their husbands' employment than they would on their own -- an option unavailable to most lesbians.

Bay Area resident Mara Math, a 39-year-old editor, said she has not had a full checkup in more than two years because she is unemployed and has no health insurance.

"It's a lesbian issue because when I had a partner, I was not included in her health insurance plan," said Math. "It's definitely worrisome, because I have a family history of breast cancer and should have a mammogram."

DOCTOR'S VISITS AVOIDED

Some lesbians do not schedule routine visits with gynecologists because they do not need birth control and do not realize the importance of regular Pap smears and other medical screening procedures.

"They might think that because they don't have sex with men, they won't get sexually transmitted diseases and don't need gynecological care," said Carmen Vazquez, coordinator of lesbian and gay health services for the San Francisco Department of Public Health.

Others avoid seeking health care or feel forced to lie to their doctors because of fear of prejudice or insensitivity. In a 1990 survey of 1,680 lesbians in Michigan, 61 percent felt that they could not disclose that they were lesbians to health care workers, and 23 percent had not received a medical exam in the preceding five years.

The focus on lesbian health issues has come after years in which members of the gay community, including many lesbians, have directed much of their energy and resources to combatting the AIDS epidemic among gay men.

Lesbians now say it is time to address their own health care needs, including the relatively overlooked issue of lesbians and bisexual women who contract HIV through drug use or through sex with partners of either gender.

CANCER RISK PROMPTS CONCERN

Until last winter, many heterosexuals and even many lesbians did not realize that lesbian health needs might differ from those of other women. Just as a marked increase in the reported incidence of breast cancer among all women has captured the nation's attention, the lesbian health movement received a jolt of publicity in February from a study suggesting that some lesbians might be at higher risk for the disease than heterosexuals.

Suzanne Haynes, an epidemiologist at the National Cancer Institute who is also a lesbian, examined previous studies and noted that some risk factors for breast cancer -- primarily alcohol use and never having given birth -- are more common among lesbians over 50 than among their heterosexual counterparts.

Using such data, Haynes estimated that older lesbians may be two to three times more likely to develop the disease than heterosexual women, whose lifetime risk is estimated at one in nine.

Although health care providers said the study highlighted the need for further research, some expressed concern at how the media reported the story. Some press accounts, they said, seemed to blame lesbians for the illness by suggesting that something physiological about lesbianism per se -- rather than particular risk factors -- could cause increased rates of breast cancer.

"A lesbian who never is pregnant is at no higher risk of developing breast cancer than a straight woman who never is pregnant, and both are equally at higher risk of developing breast cancer than a lesbian who has a child at a young age," wrote Nancy Krieger, a cancer specialist with the Kaiser Foundation Research Institute in Oakland, in a letter to the San Francisco Chronicle.

In fact, more and more lesbians in recent years have been deciding to have children. This "lesbian baby boom," as it has been dubbed, has created a whole new set of health care needs and encouraged entrepreneurs to develop services to meet them.

Leland Traiman, an Oakland nurse, is planning to open a sperm bank specifically for use by lesbians next year. What will differentiate the Rainbow Flag Health Services from other sperm banks, he said, is that it will stock only the sperm of gay men and will encourage the biological mother to meet the father and introduce him to the child shortly after the birth.

"A lot of lesbians don't want to have children by using anonymous donors, and they'd rather be connected to a gay male household than to a heterosexual one," he said.

Although some gay men express concern that the emerging focus on lesbian health is diverting the community's attention from the AIDS crisis, "the two issues are not competitive and both need to be addressed," said Ben Schatz, executive director of the American Association of Physicians for Human Rights.

"There's a fair amount of misunderstanding among gay men, as among the general population, about the fact that lesbians really do have specific health needs and concerns," Schatz said.

CAPTION: PHOTO

Carmen Vazquez heads lesbian and gay health services at the S.F. Health Department/BY LEA SUZUKI/THE CHRONICLE

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