Targeting the State: Risks, Benefits, and Strategic Dilemmas of Recent LGBT Health Advocacy

Abstract

During the 1990s in the United States, lesbian, gay, bisexual, and transgender (LGBT) health advocates undertook a significant strategic experiment that was fraught with some peril: They turned to the state in an attempt to institutionalize a broad-based health agenda. What I call here "state-centered" LGBT health politics involves concerted efforts by activists and researchers to make demands on the state for inclusion and incorporation--demands to institutionalize LGBT (or, more often, just lesbian and gay) health as a formal concern of public health and health research bureaucracies. At the crux of state-centered advocacy is the claim that lesbians, gay men, bisexuals, and transgendered persons have distinctive health concerns and would benefit from research that finds them, counts them, studies them, and compares them with others. I emphasize what I take to be the most significant recent target: the U.S. Department of Health and Human Services and its key, health-related component agencies, such as the National Institutes of Health. I suggest that state-centered LGBT health politics tends toward the reification of sexual identities, the conflation of behavior and identity in the determination of health risks, the conceptualization of difference as pathology, the playing down of sexual topics and sidestepping of nonnormative sexual practices, and the valorization of professionals and simultaneous inhibition of community participation in research design and interpretation. Avoiding these risks does not necessarily presume abandoning the state-centered approach, but it does require a careful analysis of how these risks become manifested. (PsycINFO Database Record (c) 2016 APA, all rights reserved)