factors and disease and given that
gay males are part of the state of
Vermont those are targeted at their
needs, but not specific to their
needs. And when we look at specific
risk factors, we know that STD pre-
vention and HIV are specific needs,”
said Jam's. “I guess the question
would be, what are we missing?
And what are the key health risks or
indicators that we’re not targeting
either by working broadly at the
population’s needs or specifically at
those needs.” -

In the mid-1990s, HIV
prevention workers began talking
about secondary factors to HIV
transmission. These included things
such as coming out, substance
abuse. and domestic violence,
among others. The idea was that a
gay man who was addicted to heroin

‘was more likely to become HIV

positive than someone who wasn’t.
A man coming out of the closet was
more vulnerable to HIV than some-
one who had been out for years.
Using HIV prevention dollars, many
of us worked to address these ‘sec-
ondaiy factors’ hoping that referral
to a gay-friendly therapist would
mean treatment for depression and a
decrease in risky behaviors. The
health and wellbeing of gay men
was-a-means’ to. the end‘of prevent-
“rr’i‘g*’l=iI=\r_~;:..~.-»‘=.;..‘a‘ 2  ~.rz

If you are HIV-positive in
Vermont, you have access to hous-

‘: ‘>;y.;g.

-ing assistance, health care, prescrip-

tion drugs, mental health counseling,
and substance abuse treatment. If
you are’ a gay man, your addiction to
alcohol, mental wellbeing, and
access to health care are a concern
to DoH because these factors may
contribute to risky behavior. What
DoH is not concerned with is gay-
affirming substance abuse treatment
or mental health counseling simply
because sober, emotionally healthy
gay people reflect a positive,
healthy, happy gay community. As a
result, all things gay are dealt with
by the AIDS program.

Drawbacks of Disease-based
Health Promotion

What’s missing is an approach to
health promotion that works for gay
men. _

Health promotion is a

comprehensive social and political
process. It not onlyembraces

. actions directed at strengthening

skills and capabilities of individuals,
but also actions directed towards
changing social, environmental, and
economic conditions so as to allevi-
ate their impact on public and indi-
vidual health. Health promotion, as
laid out by World Health
Organization, is the process of
enabling people to increase control
over and to improve their health.

The United States is one

‘ of the few nations that rejects this

model in favor of one based on dis-
ease, rather than population. Health
departments in the United States
have AIDS programs, offices of sub-

stance abuse prevention, divisions of

tobacco prevention, and so on. Add

will quit smoking even though I’m
depressed and don‘t'believe I will
live till I’m 30 years old anyway.”

‘ Anti-tobacco advocates
routinely include gay AA meetings,
AIDS hospices, and homeless youth
shelters on lists of places to reach
out to sexual minorities. I always

minority Vermonters by improving

the level of competency of
Department of Health staff; encour-
aging niinority-specific program-
ming by public and private sector
health care providers; and assisting
minority community-based organi-
zations to participate in programs

The DoH does not know how many gay men smoke,
how many lesbians have breast or ovarian .cancer,
or whether or not heavy drinking is an issue
in the transgender population.

to that the hundreds of disease-spe-
cific interest groups and what you ‘
have is a nation of people bombard-
ed with public health messages:
Don’t smoke, says the American

g Cancer Society. Take folic acid

-butiwhat We are not provided

before you get pregnant, says the
March of Dimes. Wear your seatbelt,
says the American Automobile
Association. Eat according to the
four food groups, er, food pyramid,
er, revised food pyramid, says the
USDA. '

We are bombarded with
health prescriptions and directi es '

means to integrate health infom'ia-
tion into a decision making process
that results in actions consistent with
our knowledge, values, and desire.
We know our diet is not right, but
we don’t know how to changeit. We
know we don’t exercise enough, but
we’re not sure how. We know we
should have safe sex, but it’s not
what we want at 3:14AM after a
night of partying with a hot guy in
our bed.

This confusion has led to
an industry of health“ information
products: self-help books, maga-
zines, exercise videos, Dr. Phil’s
Ultimate Weight Loss Challenge
show and book. Their success is
built on our inability to sort through
the massive amount of information
being dumped on us.

And minorities suffer the‘
greater burden. Not only are we
assaulted by information, we often
disrriiss the important information
because of how it is presented to us.
“Middle-aged, suburban fathers sur-
rounded by wife and children get
heart attacks and need to watch their
cholesterol, not 29-year-old, over-
weight, gay smokers.” Or messages
are so out of context with the
moment of our lives, we can’t do
anything about it. “Assuming I still
have a place to live when my par-
ents find out I’m gay and I'm not
being harassed up at school and my
boyfriend isn’t cheating on me, I

  
  
  

find this amusing because folks who
find their way to any of those serv-
ice providers generally have more

' immediate concerns. Disease-based

health promotion is less effective
because it forces health issues to
compete with each other. It’s like

‘ having a flat ti_re, going to the

garage, and finding the transmission
guy, brake specialist, windshield
installer, and tire man simultaneous-
ly talking to you.

Except that metaphor falls
apart, as does disease based health

... be  

 
   

 

way. Organic beings are meant to be»
dealt in a holistic manner, as are
‘communities.

Minority Health Matters

“If you’re a small enough minority,
you may not make it onto the big
radar screen, but that doesn’t mean
there aren’t specific needs we have
to go after,” said Jarris.

Health departments across
the country have created offices of
minority health to address disparities
and to ensure just and equal treat-
ment of minorities. Vermont has one
too, although few people have heard
of it. ” I

When asked about the
Department of Health's Office of
Minority Health, and specifically
what they do for sexual minorities, ,
Dr. Jarris said, “My understanding is
that in Vermont, the Office of
Minority Health was originallyVcon-
ceived as racial and ethnic niinori-
ties and we broadened that scope in
Vermont to include racial, ethnic,

cultural, and sexual minorities.”

But what ‘does the office

‘ do?

“That is an office that is
active and we’re working on,” said
Jam's. “The office is there, it is sup-
ported.” -

The stated goal of the
Office of Minority Health is “to
increase access to health services for

   
    

and advocate for their constituents.”
The office has one staff person and
has not published a report of its
activities.

I spoke to a number of gay
community-based organizations. _
Some of them were not aware an
Office of Minority Health existed;
none had a relationship with the
office. It’s not clear exactly what
this office does. This seems contrary
to,Dr. Jarris’s vision for the DoH.

“What I’m looking for
from folks working in different
'ar.,eas.,i‘s_  E_},lflC measurable

 

-oii'tVt'::on'ies,’:"he said.. “How do I

know in a year that you’ve done
anything? That this population is
better off? I want both process
measures as well as outcomes.
Motion without achieving anything
is not good enough.”

Sexual minorities in

Vermont need a public health infra- 4 —

structure to keep us safe and to pro-
vide the means with which we can
live healthier, happier lives. The
Department of Health needs to
demonstrate it is meeting its legal
obligation to serve all Vermonters
equally.

“If it’s the issue of, are we
missing things between our directed
approach and our general population
approach that’s going to be impor-
tant,” said Dr. Jarris. “If we don’t
figure it out, I hope someone will let
us know about it.”

In the lack_of data on sex-
ual minorities, DoH misses an
opportunity to develop a picture of
sexual minorities. At best, this is an
oversight. At worst, it is institution-
alized indifference towards gay and
lesbian people.

“We are genuinely inter-
ested in input from the community A
on how we can do better,” said Dr.
Jarris. '

A Prescription for the Dofl
To adequately serve sexual m_inori-
ties, DoH would need to focus on
four areas. First, thedepartment

 

needs to conduct a review of health
surveillance tools and ask respon- '
dents to report whether or not they
identify as heterosexual, gay, les-
bian, or bisexual and, when appro-
priate; ask about the gender of their
sexual partners.

Second, Dr. Jarris should
call a meeting of Igbt community
leaders working on health and com-
munity issues. All of the community
organizations I spoke to expressed
an interest in developing a relation-
ship with the Office of Minority
Health. Third, the department needs
to review its funding policies in
order to better serve a diverse popu-
lation.

Finally, the Office of
Minority Health (OMH) needs to
begin serving sexual minorities in
earnest by working internally to
address the Department of Health’s
failure to monitor and improve their
health and wellbeing. For example,
the OMH could conduct a review of
the department’s health surveillance
activities and produce recommenda-
tions for gathering data on sexual
minorities. The OMH, with a man-
date from the commissioner, could
fund and manage an independent
council on sexual minority health.
The role of_ this council could be to
make recommendations for gay-spe-
cific, culturallyicompetent program-
ming. OMH could manage grants to
community organizations to fund
programs to reduce health disparities
among sexual minorities. Examples
of these activities can be found in
Massachusetts, Washington State,
New York City.

The sexual minority com-
munitiesmust step up to the plate as
well. To do the work of improving
community health, we must first pri-
oritize ‘real’ movement issues — the
happiness and wellbeing of gay peo-
ple — over prove-a-point legislation
or judicial rulings that often serve a
narrow subset of the community. We
need to prioritize how government
works over who government is.

And finally, we need to be
open to taking a look at ourselves
and asking, “How can we be a better
conimunity?” V

Ric Kasini Kadour is a gay men '5
health activist living in Shoreham.
He can be reached at kasirii@ix.net-
com.com