Gap in the syllabus: Global LGBTQ+ Health

Credit: Julia Rosner

Ilia Hionidou

For the next article in our series on LGBTQ+ inclusivity in higher education, Ilia Hionidou interviews Dr Michelle Kaufman, Assistant Professor at the John Hopkins University’s Bloomberg School of Public Health.

The need for an international focus on LGBTQ+ health is investigated by Assistant Professor Michelle Kaufman, whose work focuses on HIV and Global LGBT Health at John Hopkins University’s Bloomberg School of Public Health in Baltimore. Professor Kaufman’s current research examines young men who have sex with men (MSM) in urban areas in the US who are at a high risk of contracting HIV. Another of her projects explores the risk behaviours of MSM in China. In this study, Professor Kaufman and her PhD supervisee investigate the reasons as to why these men exhibit risk behaviours (substance abuse, drinking, smoking cigarettes). Factors that may have an impact on such behaviours include internalised stigma, or whether the participants have disclosed their sexuality status to anyone, among other social variables. 

Professor Kaufman’s graduate module “Global Perspectives on LGBT Health” concentrates on the health issues that affect gender and sexual minorities outside of the US, especially low- and middle-income countries. The course follows an outline that begins by asking why it is important to study LGBTQ+ health at all, before addressing some of the finer nuances of global LGBTQ+ health, such as intersectionality and differences in sexuality and expression, including “what it means for different races, different cultures, how different populations define different types of gender.” The course also covers traditions: “culture, history and religion, and how these come into play when talking about health disparities amongst gender and sexuality groups.” Additionally, the module covers specific health areas, such as injury, violence, substance use, and HIV/AIDS. Issues characteristically faced by sexual and gender minorities such as rejection and stigma are also discussed, as well as what this does to a person’s health and how they can overcome it. The course concludes by teaching how to build community and social support for those affected by these health issues. 

Professor Kaufman emphasises that by studying LGBTQ+ health, and specifically minority health, governments, activists, NGOs and health care providers are more likely to ensure that everybody has equal access to power, resources and – most importantly – a good health status. While leading voices on LGBTQ+ health in the US become steadily more outspoken, this is not the case everywhere: “in some of the other countries I study – when it comes to sexual and gender minorities – because it is still illegal to engage in those behaviours, it is much harder to make sure that those populations get the health services that they need, such as getting tested for illnesses and that are prevention measures put in place.” For this reason, Professor Kaufman believes that it is productive to engage in an academic discourse about LGBTQ+ health so as to improve the conditions of LGBTQ+ communities across the world. Much of the academic discourse that already exists surrounding the topic of LGBTQ+ health was brought to the fore late in the 20th century, with the outbreak of the AIDS epidemic in the 1980s. 

While the contemporary AIDS epidemic is believed to have originated in the Democratic Republic of the Congo in the 1920s, it only later became recognised as an epidemic in the late 1970s. In 1981, five men from Los Angeles were diagnosed with a rare lung infection. A year later, a group of five gay men in Southern California were given the same diagnosis. Doctors therefore presupposed that the disease was solely caused by sexual intercourse between men. This was proven to be wrong in 1983, when it was discovered that the virus could be transmitted through blood and sexual contact, indiscriminate of sexual orientation. By the end of the same year, the number of people diagnosed with AIDS had risen to 3,064. 71% of these people were gay or bisexual men, 1,292 of whom had died. By 1995, in the USA, one gay man in every nine had been diagnosed with AIDS, one in 15 had died, and 10% of the 1,600,000 men aged 25-44 who identified as gay had died.

The global impact of HIV/AIDS has since been somewhat controlled thanks to research investment and the development of PrEP, a drug which significantly reduces the risk of getting HIV. However, as of 2018, there are still an estimated 37.9 million people around the world who are living with HIV/AIDS. Approximately 25% of these people are unaware of the fact that they have the virus and the majority are located in low- and middle- income countries, with an estimated 66% living in sub-Saharan Africa. Furthermore, sex workers and their clients, transgender women, MSM, and people who inject drugs make up almost 50% of the population groups affected by new HIV infections. 

Why, therefore, are LGBTQ+ people disproportionately affected by HIV/AIDS? Statistics published by the UNAIDS Gap Report outlines that there are a plethora of reasons to explain why HIV is so prevalent within the LGBTQ+ community. 

Firstly, one of the most significant reasons HIV/AIDS goes untreated is due to criminalisation, stigma, discrimination and social exclusion. In countries where homosexuality is punishable by death such as Iran, Sudan, Saudi Arabia and parts of Nigeria and Somalia, MSM are statistically less likely to use HIV services for fear of coming out. For this reason, there is often limited access to HIV prevention commodities, such as condoms, or HIV education. 

Secondly, an issue that many transgender and non-binary people face is a lack of recognition of gender identity. The Gap Report states that, due to this, “transgender people can be denied access to basic human rights, including their right to health, education and social welfare.” A combination of social exclusion, economic instability and insufficient employment, means that sex work becomes a viable form of income for many transgender people, and specifically transgender women, which heavily increases the likelihood of contracting HIV/AIDS

Thirdly, for many members of the LGBTQ+ population, it is common to experience family rejection. This is particularly true of transgender people. The Gap Report found that, “in Latin America, 44–70% of transgender women and girls have felt the need to leave home or were thrown out of their homes.” Another study from “Thailand and the Philippines found that 40% of Filipino transgender women and 21% of Thai transgender women reported paternal rejection when transitioning.”

A lot of the academic interest and funding for studies of sexuality in Public health stemmed from the international unrest caused by the 1980s AIDS epidemic. This unrest led to the foundation of a number of Centres for AIDS Research (CFAR) in 1988 across the US, funded by the National Institutes of Health. One of these 19 Centres is based at Johns Hopkins University and aims to support HIV/AIDS research, whether that includes treatment and cures, the epidemiology of AIDS, or social and behavioural aspects. Professor Kaufman states that, in this way, “academia is leading a lot of the research on HIV/AIDS.”

Recently, however, Professor Kaufman has witnessed a shift in the academic focus on LGBTQ+ health: “Now the funding for HIV/AIDS is dwindling. We have moved into a phase where it is more of a chronic illness than a death threat. Therefore, the funding for HIV is not as substantial as it used to be, especially for prevention efforts.” Due to this, there has been a recent surge in the interest of other aspects of LGBTQ+ health: “Now researchers are being creative, in that they will also apply for funding on things like substance use and still study sexual health issues because we know that there are some differences in substance use, cigarette consumption or depression among sexual and gender minority populations. LGBTQ+ people do not only suffer from HIV – they experience many health disparities.”

As the interest in LGBTQ+ Public Health increases, how is Johns Hopkins facilitating the teaching of LGBTQ+ topics inside the classroom? Professor Kaufman mentions a number of initiatives that the University is taking in order to ensure that the teaching of LGBTQ+ issues is executed appropriately, and the needs of LGBTQ+ staff are accounted for. For example, Lecturers and Professors participate in workshops to ensure that all of the faculty have resources for incorporating discussions of LGBTQ+ issues into their courses. As it is not compulsory or necessary to dedicate a subsection of every course on sexual and gender minority health, faculty members are encouraged and taught how to use relevant examples and appropriate language whilst stimulating discussion. 

Professor Kaufman praises the drive for greater inclusion, stating that “as more faculties start thinking about these issues and become more aware of ‘queering the curriculum,’ this will help to normalise the fact that [LGBTQ+ Public health] is part of the global health issues that we need to be addressing.” Additionally, the Johns Hopkins LGBT working group provides support for employees and students: 

“This is a volunteer working group run by faculty, but open to students and staff as well. It is a mix of people, primarily from the Schools of Medicine, Nursing and Public Health. They meet once a month to talk about some of the most pressing issues in the University, and which initiatives we would like to take on in the upcoming month.”

The benefits of LGBTQ+ inclusivity are not limited to inside the classroom; the practical benefits of studying LGBTQ+ global health are copious. Professor Kaufman notes that academic research provides strong evidence to support the weight and significance of these matters: “Academics provide statistics and data. Oftentimes with these social issues, you really need to have the data to make the case, especially when it comes to policy drafting, or new programming, or finding funding for those things. So, rigorous academic research that shows what the issues are and shows what works and what doesn’t is crucial.”

Recent conversation about HIV/AIDS follows White House promises to end the HIV epidemic. Professor Kaufman’s work shows that the issue of LGBTQ+ health transcends continents, boarders and the HIV crisis. The nuance and complexity of LGBTQ+ issues across the globe proves to be an ever-growing concern, and one that warrants the attention of governments, NGOS and members of the public, as well as students, universities and academics.


Share this story

Follow us online