Fenway Community Health Research Articles

Before AIDS: Gay Health Politics in the 1970s by Katie Batza

Reviewed by: Before AIDS: Gay Health Politics in the 1970s by Katie Batza Brett C. Stockdill Katie Batza. Before AIDS: Gay Health Politics in the 1970s. Politics and Culture in Modern America. Philadelphia: University of Pennsylvania Press, 2018. xii + 178 pp. Ill. $45.00 (978-0-8122-5013-8). Before AIDS cogently analyzes 1970s’ gay health activism—primarily among affluent white gay men—in the United States. Using archival research and interviews, Katie Batza challenges the narrative that gay health services emerged during the AIDS crisis in the 1980s. Simultaneously, her findings counter the portrayal of gay men in the 1970s as focused solely on sexual freedom; they also sought sexual health. The medical infrastructure developed in the 1970s proved indispensable in responding to the AIDS crisis. Batza chronicles how radical social movements inspired activists to reimagine the meaning of gay health. In turn, interactions with the state led to both the expansion and the deradicalization of gay clinics. The book is organized thematically, with each chapter comparing and contrasting how these key themes played out at Boston’s Fenway Community Health Clinic, Chicago’s Howard Brown Memorial Clinic, and Los Angeles’ Gay Community Services Center. Medical homophobia marred gay men’s health care in the 1960s and 1970s. Doctor’s visits “often led to misdiagnosis, judgment, ostracism, and treatment for their sexuality rather than their medical ailments” (p. 1). Coupled with the threat of violations of confidentiality that risked family abandonment, job loss, eviction, and so forth, homophobia often caused gay men to delay or avoid medical care. Within this context, gay men (and lesbians) took collective action to forge accessible, gay-positive STI (sexually transmitted infection) testing clinics, outreach and testing in bars and bathhouses, primary care, research, and other services. Radical social movements, local political contexts, and Great Society funding catalyzed the clinics’ formation. The dynamic milieu of the black power, antiwar, feminist, gay liberation, and other movements provided ideological and strategic models for gay health activists. A Black Panther Party clinic inspired former antiwar activists to start the Fenway clinic as part of a broader antigentrification campaign. Medical students and doctors radicalized by the antiwar movement and frustrated with homophobic medical training and care established Howard Brown. Los Angeles clinic organizers more explicitly employed gay liberation politics, promoting the concept of “oppression sickness”—“the ways in which homophobia literally made gay people sick” (p. 25). Framing oppression—not homosexuality—as pathological was integral in shifting from a medical model to a health justice model in all three clinics. Sex positivity, paired with gay cultural expertise (e.g., use of nonclinical language such as “rimming”), garnered trust among patients. Health care access expanded and improved greatly by the end of the decade. Gay health activists took advantage of Great Society (and other) grant funding. Research collaborations, professional organizations, and relationships with government agencies led to a better understanding of gay health for both health care providers and gay patients. State funding fostered the growth of the clinics, but compliance with government laws and regulations also impeded efforts to fight oppression. Ideological rifts around bureaucratization and professionalization [End Page 292] developed within the Los Angeles and Boston clinics between those committed to social justice activism and those committed to service provision. Sexism pervaded the clinics. Male activists drew upon feminist critiques of mainstream medicine, but typically dismissed lesbians’ health needs. Radical gay men and lesbians often left the clinics or were pushed out. By 1980, the clinics had shifted from volunteer-run collectives fighting “oppression sickness” to hierarchical bureaucracies with million-dollar budgets providing more narrowly defined medical care. Batza challenges the common AIDS narrative depicting gay men as pathologically hypersexual and hedonistic in the 1970s. She documents gay men’s collective efforts to fight homophobia and improve health care. Batza also argues that contrary to the common “AIDS abandonment narrative”—in which state abandonment gave rise to oppositional health activism—gay health activism was enmeshed with the state. The state provided resources instrumental to the growth of gay health care. In turn, the national gay health infrastructure created in the 1970s immediately responded to the AIDS crisis in the 1980s, providing frontline education, prevention, testing, medical care...

Post-exposure prophylaxis use and recurrent exposure to HIV among men who have sex with men who use crystal methamphetamine

BackgroundMen who have sex with men (MSM) who use crystal methamphetamine (CM) are at increased risk for HIV infection. Post-exposure prophylaxis (PEP) is a useful HIV prevention strategy if individuals are able to identify high-risk exposures and seek timely care, however to date there has been limited data on the use of PEP by CM users. MethodsA: Retrospective cohort study of all PEP prescriptions (N=1130 prescriptions among 788 MSM) at Fenway Community Health in Boston, MA was undertaken. Multivariable models were used to assess the association between CM use during exposure (7.4% used CM during exposure) and chronically (7.4% of MSM were chronic CM users) and individual-level and event-level outcomes among MSM who used PEP at least once. ResultsCompared to those who had not used CM, MSM PEP users who used CM more frequently returned for repeat PEP (aOR 5.13, 95% CI 2.82 to 9.34) and were significantly more likely to seroconvert over the follow-up period (aHR 3.61, 95% CI 1.51 to 8.60). MSM who used CM had increased odds of unprotected anal intercourse as the source of exposure (aOR 2.12, 95% CI 1.16 to 3.87) and knowing that their partner was HIV infected (aOR 2.27, 95% CI 1.42 to 3.64). ConclusionsWhile MSM who use CM may have challenges accessing ART in general, these data highlight the fact that those who were able to access PEP subsequently remained at increased risk of HIV seroconversion. Counseling and/or substance use interventions during the PEP course should be considered for CM-using MSM.

Engaging to End the Epidemic

Engaging to End the Epidemic

The Use of Respondent-Driven Sampling to Recruit At-Risk Minority Men Who Have Sex with Men in Massachusetts

This study assessed the ability of a modified respondent-driven sampling (RDS) method to recruit racial and ethnic minority men who have sex with men (MSM) at risk for HIV and other sexually transmitted infections (STIs). We used a modified RDS technique, a relatively new method of chain-referral sampling, to recruit 50 MSM in Greater Boston for a behavioral survey and interview. Traditional recruitment methods used by Fenway Community Health, a community-based health care and research facility, yield samples comprised of 15% to 30% racial/ethnic minority MSM. The present study recruited a sample of 60% racial/ethnic minority MSM, a significant difference from these earlier studies (all p values < .0001). Forty-five percent of the sample reported an annual income of less than $12,000, and 17% did not always have a regular place to live in the past year. Sixty-six percent of respondents were HIV infected; 43% reported a prior STI diagnosis. This study provides evidence that a modified RDS strategy can effectively engage at-risk racial/ethnic minority MSM, which has important implications for the enrollment of these populations in HIV prevention interventions and other social services.

Gonococcal, Chlamydia, and Syphilis Infection Positivity Among MSM Attending a Large Primary Care Clinic, Boston, 2003 to 2004

In the past decade, increases in syphilis and rectal gonorrhea have been reported among men who have sex with men (MSM) in the United States; however, limited sexually transmitted disease (STD) positivity data are available on MSM who receive their healthcare from primary care or general medical clinics. The current study sought to elucidate STD positivity in asymptomatic MSM seen at the largest primary care clinic for MSM in New England and to describe STD test positivity by reason for STD testing. As part of the Centers for Disease Control and Prevention's MSM Prevalence Monitoring Project, all medical visits between 2003 and 2004 (n = 21,927) among MSM attending Fenway Community Health (Boston) were reviewed. The prevalence of positive STD tests (chlamydia, gonorrhea, and syphilis reactivity) was determined and analyzed by demographic characteristics, HIV status, symptoms, and reason for testing. Overall, 23.4% of MSM visits included STD testing during the observation period. Their mean age was 39 years (range: 18-65 years); 84% were white, 5% were black, and 5% were Hispanic. Sixty-five percent of MSM tested were asymptomatic with 7% of asymptomatic MSM testing positive for at least one STD. STD prevalence varied by reason for STD testing: 4.4% of MSM routinely screened had at least one STD, compared to 6.9% of MSM who reported having high risk sex in the preceding 3 months, and 17% of MSM reporting an exposure to an STD. Among all asymptomatic MSM tested, 1.0% had urethral gonorrhea; 1.7% had pharyngeal gonorrhea; 5.6% had rectal gonorrhea; 2.2% had urethral chlamydia; and 4.3% were seroreactive for syphilis. Rectal gonorrhea and syphilis seropositivity were frequently diagnosed in asymptomatic MSM; STD prevalence was highest in MSM tested due to an STD exposure or reporting high-risk sex, underscoring the need to promote routine screening in high risk MSM populations.

Mental Health Concerns of Gay and Bisexual Men Seeking Mental Health Services

ABSTRACT Little data exist about the mental health needs of gay and bisexual men. This is due to limitations of existing studies such as small and nonrepresentative samples, failure to assess sexual orientation, and concerns about stigmatization, possibly causing sexual minority individuals to be reluctant to disclose their sexual orientation to researchers. Fenway Community Health is a large urban health center that serves the LGBT community. The large number of gay and bisexual men who present for mental health treatment allows for a unique opportunity to gain insight into mental health, prevention, and intervention needs for this group. The current study is a review of the mental health information from all of the gay and bisexual men who reported that they were HIV-negative during their mental health intake over a six-month period at Fenway Community Health (January to June 2000; N = 92). The most frequent presenting problems were depression, anxiety, and relationship issues. Additionally, presenting problems included current or past abuse, substance abuse, finance and employment, recent loss, and family issues. The most frequent diagnoses were depression, anxiety disorders, and adjustment disorders. These findings support the notion that presenting problems and mental health concerns among gay and bisexual men are similar to those frequently reported by individuals in other mental health facilities, however, specific psychosocial stressors are unique to this population.

Tenofovir DF Plus Lamivudine or Emtricitabine for Nonoccupational Postexposure Prophylaxis (NPEP) in a Boston Community Health Center

Nonoccupational postexposure prophylaxis (NPEP) has been used to decrease HIV transmission after high-risk exposures. However, suboptimal adherence in completing the recommended 28-day course has resulted in prophylaxis failures. Fenway Community Health, the largest center caring for HIV-infected and high-risk men who have sex with men (MSM) in New England, began an NPEP program in 1997, initially using zidovudine-based regimens. Two phase 4 studies, using tenofovir DF regimens combined with either lamivudine or emtricitabine, were conducted. This paper evaluates the experience of those who used tenofovir-based NPEP regimens, comparing the subjects to historical controls who used zidovudine-containing regimens. Between May 2004 and March 2005, 44 individuals who presented after high-risk sexual exposure were prescribed tenofovir DF/lamivudine for NPEP. Between March 2005 and March 2006, 68 individuals with 72 high-risk experiences received tenofovir DF/emtricitabine, and were compared to122 historical controls who were prescribed 126 courses of zidovudine plus lamivudine between January 2000 and May 2004. Seventy-two percent of those who took tenofovir DF and emtricitabine, and 87.5% of the participants who took tenofovir DF and lamivudine, for NPEP completed their regimens as prescribed, whereas only 42.1% of those who took zidovudine plus lamivudine did so (P < 0.0001). Participants who took tenofovir DF-containing regimens were more likely to report diarrhea or abdominal discomfort; patients who took zidovudine-containing regimens were more likely to report nausea and vomiting, which was often severe enough to lead to product discontinuation. Tenofovir DF-containing regimens for NPEP are generally well tolerated with high completion rates. Tolerability and adherence compared favorably to zidovudine-containing regimens used previously. Tenofovir DF-containing regimens should be considered for PEP to enhance adherence and regimen completion.

Retention Challenges for a Community-Based HIV Primary Care Clinic and Implications for Intervention

The present study sought to elucidate factors involved in loss to follow-up (LTF) among HIV-infected patients who had been receiving medical care at Fenway Community Health (FCH) located in Boston, Massachusetts. FCH provided care to 1143 HIV-infected patients in 2005, predominantly Caucasian men who have sex with men (MSM). Two approaches were used to address the research question. First, 495 patients were identified that had been LTF from 2001-2005. One hundred seventy-nine eligible patients completed a questionnaire to determine reasons for discontinuing care, representing a 51% response rate. Second, a cohort study was performed using the medical record data of 896 HIV-infected patients who were receiving medical care in the year 2000. Patients' utilization of primary medical care was followed until January 1, 2005 and predictors of LTF were examined using Cox proportional hazards regression modeling. Survey respondents reported that the greatest perceived barriers to care at FCH were personal/cultural, structural, and financial in nature. Twenty-two percent reported sporadic care elsewhere with gaps in care of 6 months or more, and 8% reported no regular provider for HIV. Significant predictors of LTF from regression analysis included: minority race/ethnicity, use of safety-net insurance, appointment nonadherence and no medical social work visits. To improve engagement and retention in care, organizations may use patient surveys for organizational self-assessment to effect operational changes that minimize barriers to care. A risk assessment tool based on evidence-based methods can be implemented to identify high-risk patients for innovative outreach interventions. The primary study limitation is the underrepresentation of minority and traditionally underserved populations.

The Health of sexual minorities: public health perspectives on lesbian, gay, bisexual, and transgender populations

Who Are LGBT Individuals?.- Shifting Sands or Solid Foundation? Lesbian, Gay, Bisexual, and Transgender Identity Formation.- Development of Same-Sex Attracted Youth.- Developmental Issues in Lesbian and Gay Adulthood.- Biology and Sexual Minority Status.- LGBT Health and the State.- The Importance of Being Perverse: Troubling Law, Identities, Health and Rights in Search of Global Justice.- Ethical, Legal, Social, and Political Implications of Scientific Research on Sexual Orientation.- Targeting the State: Risks, Benefits, and Strategic Dilemmas of Recent LGBT Health Advocacy.- Prejudice and Pride in Health.- Sexual Stigma: Putting Sexual Minority Health Issues in Context.- Globalization, Structural Violence, and LGBT Health: A Cross-Cultural Perspective.- Prejudice and Discrimination as Social Stressors.- Determinants of Health Among Two-Spirit American Indians and Alaska Natives.- I Don't Fit Anywhere: How Race and Sexuality Shape Latino Gay and Bisexual Men's Health.- Black LGB Health and Well-Being.- Research Methodologies.- Defining and Measuring Sexual Orientation for Research.- Sampling in Surveys of Lesbian, Gay, and Bisexual People.- Researching Gay Men's Health: The Promise of Qualitative Methodology.- From Science Fiction to Computer-Generated Technology: Sampling Lesbian, Gay, and Bisexual Individuals.- Using Community-Based Participatory Research to Understand and Eliminate Social Disparities in Health for Lesbian, Gay, Bisexual, and Transgender Populations.- Health Concerns.- Transgender Health Concerns.- Health Care of Lesbians and Bisexual Women.- Cancer and Sexual Minority Women.- HIV/AIDS Prevention Research Among Black Men Who Have Sex with Men: Current Progress and Future Directions.- LGBT Tobacco and Alcohol Disparities.- Methamphetamine Use and Its Relation to HIV Risk: Data from Latino Gay Men in San Francisco.- Healthcare Systems and Services.- Improving Access to Health Care Among African-American, Asian and Pacific Islander, and Latino Lesbian, Gay, and Bisexual Populations.- Public Health and Trans-People: Barriers to Care and Strategies to Improve Treatment.- HIV Prevention and Care for Gay, Lesbian, Bisexual, and Transgender Youths: Best Practices from Existing Programs and Policies.- Fenway Community Health's Model of Integrated, Community-Based LGBT Care, Education, and Research.

Developing an HIV-prevention intervention for HIV-infected men who have sex with men in HIV care: project enhance.

Men who have sex with men (MSM) represent the largest group with HIV in the U.S. (CDC 2005). Interventions for prevention with HIV-infected MSM are urgently needed, and integrating prevention into HIV care represents one opportunity for this advancement. This article describes the development and results of initial pilot testing of a behavioral intervention to reduce HIV sexual risk transmission behavior for HIV-infected MSM that is integrated into HIV care. To illustrate our intervention development process, we describe the setting and population (HIV-infected MSM patients at Fenway Community Health in Boston) for the project, the initial conceptualization of the project including its guiding conceptual model (information, motivation, and behavioral skills model, IMB: Fisher and Fischer 1993), the iterative process of attaining and integrating input from stakeholders, the use of peer interventionists, the open phase pilot and participant input, an overview of the intervention content, and, finally, lessons learned. The result of this process is an example of an intervention developed with strong input from the community and other stakeholders, which is ready for further testing in a randomized controlled trial.

Treatment and Outcomes of Infections by Methicillin-Resistant Staphylococcus aureus at an Ambulatory Clinic

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTI) have become increasingly common. This study's objectives were to describe the clinical spectrum of MRSA in a community health center and to determine whether the use of specific antimicrobials correlated with increased probability of clinical resolution of SSTI. A retrospective chart review of 399 sequential cases of culture-confirmed S. aureus SSTI, including 227 cases of MRSA SSTI, among outpatients at Fenway Community Health (Boston, MA) from 1998 to 2005 was done. The proportion of S. aureus SSTI due to MRSA increased significantly from 1998 to 2005 (P<0.0001). Resistance to clindamycin was common (48.2% of isolates). At the beginning of the study period, most patients with MRSA SSTI empirically treated with antibiotics received a beta-lactam, whereas by 2005, 76% received trimethoprim-sulfamethoxazole (TMP-SMX) (P<0.0001). Initially, few MRSA isolates were sensitive to the empirical antibiotic, but 77% were susceptible by 2005 (P<0.0001). A significantly higher percentage of patients with MRSA isolates had clinical resolution on the empirical antibiotic by 2005 (P=0.037). Use of an empirical antibiotic to which the clinical isolate was sensitive was associated with increased odds of clinical resolution on empirical therapy (odds ratio=5.91), controlling for incision and drainage and HIV status. MRSA now accounts for the majority of SSTI due to S. aureus at Fenway, and improved rates of clinical resolution on empirical antibiotic therapy have paralleled increasing use of empirical TMP-SMX for these infections. TMP-SMX appears to be an appropriate empirical antibiotic for suspected MRSA SSTI, especially where clindamycin resistance is common.

Developing Successful Sexual Health and Support Services for Bisexual People

SUMMARY In the last decade and a half in the Boston metropolitan area, community-based approaches have developed to meet the range of mental and general health support needs of bisexual people. We will chronicle some of this history and describe the web of programs and services available in Boston, focusing in particular on the BiHealth program at Fenway Community Health. We believe that BiHealth has been successful at serving bisexual people because of its unique approach to addressing bisexual behavior and identity. This approach is to carefully distinguish and take into consideration sexual behavior, on the one hand, and sexual identity, on the other, and to address them separately or in tandem, as appropriate. This approach includes recognizing and addressing different sub-groups of bisexual people, including self-identified bisexual people, non-identified bisexual people, and bi-curious people in particular. Here we describe the unique broad-based approaches to medical and mental health that BiHealth offers and we consider the importance of linkages to community, grassroots activism, and resources in addressing both bisexual behavior and identity. In conclusion, we offer lessons learned that we hope others will find useful in developing programs in other places for self-identified bisexual, non-identified bisexual and/or bi-curious people.

Sexual Minorities Seeking Services

SUMMARY Understanding the mental health needs of lesbian and bisexual (sexual minority) women is an integral part of designing and providing appropriate mental health services and treatment for them. In an effort to understand the mental health needs of sexual minority women who seek community treatment, a chart review was conducted of the 223 lesbian and bisexual women who presented for services between July 1, 1997 and December 31, 2000 at Fenway Community Health in Boston, MA. Data are based on clients' self-reports and clinician assessments of clients' presenting problem, relevant developmental history, prior mental health and substance abuse treatment, current reports of emotional/psychological symptoms, and areas of impaired functioning. Although substance abuse and suicidal ideation were commonly reported problems, other concerns were more frequently reported. High percentages of lesbians and bisexual women reported relationship concerns and lack of adequate social networks; rates of depression and anxiety based on clinicians' assessments were also high. Overall, lesbians and bisexual women did not differ in the issues they brought to treatment or level or types of impairment. Compared with previous community survey samples, however, study participants appeared to be healthier than general, non-clinical samples of self-identified lesbians, possibly reflecting the special characteristics of sexual minority women who seek treatment in specialized community sites such as the Fenway. Although patients who come to these sites may not represent the more general population of sexual minority women, community health centers known to serve lesbian, gay, bisexual and transgender (LGBT) individuals may be fruitful access points for studying the mental health status and treatment needs of sexual minority women.

Association of ancillary services with primary care utilization and retention for patients with HIV/AIDS

Fenway Community Health Center (FCHC), located in Boston, Massachusetts, provides comprehensive care to persons with HIV/AIDS, including medical, mental health and other health-related services. In this paper, we present results from an analysis of existing data about the demographic and clinical characteristics, service needs and utilization patterns, and primary care retention of HIV-positive primary care patients seen at FCHC during a 24-month study period. Patient data were extracted from Logician, FCHC's electronic medical record system, and imported into Microsoft Access, Microsoft Excel and SAS for manipulation and analysis. A total of 999 unique individuals were included in the study population. Most were men (97%), white (75%) and between 39 and 80 years of age. Patients averaged 6.7 medical visits annually at FCHC, and 61% had at least one medical visit every six months. Significant predictors of primary care utilization were insurance status, HIV disease stage, being on combination therapy, first CD4 count, first viral load level and receipt of ancillary services. Need and receipt of ancillary services were found through medical and case management record review; case management was the most used ancillary service, received by 36% of the study population. For most ancillary services, clients with assessed need had documented receipt of the service. Publicly insured and/or Ryan White CARE Act-funded patients had the greatest ancillary service utilization. The influence of ancillary services upon primary care entry could not be evaluated with available data; however, their influence upon primary care was significant. For patients who received primary care in every continuous six-month period, statistically significant associations were found with receipt of mental health care, case management, drug assistance, food/nutrition, complementary services and housing. Using the more rigorous FCHC standard of care (minimum of four primary care visits per year), significant associations were also found with transportation, legal services and substance abuse treatment. For non-whites and women, mental health care, food/nutrition, housing and transportation had particular significance.

Advocacy Meets the Scientific Method

ABSTRACT Dr. Judith Bradford is a social science researcher who has been a key figure in the evolution of lesbian health research. With Caitlin Ryan, Judy was instrumental in creating the National Lesbian Health Care Survey (NLHCS) in the mid-1980s. After assuming the Directorship of the Survey and Evaluation Research Lab (SERL) at the Virginia Commonwealth University (VCU), she became involved in the recent Institute of Medicine (IOM) Committee process, which resulted in increased attention to lesbian health at the national level. The IOM Committee recommendations have been instrumental in lobbying efforts by Judy and others for inclusion of LBGT issues in Healthy People 2010, the United States Public Health Service blueprint used by PHS agencies nationwide. Judy's current activities include helping to develop the Lesbian Health Research Institute and serving as the part-time Director of Lesbian Health Research at Fenway Community Health in Boston.

The evolution of the Fenway Community Health model.

Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.

Developing a Lesbian Health Research Program: Fenway Community Health Center’s Experience and Evolution

The Fenway Community Health Center (FCHC) was founded in 1971 as part of the free clinic movement and rapidly developed expertise in caring for gay men, lesbians, elderly persons, and college students. With the advent of the AIDS epidemic, FCHC developed one of the largest panels of persons living with HIV in New England and, concomitant with the rise in the HIV+ census in the clinical practice, developed a research department to undertake cohort studies of men who have sex with men. Partnerships with academic medical centers and federal research agencies facilitated the conduct of large-scale therapeutic and prevention interventions. FCHC also developed a wide array of programs for lesbians: comprehensive primary care including the provision of gynecological services and alternative insemination, individual and group counselling, and programs designed to address substance use, domestic violence, and post-traumatic stress syndromes. The increasing utilization of these services raised many questions for providers about how to understand lesbians’ health across the life continuum. To develop a research infrastructure for lesbian health and mental health research, FCHC established a multidisciplinary task force and has held two annual research forums to attract researchers and to engage the wider community. Four working groups are in the process of securing federal funding to support a robust lesbian health research effort.

The social context of drinking, drug use, and unsafe sex in the Boston Young Men Study.

The objective of this study was to evaluate the relation between drinking, drug use, and unprotected anal intercourse in young men who have sex with men. A cross-sectional analysis of first-visit data from a prospective cohort of 508 young gay men recruited from 1993 through 1994 from bars, college campuses, and the Fenway Community Health Center in Boston was performed. The major outcome measures were any unprotected anal intercourse, after drinking and when sober, stratified by type of sexual partner (steady or nonsteady) during the previous 6 months and during the most recent sexual encounter. The average age of the cohort was 23.3 years; 77.6% were white, and 76.4% were in college. These young men had a median of 10.5 male sexual partners in their lifetimes, and 3 sexual partners in the previous 6 months before enrollment. One hundred and thirty-four (26%) reported unprotected anal intercourse during the previous 6 months. Individuals who had unprotected anal intercourse were more likely to have a drinking problem (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.26-3.01) and drank more (20.4 ml/day versus 13.9 ml/day; p < or = 0.01), compared with individuals who did not engage in unprotected anal intercourse. Overall, men were significantly less likely to have unprotected anal intercourse after alcohol or drug use, based on a series of paired analysis (OR = 0.27; 95% CI = 0.15-0.48). However, when we stratified by type of sexual partner, men were significantly more likely to have unprotected anal intercourse with their nonsteady sexual partners after drinking than when sober (OR = 4.33; 95% CI = 1.37-13.7), but were significantly less likely to have unprotected anal intercourse with steady partners (OR = 0.27; 95% CI = 0.15-0.48). The patterns observed as already mentioned for drinking were also found for substance use in general. Men who were more likely to have unprotected anal intercourse after substance use were significantly more likely to have a drinking problem (OR = 7.65; 95% CI = 2.34-24.59). These results suggest that the role of alcohol and unsafe sex in young gay men is complex, with the role of situational factors of paramount importance. Alcohol and substance use interventions designed to reduce HIV risk need to specify the role of substance use in the sexual context to be successful.

Lesbian Uses of and Satisfaction with Mental Health Services

ABSTRACT In response to the dearth of specific information about lesbians' health status and practices in the health literature, a national study utilizing a self-administered questionnaire was conducted in 1987 by four associates of the Fenway Community Health Center in Boston to access data in these areas. The questionnaire solicited information about demographics, health practices, stress in personal and work lives, mental and physical health problems, sexual practices, family history of health related problems, and genetic attributes hypothesized to be related to “gayness.” Questionnaires from 1,633 lesbian women provided the database for the study. This paper discusses the portion of the survey that dealt with mental health services and life experiences. Past studies that investigated mental health needs of lesbians focused on the quality of treatment by mental health providers, rates of suicide attempts, and alcoholism. This paper compares these past findings with the responses of the lesbians in this national, community-based study. Findings indicate that although a significant number of the lesbian women in this sample had been in therapy, they sought out therapy as a coping strategy to deal with similar issues as other women, i.e., depression and relationships. Suicide attempts decreased considerably after adolescence and “coming out.” Rates of alcohol use and abuse, although difficult to compare with other studies, were higher than other women but similar to other studies investigating a community sample of lesbians. Even with a high family history of alcoholism, less than 5 percent reported having sought out therapy to deal with any issues of alcohol or drug use.

Gynecological Infections and Sexual Practices of Massachusetts Lesbian and Bisexual Women

Objective: The assumption that self-identified lesbians are at low risk for sexually transmitted diseases (STDs) and other gynecological infections may be premised upon infrequent screening, ignorance of lesbian sexual practices, and the discomfort that lesbians may feel concerning the disclosure of their sexual identity and behavior. We hypothesize that transmission between women may occur, and actual risk may depend upon the sexual behaviors as well as the number and gender of partners. Methods: In 1994, the Family Planning Council of Western Massachusetts developed a Lesbian Health Needs Assessment Survey. The Fenway Community Health Center (FCHC) supplemented the survey with a one-page STD questionnaire aimed at evaluating STD testing, diagnoses, and sexual practices among self-identified lesbian and bisexual women. Circulated only in eastern Massachusetts, 421 of the 1523 surveys, including the one-page STD supplement, that were distributed were returned. The prevalence of specific STDs among women with and without recent male sexual partners was compared and analyzed in relation to self-reported sexual behavior. Results: Among lesbians who denied having prior male sexual partners, the following gynecological infections were reported: trichomoniasis, anogenital warts, and abnormal Pap smears. The most commonly reported sexual practices were digital–vaginal penetration, oral–oral, oral–genital, and genital–genital contact. Conclusions: Probable woman-to-woman transmission of STDs and vaginitis was frequently reported. Although the true incidence of specific infections among lesbians is unknown, routine screening should be offered to sexually active lesbians.