Book Review

The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual, and Transgender Populations

N Engl J Med 2007; 356:2435-2436June 7, 2007

Article

The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual, and Transgender Populations
Edited by Ilan H. Meyer and Mary E. Northridge. 731 pp. New York, Springer, 2007. $89.95. ISBN: 978-0-387-28871-0

Homosexuals have never been popular. For millennia, there have been religious objections to same-sex attraction and behavior — people who had sexual contact with members of their own sex were regarded as sinful or depraved. In the late 19th century, medical and psychological views of same-sex desire evolved, but this development, often motivated by a wish to exculpate men and women who were drawn to their own sex, ultimately had the effect of further criminalizing and medicalizing homosexuality.

The official “identification” of homosexuality as a disorder led to shame and fear for many men and women and their families. Between the 1920s and the mid-1980s, unknown numbers of gay men and lesbians in the United States and Britain underwent psychoanalytic, psychological, and medical “treatments” to make them heterosexual. This practice continues today, although now largely under the guise of spiritual healing. Thus it is not too surprising that a book on the public health of sexual minorities does not get around to a discussion of actual health outcomes until the reader is more than halfway through it. This long preamble is necessary, however, because the people who are the focus of the book are a minority that is largely hidden in history and remains difficult to define or study.

The default assumption in all societies is heterosexuality. Homosexuality, bisexuality, and transgenderism are acknowledged only when society is presented with their evidence, usually in the form of gender nonconformity, or when lesbian, gay, bisexual, or transgender persons make themselves known. This openness has occurred mainly since the 1960s and mostly in wealthy Western countries. Although it has undoubtedly led to enormous leaps forward, we still know relatively little about the public health issues that affect people who are lesbian, gay, bisexual, or transgender. The main stumbling block is defining and measuring the population and its needs. This is where The Health of Sexual Minorities comes in.

Before we can understand the key public health problems and plan an appropriate response, we have to agree on our target. The authors of the first 18 chapters of the book describe what it is like to grow up as a member of a sexual minority in American society, how such human characteristics can be defined and measured, and what role political and judicial systems should play in these matters. The second half of the book deals with the primary public health problems of this population — including infection with the human immunodeficiency virus, mental health issues, substance abuse, and particular cancers — and the community and service responses needed.

The book is particularly good at questioning stale ideologies about growing up gay and challenging assumptions about how people manage their identities at different stages of their lives. It is also insightful in its discernment of the nature and effects of stigma and the consequences (both good and bad) of taking the “I was born that way” approach to lesbian and gay rights. However, the discussion of civil rights is heavy going, and the chapter on how race and sexuality shape Latino health is superficial. I would have preferred a more theory-driven discussion of how antihomosexual prejudice and stigma affect health, why such hostility is ubiquitous in human cultures, and how the book's unapologetically North American view (only one author comes from outside the United States) might serve the public health needs of sexual minorities in other, particularly low-income, countries. These flaws aside, this is a serious and useful book that should be required reading for public health professionals.

Michael King, M.D., Ph.D.
University College London, London NW3 2PF, United Kingdom
m.king@medsch.ucl.ac.uk