A ward of our own.

The American health care system is in need of intensive care, and if you're concerned about the future of gay and lesbian health, you have plenty of reason to be uncomfortable with who's scrubbing up for surgery. Most of the elected officials debating how to heal our country's ailing health care system are unaware of, insensitive about, or actively hostile to lesbian and gay health issues.

So it's no surprise that the often unique health care needs of lesbians and gay men won't be considered along with tightening regulation of the mighty HMOs and reforming Medicare for seniors--Congress hasn't even affirmed the right of gay and lesbian Americans to hold a job! And though health care reform as it's being discussed is important to everyone, the research is clear that many in our community won't seek health care, reformed by Congress or not, as long as our choices are limited to physicians who don't understand us.

We've known for years that lesbians and gay men are less likely than heterosexuals to access routine health care. First, nationally there are few gay- and lesbian-identified nonprofit organizations or private medical practices that specialize in such care, and most of these have focused primarily on HIV/AIDS. And all of them together are only a drop in the bucket in comparison to the numbers of gay men and lesbians who need medical care. Even fewer have specialists in lesbian health care, participate in managed care plans, or take any significant numbers of Medicare or indigent patients.

Second, not many mainstream providers are qualified to provide such care. In fact, many in our community won't even seek care from mainstream sources because of homophobia experienced at the hands of bigoted or ignorant physicians. Those who do often fail to come out, thus risking a misdiagnosis because the doctor presumes they are heterosexual. Still others come out only to face discrimination by insensitive health care providers who condemn their sexual orientation or deny them appropriate care.

Indeed, this was exactly what so many in our community encountered in the early years of the AIDS epidemic. Tens of thousands died while mainstream medical and governmental establishments did nothing--or actually made matters worse. So instead of waiting for the system to provide for us, we had no choice but to take care of ourselves.

Using our own money and expertise, gay men and lesbians built an alternative community-based health care system for people with HIV and AIDS, seeking to provide for all who needed it, offering quality and holistic services, educating medical providers about how best to serve us, and creating supportive and increasingly inviting environments that encouraged people to seek care.

What does this mean for the future of gay and lesbian health care in general? During the course of the AIDS epidemic, we've learned volumes about health care delivery to our community and have built the impressive and increasingly sophisticated infrastructures to provide it--but all of this knowledge and capability has been confined almost exclusively to HIV/AIDS. Now it is way past time for our community based organizations to realize their full potential and expand to also address the important primary and specialty care needs of lesbian and gay people, which have been largely invisible because of the AIDS epidemic. Of course we can't lessen our focus on fighting AIDS--specially now--but that doesn't mean we can't expand our focus. Expansion does not equal dilution!

With the launching of Los Angeles's Lambda Medical Group in September, the L.A. Gay and Lesbian Center is just one of the organizations rising to this challenge. And the managed care industry has been incredibly responsive--already we have contracts with 14 of the nation's largest managed care and insurance companies. Callen-Lorde Community Health Center in New York City and Fenway Community Health Center in Boston, among others, are moving in the same direction. Together we all can greatly enhance the health and strength of our communities.