Wednesday, December 9, 2009

After I Left AIDS - Part I

About a month ago, I wrote about Why I Left AIDS, but didn't get around to what I'd moved into.

While I was working in gerontology, and started taking classes again in public health, I was trying to figure out what I wanted to do research on. I knew it wasn't HIV/AIDS, and most of the other health outcomes related to gay men (suicidality, depression, substance abuse) were kind of downers. The depression bit hit close to home, and the substance abuse felt completely foreign to me, so I didn't really know where to go.
At the time, in gerontology, I was working on a variety of measures of regional variation in social conditions to try to explain health disparities. We had noticed a big difference in the occurrence of pressure ulcers (bed sores) by racial identity. While it was interesting for me to crunch large datasets, and to work with colleagues to figure out a narrative that might explain the health disparity, documenting the disparity and theorizing about why it occurred seemed unsatisfying. I wanted to measure the cause, not just the effect.
I had also been a teaching assistant for the epidemiology class at Brown for many years at that point, and we always chose an article about the link between residential segregation along racial lines and some health outcome or another, usually birth weight or premature delivery. The idea was that racial segregation, the separation of people in space, reflected social segregation, or the history and current strength of racial hierarchical ideology.
So it was a natural connection to say, hey let's look at whether the health disparity in bed sores is larger in cities characterized by high levels of racial segregation than it is in cities where people are more evenly distributed.
Unfortunately, we never got around to writing that paper (I don't think we even got to the analysis stage before I moved on), but the point is, I spent long hours figuring out how to measure, in a quantitative sense, the racial segregation of where people live, and also the levels of economic disparity (gap between the rich and poor), and how these measures vary across the U.S.
Roughly at the same time, I began to think that I wasn't so interested in documenting the extent of health disparity there was between gay men and straight men, lesbians and straight women (and there was almost no literature on bisexuals, and even less on gender identity), I was interested in measuring what causes the health disparities that do exist.
At first, I tried to think about measuring homophobia in high schools. In my own life, high school was definitely the most homophobic environment I had survived, after all.
I figured that one way to do it was to ask a wide range of students who had graduated and gone on to college to rate their high school environment with regards to homophobia. Having gone to college, they would have at least one other environment to compare to, some perspective. And by asking them about the school environment, rather than their personal experience, then queer kids and straight kids would both have valuable and relevant insights and perceptions on the issue.
I developed a 20-some odd page questionnaire and tested it on maybe 40 or so Brown undergrads, queer, straight, and in-between. At that point, it was an exercise for a survey design class I was taking, so I wasn't particularly interested in scientifically important questions like inter-rater reliability, I had a much more mundane purpose - did recent high school graduates feel like these questions made sense? Were they salient? Were they getting at what I intended them to get at? and was I missing anything?
It was a great experience (for me, anyway). And the questions did make sense (most of them), they were on target (most of them), and there were a few things I had missed. I was convinced that it was worth taking it to the next stage.
I began thinking about how to use it. It was one thing if one could describe the social environment, it was another to use it to predict health or health behaviors. In conversation with a student (Marc), we had an idea - which was to measure the homophobia at a series of high schools where more than one student had died of self-inflicted injuries to high schools where no student had died of self-inflicted injuries in many years, and to measure the extent to which the school social environment was infused with homophobia in both sets of schools.
And here's an important point - whether the students were queer, straight, or in-between was not relevant to our plan. It wasn't going to be a study about who had killed themselves, but about what sort of environment drives people to the point of ending their lives.

So maybe you're seeing a thread here already - the vast majority of research literature on queer health is about documenting the bad things that queers (and usually gay men specifically) are at higher risk for. But I wanted to take a different tack - I wasn't so concerned with what the specific health outcomes were, but the cause of them, and specifically, the cause in the sense of the social environment.
And this opened up a new possibility - examining the influence of the perfusion of homophobia in social environments not just on queer people, but on the whole population, on straight people too.
My involvement with ActUp/RI was highly influential in getting me to think about homophobia as a health hazard, but in that context, I thought about it as the reason the government was letting gay men die without saying a word, literally. Or when words were spoken, they would be words of condemnation, threats of quarantine, of judicial prosecution for having an infections disease, of punishment for exposing the "general population" to a scourge that we deserved but they did not.
Instead, I was now thinking about homophobia as a threat to the whole population.

More to come...

1 comment:

  1. Thanks Bill, for Part II. This kind of "case study" of gay men's health work is great. I'm thinking that a bunch of such case studies would be great for the leadership academy. love, Chris