and lesbians (NGLTF, 1998; see also Table 2.1). Although some states have laws that ban discrimination on the basis of sexual orientation in employment, housing, credit, and public accommodation, many do not. Passage of such laws remains controversial. For example, in Maine where such legislation passed in 1997, voters subsequently voted to overturn the law (NGLTF, 1998). In some states, laws are in place to prohibit state and county employees from receiving domestic partner benefits. Same-sex marriage is specifically banned in 25 states and is not legal in any state. Efforts are also underway in some states to prevent same-sex couples from adopting children or serving as foster parents. Finally, numerous states ban same-sex sodomy specifically or along with opposite-sex sodomy.
We still have many people in many states who can be persecuted by laws, can be put out of work, and even if we have the gold standard (randomized, controlled clinical trials), they are not going to come to our studies because they do not want to be stigmatized any more than they already are.
Donna Knustson, Public Workshop, October 6-7, 1997
Lesbian health and risks to health can be examined in the context of the health care system. In other words, are there aspects of the health care system that act to reduce lesbian's access to services, thereby possibly increasing their risk of health problems? Access to health care has been defined as the timely use of personal health services to achieve the best possible health outcomes (IOM, 1993). The three primary types of barriers are (1) structural barriers (e.g., availability of services, organizational configuration of health care providers); (2) financial barriers (e.g., insurance coverage); and (3) personal and cultural barriers (e.g., attitudes of patients and providers) (IOM, 1993). The test of equal access involves