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© 2006 American Public Health Association
DOI: 10.2105/AJPH.2005.077321
LETTER |
Correspondence: Requests for reprints should be sent to Chandra L. Ford, PhD, MPH, MLIS, 378-A Wing D, Department of Social Medicine, CB# 7240 School of Medicine, University of North Carolina, Chapel Hill, NC 27599–7240 (e-mail: chandra_ford{at}med.unc.edu).
In the July issue of the Journal, Young and Meyer1 describe how research targeting sexual minorities often relies upon the terms "men who have sex with men (MSM)" and "women who have sex with women (WSW)" in ways that elide important social considerations. The authors provide recommendations that are potentially quite useful, and they implore researchers to "aim for a deeper understanding of variations in the meaning of sexual identity and community."1(p1149) I wholeheartedly agree with the intent of their recommendations, but it is unclear how researchers could implement those recommendations without first addressing the social context within which public health research occurs.
That context encourages researchers to rely upon the very approaches the authors criticize and makes it harder to implement the more thoughtful approaches they recommend. For instance, minority group members who might provide rich insights into relevant social contexts remain underrepresented among principal investigators. Similarly, although minority communities are routinely targeted for public health research and interventions, the core standards for public health training do not require researchers to gain basic cultural competencies in order to conduct this research respectfully and competently. In addition, researchers receive almost no formal training on how social stratification, which underlies the relational minority and majority groups and, many believe, their health disparities, might be relevant to their research.
More than a decade ago, Fee and Krieger critiqued HIV/AIDS research more generally, writing that "[the biomedical model] contains within itself a dichotomy between the biological individual and social community, and then it ignores the latter."2(p1841) Although this separation of individuals from their social contexts occurs routinely in public health research, whether our efforts target minority or nonminority groups, Young and Meyer suggest that the implications of this disconnection are particularly salient when research targets sexual minorities—who, I would add, we cannot assume are less marginalized within the context of public health research than they are in society at large.
Young and Meyer’s recommended approaches are important and, if realized, have the potential both to make disparities research more meaningful to sexual minority groups and to improve the accuracy with which we specify risk groups and target populations. For these recommendations to be implemented and sustained over time, however, we must address the fundamental ways in which social stratification functions within the context of public health research. Otherwise, researchers attempting to "aim for a deeper understanding of variations" may unwittingly do little more than remarginalize minorities in some other way.
Acknowledgments
I thank Kara Keeling and Dionne Godette for their comments on early drafts of the letter.
References
1. Young RM, Meyer IH. The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse. Am J Public Health. 2005;95: 1144–1149.
2. Fee E, Krieger N. Understanding AIDS: historical interpretations and the limits of biomedical individualism. Am J Public Health. 1993;83:1477–1486.
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