LETTERS CONTINUED DISPARITIES IN LESBIAN, GAY, AND BISEXUAL RESEARCH FUNDING AT NIH Since its inception, the National Institutes of Health (NIH) has possibly spent more dollars on research to cure and treat homosexuality and “gender identity disorder” than to understand and address the concerns of lesbian, gay, and bisexual (LGB) individuals. Previous articles, including the one by Coulter et al.1 from earlier this year, have documented this lack of attention on the real and pressing concerns of these communities extending beyond HIV/AIDS. Our analysis of NIH’s fiscal year 2012 funding portfolio supports the findings of previous publications summarizing the bleak state of funding for LGB health research, providing more detailed information regarding the trends of funding at the institute and center level, for different activity codes, dollar amounts allocated, and study section or review panel. Of the 78 827 funded projects described in RePORTER at the time of study, only 26 were non-HIV LGB health related; seven were newly funded and 19 were continuing projects. Non-HIV LGB projects

Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at [email protected].

represented less than 0.05% of each of the total projects within the 13 activity codes represented (Table 1). The state of research grants is particularly disheartening; only 10 of the 27 221 R01s awarded in fiscal year 2012 represented non-HIV LGB research. Of the 27 institutes and centers at NIH, 20 awarded funding to zero non-HIV LGB projects and none devoted more than 0.05% of its funding toward these topics. The National Institute of Child Health and Human Development administered funding to the greatest number of projects (11, 0.31% of its portfolio) while the National Institute on Alcohol Abuse and Alcoholism awarded the greatest percentage of non-HIV LGB projects at 0.49% (six projects). The National Institute on Aging, the National Institute on Deafness and Other Communication Disorders, and the National Institute on Minority Health and Health Disparities each administered funding to only one project. In eliminating HIV-related studies from our analysis, we hoped to see a more equitable distribution of health topics funded than discovered by Coulter et al.1 NIH lists 237 distinct Research, Condition, and Disease Categorization categories, 43 of which were represented (Table A, available as a supplement to this article at http://www.apha.org). While there is a somewhat wide range of topics covered, it is not deep. Twenty-seven of these spending categories are represented by only one or two studies. Many of the categories related to topics highlighted by the Institute of Medicine report2 as priorities for research, such as cancer, adolescent sexual activity, sexually transmitted infections or herpes, and interventions related to homicide and substance abuse among sexual minority groups are not receiving funding outside of the context of HIV/AIDS. Our findings suggest that individual LGB health projects may not be underfunded, as the proportion of funding resembles the proportion of projects per activity code. However, well-funded, single projects on a sampling of

Supplement 3, 2015, Vol 105, No. S3 | American Journal of Public Health

topics fail to reveal the full picture of LGB health. The historical funding trends have contributed to the de facto definition of LGB health research as HIV research. Current voids of relevant research within institutes and centers, disease categories, and activity codes, now uncovered, are opportunities to contribute to a broader definition of health and addressing the other pressing health concerns of this population. j Caroline H. Voyles, MPH Randall L. Sell, ScD

About the Authors Caroline H. Voyles is a Master of Public Health student at Drexel University School of Public Health, Philadelphia, PA. Randall L. Sell is an Associate Professor in the Department of Community Health and Prevention, Drexel University School of Public Health. Correspondence should be sent to Caroline Voyles, Drexel University School of Public Health, Department of Community Health and Prevention, Nesbitt Hall 4th Floor, 3215 Market Street, Philadelphia, PA 19104 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted August 10, 2014. doi:10.2105/AJPH.2014.302265

Contributors C. H. Voyles conducted the data collection, analysis, writing, and submission. R. L. Sell conceptualized the project and contributed to the writing and editing.

Acknowledgments This project was conducted as part of Drexel University’s Opening Doors Health Disparities Research Training Program. Opening Doors is funded by an R25 grant from the National Institute on Minority Health and Health Disparities (R25MD006792).

References 1. Coulter RW, Kenst KS, Bowen DJ. Scout. Research funded by the National Institutes of Health of lesbian, gay, bisexual, and transgender populations. Am J Public Health. 2014;104(2):e105---e112. 2. Institute of Medicine Committee on Lesbian. Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies Press; 2011.

Letters | e1

LETTERS

TABLE 1—Actual and Financial Representation of Non-HIV Lesbian, Gay, and Bisexual (LGB) Projects as Part of Fiscal Year 2012 Overall National Institutes of Health (NIH) Funding Portfolio Listed by Activity Code Activity Code

Total NIH Projects, No.

Non-HIV LGB, No. (% of Total)

Total NIH Funding Allocated, $

Non-HIV LGB Funding, % (% of Total)

F31

1 239

2 (0.161)

40 056 950

96 225 (0.24)

F32 K08

1 379 967

1 (0.073) 1 (0.103)

61 959 993 130 175 088

K23

1 018

2 (0.196)

K99

358

1 (0.279)

Administrating ICs

Study Sections

NIAAA, NICHD

Health Services Research Review Subcommittee;

21 405 (0.03) 16 0984 (0.12)

NICHD NIMH

Special Emphasis Panel [ZRG1-PSE-J (50)] ITVC

150 293 765

310 587 (0.21)

NIAAA, NIMH

Health Services Research Review Subcommittee; SRNS

36 034 622

121 841 (0.34)

NIAAA

Health Services Research Review Subcommittee

NIA

Special Emphasis Panel [ZAG1-ZIJ-3(M1)]

NIAAA, NICHD, NIDA, NIMH

CIHB; CLHP; PDRP; RPIA; SPIP; Special Emphasis Panel

Special Emphasis Panel [ZRG1-F16-B (20)]

P30

3 688

1 (0.027)

—

104 439 (—)

R01

27 221

10 (0.037)

10 599 741 043

4 645 315 (0.04)

(ZRG1-AARR-F[03]); Special Emphasis Panel (ZRG1-PSE-J [50]); Special Emphasis Panel (ZRG1-PSE-K [02]) R03 R13

1 236 684

2 (0.162) 1 (0.146)

98 866 819 13 464 707

218 650 (0.22) 10 000 (0.07)

NICHD NICHD

CDRC, Pediatrics Subcommittee Pediatrics Subcommittee

R15

234

1 (0.427)

79 833 929

446 056 (0.56)

NIAAA

PDRP

R21

3 884

1 (0.026)

780 534 600

180 383 (0.02)

NICHD

CIHB

R25

690

1 (0.145)

181 663 617

168 483 (0.09)

NICHD

Pediatrics Subcommittee

R34

276

1 (0.362)

65 593 255

307 144 (0.047)

NIMH

SRNS

U54

2 077

1 (0.048)

166 666 (—)

NIMHD

Special Emphasis Panel (ZMD1-RN[09])

—

Note. CDRC = Communication Disorder Review Committee; CIHB = Community Influences on Health Behavior; CLHP = Community-Level Health Promotion Study Section; ICs = institutes and centers; ITVC = Interventions Committee for Disorders Involving Children and Their Families; NIA = National Institute on Aging; NIAAA = National Institute on Alcohol Abuse and Alcoholism; NICHD = National Institute of Child Health and Human Development; NIDA = National Institute on Drug Abuse; NIMH = National Institute of Mental Health; NIMHD = National Institute on Minority Health and Health Disparities; PDRP = Psychosocial Development, Risk and Prevention Study Section; RPIA = Risk, Prevention and Intervention for Addictions Study Section; SPIP = Social Psychology, Personality and Interpersonal Processes Study Section; SRNS = Mental Health Services in Non-Specialty Settings

COULTER ET AL. RESPOND We appreciate Voyles and Sell’s continued monitoring of the National Institutes of Health’s (NIH’s) research portfolio related to lesbian, gay, and bisexual (LGB) health. Our article examined trends from 1989 through 2011, and their analysis extends NIH funding trends through 2012. Ongoing monitoring is not only important but also necessary to ensure NIH is held accountable for their investment in understanding and improving the health of LGB populations. Curiously, projects about transgender health were not mentioned. Was this because there were not any non-HIV transgender health projects in 2012, or was there another rationale for exclusion? Regardless of the reason, we hope NIH and researchers make efforts to include—and measure—transgender people in future projects. Voyles and Sell included a thorough analysis of NIH funding by examining the total dollars

e2 | Letters

invested in each project and which institutes funded LGB projects. They found at least one promising piece of evidence: the percentages of dollars funded in LGB health are equal to the proportion of projects per activity code. However, the percentages were dismal, with the highest at 0.56%. Moreover, 74.07% (n = 20) of the institutes did not fund any non-HIV LGB projects in 2012. This is an area of improvement necessary for NIH, because most, if not all, institutes are involved with topic areas pertinent to LGB and transgender (LGBT) health. It is, however, important to note that additional institutes have funded non-HIV LGB projects since 2012 (e.g., National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Allergy and Infectious Diseases, National Institute on Nursing Research, National Cancer Institute). This suggests NIH is able to increase the number of granting institutes in a short amount of time. Thus, institutes absent any LGBT projects should be targets of focused efforts to increase LGBT health research, as this may present a target for

efficient growth. It may also be that some institutes did not fund LGB projects because viable proposals were not submitted. In addition to changes at the institutes, researchers may need to assume greater responsibility for addressing LGBT disparities in their proposals. We view analyses of NIH’s research portfolio as a call to action that can fuel NIH to improve their policies and foster a welcoming and affirming climate for LGBT health research. Additionally, we hope our analyses provide LGBT health researchers with (1) information to pair the funding gaps with issues we know are problematic1 and communities want resolved, and (2) motivation to submit high-quality proposals on such topics. j

Robert W.S. Coulter, MPH Karey S. Kenst, MPH Deborah J. Bowen, PhD Scout, PhD

American Journal of Public Health | Supplement 3, 2015, Vol 105, No. S3