Queer Health, Part I: Marriage Won’t Save You



Corey Prachniak is an LGBT rights, HIV policy, and healthcare attorney. He serves on the Steering Committee of the Network for LGBT Health Equity and tweets @LGBTadvocacy.



So, is that it?

In the relatively progressive parts of America, same-sex marriage is fast becoming law. Employment and housing discrimination is already banned by many cities and states, even as the federal Employee Non-Discrimination Act seems stalled. For many of us, the “gay rights” fight could be done. A child growing up today in L.A. or New York or Chicago will never live under the laws that haunted my generation and the ones before, taunting us that not only were we not equal, but that the rest of society liked it that way. Mission accomplished?

Not quite. Even if you live in a state where same-sex marriage is legal, that’s not the end of the story. Same-sex marriage won’t save your life. And it probably won’t improve your health.

LGBT people have more legal rights now than ever before, but that doesn’t change the fact that we’re still sexual minorities. And that exposes us to risk, discrimination, and health disparities that won’t evaporate with a simple change in the law. The marriage fight hasn’t necessarily made it easier to be queer; rather, it’s made it easier for LGBT people to be less queer. Same-sex marriage doesn’t make the medical field more culturally competent; it just lets queer people change to be less culturally different. It doesn’t open up new avenues to getting health insurance; it just lets you marry your way into benefits the same way heterosexuals can.

Being a sexual minority isn’t a binary, you-are-or-you-aren’t status. It’s a spectrum. In the past, all openly LGBT people were considered to be radicals on the scale of sexual minorities. It wasn’t possible to be LGBT and to be “mainstream.” But today it is. Some of us will be able to fit neatly into a gender identity that is considered “normal” by society, and to have a love life that people find morally acceptable. Others of us – who are gender nonconforming or queer, who don’t like the binary gender system, or who don’t want a monogamous relationship – will still be on the radical side of the spectrum. And that will expose us to risk.

Modern history of sexism and women’s rights provides useful lessons for queer activists today. Women’s rights groups made progress throughout the twentieth century on eliminating legal inequalities. But women remained sexual minorities. Those who maintained traditionally feminine looks, dressed conservatively, weren’t sexually promiscuous, and didn’t speak up for birth control and abortion access – those women were accepted as mainstream, even if they were still sexual minorities. As Nancy Polikoff writes in her book, Beyond Straight and Gay Marriage, marriage was viewed by feminists of the ‘60s and ‘70s as an institution that “policed the boundary between acceptable and unacceptable sexual expression.” On the other side of that boundary, what I would call the radical side of the sexual minority spectrum, are women who fail to meet the expectations of how they should identify and behave. They faced then, and continue to face now, violence, aggression, hatred, and discrimination for their failure to conform with what is sexually “moral” and “normal.” Society has a plethora of derogatory words to describe women who cross the line – words that simply have no masculine equivalent, because heterosexual men’s practices and identities are rarely questioned. A recent essay on Organizing Upgrade regarding the limits of marriage equality cites a 1984 piece by feminist Gayle Rubin that distinguishes between an inner circle of acceptable sexual practices and an outer circle of unacceptable ones. Thirty years later, some LGBT people may be able to find their way into the center – but not all of us will. Not all of us want to.

Sexual minorities are taught to be ashamed of our bodies. We’re taught that sex is bad. We’re taught that if we veer from the righteous path, we’ve dug our own graves and are on our own. Tragically, in the early days of the AIDS epidemic, this judgment was offered in literal terms by some members of society.

For decades, “conforming” for LGBT people meant being (or pretending to be) straight and cisgender. Today, that isn’t totally true – in some circles, we can be gay or trans – but only if we otherwise play by the rules. Now that we can get married, we had better do it and not be promiscuous. We better not protest the system of rigid genders and orientations, and rights and wrongs. We better not choose to be sexual minorities – to be radicals – to be queer.

That’s not to say that it’s wrong to want to get married, or to be cisgender, or to be a lesbian who happens to be traditionally feminine, or to be a gay man who honestly dislikes promiscuity. No one should punish an LGBT person for being traditional any more than someone should punish one for being queer.

The point is rather that we all need to stand together. We cannot let the fact that we’re now being allowed to conform with mainstream expectations to mean that we will be forced to do it.

The fact is, wherever we fall on the spectrum, we’re all still sexual minorities. Even LGBT kids growing up right now, in the post-DOMA world, will be put in sex ed classes that won’t teach them anything relevant to their personal sexual health. They’ll go from pediatricians to college clinic doctors to real-world general practitioners who won’t ask them the right questions and won’t give them the treatment they’ll need. They’ll be exploited by marketers of cigarettes, alcohol, and diet pills. They’ll be denied pre-HIV exposure drugs or hormone therapies or surgeries that they are told aren’t medical necessities. They’ll be denied health insurance if they don’t fit within a traditional family unit. They’ll be told to conform to sexual expectations or else deal with the consequences.

Same-sex marriage isn’t going to save our lives or end the health inequities we face. We need to continue fighting – not to be accepted into the system, but to change it. Not all of us can squeeze through the narrow door mainstream society has opened to let us in. If we don’t want to be left out in the cold, we’ll have to tear down some walls.

Part Two will be about health disparities sexual minorities face.

Part Three will be what we can do about it.

Published by Corey Prachniak

Healthcare and LGBT rights attorney; Chair of LGBT HealthLink's steering committee; frequent tweeter @cprachniak.

5 thoughts on “Queer Health, Part I: Marriage Won’t Save You

  1. Same sex marriage will save many lives, including those of many couples when one or both people require health insurance for life saving care and disease management. Insurance which must be purchased as an individual policy is always much more expensive than that employers award to married heterosexual couples. Individual policies can become unaffordable when someone faces partial or total disability.

    The ACA helps, but does not completely alleviate this disparity in access to health care. To minimize the value of same sex marriage, which now makes many struggling families eligible for automatic employer based insurance coverage is a big mistake. My life partner might well be alive today if we had been allowed to marry and get job based health insurance like any other couple. She died from lack of access to care.

    Same sex marriage has also served as a symbolic public referendum on whether LGBT people are in fact human and deserve equal protection and human dignity. It has provided critically necessary political momentum for LGBT rights issues. The success of same sex marriage is providing a groundswell of support to sweep the public, paving the way for additional wins on our associated issues. Success encourages our side, and demoralizes the forces of bigotry and hate. It proves the effectiveness of our movement, so others are happy to support us with actions and dollars.

    It is up to us to make certain all our issues are addressed and no one is left behind. While I would prefer social policy that accrues rights and privileges to individuals regardless of marital status, as is more generally the case in Europe, I do not dismiss the importance of the survival of the many of us who are economically marginalized, for whom marriage will provide a critical measure of the support needed to survive. It does help people who are among the most vulnerable, among them many lesbian couples who are raising children, away from urban settings and lacking community support. These families and their struggles are too often invisible and ignored by our movement. I am grateful some help is on the way to people who need and deserve it.

  2. i love this article Cor– sorry it took me so long to read it! Keep on keeping on. “For the Master’s tools will never dismantle the Master’s house.” – audre lord

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