The slowly expanding scientific literature on LGBT health is evidence of researchers' expanded interest in the field. But it's another matter to find funding to support the work.

"There's a sea change for LGBT health across the country," said Walter O. Bockting, PhD, co-director of Columbia University's new Initiative for LGBT Health. "Traditionally it's always been a topic that we needed to 'sell,' " he said. "What has changed is people are coming to us."

They may be coming for credible scientific information on LGBT health, but they aren't necessarily offering the money needed to generate it. "When we are trying to expand the research agenda, it can't be done without resources," said Bockting.

Even though the National Institutes of Health said more LGBT health research is needed, they aren't allocating additional funding for it. Said Bockting, who served on the IOM committee, "It has become an acknowledged priority, and they have shown willingness to address the gaps in knowledge." But grant applications from LGBT health researchers still have to compete on their merits. "They will receive applications [for funding]," said Bockting, "but those applications will have to compete with all other applications that NIH receives for health research. So I'm not aware of special funds for the research."

There are challenges on the medical frontlines, too, where calls for "cultural competence" in LGBT health care don't always come with incentives for providers to learn what they need to know. The problem isn't only about overloaded providers, however, but also has to do with LGBT patients simply not communicating about their particular needs.

Scott Cook, PhD, a clinical psychologist and deputy director of the Robert Wood Johnson Foundation-supported Finding Answers: Disparities Research for Change national program office at the University of Chicago, said, "Unless something is emphasized and incentivized, it's typically not going to happen. We see that in racial and ethnic care in general. Unless there is an incentive, such as reimbursement, it's really hard for [providers] to turn over resources to begin with. Same thing with LGBT patients, it's going to have to be incentivized."

Dr. Cook, who worked for eight years at Chicago's Howard Brown Health Center, the largest LGBT health organization in the Midwest, added, "Health care is starting to turn its sights to thinking it's not all about the doctor deciding what needs to be done, when, and where, that we need to involve patients in a conversation and understand their values, beliefs, what's important to them."

When activists began to "zap" meetings of the American Psychiatric Association, beginning in 1970, they demanded the doctors "Talk with us, not about us," as the late Barbara Gittings told me in an interview for my book Victory Deferred. Long before someone coined the term cultural competence, gay and lesbian activists understood that changes in the political and medical fortunes of LGBT people would come about only through dialogue. They also knew they couldn't participate as equals in such dialogue unless they were open about their sexual orientation.