NEW YORK - Vickie Smith said she was 30 before she found a gynecologist in whom she could comfortably confide that she was a lesbian.
"I certainly hadn't had anyone who didn't, like, make a face," Smith said about the doctors she'd seen before visiting Dr. Fe Mondragon. Often, she said, male gynecologists told her, "You don't seem to be sexually active ... Someone your age should be very active."
Fears of doctors giving moral lessons or simply not understanding the mechanics of non-heterosexual practices can lead patients to avoid discussing intimate details with health professionals, or worse, to steer clear of health care altogether.
To help solve these problems, the Empire State Pride Agenda lobbied state legislators Monday for $5 million to educate health professionals and provide support and resources for lesbian, gay, bisexual and transgendered people.
In the past three years, the Pride Agenda successfully lobbied for a total of about $5.5 million in state money for similar projects.
"We're kind of the last ones left in terms of underserved communities," said Sheila Healey, Empire State Pride Agenda Foundation program director.
The Albany-based group In Our Own Voices, which serves "lesbian, gay, bisexual and transgendered people of color," used a $90,000 state grant to develop Project SANO!, after the Spanish word for "healthy."
The project sponsors support groups, health seminars, and events for lesbian, gay, bisexual and transgendered people. Its most public outreach effort has been a 28-page health and human services directory listing doctors and therapists amenable to those groups and providing questions and information for determining whether other health professionals welcome and understand non-heterosexuals.
SANO! did not concentrate specifically on gay people or AIDs, which is what most people typically think of in terms of non-heterosexual health needs. While that is important, Project SANO! director Nadya Lawson said there's a range of other concerns affecting lesbians, bisexuals and transgendered people.
Additionally, when the patients are nonwhites, the concerns can become even more complex. Caucasians are welcome to use In Our Own Voices' resources, but the group aims to help what it sees as overlooked populations.
Between 5 percent and 12 percent of nursing students questioned in a 1998 study said they despised lesbian, gay and bisexual people, according to a study in the Journal of Nursing Education.
More than half of the black people who answered a 1999 Kaiser Family Foundation survey said that they felt health care professionals treat people unfairly based on race or ethnicity either very often or somewhat often. Sixty two percent of Latinos said the same thing.
The Empire State Pride Agenda said the In Our Own Voices' directory, which lists doctors in Albany and six surrounding counties, is the only comprehensive health directory in the state.
The Audre Lorde Project in Brooklyn has a less extensive health brochure for lesbian, gay, bisexual and transgendered people of color.
In Our Own Voices is developing a second directory to be published this year. More than 700 copies of the current issue have been distributed free-of-charge and the group has a little less than 300 left.
To be listed in the directory, In Our Own Voices sought recommendations of doctors, dentists or therapists that patients felt were comfortable with any race and sexual habits. The group then asked the recommended people if they would allow themselves to be listed.
The directory also suggests questions to ask doctors and health facilities. They include "Do you think there is a medical cure for homosexuality?" and "Are you involved in any gay or lesbian research?"
Mondragon, Smith's gynecologist, is listed in the directory.
The waiting room of her office in Clifton Park, an Albany suburb, does not advertise any attempt to attract lesbians -- or any specific group. One wall is filled with photos of babies she's delivered -- mostly to heterosexual couples. She also has helped lesbians start families.
Mondragon does not ask patients to reveal their sexual habits, or lack thereof, but takes care not to assume the patient's sexuality.
"We don't ask, 'Do you need contraceptives?"' said Mondragon. "We ask, 'Do you have a need for birth control?' We try to eliminate any kind of assumptions."
"If you bill yourself as (providing) women's health services," she said, "why shouldn't that include the knowledge of what lesbians do or what they need?"