Changing laws affect gay people’s health, for better and for worse

Joe Alfano got married twice in four years – to the same person. He met his husband Frank Capley at the San Francisco pride parade twelve years ago. “We locked eyes from across the crowd,” Alfano recalled. He gestured to Capley to come over to him, but let Capley coax him over instead. “We’ve been pretty much inseparable ever since,” he said.

They first married in 2004, during the short window when Gavin Newsom, then mayor of San Francisco, issued licenses to same-sex couples. Those unions were ruled illegal, so when the state Supreme Court gave marriage the green light in 2008, Alfano and Capley made another trip to the altar. The couple, who also changed their last names to Capley-Alfano, are one of the about 18,000 same-sex couples that remain legally married in the state.

Recent studies suggest that men like Joe Capley-Alfano can expect good and bad health effects from the historic legislation that’s shaped their lives in recent years, and the lives of gays and lesbians across the state and the country.

Marriage, for instance, has always been good for the health of straight men in heterosexual relationships. Now it seems that marriage may be good for the health of married gay men too, according to a Feb. 2012 study in the American Journal of Public Health.

Gay and bisexual men in Massachusetts needed less healthcare the year after same-sex marriage became legal there, according to the study of slightly more than 1,200 men. Medical and mental health care visits dropped more than 13 percent between 2002 and 2003, when the marriage law passed. This decrease bucked a statewide trend towards increasing use of healthcare.

Gay and bisexual men in the study generally needed less medical help for illnesses like hypertension and depression, said lead author Mark Hatzenbuehler.

“Disorders associated with stress went down,” Hatzenbuehler said, “and we know from previous studies that these are the policies that this group finds stressful.”

The health benefits of marriage even extended to gay and bisexual men who were not in relationships, he noted.

That finding is consistent with Hatzenbuehler’s earlier study, published in the American Journal of Public Health in 2010, which suggested that anti-gay legislation hurts the mental health of gay people generally, and not just the health of people who want to marry but cannot. Psychiatric disorders were much higher among gay people in states that passed bans on same-sex marriage in 2004 and 2005: mood disorders were more than 36 percent higher and generalized anxiety disorders almost 250 percent higher compared to gay people in states that did not pass bans.

Recent research indicates that 20 percent of gays and lesbians in California have mental health needs – a rate that is twice the state’s average, according to a Nov. 2011 study from the UCLA Center for Health Policy Research.

That difference is likely because gay people still find themselves rejected by family and the larger culture, an experience straight people don’t typically have, according to David Grant, the study’s lead author.

Marriage lends a legitimacy to same-sex relationships that helps ease the sting of past discrimination, Joe Capley-Alfano says.

“Both Frank and I were raised in an atmosphere and a culture, in a time that reinforced for us since we were children, that gay relationships don’t matter,” Capley-Alfano said, “that gays were unlovable, and that we were not capable of love.”

Marriage changed that for Capley-Alfano. The significance of their relationship suddenly became understandable to their parents, their families and to the culture at large. It also gave Capley-Alfano a sense of stability and permanence he never even knew he was missing.

“We were able to see our relationship and the future in a way that we had never imagined it before,” Capley-Alfano said. “As a result of the marriage, now there were some certains. We had each other’s backs. Through sickness and health, for richer and poorer. That made a huge difference for my mental health.”

But problems related to their status as a same-sex couple remained after the marriage, and they directly impacted Capley-Alfano’s health.

Capley-Alfano, disabled from a car accident 20 years ago, works part-time and as a contractor. He has no employer-provided health insurance and could not afford private insurance because of his preexisting condition. The state of California recognizes Capley-Alfano’s 2008 marriage, so his husband’s income disqualifies him for state assistance. Frank Capley-Alfano works as an elevator mechanic in a federally unionized job – and his benefits did not extend to his husband.

They fought for an extension of benefits, and eventually they won. Joe Capley-Alfano was insured as of Jan. 2010. But the wait took its toll. “I lived with excruciating pain and physical limitations,” he said. “It was completely preventable.”

Capley-Alfano’s difficulties affect a significant proportion of gay and lesbian people in California. Partnered lesbians and gay men are twice as likely to be uninsured as married straight people in California, according to a 2010 article in the journal Health Affairs. That lack of insurance hurts their access to healthcare and consequently their health, researchers say.

Capley-Alfano said his health improved dramatically after he had insurance. Doctors took simple steps to decrease his pain and extend the life of the titanium knee and hip. He got steroid injections, orthopedic inserts and physical therapy.

The treatment is improving his ability to walk, which had been deteriorating, he said. But the mental distress of those uninsured years still haunts him, and he does not expect it to ease anytime soon.

“I could see the hypocrisy of the situation,” Capley-Alfano said. “There is an immense amount of frustration, anger and hurt. To a certain extent, that will always be there. It will always be in the back of my head, that maybe my hip wouldn’t hurt today if situations in society were different.”

Heather Gilligan is a correspondent for the California Health Report at

Note: This article has been corrected. An earlier version of the article referred to the Capley-Alfanos as Joe Alfano and Frank Capley.

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