Research to Change Lives - Annesa Flentje, Ph.D.

Catching up with UCSF Associate Professor Annesa Flentje, Ph.D. requires flexibility and determination. We spoke while she was on route to pick up her daughter from school–yes, while managing a few dozen research projects, and a couple of UCSF appointments, she and her partner are raising three kids.   

To describe Flentje as ambitious would fall short, with an impressive list of credentials, appointments, and published studies on sexual and gender health, she is one of the leading research architects of our time. Flentje is the Associate Professor at the University of California, San Francisco in the School of Nursing, Community Health Systems, School of Medicine, and the Department of Psychiatry and Behavioral Sciences. Flentje is also the Associate Director and UCSF Site Director of The PRIDE Study and Associate Professor of Research at Alliance Health Project. Her credentials reflect her passion for uncovering and advocating to improve the lives of sexual and gender minorities by creating paths to inclusion in funding, treatment, and care.

When asked why she chose to devote her notable talents to studying LGBTQ+ folks she chuckles; yes, it’s as much personal as it is scientific. She clarified that there is a critical need to study LGBTQ+ folks because when a community bears a greater burden of poor health outcomes, as it does in the LGBTQ+ community, it is essential to demonstrate the health impacts and other effects of discrimination and stigma on that population.

These impacts and poor health outcomes, well observed in our partners, children, neighbors, and friends, are, thanks to Flentje and researchers like her, becoming quantifiable, and interventions are beginning to be developed, instituted, and accessed as the data becomes available.

For example, for the United States Transgender Survey, Flentje co-authored the study “Stressors in health care and their association to symptoms experienced by gender diverse people (GD)” they observed that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.

With The Pride Study, Flentje has also helped build an infrastructure to study LGBTQ+ health over time. The PRIDE Study is one of her cherished projects; the first large-scale, long-term national health study of people who identify as lesbian, gay, bisexual, transgender, queer, or another sexual or gender minority. If you’re reading this and would like to join, you can sign up at pridestudy.org. The focus of the Pride Study is to determine how being LGBTQ+ is related to physical, mental, and social health. Similarly, in a study of sexual minority men living with HIV, her team provided a cognitive behavioral intervention to reduce the impact of minority stress such as discrimination. By collecting blood samples, Flentje found there were biological changes in gene expression related to immune function. This study suggests that interventions to address minority stress due to factors such as sexual orientation, gender expression, HIV status, race or ethnicity, homelessness, or socioeconomic status, may be applied to improve immune function and health outcomes.

Additionally, Flentje notes that decision makers use data to drive funding and create policies and practices. When we have a community of people who are not represented in the data, then funding, and all appropriate prevention and intervention resources, are denied. Without the data and the subsequent advocacy, Flentje insists, the mental, physical, and social stressors to related to being LGBTQ+ will not be acknowledged and quantified. The consequences are deadly.

In the 10+ years since Flentje started her research program at UCSF, she insists some things have changed for LGBTQ+ patients and community members. She also agrees there is still much to do. What hasn’t changed is there is still a staggering amount of stigma and discrimination experienced within LGBTQ+ communities. What seems to have gotten worse is the confounding amount of movement targeting trans and LGBTQ communities across the country on the State and County level.

Where progress has been made are changes among policy makers who are starting to recognize the importance of measuring and including sexual and gender minoritized people in studies, which according to Flentje, is a big change.