By Bob Roehr
"I came out to my friends and one of them betrayed me. He told everyone and my locker got stuffed with notes saying, 'Don't spread your HIV! You perv!' My counselors and teachers won't help me, even the principle and vice principals won't help me. Two weeks ago I got a desk thrown at me and now I have a broken arm. I really need your help more than ever before."
That type of plea is all too common on the online peer education forum run by Advocates for Youth, program manager Jesse Gilliam told the National Coalition for LGBT Health at their fall meeting in Washington, DC on Sept. 13.
"It's really important to get a sense of the priorities from the youth perspective," said Beth Beck, director of health programs at the National Youth Advocacy Coalition. She reviewed findings from the focus group they convened.
In addition to the expected ones of coming out and family, many center around mental health issues. Beck expressed concern that LGBT youth drop out of school at a higher rate, in part because of these added pressures and few sources of support.
Unfortunately most of the existing resources are wrapped around HIV/AIDS prevention activities and are tied to CDC funding. The Bush administration has imposed tighter restrictions on content, but more importantly, the CDC has begun to shift resources from broad community-based prevention to programs targeting those who are already HIV positive.
During the 2000 funding cycle the CDC supported 88 grants that included youth. This past July only eight programs serving youth were funded, just two of them serving LGBT youth, Beck said.
Even while proven HIV prevention activities have been essentially flat funded for the last several years, funding for abstinence only until marriage prevention programs has grown several-fold.
"The impact is obvious, GLBT youth can't get married," she said. "The heterosexual focus of the programs makes them feel even more isolated. One study in Massachusetts found that GLBT youth were more likely to skip AIDS education programs because of this stigma."
Robert Winn, MD, on the faculty of family medicine at Jefferson Medical College in Philadelphia, said that since youth are different than adults, they have different issues. He urged participants not to lose sight of the fact that 70 percent of LGBT youth do just fine; the focus should be on understanding better why that is. Finally, reform is needed not just in laws but also in education and within the medical community.
Winn said the problem is that physicians are not trained very well in areas of sexuality and are uncomfortable discussin it with patients. "LGBT issues are harder still, and trans issues are completely left out."
David Haltiwanger, director of clinical programs at the Chase Brexton Clinic in Baltimore, drew from his experience as a therapist when he said that the struggle with their sexual orientation has led many LGBT people to drop out of school, or chose jobs where they are underemployed because it feels like a safer place to work. "And then later in life they regret that."
"I think of that as a health issue because the primary source of health insurance in America is through your employment. Anything you can do to help youth stay in school is going to have long term implications for their health because it will maximize their access to health care as they grow older."
Trans complex
If the issues are great and resources scant for gay and lesbian youth, the situation is even worse for trans youth, said Caeden Dempsey, field director for the National Center for Transgender Equality. "Very few therapists understand trans issues, especially as they relate to youth. There may be pressure to get the youth to conform to traditional gender roles."
Violence and murder prevention are the leading issues for this segment of the community. Trans youth seem to be more likely to face violence in their home and are more likely to end up out on the street. The pattern tends to repeat itself in the relations they later form, either because those are the patterns they have learned, or because they are trapped in these situations, financially and/or emotionally dependent upon their sexual partners and unwilling or unable to seek help.
Dempsey said there are very few places where young people can find information about their trans bodies and safer sex. The increased risk of homelessness correlates with an increased risk of involvement in sex work and in substance abuse, both of which increase the risk for acquiring HIV.
He said, "Most young people who have health insurance coverage gain it through their parent's policy. That disappears if they are kicked out. And even if they are covered through their parents or their own workplace, the policy seldom covers hormone therapy or surgery."
"The options are to wait until they are older to make the transition, or try to get them in other ways," Dempsey said. "Usually those other ways come in finding hormones on the street, which can be done, or finding sketchy doctors that will prescribe something without adequate monitoring."
The question of transitioning is complicated by the fact that there is no consensus within the trans community or within the medical community on when is the best time to do so. Some argue that individuals should wait until they are adults, while others point to the biological changes of puberty that are easier to forestall than reverse.
"Transition becomes more difficult and costly after puberty," said Miriam Yeung, policy director at the LGBT Community Center in NYC. "You don't have to shave off your Adam's apple if you don't develop it. Still, many agencies have a policy of not treating minors with hormones toward transition."
There also are legal liability issues concerning minors that chill interventions by psychologists and physicians. One participant spoke of a youth in Colorado who wanted to make a transition and the parents supported the decision. But liability issues forced the family to go outside the state to accomplish that.
Barbara Warren, Yeung's colleague at the Community Center, said they do not have these problems in Europe where the government provides health care and the liability issues do not arise. She said, "The right thing to do sometimes isn't the legally supported thing to do."
Dempsey urged that the principle goal be to give trans youth the tools to make health decisions for themselves.
