Gay Teens: Preventing Self-Harm

Many school personnel and some school nurses wish they didn¡¯t have to deal with the issues surrounding homosexual adolescents.

The author of this article does a good job of presenting the broad spectrum of humankind and where gays fit in. (The term is used to refer to gay males, lesbians and bisexuals of both sexes unless a more group specific term was needed).

As children and adolescents, gays go through the same developmental stages as heterosexual youth with the additional task of trying to resolve the conflict between their sexual and/or gender feelings and society¡¯s messages. Not all gay teens resolve this conflict successfully. Suicide is the leading cause of death in gay youth (30% of adolescent suicides are estimated to be committed by gay youth). Gay youths account for 30-35% of the homeless youth in the U.S., with a four times greater incidence of being "kicked out" or "forced out" of their homes. Once out on the streets, many turn to survival-sex as a means of support and identity. HIV positivity is also high, particularly among gay male teens 15-24-studies in New York and San Francisco place it at almost 10%.

Violence is also a problem for gay teens. Physical violence toward gays is high in most areas (40% in one study from New York). Fifty-five percent of a sample of 15-19 year old bisexual and gay males reported being verbally abused by classmates on a regular basis (half of those said the assaults occurred on school grounds).

Many studies indicate gay youths have a significantly greater incidence of substance use when compared with their heterosexual peers. Pregnancies also result when lesbians and bisexual females "experiment" with males.

As the above evidence suggests, gay teens have problems that are very similar to their "straight" counterparts-with the added complications of trying to accept their sexual orientation and "come out" to, and function in, the world at large. Physical and mental health services for gays does not require a separate delivery system. It does require that a health professional be non-judgmental (if not supportive) and willing to learn about issues which matter to their clients.

The author suggests that helping professionals, particularly in the school setting, find a way to signal gay students that their office/clinic is "gay friendly" (displaying a gay poster or symbol). Once the gay teen arrives, he suggests the use of non-biased language, such as partner instead of girlfriend or boyfriend. A thorough sexual history is essential and must include questions about gender identity, sexual identity, age of first sexual intercourse, number of male and female partners and history of sexual abuse or survival-sex, keeping in mind that the gay person remains gay regardless of his or her sexual behavior.

The author concludes:

"The health care provider, whether in a school-based clinic, a primary care clinic, an emergency department, an inpatient unit, a specialty clinic, or a shelter for homeless youth, is unquestionably in a position to assist these struggling adolescents to reduce self-harm and to increase self-acceptance."

(Nelson, J. Gay, lesbian, and bisexual Adolescents: Providing Esteem-Enhancing Care to a Battered Population. Nurse Practitioner 1997;22(2):98-109).