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GLBT Youths Face Health Care Challenges
By Mark Bartkiewicz, 17, SEX, ETC.
"When I went in for my first gynecologist exam," says 22-year-old Lisa, of Washington, D.C., "the doctor asked if I was sexually active. I answered 'yes,' and when she asked about birth control, I said I was in a relationship with a woman. I happened to glance over at the notes, and she'd written 'Lesbian?' on the chart, which is now part of my medical record."
George, 22, a young gay man from Clifton, NJ, was once afraid of disclosing his sexual orientation to his physician.
"My doctor was also the doctor for some of my coworkers," he says. "I was afraid that one day my sexual orientation might be revealed [to them]."
Young and Isolated
Lisa and George are just two of many gay, lesbian, bisexual, and transgender (GLBT) young people who struggle with concerns about confidentiality, stigma, and prejudice, and questions about whether they're receiving accurate and relevant information when they seek sexual health care.
Starting at a young age, many GLBT youths can feel isolated, fearing homophobia and discrimination. About 2 to 4.5 percent of high-school students identify themselves as gay or lesbian. Yet, according to Robert Garofalo, MD, MPH, medical director of the Uptown Teen Health Center, of the Children's Memorial Hospital, in Chicago, this figure is probably low, because many students are afraid to reveal their sexual orientation.
And some GLBT young people may not be getting the information they need, since many health care providers and people serving adolescents and young adults assume their patients or students are heterosexual. Both Lisa and George felt left out of the sexual health discussions going on in their sex ed classes.
"The sexual health education I received in school never mentioned non-hetero relationships," says Lisa.
George says that his sex ed classes didn't cover GLBT issues either. He felt "deprived" of the information that his heterosexual peers received. He remembers a time when he needed the most sexual health education.
"That was when I had unprotected sex. I was afraid of getting tested for sexually transmitted diseases [STDs], because I wouldn't know how to react to any bad news," he says.
George may not have gotten the facts about the risks of unprotected sexual behaviors among same-sex partners, something that his health care provider may not have brought up, because he or she assumed George was straight. Or the facts may not have been discussed in his sex ed class, because it focused on heterosexual sex education. He may not have received information on how to protect himself with a man, know where to go for testing or counseling, or feel comfortable about disclosing his sexual orientation.
Many months later, he finally got tested for HIV, the virus that causes AIDS. The results were negative-he was not infected. This experience scared him into taking control of his sexual health care needs-on his own.
"When my results came back negative, a huge burden was lifted off my shoulder. It was then that I made myself a promise to never again mistreat myself like that, and, to this day, I've kept that promise," he says.
Now George practices safer sex and gets tested twice a year for STDs. He found a GLBT-friendly doctor and, if he has questions about STDs or protection, he never holds back-he goes right to his doctor for information.
"I no longer hold things inside," he says.
Facing Homophobia
Homophobia is the "expressed fear, anxiety, or hatred toward homosexual people," explains Dr. Garofalo. It's present in all aspects of society and can have a detrimental effect on the mental and physical well-being of GLBT youths. It is a dark shadow on the health care system, because it can prevent GLBT youths from getting the care they need.
Sometimes when GLBT youths seek sexual health services, they can face that homophobia and ignorance in the health care system. Lisa noticed that her primary care physician made the assumption that "sexual activity means heterosexual activity." She says she never received good information from a doctor about STD transmission between women or any advice about safer-sex practices.
"The most anyone said is an abrupt, 'well, women should be careful, too,'" she says.
Even though she doesn't feel comfortable, Lisa always discloses her sexual orientation to doctors. Yet, still, having to let a doctor know makes her reluctant to go to one. Right now, she doesn't have a primary care physician.
"When I do get one, I'll make a point of finding one who's comfortable with lesbian and bisexual clients," she says.
Getting Good Care
If they're concerned about homophobia, Dr. Garofalo advises GLBT youths to only disclose their sexual orientation to a doctor or health care provider if they're ready.
"I don't think they have to come out to their medical providers. Some might have an innate sense that the provider might not be comfortable with that," says Dr. Garofalo.
But, he adds, GLBT youths should "discuss anything or everything that they feel is impacting their health or well being. This might range from conflict within the home, difficulty at school, difficulty navigating sexual relationships, physical complaints, issues relating to body image, disordered eating, nutrition, and mental health concerns," he says.
Dr. Garofalo advises GLBT youths to make sure they find a good doctor.
Young people "need to appreciate the fact that they're the consumers. Much like they buy other products, they're the consumers of health care. They might have to shop around until they find a doctor they're comfortable with," he says.
George looked around until he found a doctor he liked-one he felt comfortable disclosing his sexual orientation to. Once he learned to open up to his doctor more and ask questions, he was happy with the care he received.
"Now my physician and I are very comfortable discussing many aspects of sexual health. The way he explains things makes me feel comfortable and gives me a sense that he really cares about me," he says.
Remembering the Risks
Once they find a doctor, GLBT youths should discuss the basics about sexual health care. Women should check in with their doctors about routine gynecological exams and STDs, explains Dr. Garofalo. He adds that some women who have sex with women may also have sexual encounters with young men and need pregnancy testing.
STD testing, including HIV, is at the top of the list for young men, including men who have sex with men, according to Dr. Garofalo.
"Half of all new HIV infections are occurring in young people under the age of 25," he explains, and "a significant number of young gay men are engaging in unprotected sexual activity."
No matter the gender of your partner, "STDs do not discriminate," says Dr. Garofalo. "If you engage in a sexual activity without proper protection, you may get one."
Sexual health is also about much more than STD testing. It's about the basics of healthy relationships, too. Like heterosexual youths, "GLBT youths need to learn how to have safe and nurturing sexual relationships. Teachers, parents, and counselors should help GLBT youths learn how to lead healthy, nurturing sexual lives," says Dr. Garofalo.
After all, GLBT youths need comprehensive, quality health care. And it starts with finding the right doctor. When you're trying on a new pair of shoes, explains Dr. Garofalo, if the shoe doesn't fit, you try on another one. GLBT youths should find a doctor they're comfortable with. Do not settle for anything less.
And for those who don't have health care providers, there are publicly funded health clinics. You can look in the yellow pages under "Clinics" or "Health Clinics." These may not be as GLBT-friendly, but it's very important to seek out medical care if you need it.
 To find a local clinic for sexual health services, including HIV and other STD testing: Adolescent AIDS Program clinic locator
Check out the Gay and Lesbian Adolescent Health Resource Center (GLAHRC)
Dr. Garofalo also urges all GLBT youths to visit the Gay and Lesbian Medical Association to find a GLBT-friendly primary care physician.
Mark Bartkiewicz, 17, of Harrison, NJ, is an editor for SEX, ETC., the national newsletter and Web site written by teens, for teens, on sexual health issues, published by the Network for Family Life Education at Rutgers, The State University of New Jersey.
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