http://www.hivcareforyouth.org/adol?page=md-module&mod=01-03-01

Key Cultural & Psychosocial Challenges of HIV-Infected Youth

LGBT Sexual Orientation

Lesbian, gay, bisexual, and transgender (LGBT) adolescents come from all racial and ethnic groups, socioeconomic levels, and religious denominations. They live in large cities and small towns. They are members of single-parent, two-parent, blended, and foster families. They are student leaders, athletes, and active members of civic groups as well as school dropouts and street youth. For the most part, lesbian, gay, and bisexual youth are indistinguishable from their heterosexual peers--in fact, most are invisible.

Stages of Lesbian/Gay Identity Development

Stage One: Sensitization

Before puberty, children experience feelings of being different from their peers, based on gender-neutral or atypical gender role choices or behaviors. Few see themselves as sexually different before age 12.

Stage Two: Identity Confusion

After puberty, adolescents become aware of same-sex thoughts and feelings. Negative stereotypes of homosexuality lead to cognitive dissonance and confusion as adolescents struggle to make sense of their emerging identity. Many adolescents develop coping behaviors and usually hide their sexual identity, or they may adopt a bisexual identity.

Stage Three: Identity Assumption

During mid-to-late adolescence or early adulthood, youth begin to self-identify and disclose their sexual identity (come out) to other gay people. Over a period of several years, they interact with lesbian and gay peers; positive experiences strengthen self-esteem and dispel negative stereotypes. Access to an organized LGBT community provides opportunities for socialization and for developing relationships and finding positive role models. Youth learn a variety of strategies to manage their stigmatized identity.

Stage Four: Commitment

Self-acceptance generally culminates with incorporating sexual identity into all aspects of one's life, usually during adulthood. Sexual identity is shared increasingly with nongay friends and close family members. However, not all lesbians and gay males consolidate identity; integration depends on various factors, including access to support and positive role models, personal strengths and vulnerabilities, and experiences with discrimination.15

The struggle to develop and integrate a positive adult identity--a primary developmental task for all adolescents--becomes an even greater challenge for LGBT youth, who learn from earliest childhood the profound stigma of a homosexual identity. Unlike many of their heterosexual peers, LGBT youth have no built-in support system or assurances that their friends or family members will not reject them if they acknowledge their sexuality. The social and emotional isolation experienced by LGBT youth is a unique stressor that increases vulnerability and risk of developing a range of health and mental health problems. 16 Among the psychosocial stressors unique to lesbian and gay adolescents are:

  • Lack of awareness and limited knowledge among providers about sexuality (identity and behavior)
  • Stress from coping with stigma associated with homosexuality
  • Lack of support, or overt hostility, from family and friends
  • Need for secrecy to protect LGBT identity
  • Lack of appropriate outlets for socialization and exploration of sexual identity (secrecy and fear of discovery promote high-risk, anonymous behaviors)
  • Lack of clear HIV prevention and coping messages that include lesbian and gay adolescents

Ethnic minority youth who are also LGBT face additional stressors and challenges in consolidating sexual, racial, and ethnic identities. For many members of ethnic minority groups, race and ethnicity form core components of identity. Together with gender and sex roles (also culturally based), they frame an evolving sense of self. By the time an adolescent becomes aware that same-sex feelings and behaviors may signal homosexual orientation, primary identity--race/ethnicity--is well established. In a society that discriminates on the basis of race and ethnicity, strong connections with family and ethnic community are essential for survival. However, support is rarely available for an adolescent's homosexual identity. Only among some AI/AN groups is homosexuality acknowledged in language and lore as part of a third-gender cultural tradition, although acceptance in many of these communities has largely been replaced by more negative mainstream attitudes. For providers, cultural and behavioral differences have implications for history taking, assessment, and diagnostic workups as well as for access to prenatal and reproductive care. The unique stressors of managing multiple levels of stigma, including race, ethnicity, homosexuality, and gender, require additional sensitivity and knowledge of appropriate community resources.

References

  1. Troiden RR. The formation of homosexual identities. J Homosex. 1989;17(1-2):43-73.
  2. Ryan C, Futterman D. Lesbian and Gay Youth. New York: Columbia University Press; 1998.