Discrimination, harassment, and violence take a tremendous toll on youth. "It weighs on you like a ton of bricks," Lavonn G. explained.182 "I was so angry that I'd been tolerating this behavior, that I was trying to accept it," Beth G. told us, referring to several months of repeated verbal threats and other harassing behavior. "I realized, it's affecting me at school; it's pushing me out of classes."183
Writing for PFLAG's Respect All Youth Project, Ann Thompson Cook notes that lesbian and gay youth "often invest tremendous energy in coping with society's negativity and discrimination. Lacking healthy adult [role] models, skills and support systems, many conclude that they have no hope of ever becoming happy and productive."184 When Ritch Savin-Williams studied the effect of harassment and abuse on lesbian, gay, and bisexual youth, his findings matched what we heardfrom the youth we interviewed: he concluded that verbal and physical abuse was common in the lives of lesbian, gay, and bisexual youth and was a source of stress that was "detrimental to their mental health."185
"Drinking is a huge one," said Gwen B., describing the ways youth cope with discrimination and harassment.188 "When I drink, I drink to pass out. I don't care where I go, I just drink to pass out," Blue S. told us. Asked why she drank, she said, "It just felt so good to feel half normal."189
By the time I was seventeen, I was in my own apartment. By seventeen I had just come out. It's a whole new different world for you, without mommies, daddies, supervision. You just go wild. . . . I felt I was an adult and a big girl now. That led me into more drugs. When adolescents, teenagers, come into the city, with all the gay clubs, you have the feeling of acceptance. It's like a family; everybody wants that. I got that popularity. Drugs, a lot of everything, a lot of boys. It was fun, but I did a lot of things I should not have done. I've brought myself through a lot of problems. Drug addiction. I've been clean for three months now. If somebody had been there for me when I was younger, maybe I would have got to avoid a lot of problems.191
The 1999 Massachusetts Youth Risk Behavior Survey found that youth who identified themselves as lesbian, gay, or bisexual or who reported same-sex sexual experiences had higher rates of drug use than their peers. According to the survey, sexual minority youth-those who have identified themselves as lesbian, gay, or bisexual or who have had any same-sex sexual contact-had higher lifetime rates of marijuana use (70 percent compared to 49 percent of all other youth), cocaine (29 percent compared to 9 percent), methamphetamine (30 percent compared to 7 percent), and injected drugs (18 percent compared to 2 percent).192
Faced with the stresses caused by routine harassment, violence, and ostracization, youth who are lesbian, gay, bisexual, or transgender may engage in unprotected sex or other risky sexual behaviors. Often lacking positive sources of peer support and outlets for socialization, they may downplay or disregard health concerns out of a desire for companionship and intimacy.
Lesbian, gay, bisexual, and transgender youth who are subjected to harassment and violence may also end up living on the street in disproportionate numbers-often because they have been forced out of their homes or out of the foster care system after their sexual orientation is discovered.199 In a nationalsurvey of community-based agencies providing services to runaway, homeless, and other youth in high-risk situations, 6 percent of the youth served by the agencies identified themselves as gay or lesbian, a figure which almost certainly underestimates the proportion of lesbian, gay, bisexual, and transgender individuals in the street youth population.200 As the National Network for Youth points out:
Gay and lesbian youth are largely an invisible population, the majority of whom are dealing with rejection and unacceptance of their sexual orientation by family, friends and society in general. Because homosexuality is considered a social taboo, few gay and lesbian youth will openly discuss their sexual orientation with service providers.201
Large urban areas with sizable gay communities have larger proportions of street youth who identify themselves as lesbian, gay, bisexual, or transgender, perhaps because youth in these areas are less reluctant to identify themselves and perhaps because lesbian, gay, bisexual, and transgender street youth choose to come to theseareas.202 In Houston, Los Angeles, and New York, for example, studies of homeless youth have found that between 16 and 38 percent identified as lesbian, gay, or bisexual.203 Once on the street, these youth are at increased risk for infection with HIV or other sexually transmitted diseases because significant numbers engage in "survival sex," trading sex for food and shelter.204
As noted, most lesbian, gay, bisexual, or transgender youth never consider suicide. A recent analysis of nationally representative data of U.S. students in the seventh through the twelfth grades found, for example, that 84.5 percent of boys and 71.7 percent of girls who reported same-sex attractions or relationships had never attempted suicide and had never had suicidal thoughts.
At my old school, it was a lot of name calling. There was a lot of that, "pussyeater" and "dyke" and stuff. I used to ditch classes because of that reason, or I'd always be late. I would always be outside getting into trouble because I didn't want to go to class. People would just start saying stuff to me, or they would make it look like they wanted to throw up. It got to the point where I didn't want to live anymore. I tried to kill myself.205
Luke G., a high school football player, recounted, "I had to hide who I was. I had to have perfect grades, do all the sports, be popular-and I did, but I couldn't handle the pressure; I felt suicidal. I went into therapy and talked about the pressure but not the cause."206
An analysis of the 1995 Massachusetts Youth Risk Behavior Survey data found that gay, lesbian, bisexual, and questioning youth are more than three times as likely as other students to report a suicide attempt.207 An analysis of Minnesota junior and senior public high school students found that 28.1 percent of gay or bisexual boys and 20.5 percent of lesbian or bisexual girls reported that they had attempted suicide, as compared to 4.2 percent of heterosexual boys and 14.5 percent of heterosexual girls.208
184 Ann Thompson Cook, Who Is Killing Whom?, Issue Paper 1 (Washington, D.C.: Respect All Youth Project, PFLAG, 1998), p. 2.
185 R.C. Savin-Williams, "Verbal and Physical Abuse as Stressors in the Lives of Lesbian, Gay Male, and Bisexual Youths: Associations with School Problems," Journal of Consulting and Clinical Psychology, vol. 62 (1994), p. 262.
186 Human Rights Watch interview, Atlanta, Georgia, March 1, 2000.
187 Human Rights Watch interview, San Francisco, California, January 25, 2000.
188 Human Rights Watch interview, Greenfield, Massachusetts, May 31, 2000.
189 Human Rights Watch interview, Greenfield, Massachusetts, May 31, 2000.
190 Human Rights Watch interview, Greenfield, Massachusetts, May 31, 2000.
191 Human Rights Watch interview, Austin, Texas, March 23, 2000.
192 See Massachusetts Department of Education, 1999 Massachusetts Youth Risk Behavior Survey (Boston: Massachusetts Department of Education, 2000), chapter 4, www.doe.mass.edu/lss/yrbs99/ (accessed on April 3, 2001). See also Robert H. DuRant, Daniel P. Krowchuk, and Sara H. Sinal, "Victimization, Use of Violence, and Drug Use Among Male Adolescents Who Engage in Same-Sex Sexual Behavior," Journal of Pediatrics, vol. 133 (1998), p. 113.
The connection between victimization and alcohol or drug use is illustrated by another finding from the 1999 Massachusetts Youth Risk Behavior Survey. The survey found that, for girls, recent alcohol consumption was strongly associated with dating violence and unwanted sexual contact. Girls who reported recent alcohol use were also significantlymore likely to report having ever been hurt by a date and having experienced sexual contact against their will. See 1999 Massachusetts Youth Risk Behavior Survey, chapter 3. See also Karen M. Jordan, "Substance Abuse Among Gay, Lesbian, Bisexual, Transgender, and Questioning Adolescents," School Psychology Review, vol. 29 (2000), p. 201; F. Shifrin and M. Solis, "Chemical Dependency in Gay and Lesbian Youth," Journal of Chemical Dependency Treatment, vol. 5 (1992), p. 67.
193 See G.F. Lemp, A.M. Hirozawa, and D. Givertz, "Seroprevalence of HIV and Risk Behaviors Among Homosexual and Bisexual Men: The San Francisco/Berkeley Young Men's Survey," Journal of the American Medical Association, vol. 272 (1994), p. 449; I.H. Meyer and L. Dean, "Patterns of Sexual Behavior and Risk Taking Among Young New York City Gay Men," vol. 7 (1995 supplement), p. 13.
194 See Gary Remafedi, "Predictors of Unprotected Intercourse Among Gay and Bisexual Youth: Knowledge, Beliefs, and Behavior," Pediatrics, vol. 94 (1994), p. 163; G.F. Lemp et al., "Seroprevalence of HIV and Risk Behaviors," p. 449.
195 Caitlin Ryan and Donna Futterman, "Lesbian and Gay Youth: Care and Counseling," Adolescent Medicine, vol. 8 (1997), p. 313.
196 See Centers for Disease Control and Prevention, HIV/AIDS Surveillance Report, vol. 12 (2000), table 13.
197 Human Rights Watch interview, Austin, Texas, March 15, 2000.
198 Emery S. Hetrick and A. Damien Martin, "Developmental Issues and Their Resolution for Gay and Lesbian Adolescents," Journal of Homosexuality, vol. 14 (1987), p. 29.
199 Half of the fifty-four lesbian and gay youth in the child welfare system interviewed by Dr. Gerald P. Mallon reported that they had spent periods of time living on the streets in preference to the hostile environment they found in child welfare settings. Three of the fifty-four told him that they were expelled from their homes when their parents discovered their sexual orientation. Others left their homes because family members subjected them tophysical violence. One New York child welfare advocate told Dr. Mallon, "We just keep seeing kids getting beaten up and thrown out of their houses, kids getting beaten up by their fathers for being gay, or young lesbians getting sexually abused by male relatives trying to change them so they won't be gay." Gerald P. Mallon, We Don't Exactly Get the Welcome Wagon: The Experiences of Gay and Lesbian Adolescents in Child Welfare Systems (New York: Columbia University Press, 1998), pp. 111, 50-51, 98.
200 See National Network of Runaway and Youth Services (now the National Network for Youth), To Whom Do They Belong? Runaway, Homeless and Other Youth in High-Risk Situations in the 1990s (Washington, D.C.: National Network of Runaway and Youth Services, 1991), p. 5. In several other studies of shelter care facilities and street locations where homeless youth are known to congregate, 3 to 10 percent of youth reported their sexual orientation as lesbian, gay, or bisexual. See, for example, M. Greenblatt and M.J. Robertson, "Homeless Adolescents: Lifestyle, Survival Strategies, and Sexual Behaviors," Hospital and Community Psychiatry, vol. 44 (1993), p. 1177.
201 National Network of Runaway and Youth Services, To Whom Do They Belong, p. 5. The unwillingness of some service providers to acknowledge that they serve youth who are lesbian, gay, bisexual, or transgender undoubtedly reinforces the reluctance of many youth to discuss their sexual orientation. Dr. Mallon recounts that one staff member at a New York social services agency told him, "We don't have any residents who are gay or lesbian. We have over a hundred adolescents in our programs and I know all of them and none of them are gay or lesbian!" Mallon, Welcome Wagon, p. 7.
202 One youth services director suggests, "These cities are places where gay youth believe they will find acceptance and nurturing, but instead they tend to experience exploitation and homelessness." Gabe Kruks, "Gay and Lesbian Homeless/Street Youth: Special Issues and Concerns," Journal of Adolescent Health, vol. 12 (1991), p. 516. Among homeless youth as a whole, however, approximately 75 percent remain in their original communities, suggesting that "migration" of lesbian, gay, bisexual, and transgender youth to the large cities is less significant than is often assumed. See J.A. Farrow et al., "Health and Health Needs of Homeless and Runaway Youth: A Position Paper of the Society for Adolescent Medicine," Journal of Adolescent Health, vol. 13 (1992), p. 717.
203 A study of inner-city homeless youth aged eleven to twenty-three found that one-quarter reported that they were lesbian, gay, or bisexual. Sixteen percent of runaways between the ages of ten and twenty-four at one medical clinic in Los Angeles identified themselves as lesbian, gay, or bisexual, compared to 8 percent of nonrunaway youth at the clinic. And in a study of homeless young men between the ages of fifteen and twenty at a Covenant House medical clinic in New York, 25 percent reported being gay or bisexual. See N.H. Busen and B. Beech, "A Collaborative Model for Community-Based Health Care Screening of Homeless Adolescents," Journal of Professional Nursing, vol. 13 (1998), p. 316; G.L. Yates et al. "A Risk-Profile Comparison of Runaway and Non-Runaway Youth," American Journal of Public Health, vol. 78 (1988), p. 820; R.L. Stricof et al., "HIV Seroprevalence in a Facility for Runaway and Homeless Adolescents," American Journal of Public Health, vol. 81 (1991 supplement), p. 50.
204 See Madlyn C. Morreale and Allison J. Boyle, "HIV Prevention for Two Populations of Youth in High-Risk Situations-Homeless Youth and Sexual Minority Youth: An Introduction to the Published Literature," Issue Brief 5 (Washington, D.C.: National Network for Youth, n.d.), p. 13.
205 Human Rights Watch interview, Long Beach, California, October 13, 2000.
206 Human Rights Watch interview, Austin, Texas, March 15, 2000.
207 Robert Garofalo et al., "Sexual Orientation and Risk of Suicide Attempts Among a Representative Sample of Youth," Archives of Pediatrics and Adolescent Medicine, vol. 153 (1999), p. 487.
208 Gary Remafedi et al., "The Relationship Between Suicide Risk and Sexual Orientation: Results of a Population-Based Study," American Journal of Public Health, vol. 88 (1998), p. 57. The study compared 212 boys and 182 girls who identified themselves as gay, lesbian, or bisexual to an equal number of heterosexual boys and girls.
209 See Oregon Department of Human Services, "Suicidal Behavior, a Survey of Oregon High School Students, 1997," available at www.ohd.hr.state.or.us/chs/teensuic/teensuic.htm (accessed on April 23, 2001).
210 Stephen T. Russell and Kara Joyner, "Adolescent Sexual Orientation and Suicide Risk: Evidence from a National Study" (paper presented at the annual meeting of the American Sociological Association, San Francisco, California, August 1998), p. 8.