Promoting the Successful Development of Sexual and Gender Minority Youths

Because of societal discomfort with atypical expressions of sexual orientation and gender identity, lesbian, gay, bisexual and transgender (LGBT) youths have experienced enhanced developmental challenges compared with their heterosexual peers.A recent special issue of the American Journal of Public Health delineated how social stigma affecting LGBT youths has resulted in a wide range of health disparities, ranging from increased prevalence of depression and substance use to downstream effects, such as an increased risk for cancer and cardiovascular disease when older.We review the clinical significance of these findings for health care professionals, who need to become informed about these associations to provide better care for their sexual and gender minority youth patients, and to be able to educate their parents and other caregivers.Homosexual and gender nonconforming behaviors have been variably expressed in different cultures since the beginning of recorded history. However, only in recent years has there been sufficient scholarship about sexual and gender minority youths to enable clinicians to learn more about the unique health needs of these populations.1 For most of the 20th century and previous centuries, sexual and gender minority people were not recognized as discrete populations that required specific, culturally responsive attention from health care professionals and public health programs. However, awareness increased after the emergence of the gay liberation movement in the late 1970s, and was exponentially enhanced as clinicians began to recognize an increasingly varied panoply of sexually transmitted infections, culminating with the AIDS epidemic. These observations were only the tip of the iceberg, because many health issues faced by sexual and gender minorities were not exclusively related to their sexual behavior, but were often a response to the stigma and discrimination they experienced.2 Societal understanding of these issues has been informed by the emerging awareness of health disparities that are not only prevalent among racial and ethnic minority populations, but are common among sexual and gender minority populations.3 This emerging awareness has also led to the recognition that health systems must become responsive to the reality of a diverse array of minority health disparities, to enhance access to appropriate health care for disenfranchised populations.4 An understanding of the reasons why specific populations may not fully engage in care is critical to creating more culturally responsive systems for health care, as well as the specific clinical conditions that may be more prevalent in subpopulations. It is also important that clinicians learn how to improve the ways that sexual and gender minority youths experience their clinical care, including evaluating how provider attitudes may affect physicians’ ability to provide nonjudgmental care.For sexual and gender minority populations, the recognition of the importance of addressing their unique health needs is a recent development.5 Historically, many key professional documents, such as the early versions of the Diagnostic Management System (DSM) of the American Psychiatric Association, presumed that individuals who were homosexual or who displayed gender nonconformity were ipso facto experiencing a mental health illness. Only in recent decades have health professionals recognized that past dogma and professional bias caused much harm, and prevented development of ways for providers to help their sexual and gender minority patients to optimize their resilience to lead confident, healthy, productive lives.6,7 Health care professionals’ understanding of sexual and gender minority subcultures is particularly important to ensure the successful growth and development of lesbian, gay, bisexual and transgender (LGBT) youths, given young people’s developmental vulnerabilities, and the normative role that trusted health professionals can play. The February 2014 issue of the American Journal of Public Health has provided a wide array of studies based on recent data from the Youth Risk Behavioral Survey (YRBS) system, which provides data that can inform and improve the clinical care of sexual and gender minority youths.Careful analyses of the life experiences of sexual and gender minority populations suggest that proximate causes of psychological distress and risk-taking behavior for some stem from early childhood experiences, including physical and emotional abuse by family or peers, as well as general societal stigma and discrimination (Institute of Medicine5 [IOM]), resulting in dysfunctional behavior.8,9 Similar health disparities (e.g., increased risk for HIV or sexually transmitted infection), depression, and substance use are now being recognized among sexual and gender minorities in developing countries.10 These findings suggest that successful responses to the global HIV/AIDS epidemic will require the development of culturally sensitive programs that address concomitant clinical concerns and root causes, such as societal and institutional homophobia. Research is needed to understand how the majority of sexual and gender minority people lead resilient and productive lives in the face of discrimination and to develop assets-based interventions that build on the community supports that they have created.