Credit: Illustration by Stephanie Rudig

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LGBTQ youth don’t want their parents and doctors to slap metaphorical “risk” stickers on their foreheads when they disclose their sexuality. And coming out of the closet remains a big deal for many.

Queer American youth have an easier path than their predecessors did in many respects—coming of age after HIV became a manageable condition, with gender transitions a common topic in mainstream media, and with the legality of gay marriage. But shifts in national policy and dialogue have not reached every home’s kitchen or doctor’s office, and even those adults who have embraced the changes sometimes say things that leave their teens feeling like high-risk sex accidents waiting to happen.

These are some key findings in a recent D.C.-based study on health and wellness for LGBTQ youth conducted at Whitman-Walker Health, the stalwart D.C. clinic. Jennafer Kwait, who serves as Whitman-Walker’s LGBT research manager, designed and implemented the study with a grant from Washington AIDS Partnership. 

Its goal was to find out what wellness means for queer young people. It consisted of five focus groups in which people between the ages of 16 and 24 could share their thoughts and experiences. The 44 who participated offered geographic variety, as some were District natives while others were in D.C. for college, an internship, or to start their careers.  

“Sometimes the younger participants were still telling me things in story form—they were living it,” says Kwait. “It was current, it was present. Whereas participants who were older were able to reflect back and look at the significance, and they weren’t necessarily living the moment anymore.”

One participant recalled receiving immediate and loving parental support after coming out, only to hear them express anxiety about the risk of HIV. “There are parents who are my age and grew up in the thick of it, and that’s what comes to mind,” says Kwait. “So it comes from a place of caring, but at the same time it says, ‘Now all you are is just sex.’” Some teens share their sexuality well before they start having sex with anyone. 

Young women in the groups talked about doctors who kept asking if they were pregnant or at risk of pregnancy upon learning that they were sexually active. But when these young women told their doctors they were having sex, they didn’t mean the straight variety. 

And several participants felt they’d been labeled with a higher risk for mental health issues because of their sexual identities. 

The solution? Start with open-ended questions. “A parent could ask: Is there anything you’re concerned about? What else do you want to tell me about?” says Bianca Palmisano, whose group, Intimate Health Consulting, works with people employed in the helping professions to grow their sexual health competency. For doctors, she recommends: “‘Can you tell me about any relationships you’re in right now?’ as opposed to, ‘Do you have a boyfriend?’ or ‘Who are you having sex with—men, women, or both?’”

Palmisano heard about the focus groups shortly before they began, and she contacted Kwait to let her know about her expertise. At 24 she was on the older end of the age range, but she was interested in both participating in and spreading the word about the focus groups. She ultimately joined the first group (information she chose to disclose, as Whitman-Walker will not disclose the names of anyone who participated in the study) and also helped reach queer people in the city to encourage them to participate. 

As the research process unfolded, it emerged that the groups appeared to be a boon for participants. “It served the purpose for young people who were more disconnected from others—who had similar identities, or similar experiences of bias or stigma or not being able to be their authentic selves—to have a place to share and to talk about things that they typically don’t talk about, and to have an adult in the room saying, ‘You’re the expert. Not only do we embrace who you are, but you’re the expert on your experience, and share it, and it’s valid.’”

One participant told the group that they weren’t really out of the closet; it was the first time they’d ever discussed these matters. Palmisano, on the other end of this particular spectrum, came out to her family at 15. 

At the beginning of each session, Kwait handed out a demographics sheet she’d worked on for hours. Writing a list of sexuality options for young people in 2017 isn’t a straightforward task. Among the questions: “How do you think of yourself in terms of your sexual orientation?” 

The four options were: Gay/lesbian/same-gender-loving/homosexual; Bisexual; Straight/not lesbian, gay, bisexual/heterosexual; and Another self-identified sexual orientation, with a blank space after that last category. One write-in answer that appeared several times was pansexual, which means not limiting sexual choice to any particular gender.

At least one participant identified as asexual and felt isolated in our hyper-sexual culture.

“Same-gender-loving,” a term activist Cleo Manago coined for the African-American gay community in the 1990s, has aged well. People of different races and identities sometimes use it. “That term is also trans-friendly,” says Whitman-Walker’s external affairs manager Jewel Addy. “It’s just a more modern way to talk about your sexuality in relation to gender.”

Kwait says some participants used their lunch cards (which they got for participating, along with a $5 transportation card) to eat out together after the sessions ended. No wonder. 

“In no group did it not come up that having supportive friendships and supportive peers, and being able to be with other young people who are like me, who get it, was incredibly important to their well-being,” she says.  

Though the study is complete, a next step is underway: forming a youth advisory board at Whitman-Walker that will develop two “toolkits,” one for parents and caregivers looking for tips on how to talk to their LGBTQ cubs, and another for the youth, so they’ll know how to advocate for themselves at the doctor’s office. Kwait is hiring six young people to help complete that work.