INCREASING SENSITIVITY TO ADOLESCENTS NEEDS

Increasing Sensitivity to Gay/lesbian/ bisexual adolescents mental health needs

Increasing Sensitivity to Gay/lesbian/ bisexual adolescents mental health needs

Chapter I

what are the experiences of gay/lesbian/bisexual adolescents?

Introduction

In the past 10 years there has been increased recognition in the medical literature of gay and lesbian adolescent patients and their special problems and needs. The prevalence of homosexuality is highly contested; studies are difficult to compare because there is no objective parameter which measures sexual orientation, with estimates ranging from 3% to 10% across men and women. The prevalence of bisexuality is more poorly defined, although it has been noted that more people self-identify as either heterosexual or homosexual than bisexual and that more females than males self-identify as bisexual .

To adequately care for gay, lesbian, and bisexual youth (referred to in the remainder of this article as “gay”), an understanding of homosexual identity development among providers of health care to adolescents is requisite. Troiden proposed a four-stage model for this process, which often develops during childhood and adolescence. Available research indicates that many gay adolescents are aware of their homosexuality by early or middle adolescence (roughly age 11-16 years), and that this awareness tends to arise at a slightly younger age for boys than for girls. It should be noted that homosexual experiences are not necessary for development of a homosexual identity; in one study, 8% of adolescent and young adult subjects had not had same-sex sexual activity, yet self-identified as gay .

Gay adolescents share many of the same developmental tasks as heterosexual adolescents. However, they are at increased risk for physical abuse, school problems running away from home [other psychosocial problems, and depression and suicide. Gay male youth are also at high risk for contracting sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV). Several authors have recommended clinical approaches to this patient population which include methods used in the overall practice of adolescent medicine. Most adolescent medicine experts agree that medical confidentiality is a cornerstone of effective adolescent health care and that lack of confidentiality is a barrier to care. A recent study of knowledge about confidentiality in 1295 high school students found that less than half of teens surveyed (43.8%) recalled being informed about privacy when they went to the doctor, and only one-third were aware of their right to confidential care for STDs and drug problems .

Chapter II

Literature review

Although recommendations on the clinical approach to adolescent homosexuality exist in the medical literature, little is known about how primary care providers are dealing with gay adolescents in daily practice. Health care providers may avoid the subject of sexual orientation because of lack of training; a 2005 survey of 4-year medical schools found the mean amount of course time devoted to the topic of homosexuality to be 3 h and 26 min . Compounding this lack of training is a paucity of documented information on the gay adolescent's health care experience. In a 2005 study, gay youth were asked if they were able to talk ...