Box Turtle Bulletin

Gay Healthcare Reform

If we believe our politicians, health care is broken in America and the Federal Government is the only one who can fix it. Our President is so concerned about implementing healthcare reform that he can\’t spare a moment to work on equality for gays and lesbians.

However, a more cynical observation may be that for gay and lesbian Americans, the Federal Government is the problem rather than the solution to our immediate health care concerns. And before we focus on the controversial and highly combative effort to overhaul the country\’s methods of providing health care, let\’s at least make sure the rules are applied fairly and equally.

Here are four things that the administration could work with Congress to make health care more affordable for gay people… should they want to.

• Provide federal employees with domestic partner health care benefitsThis is a no-brainer. To deny health care benefits to the spouse of an employee solely because they are gay is un-American.

  Pass the Domestic Partners Benefits and Obligations Act.

• Stop taxing partner benefitsIf Joe\’s company provides his spouse with health care, everyone is pleased. But if Joe\’s spouse is the same sex as Joe, and only if so, the federal government treats this as part of Joe\’s compensation and requires him to pay income tax on the benefits.

  This tax based solely on sexual orientation is probably unconstitutional, is definitely immoral, and is entire unjustifiable.

• Allow ‘Married Filing Jointly’ tax status for legally married AmericansJoe and his spouse Fred cannot file jointly on their federal returns. Which means that costs spent for Fred\’s medical care cannot be deducted on Schedule A of Joe\’s income tax return. For households in which only one spouse works or in which income is not proportionate, this can be a huge financial burden without any consideration.
• Reverse the ban on HIV travel and immigrationThis requires nothing but the signature of the President.

The President can try to sell us on his medical overhaul based on its merits, benefits and costs. But I\’ll not be impressed in the slightest if it does not correct the inequities that the government has set up to unfairly deny health care rights to gay Americans and to unfairly tax them on the ones they do get.

Research: Anti-Gay Harassment in Childhood Leads To Poor Adult Health

Mark S. Friedman, Michael P. Marshall, Ron Stall, JeeWon Cheong, Eric R Wright. “Gay-related development, early abuse and adult health outcomes among gay males.” AIDS and Behavior 12, no. 6 (November 2008): 891-902. Abstract available at DOI 10.1007/s10461-007-9319-3.

The Urban Men’s Health Survey (UMHS) has revealed a lot of useful information in the decade since it was conducted. Much of it “dismaying,” in the words of Ron Stall, who worked on the survey at the Centers for Disease Control and Prevention and is now at the University of Pittsburgh. Stall was one of four researchers from the University of Pittsburgh (joined by a fifth researcher from Indiana University – Purdue University Indianapolis) who analyzed a subset of that data and concluded that “experience of homophobic attacks against young gay/bisexual male youth helps to explain heightened rates of serious health problems among adult gay men.”

The UMHS was a telephone interview of a probability sample of men who have sex with men (MSMs) living in four cities: San Francisco, New York, Los Angeles, and Chicago. The survey was conducted between November 1996 and February 1998, with 2,881 UMHS participants being asked a wide-ranging battery of questions resulting in 855 variables. The results of that survey were fed into a database, which scores of researchers have been mining ever since for dozens of studies covering many different topics. Dr, Mark Friedman, who has previously investigated the link between anti-gay hostility and suicide among young gay males, led a team which poured over responses to key questions in that database to see if a link could be established between anti-gay hostility against young gay men and adverse health outcomes as adults.

Among the many questions in that survey, participants were asked about their experiences, if any, with parental physical abuse, gay-related harassment during childhood and adolescence, and forced sex. They were also asked about four gay-related identity milestones: the age at which they became aware of their same-sex attractions, age of first same-sex sexual activity, age of deciding that they were gay, and age of first disclosure that they were gay.

Participants were also asked about current depression, HIV serostatus, sexual risk behavior during childhood, partner abuse during adulthood, anti-gay victimization during adulthood, and suicide attempts during childhood.

Dr. Mark Friedman and associates used the responses from these questions from 1,383 men aged 18 through 40, and divided them into three categories (early bloomers, middle bloomers and late bloomers) according to how participants answered questions based on the four gay-related identity milestones. Then, by looking at the answers to the other questions, they were able to demonstrate three principle findings:

1) Gay males who developed early with respect to their sexual orientation were much more likely to experience anti-gay harassment and sexual abuse during adolescence than middle bloomers and late bloomers. This might be something of a “duh” conclusion since it stands to reason that those who are more visibly gay draw more attention than those who aren’t, and those who are visibly gay earlier have more time in which to experience anti-gay harassment and sexual abuse. Nevertheless, it’s important to establish this finding statistically, because it leads to the next finding.

2) Those early bloomers were also more likely to anti-gay victimization, depression, and become HIV-positive as an adult. Taken alone, this finding might play into the hands of anti-gay activists who contend that gay youth should remain closeted and continue to deny their true experiences for as long as possible. Well, not so fast, because…

3) While early bloomers were more likely to experience adverse health outcomes as adults, it wasn’t just because they were early bloomers. Friedman and associates found that harassment and violence were very common experiences among all young gay and bisexual males. Regardless of “bloomage,” 74% reported experiencing anti-gay harassment and 24% experienced parental physical abuse before the age of 17. And these experiences were capable of statistically predicting specific negative health outcomes as adults:

• Early gay-related harassment was found to be positively associated with gay-related victimization in adulthood;
• early parental abuse was found to be positively associated with partner abuse, gay-related victimization, depression, attempted suicide and becoming HIV-positive;
• and early forced sex was positively associated with adult partner abuse, depression, engagement in high-risk sex, and becoming HIV-positive.

The men in this survey became adults, on average, in the mid 1980’s. We don’t know whether adolescents today experience statistically the same levels of abuse and harassment as adolescents did then. But the authors conclude that regardless of the extent of anti-gay harassment today, that:

“…a compelling case can still be made that the three sets of findings above, as a whole, support the hypothesis that the experience of homophobic attacks against gay youth contribute to health disparities among gay men. … [T]his suggests that their experience of abuse is related to homophobia and that these experiences in part determine the adult health problems that gay men often experience.

“To summarize, some of the health disparities of gay and bisexual men may have their genesis in these individuals’ childhood and adolescent years given that these disparities are already in place by early adulthood. The findings described above support the hypotheses that the disparities appear to be due, in part, to the timing of [gay-related development] and the violence these individuals experience related to being gay during their formative years.”

This week is National No Name Calling Week, sponsored by the Gay, Lesbian and Straight Education Network (GLSEN). According to GLSEN’s non-representative survey of 6,209 middle and high school students, 86% of LGBT students experienced harassment at school in the past year, 61% felt unsafe at school because of their sexual orientation, and 33% skipped a day of school in the past month because of they felt unsafe. This survey isn’t statistically representative nationwide, but that’s beside the point. They found an awful lot of harassed and frightened kids out there.

Of course, Focus On the Family is against No Name Calling Week, complaining that it has a hidden agenda. And they’re right; it does. The “hidden agenda” consists of safer youth and healthier adults, which Focus continues to oppose at all costs. After all, they’ve invested a lot of energy in maintaining the image of gay men as depressed, suicidal and unhealthy. Now we know that their own policy solutions will only serve to perpetuate that image.

Study Identifies Link Between Rejecting Parents and Negative Health Among LGB Youth

Caitlin Ryan, David Huebner, Rafael M. Diaz, Jorge Sanchez. “Family rejection as a predictor of negative health outcomes in White and Latino Lesbian, Gay and Bisexual young adults.” Pediatrics 123, No. 1 (January 2009): 346-352. (DOI: 10.1542/peds.2007-3524)

In a new paper published this month, Dr. Caitlin Ryan and her colleagues at San Francisco State University were able to demonstrate a predictive link between specific, negative family reactions to their child’s sexual orientation and serious health problems for these adolescents in young adulthood. According to this study, such adverse health problems include depression, illegal drug use, risk for HIV infection, and suicide attempts. This study appeared in the January issue of the journal Pediatrics, the official journal of the American Academy of Pediatrics, and is being hailed as a landmark departure from previous studies, which tended to look at a wider range of sources of social rejection — schools, peers, etc. This study looked specifically at parental acceptance or rejection and its impact on LGB youth health.

The study was based on questionnaires administered to a sample of 224 white and latino LGB young adults, aged 21 to 25, and open about their sexual orientation to at least one parent or guardian. (Twenty-one additional participants who identified as transgender were also recruited, but their numbers were too small for statistical analysis, and thus were excluded from this particular study.) Participants were recruited through various venues, including bars, clubs, LGBT service agencies and community groups, all within 100 miles of San Francisco.

On average, participants became aware of their same-sex attractions at the age of 10.76 years. They came out to themselves at age 14.16 on average, came out to others at age 15.32 on average, and came out to family at age 15.82 on average. Men were on average aware of their same-sex attractions about two years earlier than women, and they came out to themselves about one year earlier than women.

Study participants were asked a series of questions resulting in 51 close-ended items that assessed the presence and frequency of each rejecting parental or guardian reaction to the participant’s sexual identity when they were teenagers. The questionnaire used, the FAP Family Rejection Scale, has a high internal consistency (Cronbach’s α = .98).

Levels of depression were assessed using the Center for Epidemiologic Studies Depression Scale. Substance use and abuse were quantified in 3 ways: heavy alcohol drinking in the past 6 months, use of illicit drugs in the past 6 months, and substance use–related problems in the last 5 years. Sexual behavior was assessed in the last 6 months by asking about number, gender, and type of sexual partners, type of sexual activity, and whether condoms were used when activity involved anal or vaginal penetration.

Compared to peers who reported no or low levels of family rejection, LGB young adults who reported higher levels of family rejection during adolescence were:

• 8.4 times more likely to report having attempted suicide,
• 5.9 times more likely to report high levels of depression,
• 3.4 times more likely to use illegal drugs,
• 3.4 times more likely to engage in unprotected sexual intercourse.

To give you an idea of how dramatic an effect that higher levels of family rejection can have on an individual, here’s something else to ponder. Compared to peers who reported no or low levels of family rejection, LGB young adults who reported only moderate levels of family rejection during adolescence were:

• 2.3 times more likely to report having attempted suicide,
• 2.9 times more likely to report high levels of depression,
• 1.4 times more likely to use illegal drugs,
• about as likely (1.04 times) to engage in unprotected sexual intercourse.

Latino men reported the highest number of negative family reactions to their sexual orientation in adolescence.

While these findings are very important, it’s important to keep in mind some of the study’s limitations. The biggest one that jumped out at me — and one the research authors didn’t address — was whether there were any confounding factors leading to these outcomes. For example, in this particular sample, what were the subjects’ experiences with peer rejection, bullying or violence? If subjects who experienced a high degree of rejection by their parents also happened to experience a greater degree of bullying, for example, then outcomes attributed to rejecting parents could have been affected by bullying as well. Since the researchers weren’t able to control for those outside factors, we don’t really know what, if any, external influences may have contributed to these outcomes.

And also, this study has all the usual weaknesses of virtually every other social science study. The authors caution:

There are several limitations to the study. This is a retrospective study that measures young adults’ reported experiences that occurred several years earlier, which may introduce some potential for, recall bias. To minimize this concern, we created measures that asked whether a specific family event related to their LGB identity actually occurred (eg, verbal abuse), rather than asking generally about “how rejecting” parents were. Although we went to great lengths to recruit a diverse sample drawing from multiple venues, our sample is technically one of convenience, and thus shares the limitations inherent in all convenience samples. Thus, these data might not represent all subpopulations of LGB young adults, as well as individuals who are neither white nor Latino. The study focused on LGB non-Latino white and Latino young adults to permit more in-depth assessment of cultural issues and experiences related to sexual orientation and gender expression, so it did not include all other groups and drew from 1 urban geographic area. Subsequent research should include greater ethnic diversity to assess potential differences in family reactions. Lastly, given the cross-sectional nature of this study, we caution against making cause–effect interpretations from these findings.

Nevertheless, this study highlights some important implications for identifying youth at risk for family violence and for being ejected from their homes. We know that LGB youth are overrepresented in foster care, juvenile detention, and among homeless youth. And we also know that conflict over an adolescent’s sexual and gender identity is one of the primary reasons for being kicked out of the home. And for whatever reason, this study seems to suggest that Latino gay and bisexual men are at a particularly higher risk of being rejected by their parents.

This study opens a long-neglected area of research. Further research which replicates and improves on this study is badly needed. But one thing for certain, those groups — specifically, certain ex-gay groups come to mind — which encourage parents to engage in rejecting behaviors with their children bear a tremendous responsibility. The cost to the well-being of LGB youths can be staggering.