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Lesbian, Gay, Bisexual, and Transgender Health

LGBTQ Youth Programs-At-A-Glance

Societal factors such as bullying, violence, and discrimination heighten health risks for anyone. However, lesbian, gay, bisexual, transgender, and questioning (LGBTQ)* youth experience elevated risk and associated negative health and mental health outcomes. Recognizing these serious health risks, CDC works with national, state, and local partners to address the health, education, and safety needs of LGBTQ youth.

* Variations of this acronym are used throughout the Web page to reflect relevant populations. Many studies consider lesbian, gay, and bisexual youth, but do not include transgender and questioning youth.

Data Collection and Analysis

CDC provides funding for state, territorial, and local education and health agencies to conduct the Youth Risk Behavior Survey (YRBS), which monitors health risk behaviors among U.S. high school students. CDC has encouraged its sites to add optional questions about same-sex sexual contact and sexual identity to Image of young female college students. their YRBS questionnaires. Collecting such data enables those working with youth to better understand the health and safety risks among sexual minority youth1 and then adjust prevention priorities accordingly.

In 2011, CDC analyzed data from YRBS to identify associations between sexual minority status and health risk behaviors. The findings of this analysis are described in a CDC report, “Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9–12 in Selected Sites—Youth Risk Behavior Surveillance, United States, 2001–2009.” The report documents the disproportionate rates at which sexual minority students experience many health risks, including tobacco, alcohol, and other drug use; sexual risk behaviors; and violence.

During the 2013 YRBS cycle (pertaining to optional questions about sex of students’ sexual contacts and students’ sexual identity)―:

  • Three states and one large urban school district asked only about the sex of students’ sexual contacts
  • Three states, two large urban school districts, and one territory asked only about students’ sexual identity
  • Fifteen states, 16 large urban school districts, and one territory asked about both the sex of students’ sexual contacts and about students’ sexual identity

Starting in 2015, the national YRBS questionnaire and the state/local standard questionnaire will include questions about sexual identity and sex of sexual contacts.

School Health Profiles and the School Health Policies and Practices Study, CDC’s two large surveillance systems measuring school health policies and practices, assess school health policies and practices relevant to LGBTQ youth, such as:

  • Existence of gay-straight alliances (GSAs) or similar student organizations in schools
  • Identification of safe spaces for LGBTQ youth
  • Prohibition of harassment and bullying
  • Provision of health and mental health services to LGBTQ youth
  • Professional development and training for school staff about the needs of LGBTQ youth
  • Inclusion of LGBTQ-related topics in sex education curricula
  • Classroom teaching about sexual orientation
  • Referrals to health and mental health service providers experienced in serving LGBTQ youth

 

State and Local Prevention Programs

CDC provides funding and technical assistance to partners in 18 states, the District of Columbia, and 17 large urban school districts to help them and schools implement effective policies and practices to reduce sexual risk behaviors among youth. These programs are focusing increasingly on LGBT youth as part of their HIV, STD, and pregnancy prevention activities.

Examples of program activities include:

  • Providing training for district and school staff to ensure that health curricula are inclusive of and relevant to LGBT students
  • Supporting schools in establishing GSAs and safe and supportive environments for LGBT youth
  • Linking schools to community organizations that provide sexual health services for LGBT youth
  • Developing resources to help school staff understand the special concerns and needs of LGBT youth
  • Collecting data on risk behaviors among LGB youth as part of the Youth Risk Behavior Survey

In 2010, state and local education agencies funded by CDC reported specific activities to address LGBTQ youth. See the following for examples:

  • The School District of Philadelphia provided annual skills-based training entitled “Fostering Knowledge About and Respect for LGBT Youth” for all K-12 staff and teachers; developed a community resource guide for schools and community-based organizations on referral services for LGBT youth; and collaborated with the American Psychological Association (APA) to provide training to school nurses, psychologists, social workers, and counselors.
  • The Rhode Island Department of Education established a statewide task force on lesbian, gay, bisexual, transgender, queer, and questioning youth. The task force released a statewide plan with recommendations in the areas of education, policy, health and human services, child welfare, mental health, and data collection to ensure these young people’s needs are addressed. Among the recommendations were that 1) questions about same-sex sexual activity and sexual orientation be added to the state YRBS, 2) training be provided for school staff on issues pertaining to LGBTQ youth, 3) GSAs be established when requested by students, and 4) lesbian, gay, bisexual, transgender, queer, and questioning identity be included in definitions of diversity.
  • The HIV/AIDS Prevention Unit of the Los Angeles Unified School District (LAUSD) developed a chapter about sexual orientation for inclusion in the Sexuality and Society textbook that is used in required health education courses in LAUSD high schools. The district also employs two full-time staff members to address issues pertaining to LGBTQ youth, and approximately 35,000 LAUSD employees and students—including all teachers hired since 2003—have received the district’s anti-bias training.
  • In response to requests from school districts throughout Michigan for guidance on creating safe school environments for sexual minority students, the Michigan Department of Education (MDE) collaborated with the Calhoun (Michigan) Intermediate School District to update a guide and training program on the topic and to offer trainings statewide. Copies of the guide, A Silent Crisis: Creating Safe Schools for Sexual Minority Youth, have been distributed throughout Michigan and 20 other states. MDE has conducted workshops using the guide for educators in 180 Michigan school districts.

 

Young Men Who Have Sex with Men (YMSM) Project

CDC's Division of Adolescent and School Health (DASH) provides funding and support through a 5-year cooperative agreement for the Young Men Who Have Sex with Men (YMSM) Project to three local education agencies and a national non-profit organization to implement multi-component, school-centered HIV prevention activities for teen MSM ages 13-19. Recipients of the competitive funding are the School Board of Broward County, Los Angeles Unified School District, San Francisco Unified School District, and Advocates for Youth. The project is guided by the National HIV/AIDS Strategy.

Goal

Reduce HIV and other STDs among black and Latino young men who have sex with men through school and community-based partnerships by:

  • Increasing the number of teen YMSM who are tested and treated for HIV and other STDs
  • Decreasing sexual risk behaviors among teen YMSM
  • Reducing absenteeism and school drop-out among teen YMSM

Core Strategies

  1. Implement or expand HIV and other STD testing and treatment in schools and school-based health centers
  2. Increase collaboration in order to support referrals to HIV and other STD testing, treatment, and evidence-based educational interventions
  3. Develop systems in schools to support student referrals to HIV and other STD testing and treatment
  4. Assess state and district education policies and their implementation related to HIV and other STD testing, treatment, and prevention
  5. Promote safe school and school-based health center environments
  6. Provide evidence-based education interventions tailored for black and Latino YMSM
  7. Implement social marketing that promotes the core strategies

Project Rationale

School-Centered HIV/STD Prevention for Young Men Who Have Sex with Men (YMSM) Project Rationale

 

Program Evaluation

CDC is supporting evaluation of a 5-year project designed to reduce HIV and other STDs among African American/black2 and Hispanic/Latino3 teen young men who have sex with men (YMSM). Initial evaluation activities centered on gaining a better understanding of the experiences of black and Hispanic/Latino teen YMSM, particularly related to sexual health services. This first stage of the evaluation was designed to obtain information that would specifically guide program work in these services. Findings focused on YMSM students’ experiences in school; their willingness to talk to school staff about topics such as safety, sexual orientation, relationships, and health services; and their experiences with, and interest in, sexual health services both within and outside of schools. The next stage of this evaluation focuses on collecting baseline data and developing plans for collecting follow-up data. Basic evaluation activities will take place in all three participating school districts; more in-depth evaluation activities will be implemented in a single district. Key outcomes of interest include HIV and STD testing among YMSM, numbers of referrals to testing and related services from school staff, and changes in the school environment for YMSM.

CDC also funds selected state and local education agencies to help school districts and schools implement effective policies and practices to reduce sexual risk behaviors among youth, including youth at disproportionate risk (such as LGBT youth, especially YMSM), through funding opportunity announcements such as Promoting Adolescent Health Through School-Based HIV/STD Prevention and School-Based Surveillance. Funded agencies are required to report performance and process measures reflective of their specific work in addressing the needs of sexual minority youth.

 

Collaboration with National Nongovernmental Organizations (NGOs)

CDC provides funding and technical assistance to several national nongovernmental organizations (NGOs) to build the capacity of school districts and schools to meet the HIV/STD prevention needs of a selected group of youth at disproportionate risk―including LGBT youth. These NGOs focus their capacity-building activities around three approach areas:

HIV/STD Prevention ApproachNGO Working with School Districts/Schools
Exemplary Sexual Health Education
  • Advocates for Youth
  • Healthy Teen Network
Key Sexual Health Services
  • National Coalition for STD Directors
  • CAI
Safe and Supportive Environments for Students and Staff
  • American Psychological Association
  • Gay-Straight Alliance Network

These NGOs collaborate with other partners to support policies that better meet the mental and sexual health needs of LGBT youth.

 

1 Those who identify as gay, lesbian, or bisexual, or who have sexual contact with persons of the same or both sexes.

2 African American/black: Referred to as black in this Web page content.

3 Hispanics/Latinos can be of any race.

 
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