Psychological conditions that are epidemic among urban homosexual and bisexual youth warrant conscious efforts to foster self-esteem, positive relationships, and social support.
"He would walk into a room and say a couple quick words and everybody would just forget their problems and smile. He had a gift."
Bud Hill was describing 15-year-old Jadin Bell, a popular kid with green-dyed hair and a supportive family in La Grand, Oregon.
Jadin died February 3, after being on life support since January 19. That was the day he hung himself from an elementary school play structure after being bullied by schoolmates because he was gay.
"He was different," said Hill, a family friend, "and they tend to pick on the different ones."
Two days after Jadin hung himself, President Obama proclaimed in his second inaugural address that gay Americans should finally be treated as fully human and equal citizens. As he spoke, Jadin Bell lay dying in an Oregon hospital, one of the inestimable number of young men whose "difference" marks them for ridicule and ostracism and, too often, early death by their own or another's hand.
If "it gets better" with age, according to the campaign started in 2010 after a rash of gay youth suicides, it isn't only because high school bullies are left behind to wallow in the filth of their own hatred. It's because, despite the tremendous odds stacked against us, most gay men are able to find the resilience we need to survive and thrive.
The day Jadin Bell died, a new study published in Pediatrics reported that although bullying drops as young people move beyond high school, young gay men are almost four times more likely than their straight peers to be bullied.
The project has actually found that increasing family support reduces the young people's substance abuse, HIV risk behaviors, and suicidality.
Other grim statistics show that driving young sexual minority people to the brink of despair has terrible consequences, as it did for Jadin:
- Nearly eight out of ten LGBT middle and high-school students reported physical or verbal harassment in the Gay, Lesbian, and Straight Education Network's 2011 National School Climate Survey. This was actually an improvement over previous years.
- Gay and lesbian teens are two to three times more likely than other youths to commit suicide.
- They are five times more likely to miss school because they feel unsafe after being bullied because of sexual orientation.
At The Fenway Institute in Boston, Kenneth H. Mayer, the medical research director as well as a professor of medicine at Harvard, said that greatly improved HIV medical care has allowed researchers breathing room to focus on issues such as resilience and the reasons LGBT people face so many challenges. "From 1981 to 1996," said Mayer, "I don't think we caught our breaths by having to think about our own health, having our friends dying."
He said the research literature has made it clear that bullying, exclusion from the military and being forbidden to marry have consequences. "These send messages that they are not normal and right, and that has downstream consequences," said Mayer.
University of Pittsburgh medical anthropologist Ron Stall and his colleagues have identified four interconnected "epidemics" of psychosocial health conditions among urban gay and bisexual men, each magnifying the others: childhood sexual abuse, partner violence, depression, and drug use. Together, their insidious effects are called "syndemics."
"Something horrible is happening during adolescence to young gay men," Stall told me in a 2010 interview for my book Victory Deferred. "These young men don't understand what's happening to themselves. There's no community. Sometimes if the 'sissy boy' goes to dad to tell about getting beat up on the playground, he risks being beaten up by his dad. That kind of experience has got to be searing, and leaves scars on gay men."
The scarring manifests itself in still more startling statistics for gay men compared to non-gay people--including higher rates of anxiety, depression, alcohol and other substance abuse, and greater risk for HIV infection.
The Centers for Disease Control and Prevention (CDC) reports that in 2009, gay and bisexual men accounted for 61 percent of all HIV infections in the United States, and 78 percent of all new infections among men . Although new HIV infections were "relatively stable" among men who have sex with men between 2006 and 2009, the CDC says they increased 34 percent among young gay and bisexual men--mainly due to a 48 percent increase among 13- to 29-year-old African-American gay and bisexual males.
It's a popular assumption that gay men have such high rates of HIV and other sexually transmitted infections because of irresponsible hedonism. It's rare that even those of us at high risk consider that something deeper than pleasure-seeking may be what's really driving the urge to merge-at-all-costs, that maybe we are confusing "horny" with, say, depressed or lonely. Or that we have taken to heart the many messages we receive telling us that our "difference" means we are broken, unlovable and unworthy of an intimate relationship.
Gregory M. Herek, a professor of psychology at the University of California at Davis, and an internationally recognized authority on prejudice against lesbians and gay men, hate crimes and anti-gay violence, and AIDS-related stigma, said in an interview, "Certainly in the past, everybody was brought up with the attitude that homosexuality was wrong, a sickness, sin, that everybody who was gay or lesbian was a bad person. So being raised in that it's almost inevitable that almost all people have accepted or believed it."
But not everyone accepts or believes it. In fact fewer than ever do, and they have much to teach. "What I think is amazing," said Herek, "is how many people are doing fine and are mentally healthy, and leading whole and productive lives. How do they do that? Given all they're up against, how do they come out of it? The answer is resilience. If they've overcome this internalized self-stigma, they have more resources for overcoming this psychological distress."
As proof, Ron Stall in a recent interview pointed to his study of gay men's psychosocial health problems. Eleven percent of the 812 men reporting one problem had recently engaged in high-risk sex, as had 23 percent of the 129 men reporting three or four problems. The evidence of resilience among these men was in the fact that the overwhelming majority of them had not engaged in high-risk sex, even the men burdened with multiple psychosocial health problems.
Stall said, "We were able to show that guys who do the best job of resolving internalized homophobia [or self-stigma] are the least likely to have current victimization, substance abuse and compulsive [high-risk] sex."
He said such findings demonstrate that, to be truly effective, HIV prevention and substance abuse interventions need to build on gay men's resilience, to be "strength-based," rather than deficit-based. "We're so focused on risk factors to the point that we forget about resilience," he said. "It seems to me a smarter way to go would be to look at the guys who are thriving in spite of the adversities, how they pulled that off, see what the lessons learned are, and apply that to the interventions we already use and have developed."
In fact, the National Institutes of Health's LGBT Research Coordinating Committee in a January 2013 report recommended the institutes ramp up their research on resilience among LGBT populations, as they were advised to do in a 2011 Institute of Medicine (IOM) report commissioned by the NIH. The NIH committee said resilience should be studied to find out "how it develops, may protect health, and may buffer against the internalization of stigma and/or other negative experiences associated with sexual or gender minority status."