Finding a Better Way: Rights. Respect. Responsibility.®

Advocates for Youth (Advocates) organized its first European Study Tour (EST) in 1998 to explore the differences between Western European and U.S. approaches to adolescent sexual behavior and responsibility. Through this tour, Advocates sought to explore why rates of teen birth, abortion and sexually transmitted disease are consistently lower in Western Europe than in the United States. Participants visited the Netherlands, France and Germany, and attended lectures from public policy representatives, examined media campaigns, visited clinics and schools, and conducted a wide range of interviews with parents and young people in each of the three countries.

Following the tour, participants determined that the societal factors contributing to the improved reproductive and sexual health outcomes experienced by youth in these nations, include:

• A pragmatic approach to adolescent sexual health where science, not religious ideology, dictates public health policies and programs, and comprehensive sex education is valued, not feared;
• A public acceptance of adolescent sexual development as normal and healthy;
• An investment in youth as valued members of society; and
• The effective use of mass media public education campaigns.

Participants concluded that the values rights, respect and responsibility (3Rs) underlie the Dutch, French and German approaches to adolescent sexual health. Over the past decade, Advocates for Youth has come to embrace these three values as the core philosophical tenets that animate its vision:

Rights: Youth have an inalienable right to accurate and complete sexual health information, confidential reproductive and sexual health services, and a secure stake in the future.

Respect: Youth deserve respect. Valuing young people means partnering with them in the design, implementation and evaluation of programs and policies that affect their health and well-being.

Responsibility: Society has the responsibility to provide young people with the tools they need to safeguard their sexual health; and young people have the responsibility to protect themselves and their partner from too-early childbearing and sexually transmitted infections (STIs), including HIV.

Building a 3Rs Advocacy Campaign for LGBT Youth

Advocates for Youth believes that the 3Rs philosophy should extend to all young people, regardless of their class, race/ ethnicity, sexual orientation or gender identity. That said Advocates recognizes that youth who are or are perceived to be lesbian, gay, bisexual and transgender—as well as youth questioning their sexual orientation or gender identity (LGBT) [1] —are marginalized in societies around the globe. Assessment and amelioration of this marginalization, and the context in which it develops, must be a critical component of any effort to improve adolescent sexual and reproductive health.

Marginalization Contributes to Poor Health Outcomes for LGBT Youth

LGBT youth face tremendous difficulties growing up in societies where heterosexuality is presented as the only acceptable orientation, youth are not free to self-determine gender identity and expression, and homosexuality is regarded as deviant. Research in the United States suggests that homophobia, transphobia and heterosexism greatly contribute to higher rates of suicide, violence, victimization, risk behavior for HIV infection, and substance abuse among LGBT youth as compared to their heterosexual peers. For example:

• A recent report by the Gay and Lesbian Task Force and the National Coalition for the Homeless estimates that between 20 and 40 percent of homeless youth identify as lesbian, gay, bisexual or transgender [2].
• In a nationwide survey, over 86 percent of LGBT students between the ages of 13 and 21 reported verbal harassment at school. Over 22 percent reported being physically assaulted at school because of their sexual orientation while over 14 percent reported physical attacks because of their gender expression [3].
• The consequences of physical and verbal abuse directed at LGBT students have been shown to include truancy, dropping out of school, poor grades, and having to repeat a grade. For example, over 32 percent of LGBT youth reported missing a day of school in 2007, compared with less than five percent of a national sample of secondary school students [4].
• LGBT youth also suffer higher rates of suicide and suicidal ideation. One study indicated that 30 percent of gay, lesbian, bisexual and transgender high school students between the ages of 13 and 19 reported thinking about suicide in the previous year, compared to six percent of their heterosexual peers, and youth perception of having been treated badly or discriminated against accounted for an elevated risk of self harm and suicidal ideation [5]. In another study, 25 percent of transgender youth reported attempting suicide [6].

Comparable international data on the health and wellbeing of LGBT youth is hard to come by. Although certain exceptions do exist, statistics are rarely disaggregated by age, sexual orientation or gender identity. More importantly, cross-cultural comparison of the impact of marginalization on LGBT youth is difficult. However, qualitative studies and anecdotal evidence from the field indicate that homophobia and harassment of LGBT youth exists in many, if not most societies. It is also safe to conclude that this marginalization, discrimination and harassment negatively impacts the health and well being of many LGBT youth across the globe.

Developing National Intervention Models: The Interdependence of Research, Civil Society and Government

This report explores three countries’ responses to one aspect of LGBT marginalization—school harassment of LGBT youth. In particular, the authors studied the policies and programs of the United States, Germany and Brazil in an effort to identify lessons learned that could help ameliorate school harassment of LGBT youth and create the beginnings of a 3Rs movement to end homophobia and transphobia and the negative impact they have on young people. These countries where selected as snapshots of important, trend-setting work being done in different regions of the world.

This report has, at its core, three main goals:

• To spur local, national and international advocacy around adolescent sexual and reproductive health that incorporates the rights and needs of LGBT youth;
• To advocate for improved qualitative and quantitative data collection on the health issues affecting LGBT youth; and
• To foster international exchange of intervention strategies, research methods and findings, and lessons learned concerning the health issues affecting LGBT youth.

Research indicates that there have been many efforts by schools across the globe to address the harassment of LGBT youth in schools. Many of these are well documented, but alone, these efforts often prove insufficient to interrupt cycles of marginalization. Some of the most common school interventions to date have included:

• The development of zero-tolerance school policies with regards to harassment;
• Training school staff, teachers and administrators to be more sensitive to the needs of LGBT youth and to respond to incidents of harassment in the school and classroom;
• LGBT peer-to-peer support; and
• Incorporating LGBT-relevant material into school curricula.

While these interventions may incrementally improve the school lives of LGBT youth, the authors of this report believe that they are insufficient to create systemic, sustainable cultural change. To create such change, models of intervention must include various levels of interrelated and interdependent efforts by stakeholders in government and civil society, and must be aimed at ending both interpersonal and structural marginalization/ harassment of LGBT youth.

To examine this hypothesis a bit closer, this report provides a broad snapshot of efforts to break cycles of marginalization of LGBT youth in three countries—the United States, Germany and Brazil. None of these countries presents a perfect model, and in each much work remains to be done. However, our research found that in each of the societies studied, three levels of interrelated and often interdependent interventions exist, and that there are lessons to be gleaned from such findings. The three points of intervention include:

• Research (qualitative or quantitative) and its dissemination regarding LGBT health statistics; the experiences of LGBT youth; and/or others’ attitudes towards LGBT youth,
• Civil society mobilization and advocacy in reaction to that research or in efforts to spur such research efforts and/or policy and program response to the needs of LGBT youth, and
• Governmental policies and programs in response to civil society mobilization and/or dissemination of research findings on the health and wellbeing of LBGT youth.

Ultimately, marginalization stems from interpersonal and structural ignorance and inaction. (Figure 1.1) To break a cycle of marginalization, three points of intervention exist: the dissemination of data and research regarding the extent and impact of the marginalization, civil society mobilization and advocacy by and for the marginalized population, and improved governmental policies and programs to redress the issue. (Figure 1.2).

Which point of intervention occurs first, or is in response to the other, varies by country. Further, as is made clear via brief introductions to each section, the national models discussed reflect each country’s social, political, cultural and historical context. Nonetheless, all three levels of intervention can be found in each model. Challenges faced and lessons learned from each country are summed up at the end of each section and recommendations for action by key stakeholders are included at the end of the report.

1. The term “queer” - rooted in queer theory – is important to this discussion because it emphasizes that the labels lesbian, gay, bisexual, transgender, and other gender and sexual identity labels are social and political constructions, and highlights that an individual’s sexuality and gender are not singular, static or essentially definable. Nonetheless, the labels LGBT are utilized in this paper primarily for facility, because the preponderance of data collected also employs those labels, as do many of the public policies referenced in the report.

2. Ray, N. (2006) Lesbian, Gay, Bisexual and Transgender Youth. An Epidemic of Homelessness. New York: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless. http://www.thetaskforce.org/downloads/HomelessYouth.pdf

3. Kosciw, J.G., Diaz, E.M., Greytak, E.A. (2008). The 2007 National School Climate Survey: The Experiences of Lesbian, Gay, Bisexual, and Transgender Youth in Our Nation’s Schools. New York: Gay, Lesbian, and Straight Education Network.

4. Same as above

5. Almeida, J., Johnson, R.M., Corliss, H.L., et al. (2009). Emotional Distress Among LGBT Youth: The Influence of Perceived Discrimination Based on Sexual Orientation. Journal of Youth and Adolescence, 38: 1001-1014.

6. Grossman, A., D’Augelli, A. (2007). Transgender Youth and Life-Threatening Behaviors. Suicide and Life-Threatening Behavior, 37(5): 527-537

7. Adapted from “Cycle of Marginalization” model presented to United States Agency for International Development Interagency Youth Working Group, June 2009. “Public Policy and Government Programming for Young MSM: Case Studies from Brazil and Mexico,” prepared and presented by Brian Ackerman on behalf of Advocates for Youth.