Imagine the moment you walk into your doctor's office and you see a rainbow flag sticker or an educational poster with a group of LGBT people promoting good health. Would you be more willing to be out to your doctor? What if you were a teenager?

An estimated 70 percent of queer youth are not out to their doctors, despite being out to almost everyone else in their lives, including to some family members, according to a study released in December by the Rand Corporation, a nonprofit research organization, and the University of California, Los Angeles. The study surveyed 179 gay, lesbian, and bisexual teens who had attended a conference.

Bisexual youth were least likely to be out to their doctors and transgender youth were barely represented in the survey, so more research is needed to identify their health needs.

"The thing that was surprising is this is a group that is out enough about their orientation to attend a conference of LGBT youth and even most of them were not out to their physicians," said Dr. Mark Schuster, senior author of the study and a pediatrician at UCLA and health policy researcher at Rand.

The catch is that 64 percent of the GLB teenagers surveyed said they want to be out to their doctors, all the doctors need to do is ask. So, where is the disconnect?

"[This is] common, very common," said Caitlin Ryan, director of the Family Acceptance Project in San Francisco. Ryan is currently conducting a statewide intensive study focused on queer youth health issues that will be released later this year. According to Ryan the complexity of the situation hasn't changed since the early 1980s when she first began studying LGBT health issues.

There are a number of reasons that youth do not discuss their sexual orientation with their doctors: fear of rejection, ridicule, parents' disapproval, and more. Youth who are not out to their parents often fear that their doctor will tell their parents. For teenagers in particular, there's the natural struggle with their parents over privacy and autonomy, especially when relationships and sex are involved. Add being queer into the equation and the situation quickly becomes complex.

"The thing that causes a lot of stress for teenagers and young adults [is] 'relationships,'" said Curtis Moore, executive director of Bay Area Young Positives. "It's a catch phrase for two people who think the other one likes the other and they are engaging in some sexual act ... it's not about holding hands and carrying books anymore. So, we have to keep it real."

A safe place

It's difficult to retain an objective and logical perspective when it comes to sex and sexual orientation, especially when it seems teens, doctors, social workers, and parents are unclear about teenagers' legal rights regarding confidentiality among patient, doctor, and parent. Sex and sexual orientation are hot button issues, even in 2007. This continues to be problematic for those between the ages of 15-18, when teens are negotiating their identity and sexuality. Queer youth and advocates expressed repeatedly the importance of providing a safe space.

How does one create a safe space for queer youth when expensive campaigns have been waged on both sides of the debate over parental consent and teens' rights to privacy when it comes to sexual health and sexual orientation? How do LGBT youth learn how to be their own advocates?

California seems to consistently lean toward protecting teens' rights to autonomy and privacy when it comes to their health. In 2006, teen rights to privacy regarding sexual health education in California's Palmdale school district were honored by the state Supreme Court, which allowed the public school system the freedom to provide appropriate sex education and information without parents' consent.

Last year, voters defeated Proposition 85, the parental notification initiative to limit teens' rights to obtaining an abortion without their parents' knowledge.

But the debate is far from over when it comes to teenagers' rights to privacy as it concerns their healthcare.

From a teenager's perspective it's illogical – especially when they are able to get a driver's license and work – that they are not necessarily allowed to make their own health decisions. In particular, for queer youth, it can be a frightening situation that increases the health risks among a population that is already at a high risk for emotional and physical health-related issues.

"I'm not out to my doctor," said Jack Cen, 17, a Lowell High School student who was honored with a Youth Warrior Award by the city at a daylong youth seminar last weekend for his work at the Lavender Youth Recreation and Information Center. "I go to a Chinese doctor and I fear that he will talk to my family about my sexual orientation. Even when they mention the privacy laws, I don't feel completely comfortable disclosing anything because they just state the law without specifying what it entails. I would like it if doctors showed me that it really is an important aspect of their jobs."

There is a consensus between health experts, community service providers, and queer youth that doctors and other healthcare providers just don't have the training or the time to ask youth about their relationships

Student Jack Cen said that he is not out to his doctor. Photo: Rick Gerharter

and sexual orientation.

"I don't think that they are adequately trained specifically to deal with LGBTQ youth," said Kenny Gong, 19, chair of the health and social services committee of the San Francisco Youth Commission. "There are a lot of doctors that are very sensitive and very accepting and because of that [they] are able to gain the information that's available that they pass out to their LGBTQ patients."

UCLA's Schuster found that 58 percent of the time a youth's sexual orientation was brought up was when a doctor discussed sex or sexual health with a teenager.

"[Service providers] don't realize that someone's sexual orientation is a little bit more encompassing," said BAY Positives' Moore. "It comes with the fear of rejection, alienation, and everything else that comes with it that could contribute to other health concerns. You could be a celibate gay teenager that is more worried about the rejection that will probably be experienced and the stress that brings on."

San Francisco is unique in the fact that students have access to a wellness program that provides health centers at seven high school campuses and other youth-focused health centers. The health centers provide coordinated health, mental health, substance abuse, and other support services to 3,000 students every year. The centers opened during the 2002-2003 school year with annual funding of $1.4 million from San Francisco's general fund.

The wellness program works with the school district's Sexual Minority Youth Program and community organizations, and has been a highly successful collaboration, according to Deborah Bryan, a nurse practitioner at Galileo High School who oversees the program there. The program states on its Web site that it's increasing San Francisco students' health and well-being and reported a 5 percent drop in cases where teens acknowledge problems with depression and thoughts of suicide, both of which are risks facing queer youth, according to studies.

Bryan told the Bay Area Reporter that many queer youth are referred to the centers by their parents, who have discovered their children questioning their sexual orientation.

Youth-focused health programs are only one part of the solution to provide necessary health services to youth, queer or not. As Cen stated, if his doctor made him feel secure by informing him about his rights within their relationship and how much information could be provided to his parents, he might not use the youth health centers as often.

"A young person has to feel safe ... doctors need cultural sensitivity to provide a competent level of [care] ... to instill trust," said Esperanza Macias, executive director of Health Initiatives for Youth. Her organization provides training for doctors and service providers to help them identify queer youth issues and information about how to create an inviting atmosphere.

Healthcare professionals and teens expressed that signaling to them indirectly with informative pamphlets, posters, and other information targeted at queer youth lets them know that they are in a safe environment. This helps build trust and relationships so they can be honest about who they are and that their experiences will be heard and accepted.

It's rare that teens are secure enough to be able to express what is happening in their lives when it's very personal if they don't have support or know how to seek it out beyond their own peer group and family setting.

Ai Nakamura, 16, is a George Washington High School student who switches between identifying as a bisexual young woman and as a queer girl and is unusually comfortable with her sexuality for her age. Her mother proudly watched her as she was also honored with a Youth Warrior Award on January 20 for her work as a gay-straight alliance coordinator at the Richmond Village Beacon Community Center.

When asked by the B.A.R. if she was out to her doctor Nakamura didn't hesitate for a second.

"I'm out to my doctor," she said. "I never bothered hiding it. It's easier this way. You don't have to say, 'a friend of a friend said...'" She smiled holding her girlfriend's hand as she looked over at her mother.

In an ideal world more queer teens would be like Nakamura: confident, accepting, and comfortable with their sexuality enough to take initiative to be their own healthcare advocates. In Nakamura's case with her mother by her side it was an example of the goal for the well being for all queer teens. She had support from her family and her peers that allowed her to speak on her own behalf as well as advocate for others.

"They are not just regular youth," said Gong, who agrees that LGBT youth who need support aren't receiving it. At the same time he sees that the foundation empowering queer youth is growing proving that they are being seen which is promising.

"They are the future of the entire queer community."