Gay, lesbian, and bisexual adolescents: providing esteem-enhancing care to a battered population.

Suicide, HIV infection, violent victimization, homelessness, and substance use are known to affect gay (gay males, lesbians, and bisexual persons of both genders) youths at disproportionately high rates. This article explores the difficulties gay youths experience in this society specific to their sexual orientation. These difficulties become internalized by many gay youths, leading to high rates of preventable morbidities and mortalities. Stages of the "coming out" process for gay persons are reviewed within the framework of child and adolescent development. Barriers within the health care system, as well as within other social systems, specific to gay youths are examined. Such barriers include language use by the provider, sexual and social history questions asked by the provider, environmental images in the health care setting, and the responses of the provider to the adolescent. Strategies such as the use of gender-neutral wording, homosexual inclusive questioning in history taking, and the use of inclusive environmental clues to allow gay adolescents to feel safe and accepted are discussed. Health care providers are encouraged to employ such strategies to help reduce these barriers within various health care settings.