Sunday, January 3, 2010

Untreated gender identity disorder

Putting Adolescents at Risk

By Dale O’Leary


Males who self-identify as “gay” before age 18 are highly likely to have been victims of sexual abuse and/or to suffer from untreated Gender Identity Disorder (GID). This puts them at high risk for a number of negative outcomes. When these problems are untreated, the boys often act out in ways that draw negative attention to themselves. The strict restriction of bullying and other mistreatment by fellow students is, of course, important, but it is equally important to address the underlying problems. Even if an adolescent boy does not suffer from sexual abuse or GID, sexual activity combined with the predictable adolescent irresponsibility carries a high risk.


A study by Lemp and associates of sexual risk behaviors of young (ages 17-22) men who have sex with men found that 22% reported beginning anal sex with men when they were ages 3 to 14, of these 15.2% were already HIV-positive. Of those who began sex when they were 15-19, 11.6% were HIV positive. While of those who began sex with men when they were 20-22 only 3.8% were HIV positive. It is clear that every year a male with SSA delays sexual involvement reduces his risk of HIV.


The hope that identifying boys with SSA and providing them with HIV prevention education will reduce the risk of infection is not supported by the research. According to a review of studies of HIV prevention programs, “the efficacy of health education interventions in reducing sexual risk for HIV infection has not been consistently demonstrated…More education, over long periods of time, cannot be assumed to be effective in inducing behavior changes among chronically high risk men.” (Stall, 1988) Although AIDS among MSM (men having sex with men) is no longer making headlines, the epidemic has not subsided. Of particular concern is the wide spread use of Crystal Meth in combination with unprotected sex (barebacking). (Halkitis 2005; Wainberg, 2006)


The Lemp study also found that of the 425 homosexuals males, ages 17 to 22, they surveyed, 41.4% reported an oc­casion of forced sex. (Lemp 1994) These young men would probably qualify as vic­tims of sexual abuse. Another study of 196 homosexually active men found that 29% reported that they had been pressured at least once into having sex. Of those pres­sured, 97% said that one or more of these experiences involved unprotected anal inter­course, an HIV risk. (Kalichman 1995)


            The study by Osmond also found evi­dence of sexual child abuse: "some of these subjects reported that they had first engaged in regular sex with a male when they were as few as 4 years old."(Osmond 1994) The Remafedi study of the sexual behavior of 239 homosexually ac­tive boys 13 to 21 found that 42% had a history of sexual abuse/assault. (Remafedi  1994)


            Sexual child abuse and sexual assault have been linked to lifelong psychological prob­lems, includ­ing depression, sexual addiction, drug addiction, involvement in prostitution, and suicidal feelings. Those promoting in-school support groups for students who think they may be homosexual frequently point to the multitude of problems among adolescents with SSA. Sexual child abuse and sexual assault must be considered as possi­ble causes.  


            AIDS education, which provides chil­dren and adolescents with explicit infor­mation about various forms of sexual behavior that spread the disease, may create curiosity and en­courage experimentation among young men. AIDS education has also been used as a vehicle for promoting positive attitudes toward homo­sexuality and it is possible that the number of young men experimenting with homosexuality will increase.  As support groups in schools for boys who think that they might be homosexual are being set up, these boys will be encouraged to "come out."  This "coming out" will probably include engag­ing in sexual activity at an ear­lier age and more often. These young men may also become part of the urban homosexual commu­nity, traveling to centers of homosexual ac­tivity where they are likely to encounter HIV-positive adults interested in engaging in sexual activity with attractive teenagers.


            The following is the conclusion of a study of the association of health risk behaviors and sexual orientation: “GLB youth who self-identify during high school report disproportionate risk for a variety of health risk and problem behaviors, including suicide, victimization, sexual risk behaviors, and multiple substance abuse use. In addition, these youth are more likely to report engaging in multiple risk behaviors and initiating risk behaviors at an earlier age than their peers.” (Garofalo 1998)


Since a certain percentage of males who experience SSA in adolescence find that these feelings disappear in time, schools should not encourage adolescent boys to “come out,” but offer positive support to deal with underlying problems.



Robert Garofalo, et al. (1998) “The association between health risk behaviors and sexual orientation among a school-based sample of adolescents,”  Pediatrics, 101 (5) p. 895-898.

Halkitis, P., Wilton, L., Drescher, J. eds. (2005)  Barebacking: Psychosocial and Public Health ApproachesHaworth Medical Press: NY


Kalichman, S., Rompa, D. (1995) Sexually Coerced and Noncoerced Gay and Bisexual Men: Factors Relevant to Risk for Human Immunodeficiency Virus (HIV) Infection. Journal of Sex Research. 32, 1: 45 - 50.

Lemp, G., Hirozawa, A., Givertz, D., Nieri, G., Anderson, L., Linegren, M., Janssen, R., Katx, M. (1994) Seroprevalence of HIV and Risk Behaviors Among Young Homosexual and Bisexual Men.  Journal of the American Medical Association. 272, 6: 449:454.


Osmond, D., Page, K., Wiley, J., Garrett, K., Sheppard, H., Moss, A., Schrager, K., Winkelstein, W. (1994) HIV Infection in Homosexual and Bisexual Men 18 to 29 years of age: The San Francisco Young Men's Health Study. American Journal of Public Health. 84, 12: 1933 - 1937.


Remafedi, G. (1994) Predictors of unprotected intercourse among gay and bisexual youth: knowledge, beliefs, and behavior. Pediatrics. 94 : 163 – 168.


Stall, R, Coates, T, Hoff, C (1988) “Behavior Risk Reduction for HIV Infection among gay and bisexual men”, American Psychologist, 43, 11: 883.


Wainberg, Milton et al. (2006) Crystal Meth and Men who Have Sex with Men: What mental health care professionals need to know,  Haworth Medical Press, NY.


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