Editor’s Note: In the July and August 2019 print issues, we published a series about the LGBTQ college experience and its impacts on health. Here, we’ve published both parts together.

by Isaac Stephens

Alicia anchored her eyes to the school nurse’s hands as they laboriously rolled a condom over the tip of a banana. She wouldn’t let her attention waver. If she wanted to have sex, Alicia thought, she needed to know how to do this. Now 23, and a graduating fifth-year at Northeastern University, she laughs at her younger, more close-minded self. “Joke’s on you, 14-year-old Alicia. You’re a lesbian.”

Alicia, who asked that her last name be omitted for professional reasons, has known in some way or another that she is attracted to women for about two years now. But realizing that was difficult. At her small private high school in Oxford, Connecticut, only one student in her class of 50 was openly gay, and most, she says, bordered on homophobic. Alicia says for a long time, this included herself.

When she finally came into her own and started dating women, the attitudes and stigmas she had internalized as a teenager stuck around, and she was left stranded, neck-deep in a river of self-doubt and anxiety. 

For Alicia, these feelings were rooted in ideology. For many, the problem is broader than that. Members of the LGBTQ community in general are considerably more likely than others to live with mental health issues like anxiety and depression. Lesbian and bisexual women in particular are close to four times more likely than heterosexual women to live with generalized anxiety disorders. Men who have sex with men deal with major depression and panic disorders at respective rates four and five times greater than strictly heterosexual men. In large part, studies suggest, this is a direct result of cultural and systemic stigmatization.

Alicia says for her, this was epitomized by her high school’s far-from-comprehensive sex education program. “It was about how men and women have sex,” she said. “It was never about how gay people have sex.” The curriculum perpetuated the attitude of heteronormativity — the idea that gay people are apart from the norm — magnifying the community’s already-intolerant atmosphere. Because the school had established the LGBTQ community as alien, Alicia suggests, people felt they had license to build walls.

Alicia remembers, for example, joking with her friends about a teacher with a pride flag on her desk. She remembers scoffing as her parents, two black Democrats in a town largely made up of rich, white Republicans, cried “happy tears” watching Obama win reelection. And she remembers staunchly opposing the legalization of gay marriage, along with most of her friends.

Timothy Wang, a senior policy analyst at the Fenway Institute, a national research center that focuses on LGBTQ health, says the heterosexual-exclusive sex education classes at Alicia’s high school likely contributed to its intolerant environment.

“In schools that have more inclusive [curricula], LGBTQ youth feel more accepted or safer in schools,” he says. “It’s moralizing. It de-stigmatizes the entire issue, and just presents it as a normal part of human existence.”

A variety of studies support Wang’s assertions. According to a 2017 study by GLSEN, an LGBTQ education organization, queer-inclusive curricula are associated with safer school environments, a stronger sense of belonging, and lower levels of victimization. Sex education researchers also found that classes that portray the LGBTQ community positively or neutrally are correlated with a reduction in prejudicial attitudes.

Alicia found herself on the other side of stigmatization as well. After enrolling at Northeastern and interacting with gay people in her daily life, she started to become more open-minded. She realized she liked women in her third year at Northeastern and shortly afterward started her foray into the WLW (“women who love women”) dating world. But Alicia had never been taught how to have sex with a woman. So, no matter how much she wanted to, she couldn’t — mostly out of anxiety.

“When I would have sex with girls, I would clam up. I just could not do it,” Alicia says. “I became emotionally unavailable, where I was just too afraid to connect, too afraid to get too deep into it, because if I messed up, or I wasn’t good enough — or wasn’t gay enough — I didn’t want to get hurt.” When one of her first female partners brought her fears to life, saying Alicia “wasn’t ready” to be with a woman, it magnified her insecurities. 

Alicia is black, and since freshman year of high school, she’s stood over six feet tall. She sometimes has doubts about her sexuality, she says, because she doesn’t fit the WLW stereotype. “If I don’t say I’m a lesbian, people often don’t know,” she says. “I had a lot of trouble in the beginning with feeling gay enough to date another woman.”

Past her own physicality, Alicia’s doubts were amplified by fears that she was still actually attracted to men. For the year or so after finding out that she liked women, she thought she was bisexual. “When I walked into a bar, I picked out the guy who I thought others would find the most attractive and go for him,” she said. “I just wanted them to want me.” She now realizes that she was never attracted to men in the way that she is attracted to women. When she went for guys, she says, she was just looking for male validation — doing what she had been taught her whole life to do.

Alicia’s self-doubt, coupled with her sexual anxiety, was too much for her to deal with on her own. “I really was very messed up for a very long time,” she says. It took months of therapy — and meeting a more understanding partner — for Alicia to be confident in herself again. But even now, she says, the little voice telling her she “isn’t gay enough” hasn’t completely gone away.

Sexual health

Beyond the problems associated with not knowing how to have sex, LGBTQ individuals often have issues making sex safe. Part of this can be explained away by anatomy — STDs are more likely to be contracted during anal sex than PIV sex — but that issue could largely be solved through destigmatization. The obvious starting point is sex education.

A large body of research suggests that comprehensive sex education — that’s condom-on-banana education — does a better job than abstinence programs, both at delaying when students start having sex and at getting them to use protection.

But for many people in the LGBTQ community — even for those who could theoretically wear condoms — what the federal government might consider even “comprehensive” sex education is inadequate. The vast majority of the United States’ sex ed programs don’t even acknowledge gay, lesbian, bisexual, and transgender individuals, so people from those populations are left with a distorted view of their own health needs.

Colin Thompson, a fifth-year environmental science student at Northeastern, already knew he was gay when he took sex-ed in sophomore year of high school, so he knew for sure he wasn’t going to have the kind of sex his gym teacher was discussing. His district’s curriculum was typical of Texas and left out any reference to the LGBTQ community. HIV, for example, was not talked about in Texas because it was seen as a “gay disease,” Thompson says.

From his perspective, the school was sending a message that discussions about queer sexual health were not a part of civilized conversation. This had potentially disastrous impacts on Thompson’s perceptions. “I’ve always considered it as a negative thing,” he says. “So, when it came to sexual liberation and entering college, I could never really start that conversation without feeling some sort of resentment towards myself.”

Thompson says this attitude led him into a host of bad decisions. “A lot of the times when I was [in my] younger years, I would be hooking up with people, and they wouldn’t want to use protection — I’d be like, ‘okay, I guess that’s fine.’ I was getting myself into a sticky situation.” When he finally went to get tested in his third year, Thompson says, he was lucky to be free of STDs.

For two years now, Thompson has been using adequate protection, including an HIV-prevention pill called pre-exposure prophylaxis, or PrEP for short. But many people in the LGBTQ community still aren’t. In its 2014 report, the CDC found that almost two thirds of surveyed homosexually active men had had condomless anal sex that year. The same study also found that 96.5 percent of HIV-negative men who have sex with men did not use PrEP to protect against the virus.

After years of risky behavior, Thompson was fortunate enough to find that he was disease-free. Many people aren’t so lucky. Gay and bisexual men accounted for 56 percent of HIV infections in 2015, contributing to similarly high proportions for other sexually transmitted diseases as well. This phenomenon isn’t exclusive to queer men — bisexual women and heterosexual-identifying WSW show higher rates of STIs than women who exclusively have sex with men. Both of these disparities have been linked to risky behaviors.

Max Fournier, the president of Northeastern University Pride, says that these behaviors are probably rooted in a lack of understanding. “From my general experience of just hearing people in the queer community talk about their general knowledge of…practicing safe sex, or how sex works, they didn’t get anything valuable through high school education,” he says. “The biggest misconception is that you don’t need to wear a condom or have your partner wearing a condom if you can’t get pregnant from sex.”

The reasons for the lapse in knowledge is obvious: Less than 5 percent of students have access to LGBTQ-inclusive sex education classes, and stigmatization keeps students from talking about sexual health with their peers. Because most states don’t seem apt to change their curricula anytime soon — Massachusetts being an exception — the path of least resistance for sexual health, as with mental health, seems to be destigmatization.

The role of friends

For Alicia, the transition from straight, to bisexual, to lesbian; from Mitt Romney to Lori Lightfoot; from Vineyard Vines to baby-blue blazer came slowly. Most of those eureka moments, she says, only came with guidance from friends.

When Alicia arrived at Northeastern, she was a staunch conservative, and a very straight one at that (or so she thought). “I was really against gay marriage, and I thought that everyone on welfare was lazy and all immigrants [were] illegal,” she says. But her attitudes were largely a product of her environment. As she talked to more and more people — people that didn’t fit the mold of her Connecticut hometown — her views began to change. “When I came to college, that bubble burst, and I met people who were first generation [college students]. I met people who are gay. I met people who just weren’t who I grew up with.”

After being exposed to the world, she says, she was hit with an identity crisis. “I realized that everything I’d been believing the last 10-ish years my life […] was just completely, completely wrong.”

This was only the first crisis of many. In Alicia’s third year of college, she got the first inkling of a realization that she might be attracted to women. “There [was] a girl in class who was absolutely gorgeous, and she was so friendly and so sweet. She would bring me chocolate flowers to class now and then…She would always have a hair band for me, or she’d bring me a part of her salad.”

Alicia didn’t think anything of it, though, until she talked to her lesbian best friend, who told her it sounded like she had a crush. At first, she was in denial, and brushed it off as just thinking the chocolate flower girl was “really cool.” The first day of spring came a week later, though, and brought with it hosts of sundress-clad women. Sitting in the dining hall that day, Alicia says, she burst into tears: Her attraction to women could no longer be ignored. With flashbacks to years of overlooked crushes circling in her head — Kristen Stewart, Kim Possible — she called her best friend, still crying. “I think I’m gay.”

From there, Alicia’s journey to self-acceptance was largely facilitated by her queer peers. “If I didn’t have gay friends in college […] I think it would have been a much longer time before I realized,” she says. “When I [was] walking with a bunch of my friends who were into girls, and they were like ‘oh, that girl’s really pretty,’ I’d be like, ‘wow, what if I thought she was hot.’ And then I’m like, ‘wow, I kind of do think she’s hot.’”

Dialogue between peers certainly seems like a promising way to reduce the influence of internalized homophobia. For many people in the LGBTQ community, though — particularly those growing up in conservative areas — having queer or accepting friends isn’t a realistic option. Representation might be the next best thing, especially in areas without inclusive sex education. Without help coming from school, Wang says, many LGBTQ teens turn to media as a source for sexual knowledge.

Research has long suggested that there is a link between ethnic minority groups’ self-esteem and their representation in media. A paper by Dana Mastro in the Oxford Research Encyclopedia cites decades of studies connecting stereotypical depictions and low rates of representation with low self-esteem. This has tangible effects: As early as 2002, research demonstrated positive correlations between representation and children’s grades in school.

LGBTQ representation specifically is important because it helps questioning members of the community. A 2013 survey published in the journal Media Psychology found that for adolescents who were less sure of their sexuality, exposure to gay- and lesbian-oriented media positively impacted self-image and decreased feelings of dejection.

A 2018 report by GLAAD, an LGBTQ advocacy group, found that 6.4 percent of characters on broadcast networks’ primetime scripted shows were portrayed as queer — more, proportionally speaking, than the 4.5 percent of Americans who identify as such. But this potentially promising picture falls away upon closer inspection. Representation of the LGBTQ community on broadcast and cable networks skews disproportionately towards gay and lesbian characters, leaving 45 percent of queer viewers — mainly bisexual and transgender people — behind. Further, according to a 2015 report by researchers at USC, queer characters are often consolidated to only a few LGBTQ-oriented shows. This means that for the majority of viewers, functional representation is a lot less.

Stereotypical depictions only add to this problem, according to GLAAD. Bisexuals, for example, are often portrayed as immoral and manipulative, and bisexuality is often used as a plot device rather than an identity.

When children have role models that match their demographic identity, they think more — and think better — about their futures, according to a 2002 study published in the Teachers College Record. So, for people like Alicia — people who don’t fit neatly into the box of a stereotype — the problems caused by lacking representation only get worse. USC’s 2015 report found that almost 80 percent of LGBTQ characters in mainstream media shows were white. More than 70 percent were male.

To combat this, Alicia says, she makes a point to broadcast her gayness when working as a director of a mentorship organization’s Northeastern chapter. She says that as a gay, black, female student leader, it’s her job to make self-acceptance easier for everyone else — easier than it was for her.

“Somebody in that room is going to think of me when they think about their own identity,” Alicia says. “They’ll see that I [am] comfortable with it, and therefore they should be too.”

Isaac Stephens is a journalism student at Northeastern University.