Access to Safety: Health Outcomes, Substance Use and Abuse, and Service Provision for LGBTQ Youth, YMSM, and YWSW Who Engage in Survival Sex

RESEARCH REPORT Access to Safety Health Outcomes, Substance Use and Abuse, and Service Provision for LGBTQ Youth, YMSM, and YWSW Who Engage in Survival Sex Meredith Dank Lilly Yu Jennifer Yahner February 2016 ADOLESCENTS AND YOUTH ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Copyright © January 2016. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image from Will Anderson. Contents Acknowledgments Highlights 1 Terminology and Definitional Considerations 2 Literature Review 5 Mental Health 5 Physical, Sexual, and Reproductive Health 6 Substance Use 7 LGBTQ Service Usage 7 Current Study Goals and Methodology 9 LGBTQ Youth Health Issues, Substance Use, and Treatment Service Experiences 10 Youth Demographics 10 Sexual, Physical, and Mental Health Problems 11 Medical Treatment Service Experiences 21 Substance Use Behaviors 25 Service Provider Experiences 30 Service Provider Perspectives 37 Who Are the Service Providers That Serve LGBTQ Youth Trading Sex for Survival? 37 Who Are Service Providers’ Clients? 40 What Are Clients’ Health Outcomes? 42 What Challenges Do Service Providers Face in Serving LGBTQ Youth Engaged in Survival Sex? 44 Discussion and Summary 47 Policy and Practice Recommendations 51 Increase the Number of Medical Vans That Meet Youth Where They Are, and Establish More Youth-Focused Medical Care at Clinics and Emergency Rooms 51 Raise Awareness of Preexposure Prophylaxis Medication and Make It More Widely Available and Accessible to Youth to Help Reduce the HIV Infection Rate 52 Establish and Fund More Holistic and LGBTQ-Sensitive Mental Health Counseling and Care for Youth and Staff 53 Expand Training to Mental Health Care Professionals and Other Youth Provider Staff on Signs of PTSD and Complex Trauma and Increase Resources Available to Treat LGBTQ Youth, YMSM, and YWSW Suffering from PTSD 54 Increase Language Capacity and Provide Cultural Competency Training to Staff Who Work with Foreign-Born, Non-English-Speaking LGBTQ Youth 55 Establish a Centralized, Formal Youth Services Referral Database 55 Listen to the Voices of Youth Regarding Their Recommendations for Services and Access to Programs and Safety 56 Concluding Thoughts 59 References 60 About the Authors 62 Statement of Independence 63 HIGHLIGHTS Acknowledgments This report was funded by the Urban Institute. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. The data collection for this report was supported by Grant #2011-JF-FX-0001 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, US Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect those of the Department of Justice. The authors thank the brave and resilient youth who participated in this study, as well as Andrea Ritchie and the staff of Streetwise and Safe, who helped us identify appropriate youth and conduct interviews for this study, especially Bhavana Nancherla, Kimi Lundie, and Jonathan Gonzalez. We also thank Isela Bañuelos and Kuniko Madden and the Urban Institute full-time and temporary staff who assisted throughout various stages of data collection, transcription, and coding: Pam Lachman, Dwight Pope, Doug Gilchrist-Scott, Andrea Matthews, Emily Tiry, and Rachel Goldberg. In addition, we are grateful to those who provided careful reviews of project findings: Mitchyll Mora and Brendan Conner of Streetwise and Safe. HIGHLIGHTS 1 Highlights In 2011, researchers from the Urban Institute launched a three-year study of lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth; young men who have sex with men (YMSM); and young women who have sex with women (YWSW) engaged in survival sex in New York City. Working in partnership with the New York City–based organization Streetwise and Safe, researchers trained youth leaders to conduct in-depth interviews with 283 youth who engaged in survival sex in New York City and self-identified as LGBTQ, YMSM, or YWSW. In February 2015 we released the first report, which focuses on the experiences and needs of youth engaging in survival sex; in September 2015 we released the second report, which describes youths’ interactions with the criminal justice and child welfare systems. In this third report of the series, we focus on youths’ sexual, physical, and mental health problems; substance us