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Santa Maria: Helping LGBTQ+ youth experiencing homelessness begins with building trust

Dean Diane Santa Maria

Rates of homelessness and suicide among sexual- and gender-minority youth greatly exceed those of their heterosexual and cisgender peers, said Diane Santa Maria, DrPH, MSN, RN, dean of Cizik School of Nursing at UTHealth Houston.

These youth face many obstacles accessing health care services, and providers must overcome a multitude of challenges to build the trust needed to keep lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) youth coming back for the care they need, she said.

Santa Maria holds The Jane and Robert Cizik Distinguished Chair and the Huffington Foundation Endowed Chair in Nursing Education Leadership at Cizik School of Nursing. She has received more than $3.8 million in National Institutes of Health funding for primary and supplementary research projects assessing the efficacy of a nurse case management HIV prevention and care intervention among youth experiencing homelessness and holds co-director positions with the Texas Development Center for AIDS Research (TX D-CFAR).

According to the 2022 National Survey on LGBTQ+ Youth Mental Health (the Trevor Project), 45% of LGBTQ+ youth seriously considered suicide in the past year. The percentage is even higher for transgender and nonbinary youth who may struggle even more for a sense of belonging, Santa Maria said.

She shared other statistics related to sexual health, practices, and increased risk for sexually transmitted infections and teen pregnancy among LGBTQ+ youth, but she cautioned against applying generalities to any specific patient or person.

“It can be difficult to remember than population-based trends are not an individual,” she said. “We always have to use person-first language. Just because a group is at higher risk doesn’t mean an individual is at higher risk.”

Establishing trust with LGBTQ+ youth who have been rejected by their families or aged out of foster care and juvenile justice systems can be an uphill battle, especially when a health care provider doesn’t understand their sexual or gender-affirming health issues or feels uncomfortable discussing such topics.

“It’s the first two or three minutes of their interaction with a provider that determines whether they seek health care in the future,” Santa Maria said.

Estimating the number of LGBTQ+ youth experiencing homelessness can be difficult because they typically don’t want to be found. “Youth often don’t want to interact with systems they may have had bad experiences with in the past, so they go to great lengths not to look homeless,” Santa Maria said.

However, the Houston Independent School District alone has identified about 30,000 students who identify as homeless or unstably housed. In contrast to some other cities, these youth in Houston tend not to be just passing through – most grew up here and now float between shelters, friends’ couches, and the streets.

To address the myriad issues contributing to homelessness among LGBTQ+ youth, Santa Maria calls for elimination of barriers within health care systems, more awareness and inclusivity in the care of transgender patients, and integration of nonheteronormative perspectives in sex education, among other steps.

One of the most important ways anyone can help is to encourage friends or family members to maintain connections with their children who may be LGBTQ+, Santa Maria said. Shelters and drop-in centers work with youth every day who have faced rejection from their families.

“It’s just a tragedy,” she said. “I think we really need to find ways to help families understand their role and give them the coping strategies to figure out how to continue that parenting role – to protect and support LGBTQ+ children.”

Sherri Green, Cizik School of Nursing

In this story

Diane M Santa Maria, DrPH, MSN, RN, ACRN, PHNA-BC, FSAHM, FAAN

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