Gay, Lesbian, Bisexual, and Transgender Youth Suicide Problems in Australia and New Zealand?
To Index: Aboriginal / American Indian / First Nations Two-Spirit GLBTQ Information Pages  - A Suicide Focus
Results from more than 30 gay / bisexual male youth suicidality Studies
T-S, T-s: Two Spirit / Two Spirited
GLBTQ: Gay, Lesbian, Bisexual, Transgender, Queer

For Explorer Browser: Best Viewed With "Smaller" Font Setting! Go to "Page" & "Text Size"
Subject Index: GLBT Information in 21 Categories.

American Indian / First Nations
Two-Spirited Youth Suicidality

Talking About Suicide & LGBT Populations (2011): Suggestions & Recommendations.

Related CASP 2006 Conference Presentation.

Section Index

Aboriginal GBTT-s Males Are More At Risk For Suicidality Than Other Aboriginal Males & White GBT Males.

American Indian Male (Female) Suicidality: A Higher Risk For Having Attempted Suicide.

American Indian / First Nations Male/Female Youth Suicide Rates: A Higher Risk for Suicide.

Information Excerpts on Terms Such as "Two Spirit" - "Two Spirited" - "Berdache" - "Winkte" - "Nadleeh" - etc.

North American Aboriginal / American Indian / First Nations GLBT-s Internet Resources.

Aboriginal & Sexual Minority Over-Representation In Street Youth Population.  Higher Suicidality Risk For Street Youth. Highest Suicidality for Sexual Minority Street Youth.

Vancouver's MSM Vanguard Cohort, Montreal's MSM Omega Cohort & Vancouver's VIDUS Cohort (Injection Drug Users): Aboriginal & Sexual Orientation Related Results... Suicidality, Sexual Abuse, Sex Trade...

Feds support new national LGBT youth suicide prevention task force (USA, 2010)
Related: 1, 2, 3. Notes of Caution / Warnings: 1, 2 (Paragraphs 7-9), 3, 4.
Will it be white racist GLBT suicide prevention? - To be Ignored: Two Spirit Youth? GLBT Street Youth?
Will these GB adolescent males also be ignored as it was done by HIV/AIDS Prevention Researchers?

What If It Doesn’t Get Better? Queer and Aboriginal Youth Suicide (2010).
To Effectively Address a Serious Problem, Good to Know How It Developed. Related Paper.
A Department of Silence: Bullying of LGBT youth not a priority (2010)

"American Indian and Alaska Native Suicide Prevention" Website

"Honouring Life Network," Canada: Aboriginal Youth Suicide

"Action Alliance for Suicide Prevention," USA

Aboriginal GBTT-s Males More At Risk For Suicidality Than Other Aboriginal Males

Aboriginal GBTT-s Males More At Risk For Suicidality Than White GBT Males

Introduction / Summary

Homosexuality is a risk factor in North American male youth suicidality: attempting suicide (Tremblay & Ramsay, 2000; Bagley & Tremblay, 2000; McDaniels et al., 2001), but it is not yet known - for sure - if Aboriginal GBTT-s (Gay, Bisexual, Transgender, Two-Spirited) individuals would be overrepresented in suicidal behaviors or suicide statistics. This lack of knowledge falls within the context of white GLBT suicidality having been very controversial in spite of the cumulating evidence supporting their "at risk" status (Remafedi, 1999), with an ongoing resistance by mainstream professionals to incorporate this factor in their research  and practice (McAndrew & Warne (2004). There has also been a neglect of related mental health issues in fields like psychology (Rothblum, 1994), community psychology (D'Augelli, 2003, Harper & Schneider, 2003), social work (Miller, 1998; Van Voorhis & Wagner 2001, 2002) and family therapy (Clark & Seovich, 1997), but some recent improvement have been occurring as described by Phillips et al. (2003) and Morrow (2003).  The latter noted that serious problems nonetheless still exist: “Lesbian, gay, and bisexual (LGB) concerns continue to be underrepresented in the counseling literature, although progress was made in the 1990s in the content and quantity of literature dealing with these issues. Despite progress in several areas, the scholarship on specific marginalized groups within the LGB community is particularly sparse: LGB people of color, bisexual women and men, lesbian women, LGB people with disabilities, and transgendered individuals.” Phillips et al. (2003) also noted the lack of  “attention to within-group differences (e.g., bisexual people and LGB people of color).”

People of color include Aboriginal people who generally have been at higher risk for multiple problems, including suicidality. In the United States, for example, Aboriginal youth are about 2 to 2.5 times more like to commit suicide than their White counterparts and in Canada the risk factor is about 5-times (Web Page). Their risk for attempting suicide nationally, compared to their White counterparts, ranges from 1.4 to 5.6 times (Web Page). However, a research neglect has existed with respect to Aboriginal suicidality in general (Olson, 2006) and, even if American Indian youth suicide is gaining some attention (Kozlowicz, 2006), papers, articles and alerts on Aboriginal youth suicide issues have generally ignored homosexuality and homophobia as possibly being implicated in the problem (e. g. Advisory Group on Suicide Prevention (2003); SIEC Alert 52, 2003;
Cutcliffe, 2005; Mignone, 2005; Kozlowicz, 2006; Strickland, 2006), a fact noted by Brotman et al. (2002) with respect to most Two Spirited health issues. The silence on the likelihood of a Two-Spirited suicidality problem is also the result of the fact that "sexual orientation" information is not sought and reported by coroners investigating deaths by suicide. Even if such reporting did exist, however, it might be difficult, if not impossible to know that some suicides were in the homosexual/bisexual category. For example, some males - who later acknowledged themselves to be gay - have reported that their attempt to end their lives was timed to occur when a break-up with a girlfriend had happened. This timing was chosen because it was believed that no one would then suspect that it was their homosexuality that was most implicated in their wish to die (Dorais, 2000). When such young males commit suicide, given the planned deception, it would be almost impossible to suspect or discover that homosexuality the major factor in the decision to commit suicide. 

Although the information noted above was not been produced from studies of North American Aboriginal males who attempted suicide in their youth (nor has such information been produced from white English speaking Canadian or American male youth mostly because such research is not done), it is known from the literature on HIV/AIDS that many urban homosexually oriented Aboriginal males have had difficult lives likely characterized by high levels of suicidality. For example, many of those with AIDS have avoided returning to their reservations (or off-reservation homes) because they did not want their family or community to know about their homosexual orientation, or because they had left their reservations (or off-reservation homes) where intense homo-negativity had been manifested, in some cases when their GBTT-s status had become known. These males would therefore be experiencing the most alienation as the result of their homosexuality, compared to other GBTT-s Native males (the few?) who have experienced tolerance - or even acceptance - in their homes and communities (Note 1).  Some related issues have been noted in a paper on HIV/AIDS and Aboriginal Peoples (Situational Analysis, 2001):

"Available data indicates that prior to 1989, over 80% of Aboriginal AIDS cases were two-spirited men..., and was still well over 60% in the 1989-1993 time period... The majority of the Aboriginal persons living with HIV/AIDS (APHAs) early in the epidemic were found in the urban centres of Vancouver, Toronto and Montreal. Typically, they had lived away from their communities for years and felt that they could not return home due to AIDSphobia and fears of rejection... Homophobia has been recognized as an issue in some Aboriginal communities, and the resulting moral judgements and negative attitudes can make implementing awareness and education strategies challenging."
Ryan (2003), Monette et al. (2001),  The Aboriginal Nurse (2002) and others have reported that a very high level of homophobia has existed in many Canadian Aboriginal communities and The Canadian Aboriginal AIDS Network: CAAN (2000) and Zoccole et al. (2005) have recommended that this issue be addressed. Vernon & Jumper-Thurman (2002) have done the same with respect to American Indians where a similar homophobic situation has existed (Gilley, 2005): "Many gay American Indian (GAI) men feel alienated from their tribal, ceremonial and social communities because of homophobia and heterosexism." Such anti-homophobia  recommendations, however, have also been made for all of North America, and in other countries in association with HIV/AIDS issues given that homophobia is very common globally. The Canadian situation for Two Spirited individuals was summarized by Garmaise (2004):
"Two-Spirit Aboriginal people struggle with the legacy of genocide and colonization – residential schools and their intergenerational effects, violence, addictions, poverty, and loss of language and culture. Two-Spirit people also face homophobia and transphobia from the dominant non-Aboriginal culture and from their own communities. Many Two-Spirit people are displaced from their home communities and culture; others are forced to lead secretive lives. All these factors contribute to low self-worth, mental and emotional health issues, addictions as coping mechanisms, and high-risk activities. The gatherings provide a safe space for people to recover or affirm their cultural and social identity as Two-Spirit Aboriginal people... International Two-Spirit Gatherings began in 1988 with a gathering of Canadian Aboriginal and Native American gays and lesbians in Minneapolis, Minnesota.."
Walters et al. (2001) describes the American American (AI) situation:
AI GLBTT-S must contend with pervasive racism within non-AI lesbian and gay male communities (Walters, 1997) as well as homophobia within AI communities (Deschamps’, 1998; Meyers, Calzavara, Cockerill, Marshall, & Bullock, 1993; Sullivan, 1991)... Four of the seven focus groups specifically discussed how invisibility (both as an AI in the GLBT community and a GLBTT-S in the AI community) is a general problem as well as a barrier to accessing services.Many groups contextualized the invisibility problem as stemming from the colonization process and the entrenched stereotypes that exist within the non-AI imagination. For example, one group member stated, "So many myths and stereotypes persist . . . most  [non-AI city people] think we live in the West or on a reservation." Invisibility within AI communities makes it difficult for AI GLBTT-S to identify each other for social support. Many participants commented on an "automatic heterosexual assumption--where [AI] community members just don’t consider being gay or lesbian as a possibility or a Native reality."... Dealing with the racism in the non-AI GLBT community and in society in general as well as the homophobia within the AI community were identified as critical issues. As one GLBTT-S participant pointed out, "There’s still gay stigma where you are seen as abnormal."" [See Waters et al. (2004) for the description of a 2002-2007 NIMH funded Two-Spirited study in progress.]
The possibility that North American aboriginal GLBTT-s individuals - especially males - have elevated suicide rates has been mentioned, suggested or hypothesized by Wilson (2000), Anonymous (2003), Jenkins (2005), and likely others, and it has more formally been noted by White & Jodoin (2003). However, in the latter case, the study references used to suggest that "Aboriginal gay youth" are at risk are not studies of Aboriginal gay youth. They are studies of predominantly white gay and bisexual youth (often including heterosexual youth) that mentioned nothing about Aboriginal youth. In many ways, this type of referencing can certainly be a blessing to all who may not wish to address the possible  "at risk" status of "Aboriginal gay youth," especially for reasons related to homophobia and homohatred. That is, if references are checked, supporting evidence for what is stated - the "at risk" status of "Aboriginal gay youth" - will not be located. However, two American studies could have been cited to support the proposition/assertion: the Borowsky et al.(1999) and Paul et al. (2002) / Mills et al. (2004) studies. In the Borowsky et al. (1999) study of American Indian adolescents, males reporting having only same-sex sexual fantasies were about two times more at risk for having attempted suicide (25.0%) than their heterosexual (11.7%) or bisexual (10.9%) male counterparts. A later study carried out by Barney (2003) compared the "at risk" American Aboriginal adolescent gay males reported on in the Borowsky et al. (1999) study to their heterosexual counterparts on a number of items (Note 2). He reported:
"Thirteen percent of gay adolescents had been sexually abused, as compared to 2.4% for heterosexual adolescents. Seventeen percent of gay adolescents had been physically abused as compared to 7.5% for heterosexual adolescents.... Gay adolescents were significantly more likely to have both thought of suicide (47.3% vs. 23.6%) and/or actually attempted suicide (23.2% vs. 11.1%). Gay adolescents were less satisfied with life (67.8% vs. 85.2%) and had a greater history of being depressed (35.1% vs. 14.0%) or sad (21.1% vs. 11.4%)." Note: The "attempted suicide" percentage discrepancy with the Borowsky et al. (1999) study (23.2% vs. 25.0%) is likely related to the scrubbing of the data carried out by Barney (2003).
The Paul et al. (2002) / Mills et al. (2004) studies are based on a stratified random sample of 2,881 MSM (Men Who Have Sex With Men: age range = 18–86 years, median age= 37 years, and living in 5 large American cities) who predominantly identified as homosexual or gay (84%). There were 76 Native American males in the sample (3%) and they were more at risk for having attempted suicide in their lifetime (30%) and before the age of 25 years (25%) that white males: 11%, 8%, respectively (Table 1). They were also more at risk for currently being distressed (20%) and depressed (26%) than white male: 13%, 16%, respectively (Table 2). For the whole sample of MSM, the  lifetime attempted suicide incidence was 12%, Paul et al. (2002) noting that, given the 1.5% to 3% incidence for the American male population, this would mean that homosexually oriented males (MSM) are about 3 times more at risk for attempting suicide, this being a conservative estimate given that the numbers would indicate a 5-fold risk. For Native American adult males, however, their greater risk for having attempted suicide (Lifetime Incidence = 30%), compared to white males, would be about 13-times, at least for those living in the larger cities. For a sample of 108 Two Spirited males, Walters (2006) reports a lifetime attempted suicide incidence of about 30%.

Interestingly, in what may be the only provincial document in Canada - produced in British Columbia - that is related to suicide and abuse prevention for homosexually oriented youth, "Suicide and Abuse Prevention Among Gay, Lesbian, Bisexual, Transgender & Two-Spirited (GLBT) Youth: Proposed Framework for GLBT Youth Suicide and Abuse Prevention" (BCIRPU, 2005), not one of the above noted papers suggesting that Two Spirited male youth have been at elevated risk for suicidality is cited. It is almost like the authors added "Two Spirited" as an afterthought (to maybe be politically correct?), but then 'forgot' that something specific to these youth should have been mentioned in the document. In a related presentation at the 2006 CPHA Conference (Kinney, 2006), however, the word "Two Spirited" was not included in the presentation abstract, likely meaning that sexual minority youth suicide and abuse prevention efforts may only be directed at non-Aboriginal GLBT individuals and that Two Spirited issues will be neglected, as usual, as it was noted by Brotman et al. (2002). This may have been the result of only having consulted white GLBT people on this project and they do have a history of being racist and consequently ignoring issues, including health issues, of GLBTT-s people of color (Tremblay, 2000-2006). Wilson (1996) speaks to some related issues:
"The aspect of my own experience (and that of my two-spirit friends) that current sexual and racial identity development models cannot encompass is that my strength and identity, along with the strength and identity of my peers, is inseparable from our culture. Educators and school counselors need to acknowledge that this is the reality for our community. This means that we need to stop assuming that all lesbian and gay people can find support in mainstream gay culture, and that we make a point of creating opportunities for two-spirit indigenous people to find their place in their traditional communities. There has been little research done on the developmental experiences of Indigenous American people, and there is almost no research on the experiences of two-spirit people, despite grim statistics that reveal the urgency of addressing the needs of these groups."
A common situation described by Vancouver's Urban Native Youth Association (2004) indicates that many Two Spirited youth in British Columbia do have some unique problems and needs that are often likely not being met:
"Another devastating result of the residential school experience was the denigration of women and Two-spirit people in Aboriginal communities. The dominant religion did not make room for women to have equal roles as men, or for there to be alternate genders or sexual preferences than that of heterosexuals. As a direct result of the residential school experience, homophobia is now rampant in most Aboriginal communities, even more so than in mainstream society. The religious dogma of the Residential Schools have erased a proud and rich history of Two-spirit people in most Aboriginal communities. Today, many Two-spirit youth leave their communities hoping to find, safety, acceptance, and fulfillment in the big city. Unfortunately when they arrive, they face harsh realities when being confronted with racism, a lack of skills and training to find employment, a lack of familial support, a lack of support within the larger GLBT community, and even homophobia. Hence, Two-spirit youth are finding themselves living on the streets of the big city, which puts them at great risk of sexual exploitation, chemical dependency, suicide, and contracting HIV... The Urban Native Youth Association offered a Two-spirit Counsellor Program for two years, but unfortunately the funding was discontinued. As UNYA works toward making all of their programs welcoming, accessible, and safe for Two-spirit youth, they ultimately would love to host another program that works specifically with Two-spirit youth on a continual basis."
In Canada, little has been studied and reported about Two Spirit individuals and their suicidality risks. On the basis of this question "Have any of the following social factors affected your life?" that was replied to in a survey of 189 Two Spirit male respondents, Monette et al. (2001) reported that 32% of males had responded affirmatively to "suicide."  The nature of the question, however, makes it impossible to know if the suicide issue is personal, as in having attempted suicide, or maybe, if their lives were affected negatively by the suicide or attempted suicide of another individual.

Nonetheless, there seems to be some information available that has not yet been acknowledged or written about as the following anecdotal information indicates:
At a 2004 conference, and male expert on Aboriginal youth suicide made a presentation on this issue existing in one of Canada's largest province. He did not mention anything related to Two Spirit individuals likely being at high risk for suicidality and suicide. After the presentation, he was asked about this possibility and he mentioned that it was a major factor as based on his experiences in the field. Why this was not mentioned in his presentation was not explained.
At a 2004 conference, an Aboriginal social worker from a large reservation located in western Canada was privately asked if homosexuality was a factor in youth suicides on the reservation. It was noted that the last two youth suicides were by Two Spirited male youth, but that this fact was generally not known. One good reason for their closeted status was that homophobia was rampant on the reservation, including being a major attribute of other social workers on the reservation. The two young males who had committed suicide were only known to be Two Spirited by a few individuals who were not making this knowledge public given, apparently, that many on the reservation would have been happy to know that such individuals had killed themselves.

See:  Some Problems of  Young Two Spirit Males that Could be Related to Elevated Suicidality Risks.

Table 1: The Urban Men’s Health Study: 1996-98
Random Sample - MSM Suicidality - Paul et al. (2002)
Total Sample, N = 2881
Age: 18 to 70+ Years
Suicide Attempters
n = 326
Age 25?


All Males
Hispanic /
Asian/Pacific Islander
Native American
RR, Statistical Significance6
1. The counts (n's) are not given in the paper but they are given by Mills et al. (2004) and would be an approximation. Therefore, all "n's" given in table are estimates. - 2. For having attempted suicide. - 3. For suicide attempts. - 4. For first suicide attempt. - 5. Significance for the suicidality variable and all 'race' groups. - RR = Risk Ratio: Greater risk for Native American males, compared to White males. Significance for 2X2 RRs calculated from estimated n's.Statistically significant is: < 0.05

Table 2: The Urban Men’s Health Study: 1996-98
Random Sample - MSM Mental Health / HIV
Mills et al. (2004), Catania et al. (2001)
CES-D = < 16
CES-D = 16-21
CES-D = > 21
All Males
Hispanic /
Asian/Pacific Islander
Native American
X2 = 23.76 -  df =8  - p = 0.0033
X2 = 22.5
df = 4, 0.0014
RR, Statistical Significance5
p = 0.001
p = 0.09
p = 0.02
p = 0.04
1. The counts (n's) given by Mills et al. (2004) for euthymic, distressed, and depressed on the Center for Epidemiologic Studies Depression Scale (CES-D). The counts are not given by Catania et al (2001) for HIV status. The Mills et al. (2004) counts are used to calculate the RR estimate for HIV-positive status. 2. Euthymic means being in the "normal" range on the CES-D scale.  - 3. Significance for the three mental health variables and all 'race' groups given in paper.. - 4. Not given but calculated by author.- 5. RR = Risk Ratio: Greater risk for Native American males, compared to White males. Significance for 2X2 RRs calculated from given or estimated n's. Statistically significant is: < 0.05 - 6. This means that Native American MSM are 1.3 times less likely to be non-distressed/depressed. Expressed as "Odds" (a better statistical measure), the odds for Native American MSM males being non-distressed/depressed are 2.1 times less that it is for White males.

Some Problems of  Young Two Spirit Males that Could be Related to Elevated Suicidality Risks

Aboriginal / Non-Aboriginal Comparison Results from Vancouver's Vanguard Project: A cohort study of MSM (Men Who Have Sex With Men) ranging in age from 18 to 30 years
. "Of 681 eligible participants who had completed baseline questionnaires at the time of analysis, 57 (8.4%) self-identified as Aboriginal and 624 (91.6%) as non-Aboriginal. Aboriginal MSM were significantly more likely to be unemployed, live in unstable housing, have annual incomes < $10,000 and receive income assistance (all p<0.01). Aboriginals had higher depression scores (p<0.01) and were more likely to report non-consensual sex (p=0.03), sexual abuse during childhood (p=0.04) and having been paid for sex (p<0.01). In terms of sexual risk behaviours over the past year, Aboriginal MSM were no more likely to have had sex with a male partner they knew at the time to be HIV positive, to have had more than 50 male partners or to have unprotected anal insertive or receptive intercourse with their male partners (all p>0.05)" (Heath et al. 1999).
Aboriginal Males More Likely to be Involved In Sex Trade (Vanguard Cohort Project): "Of the 761 eligible participants, 126 (16%) reported involvement in sex trade work. Multivariate logistic regression analysis revealed regular alcohol use (Odds Ratio (OR): 3.6 95% Confidence Interval (CI): 1.8-7.2), aboriginal ethnicity (OR: 3.7 95%CI: 1.6-8.7), unemployment (OR: 3.9 95%CI: 2.1-7.3), history of residence in a psychiatric ward (OR: 4.2 95%CI: 1.8-9.8), bisexual activity (OR: 7.0 95%CI: 3.5-14.1) and the use of crack (OR: 7.4 95%CI: 3.0-18.7) to be independently associated with sex trade work. Sex trade workers had a significantly higher HIV prevalence at baseline compared with non-sex trade workers (7.3% vs. 1.1% P < 0.001). As well, HIV incidence was found to be significantly higher for sex trade workers compared with non-sex trade workers (4.7% vs. 0.9%, P = 0.011)" (Weber et al., 2001). The lifetime "Attempted Suicide" incidence in a subsample of the cohort (n = 345) was 19.4% but the results were generated on the basis of comparing white participants with non-white participants (aboriginal, Black, Asian, Others), with specific information about Aboriginal MSM not being given. See: Botnick et al. (1999).

MSM Sex Trade Risk Factors (Vanguard Cohort Project): "Relative to the remainder of the cohort (n=621), men who had been paid for sex in the previous year (n=110) were significantly younger, less educated, reported lower incomes and were more likely to be non-white (43% vs. 26%; unless otherwise indicated, all p<0.001). Sex trade workers (STW) were also significantly more likely to have unstable housing, to have ever been institutionalised, to be depressed and to use both injection and non-injection drugs. They reported consensual sex with both men and women at a younger age, and were significantly more likely to have ever experienced non-consensual sex (50% vs. 32%). They were also more likely to have had unprotected insertive (p<0.001) and receptive (p<0.05) anal sex with a casual partner in the previous year. In comparing STW with stable vs. unstable housing, those with unstable housing were significantly less educated, more likely to have ever been incarcerated, report bisexual activity, use crack and inject drugs. HIV incidence was much higher among STW relative to the remainder of the cohort (5% vs. 0.9%; p<0.001), and was also much higher for STW with unstable housing relative to those with stable housing (8.96% vs. 3.48%; p=0.016)" (Miller, 1999).

Aboriginal Males in the Child/Youth Sex Trade: - The youngest age for males in the Vanguard Cohort Project was 18 years, meaning that information was not produced on younger males who are involved in the child/youth sex trade often referred to as "child sex exploitation." It has been reported, however, that Aboriginal males adolescents have been overrepresented in the male child-youth sex trade in Canada, as it has been the case for Aboriginal females (Assistant Deputy Ministers’ Committee on Prostitution and the Sexual Exploitation of Youth, 2000; Kingsley & Mark, 2000). McIntyre (2005), from a study of 37 male prostitutes in Alberta, reported that:
Young men in this study were gay, heterosexual and bisexual
54% of this population are of Aboriginal heritage [61% for Western Canada (McIntyre, 2009)].
51% had involvement with Child Welfare Services
Over half of this population had grown up in care.
60% had a history of being thrown out of their homes
65% had not completed high school
95% had a history of running away
86% experienced staying in shelters
57-70% had a history prior to the street of being sexually violated
86% had been physically violated or abused while growing up
73% began the sex work under the age of 18
49% began sex work by the age of 15
35% began sex work by the age of 13
Males enter the trade younger and stay longer than young women
Drug use is extensive

Almost everyone felt no one should do this type of work
The fear of gay-bashing exists
54% identified periods of contemplation of self-harm

Out of the closet and onto the street (2011): “There’s a lot more homophobia within some First Nations communities now” ... In 2010, 29 per cent of the male sex workers in Vancouver identified as First Nations or Métis, according to the yearly evaluation carried out by the sex worker outreach and support program Hustle: Men on the Move. A 2005 survey led by researcher Sue McIntyre found that 43 per cent of young men in British Columbia’s sex trade were Aboriginal. The statistics reflect the number of individuals who could be found accessing services and were willing to share their experiences. Many are hard to spot due the perception that men don’t sell sex and because they may also avoid using support providers. “When you are 15 or 14 or 13 and you are out on your own and you have no work experience you can’t get a job,” David says. “So what do you turn to? The sex trade.” David’s drop-in group would meet once a week, attracting between 4 and 20 Aboriginal youth a night. “There was nothing else out there,” he says. “And I was starting to realize that the street-entrenched youth who were Two-Spirited weren’t using mainstream drop-ins.”
Male Sex Work and Sexual Identity in Canada. - Travailleurs du sexe hommes autochtones. - Aboriginal Male Sex Workers.
A History of Having Been Foster / Group Homes and the Risks, Including Becoming Involved in the Sex Trade: From a non-random sample of 189 Two Spirited Canadian males, Monette  et al (2001) reported that "over 70% have lived on a reserve [72%] and half [49%] have experienced homelessness.  One third have lived in a foster home [34%] [Group Home = 26%, in a Detention Facility: 18%, On The Street - Homeless = 49%]".  Given, however, that about 4 to 5 percent of Aboriginal children/youth have been in foster care in the past 30 years (Wensley. 2006), this would mean that the Two Spirited males studied by Monette  et al (2001) were about 6 to 8 times more likely to have such a history compared to other Aboriginal children/youth in Canada. It has been argued in Canada that being in foster might be a risk factor of suicidality (Charles & Matheson, 1991), but related statistics do not seem to have become available, even to 2006. However, statistics have become available for individuals with a history of having been in care as children/youth in Sweden (Vinnerljung et al., 2006):
"Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood... Sex and year of birth standardised risk ratios... follow a similar pattern for suicide during adolescence (13-17) and young adulthood (19+). We find a four- to five-fold excess risk for the child welfare groups compared to the general population, and these risks are about twice as high as the risks for inter-country adoptees. When parental psychosocial risk, socio-economic factors and ethnicity are adjusted for in model 2, risk ratios are lowered to around twofold for all child welfare groups, in both age periods."
Homophobia and related abuses have been reported to common in youth residential services, in group homes and in foster homes (Mallon, 1992; O'Brien, 1993; Mallon, 2001):
"The children in my study reported that verbal harassment was often inaugurated at home within their own family systems. Many of these young people reported that relatives and others in their community helped to increase the momentum of this violence by joining in the harassment. The extent to which gay and lesbian young people experienced verbal harassment and physical violence in foster care placements, by their peers and by staff charged with caring for them, was astounding to me. The stigma attached to being gay or lesbian often prevented them from reporting their victimization (Goffman, 1963). Many young people reported that when the abuse was acknowledged, the victims themselves were blamed. Consequently, at times, more than half of the informants in this study choose the apparent safety of the streets over the foster care system.

Tirades from family members, peers, and, in some cases, staff members that began with taunts such as ‘‘you fucking faggot,’’ ‘‘bulldyke,’’ ‘‘homo,’’ and ‘‘queer’’ in some cases escalated into punches, beatings, burnings, and rape. Gay and lesbian young people deemed as disposable individuals, deserving of being jostled into line or kept in the closet, frequently found environments which were so poor, where the fit was so bad, that many felt as though they literally had to flee for their lives. Some of those who migrated to a safer environment found the safety and fit that they were searching for. Others found even less favorable complementarity (Meyer, 1996)." (Mallon, 2001)
As the result of such studies of homophobia related abuses, a few recent documents on good practice with sexual minority youth have been produced (e.g., New York State Office of Children and Family Services, 2006; Wilber, 2006). However, recommendations in documents do not necessarily mean that good practice will follow, although improvements are expected, and almost nothing has been produced that describes problems specific to Two Spirited male and female children and youth. In Canada, homophobia was noted to be implicated in some male Aboriginal and non-Aboriginal adolescents having ended up on the street (after having been thrown out of their home because they were discovered to be gay, for example) and then working in the sex trade (McIntyre, 2005), and the same phenomenon was reported in the United States for gay and lesbian adolescents (Savin-Williams, 1994; Kruks, 1991). To a lesser extent, and without noting that homophobia might be a serious problem in many Aboriginal families and even in Aboriginal social services (as it was noted for Aboriginal services in Vancouver by de Castell et al., 2002), Kingsley & Mark (2000) did note that:
"The vast majority of commercially sexually exploited youth are girls. Estimates of girls in the sex trade run between 75–80 per cent with the remainder being boys, transgendered and transsexual individuals. Gender minorities and gay youth are often subject to social and familial disapproval, and experience feelings of isolation from their peers. There is real vulnerability caused by being young and gay in a heterosexual world, which leads to social isolation in mainstream society.

Aboriginal gay male youth, as well as those who are transgendered and transsexual, may feel forced into commercial sexual exploitation as a form of self-recognition and a means of practicing. Although they represent the minority of commercially sexually exploited youth, boys still need services since the risks associated with violence and homophobia are present regardless of biological gender."
One example was given of a sexual minority male youth who was rejected by his family: " "I think I would have jumped from the CN tower a couple of times, just from being transsexual, because that's one of the things that has been so hard. Being 21, a prostitute for ten years, being a transsexual, and just living this entire lifestyle is very hard. I've tried going home [to the reserve] ...a few times, but it just doesn't work because of my sexuality. It's much easier for me to be in the city and deal with it."  Male youth, Toronto
In the literature on adolescent prostitution, it is often noted that the male and female situations are quite different, that females form about 80% of the adolescent sex workers, that males begin sex work at a later age that females, and that males are much less visible (Assistant Deputy Ministers’ Committee on Prostitution and the Sexual Exploitation of Youth, 2000). However, McIntyre (2005) reported that males began sex work at a younger age and that they also operate "under the radar," meaning that they are not as visible as females and may therefore not be counted. It is therefore possible that the percentage of males in youth prostitution has been underestimated. In Vancouver, for example, de Castell et al. (2002) does mention the possibility that more males than females are involved in the sex trade:
"The ethnicity of the respondents was primarily Caucasian, although it is important to note the relatively higher representation of Metis youth, and in particular, young Aboriginal women. Here it is worth noting that whereas over half (56%) of males identified as queer or gay, less than a quarter (23%) of the females identified as queer or lesbian. As the qualitative aspects of the project illustrate, this difference may stem from the fact that, among the represented population, there seems to be more males involved in homosexual “survival sex” than females - this is, however, merely one interpretation of the figures..."
It would be possible to estimate the proportions of adolescent males involved in prostitution but, to date, only Norway has produced reasonably valid statistics. On the basis of a representative sample of adolescents living in Oslo (N = 10,828, age = 14-17 years), Pedersen & Hegna (2003) reported that the "1.4%" of adolescents who sell sex consisted of 0.6% girls and 2.1% boys, meaning that for every "1" girl selling sex, there are "3.5" boys selling sex. In other words, about 78% of adolescent involved in the sex trade in Oslo are male. If the same has applied in Canada, this would mean that about two out of three adolescent males involved in the sex trade have been "under the radar," operating undetected by most who have studied adolescent prostitution.

Multiple Factor Likely Implicated in Elevated Suicide Risk: “Two-Spirit[ed] People . . have experienced homophobia resulting in rejection from family and community. Some individuals experience internalized homophobia, and an inability to accept their own sexuality due to judgmental attitudes from society in general. Lack of acceptance produces ramifications of substance abuse, sexual, mental & physical abuse, no family or community support, internalized racism, sex trade, language barriers, low self-esteem, shame, fear, guilt, lack of work experience/education, lack of safer sex negotiating skills, sexual identity crisis and lack of peer counselling. This scenario has produced isolation which may result in suicide.” Deschamps (1998) citing McLeod & Peterson (1993).

Sexual Abuse: For Association between sexual abuse (uncluding child sexual abuse) and Aboriginal individuals, see study results produced from Vancouver's MSM Vanguard Cohort and Vancouver's injection drug user MIDUS cohort. For information on Aboriginal child/juvenile prostitution in Canada, see: Kingsley & Mark (2000).

"As we begin to unpack the great diversity of genders in Native North America and the ways in which sexuality informs performance of gender roles, we are drawn back to the original definition of berdache. Our research shows that there are indeed individuals today appropriately called berdache by researchers. We refer specifically to feminine boys and young males living on reservations and in urban places, both in Native and non-Native communities, who are passive sexual consorts of heterosexual and homosexual adult men. The emphasis in these relationships is sex.... On some reservations, feminine boys are used sexually by married men. In studies of male juvenile prostitutes in Seattle, Washington, it is primarily heterosexual adult males who seek out boys for passive anal and oral sex. In both Seattle and on reservations, such behavior is negatively sanctioned. It is not glamorous; it is not romantic; it is "sex for survival." These boys (aged nine to seventeen) are berdaches in the literal, original meaning of the word: boys used for sexual purposes. The married "heterosexual" men on reservations who engage in sex with boys retain their heterosexual status; they are never considered to be bisexual or homosexual. In some urban gay settings, these men are commonly called "Men who have Sex with Men (MSMs)." Reference: "Debra Boyer, "Male Prostitution: A Cultural Expression of Male Homosexuality," Unpublished Ph.D. Dissertation (Seattle: University of Washington, 1986). Related Note: "We are not referring to all intergenerational male-to-male relationships, but only to exploitative pedophilia, which falls in the legal domain of child abuse: the "children" are not of legal sexual consent age. We are also not describing or referring to relationships that teenage boys have with older men as they are discovering and testing their homosexuality; that is the subject of another paper." Source: Thomas W, Jacobs SE (1999). ’…And We Are Still Here’: From Berdache to Two-Spirit People. American Indian Culture and Research Journal, 23(2): 91-107.
Was available online at: . Comment: Some of Debra Boyer's dissertation research results were published later as:  Boyer D (1989). Male prostitution and homosexual identity. Journal of Homosexuality, 17(1-2): 151-84. PubMed Abstract. Also published as:  Boyer D (1989). Male prostitution and homosexual identity. In G. Herdt (Ed.), Gay and Lesbian Youth (pp. 151-184). Binghamton, NY: Harrington Park Press.


Note 1:  Brotman et al (2002) report on the varied responses to Two Spirited individuals in North American Aboriginal communities: "In urban settings, acculturation is more present, leading to negative attitudes and behaviours toward Aboriginal gays and lesbians. In broad terms, traditional Aboriginal societies tend to respect Aboriginal glbt people, while acculturated Aboriginal people tend to devalue and stigmatize them (Williams, 1984). Jacobs and Brown (1997) confirmed this in their interviews with a number of US Aboriginal gays and lesbians. They found that urban residence strengthened acculturation and weakened links with the reserve, leading to a stronger identification with the urban Aboriginal community. Moreover, the participants reported openness and acceptance of their sexual orientation by their communities and families of origin. Crow, Wright and Brown (1997) performed a comparative study of two tribes, the Santee Dakota and the Lakota, to show the differences in perception, acceptance and tolerance of homosexuality and transgender identity between the tribes. In the Santee Dakota, individuals who are not-man and not-woman are called winkte; this term denotes a man who, in his youth, disliked hunting and war and preferred the sedentary crafts of women. As an adult, this individual will be rejected by his tribe and considered “socially dead” by the members of his family; he will no longer be allowed to interact socially with his tribe or family. An individual who decides to live as a winkte must leave his tribe and find acceptance by members of another more tolerant, more homosexual-positive tribe. Contrariwise, for the Lakota, the winkte has prestige and is often considered to be a wicasa wakan or sacred man. The wicasa wakan is a healer, a performer, a wizard or a winkte who adopts feminine lifestyle, crafts, arts and dress. The Lakota consider this individual to be an essential member of their community. Meyer (1998) conducted interviews with Canadian Aboriginal people from the Inuit, Mohawk, Ojibwa, Naskapi and Dene communities. All these people self-identify as Two-Spirit, gay, lesbian, bisexual or transsexual. Meyer observes that coming out is difficult for these individuals because of the “internalized concept of sin” stemming from Christian evangelization and its acceptance by the family and the community..."

Note 2
The Borowsky et al. (1999) study is based on the 1990 National American Indian [and Alaska Native] Adolescent Health Survey: N = 13,454, Age Range = 12-18 years, Grades 7 to12. "The sample of students came from reservation-based schools in Alaska, Arizona, California, Minnesota, Montana, New Mexico, South Dakota, and Tennessee. The 13,454 youths surveyed represented approximately 20% of the eligible students in the geographic areas participating in the survey." A little less than 11,666 students replied to the questions related to suicidality and to items related to sexual orientation. Sexual orientation was represented in terms of responses to a question about sexual daydreaming; adolescents were asked if, in such daydreams, they thought about males, females, or both. This created three sexual fantasy categories: Opposite Sex Only (Heterosexual), Same Sex Only (Homosexual / Gay / Lesbian), and Both Sex (Bisexual). Related suicidality incidences (ever having attempted suicide in one's lifetime) are given below (Borowsky et al., 1999: Table 4, p. 577):

Sexual Orirentation and Suicidality

The lifetime incidence for Gay male adolescents having attempted in their lifetime (25.0%) is similar to results in many studies of young homosexually oriented males
(Tremblay & Ramsay, 2000; Bagley & Tremblay, 2000; McDaniels et al., 2001), but the male and female bisexuality results ('Both Sexes") are at odds with the Robin et al (2002) study that reported bisexual males and females to be at the highest risk for having attempted suicide (See Graph of Results). It must be noted, however, that the sexual orientation categories in the Robin et al (2002) study are based on their reported sex partners (only male, only female, or both), this being a different measure of sexual orientation than the one used by Borowsky et al. (1999). Furthermore, the Robin et al (2002) measure for "attempting suicide is not "lifetime," but "in the past 12 months." The Borowsky et al. (1999) study results, however, are also at odds with the results of two other studies that reported bisexual adults to be at greater risk for having attempted suicide: Jorm et al., 2002 (Australian adult males and females analyzed together, graphs of results) and Paul et al., 2002 (American men who have sex with men, graph of results).

The Borowsky et al. (1999) male bisexual results (bisexual males are not more at risk for having attempted suicide in their lifetime than heterosexual males) and the fact that homosexual/lesbian females and bisexual males are at lesser risk for having attempted suicide in their lifetime, compared to heterosexual females, suggests that differences may be expected when comparing adolescent study samples are predominantly white with study sample of American Indian / Alaska Native adolescents. That is, adolescent suicidality results - as related to varying measures for sexual orientation that have been discussed in the literature (Saewyc et al., 2004) - that are generated from predominantly white samples may not necessarily apply to non-white 'race'/ethnic minority adolescents, although some studies results have produced similar results for adolescent males who are predominantly Hispanic/Latino, African American (Rotheram-Borus et al., 1994: 138 gay/bisexual adolescents, 81% Hispanic or Black, lifetime attempted suicide incidence = 39%) and adult males who are Hispanic/Latino, African American, Asian and White (Paul et al., 2002), this study also reporting that American Indian MSM males were at about 3-times greater risk for having attempted suicide before the age of 25 years compared to all other MSM male groups (Table 1). Furthermore, all 'race'/ethnic minority MSM males had a significantly lower mean age at which they had attempted suicide, compared to White MSM males (Table 1), again indicating that some differences may be expected cross-culturally. In a large samples of 1,925 American lesbians, for example, the lifetime incidence for having attempted suicide was 16% for White lesbians, compared to 27% and 28% for African American and Latina lesbians, respectively (Bradford et al., 1994). Walters (2006) reports a lifetime attempted suicide incidence of about 30% for a group of 60 Two-Spirited females.

Such variations in study results support the study of sexual orientation issues in minority 'race'/ethnic groups, separately, that is rarely done; most studies are either of White individuals or predominantly White individuals. It also supports advocating for state/provincial/national study samples that would include measures for sexual orientation and be large enough to have sufficient numbers (required for statistical significance) of homosexually oriented 'race'/ethnic minority individuals so that similarities and differences between each group, with White homosexually oriented individuals, and with heterosexual individuals in each
'race'/ethnic minority  group, can be established. Unfortunately, the present sample sizes for Youth Risk Behavior Surveys (from 2,000 to 5,000), for example, preclude knowing anything about homosexuality issues in 'race'/ethnic minority groups, and almost all these national/state-/city-wide surveys do not include sexual orientation measures. It must be noted, however, that the official version of the Youth Risk Behavior Survey, as made available by the Centres for Disease Control (CDC, 2006), continues to not include sexual orientation measures. Such measures must be added to the survey as it is done in Massachusetts (Massachusetts Department of Education, 2006), Vermont (Vermont Department of Health, 2006), and in some major school districts in Boulder, Colorado (Boulder County Public Health, 2006). As a rule, however, most Youth Risk Behavior Surveys are carried out without adding measures for sexual orientation. This also applies for the Bureau of Indian Affairs that had carried out Youth Risk Behavior Surveys in 1997 and 2001 (Bureau of Indian Affairs, 2001; Shaughnessy et al., 1997). The first national survey done of adolescents on American reservations, however, was the more comprehensive 1990 National American Indian Adolescent Health Survey carried out by the University of Minnesota Adolescent Health Program. Improvements could have been made to the survey (Saewyc et al., 1998), but it did produce many research papers, including two papers reporting sexual orientation related data: Borowsky et al., 1999 & Barney, 2003. Data from the survey was also used in a major U.S. Congress 1990 report, "Indian Adolescent Mental Health."

Bibliography & Excerpts

The Aboriginal Nurse (2002). Two-spirit people and sexual diversity. Internet:
"Unfortunately, most two-spirit and transgendered Aboriginal people live with high levels of discrimination and intolerance... The Need to Change Attitudes: Our youth program developed a workshop on two-spirit issues. We were shocked at the level of homophobia we discovered within the community. People were verbally abusive to us. On the other hand, a young woman in the group came out to us afterward, so we felt we had reached someone and provided some support... Cultural reluctance to talk about sexual matters in general, and sexual diversity specifically, prevents two-spirit Aboriginal people from gaining acceptance in the community. Discrimination is widespread, and creates fear, especially in small, closeknit rural areas. Homophobia, the fear of homosexuals, needs to be addressed in Aboriginal communities."
Advisory Group on Suicide Prevention (2003). Acting on What We Know: Preventing Youth Suicide in First Nations. PDF Download. PDF Download.
"Many First Nations youth are perceived and/or perceive themselves to be marginalized in relation to mainstream society as well as within their own communities. Their sense of isolation may be profoundly greater than either that of their non-Aboriginal peers or that of older adults within their communities. This isolation occurs because the traditional belief systems that identify youth as an important stage in the cycle of life are non-existent or have become fragmented in many First Nations. In First Nations families or communities where original cultural teachings and practices have been maintained or restored, there is usually a positive sense of the many roles, social duties and obligations to be fulfilled by the youth. However the experience of many First Nations youth is steeped in social disintegration and conditions associated with marginalization — physical, emotional and sexual abuse, neglect, poverty, substance abuse 18 and deplorable socio-economic standards. Many First Nations youth are feeling the impact of what has been termed “transgenerational grief”, carried from the trauma previous generations experienced in residential schools and other forms of cultural oppression. Further, the Aboriginal youth unemployment rate in 1996 was 32 percent — almost double the non-Aboriginal youth rate. Youth in general tend to be more concerned with acceptance within peer relationships than participation within broader community processes. Lack of participation shows up in strained relationships between youth and those who are significant to them. They may be feeling left out even in their own homes because they lack support from their families and other adults. They also may be marginalized because as a First Nations sub-population, their values and concerns are not completely accepted inside or outside their communities. In the first instance, the Nishnawbe-Aski Youth Forum Report shows the political, cultural and economic isolation First Nations youth often experience in Ontario First Nations communities. As for youth feeling like outsiders elsewhere, there are numerous accounts of the adjustment problems they face in urban settings, for example when attending urban-based institutions such as colleges and universities."

Note: This document does not contain anything about sexual minority / Two Spirit  issues.

? (2001). Situational Analysis: A Background Paper on HIV/AIDS & Aboriginal People. Ottawa: Health Canada.

Anonymous (2003). Tulsa Two Spirit Society Is Making A Difference. Seasons: Newsletter of the National Native American AIDS Prevention Center, Fall 2003. PDF Download.
'Cocke says they have a lot of issues to deal with. “There’s a high suicide rate among gay urban teenagers.” These teens have difficulty reconciling living a gay life with their religious backgrounds and feel very isolated. They’re also engaged in unhealthy sexual and drug activities, putting themselves at risk for HIV and other STDs. “We formed the Tulsa Two-Spirit Society to help them and others who feel like them,” says Cocke." (p. 7)
Assistant Deputy Ministers’ Committee on Prostitution and the Sexual Exploitation of Youth (2000). Sexual Exploitation of Youth in British Columbia. British Columbia. Assistant Deputy Ministers’ Committee on Prostitution and the Sexual Exploitation of Youth. British Columbia. Ministry of Health and Ministry Responsible for Seniors. PDF Download.
Bagley C, Tremblay P (2000). Elevated rates of suicidal behavior in gay, lesbian, and bisexual youth. Crisis, 21(3): 111–117. Abstract. Draft of Paper.

Barney DD (2003). Health Risk-Factors for Gay American Indian and Alaska Native Adolescent Males. Journal of Homosexuality, 46(1/2): 137-157. PubMed Abstract.
This is a study of the male subset of the Indian Adolescent Health Survey (N = 12,294) carried out in the United States between 1988 and 1990. It compares gay American Indian and Alaska Native male adolescents [1.4% of males] to their heterosexual counterparts [94% of males]. "Results indicate that there were no real differences between gay and heterosexual male respondents for substance use or attitudes about school. Statistically significant differences were found, however, in areas of mental health, as well as physical and sexual abuse. Gay adolescents were twice as likely to have thought of or attempted suicide. Gay adolescents were twice as likely to have been physically abused and nearly six times more likely to have been sexually abused. Gay American Indian or Alaska Native adolescent males constitute a very vulnerable population and are clearly in need of targeted health and social services.Unfortunately, the benefits seen by adults of the “two-spirited” gay and lesbian American Indian movement have not been accessible to Indian and Native adolescents... Thirteen percent of gay adolescents had been sexually abused, as compared to 2.4% for heterosexual adolescents. Seventeen percent of gay adolescents had been physically abused as compared to 7.5% for heterosexual adolescents.... Gay adolescents were significantly more likely to have both thought of suicide (47.3% vs. 23.6%) and/or actually attempted suicide (23.2% vs. 11.1%). Gay adolescents were less satisfied with life (67.8% vs. 85.2%) and had a greater history of being depressed (35.1% vs. 14.0%) or sad (21.1% vs. 11.4%)."

Total Sample = 15,740, After Scrubbing = 12,294, 46.6% males = 5,729 males (Approximate) and 4,254 males responded to the questions about sexual fantasies. Therefore, about 25% of males did not answer this question related to sexual orientation or to the other two questions related to sexual orientation. Heterosexual Males  = 4,254, Gay Males = 65.

BC Injury Research and Prevention Unit: BCIRPU (2005). Download Page For Three Documents: N/A New Link.
Introduction Statement: With injuries the leading cause of death and hospitalization for children and young adults, the Pop Health Unit selected young adults as a new priority target population with a focus on suicide and abuse prevention. The BC Injury Research and Prevention Unit (BCIRPU), with assistance from Gary Ockenden (withinsight services), prepared the following documents to assist Interior Health in strategic planning:
Related Presentation - a poster abstract - by Jacqueline Kinney at the 2006 CPHA (Canadian Public Health Association) 97th Annual Conference: "Planning for Suicide and Abuse Prevention among Gay, Lesbian, Bisexual and Transgender Youth". Presenting Author: Ms. Jacqueline Kinney. Co-Authors: Fahra Rajabali, BCIRPU, Ian Pike, Director, BCIRPU, Pamela Joshi, Project Coordinator, BCIRPU, Gary Ockenden, Withinsight Services.

Introduction: A Planning Framework for the Interior Health (IH) region of British Columbia was developed for Gay, Lesbian, Bisexual and Transgender (GLBT) Youth Suicide and Abuse Prevention. This plan will build capacity in the IH Authority and reduce the burden of injury among the GLBT youth population.
Objectives: To develop a strategic implementation plan and review evidence-based best practices for the prevention of suicide and abuse among GLBT youth in the IH.
Methods: The planning process merged best practices with suicide and abuse prevention programming activities. Programs demonstrating efficacy through evaluation and consistency with best practices were reported to the IH. 
Results: The outcomes of this Planning Framework for Suicide and Abuse Prevention among GLBT Youth will entail:

Development of a population health framework for planning and implementation
Building capacity and networking
Recommending initial pilot projects for immediate start-up

The deliverables for the Planning Framework for Suicide and Abuse Prevention among GLBT Youth are:
A framework that includes a review of existing youth suicide and abuse prevention activities, evidence and best practices
Targets for improving health outcomes and indicators of improvement
Implementation of evidence-based pilot project(s), aimed at GLBT youth 
A strategic implementation plan for inclusion in the 2005-2008 Interior Health Population Health Plan
Conclusions:  The amalgamation of evidence-based practices for GLBT youth suicide and abuse prevention programming and stakeholder input will help ensure
1.Success at reducing the burden of suicide and abuse related injuries, and
2.Resources are allocated effectively for prevention activities.
Reference Document: Poster Abstract:

Borowsky IW, Resnick MD, Ireland M, Blum RW (1999)Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Archives of Pediatric and Adolescent Medicine, 153(6): 573-80. PubMed Abstract. Full Text.
Incidences for having attempted suicide in the past 12 months: Aboriginal Males = 8.0%. Aboriginal Females = 14.0%
Lifetime incidences for having attempted suicides: Aboriginal Males = 12.0%. Aboriginal Females = 22.0%

Sexual Orirentation and Suicidality

Note: Approximately 68 males reported having only "same sex" sexual fantasies, with 17 having attempted suicide.
See Note 2 for a discussion of lifetime "attempted suicide" results in different categories.

Botnick MR, Heath KV, Cornelisse PG, Strathdee SA, Martindale SL, Hogg RS (2002). Correlates of suicide attempts in an open cohort of young men who have sex with men. Canadian Journal of Public Health, (1): 59-62. PubMed Abstract. Full Text.

Botnick MR, Heath KV, Cornelisse PGA, Strathdee SA, Martindale SL, Schechter MT, O'Shaughnessy MV, Hogg RS (1999). Social Determinants of Suicide Attempts in a Cohort of Young Men Who Have Sex With Men. Paper presented at the 8th annual Canadian Conference on HIV/AIDS Research, in May 1999, in Victoria, BC. Internet: . Published Paper; Botnick et al. (2002).

Boulder County Public Health (2006). Youth Risk Behavior Survey. Index Page.

Bradford J, Ryan C, Rothblum ED (1994). National Lesbian Health Care Survey: implications for mental health care. Journal of Consulting and Clinical Psychology, 62(2): 228-42. PubMed Abstract.

Brotman S, Ryan B, Jalbert Y, Rowe B (2002). Reclaiming space - regaining health: The health care experience of two-spirit people in Canada. Journal of Gay and Lesbian Social Services, 14(1): 67-87. Abstract.
"Currently, the body of academic research on health and health care access largely excludes gay, lesbian, bisexual, and transgendered/transsexual people (glbt). The smaller growing body of research on glbt health has little reference to Two-Spirit people. This paper attempts to redress these glaring absences..."

"Over the past decade there has been a steadily growing interest in the health and health care needs of gay, lesbian, bisexual and transgender (glbt) people. Research and policy focused upon health outcomes and best practices is beginning to emerge as a result of the efforts of glbt activists and their allies in health professions to promote the needs of glbt people and communities. Although much glbt research and policy continues to be dominated by a focus on HIV prevention and treatment among gay and bisexual men, the health care experiences and needs of all gay, lesbian and bisexual people are beginning to gain attention in medical, nursing and social work literature. Despite these efforts, there are still significant gaps in health research, policy and practice with gay, lesbian, bisexual and transgendered people. This is particularly evident with respect to Two-Spirit people who have largely been left out of health research and policy activities. Both mainstream and glbt health policy and research initiatives have paid little attention to the health care needs facing Two-Spirit people and communities. In fact, few practitioners, policy makers or researchers in the field of glbt health are even aware of the term Two-Spirit. Aboriginal communities themselves have little documentation on the lives and experiences of Two-Spirit people. As such, Aboriginal wellness and healing initiatives, which have emerged in recent years, have rarely considered the needs of and issues facing Two-Spirit people. This lack of information has a substantial negative impact upon the capacity of glbt, Aboriginal and mainstream health care organizations to develop health and social services and policy appropriate and sensitive to Two-Spirit people.

The lack of attention to the needs of Two-Spirit people is particularly problematic given that they face a number of health related concerns and issues because of their experience of multiple oppression. The lack of attention to the needs of Two-Spirit people is particularly problematic given that they face a number of health related concerns and issues because of their experience of multiple oppression. There is growing documentation on the health impacts of colonialism3 on Aboriginal people generally (Waldram, 1994; Wotherspoon, 1994). Poverty, inadequate housing, substandard living conditions and the disintegration of traditional ways of life have threatened many Aboriginal communities, both reserve-based and urban. High rates of substance abuse, addictions and suicide and higher rates of morbidity and mortality have all been linked to colonial and racist oppression by governments and mainstream society against Aboriginal people (Monture-Angus, 1995; Waldram, 1994; Wright, Lopez & Zumwalt, 1997). Clearly, Two-Spirit people face health hazards because they are Aboriginal living in such a society. They also face health problems because of their marginal status as glbt. Isolation, exclusion and rejection by families, communities and society have a substantial negative impact upon glbt people’s sense of self, their ability to come out and self-affirm, their health and their capacity to locate appropriate and relevant health and social services (Ryan, Brotman & Rowe, 2000). It is the experience of these interlocking forms of colonial and heterosexist, homophobic/ transphobic4 oppression that make Two-Spirit people’s experience of health and health care significantly problematic and which places them at a unique disadvantage with regard to health care access and service delivery. The multiple oppression faced by Two-Spirit people makes their experience of health qualitatively different–different enough to warrant a separate and specific inquiry.

This paper seeks to address the realities and experiences of Two-Spirit people, both within society generally and in the context of health. The authors seek to identify the major published writing with and about Two-Spirit people and to present the findings of a larger study on health care access among gay, lesbian, bisexual and Two-Spirit people which are relevant to the Two-Spirit community. To this end, findings reported here centre upon Two-Spirit people’s notions of identity and community, the meaning of health and the experience of health care barriers within and outside of Aboriginal communities. The intent of this paper is to document information on Two-Spirit people and to address issues from the perspectives and through the voices of Two-Spirit people themselves...."
Brown LB (1997, Editor). Two Spirit People: American Indian Lesbian Women and Gay Men. New York: Harrington Park Press. Amazon Books. Monograph Published Simultaneously As the Gay & Lesbian Social Services , Vol 6, No 2.
Bureau of Indian Affairs (2001). 2001 Youth Risk Behavior Survey of High School Students Attending Bureau Funded Schools. Bureau of Indian Affairs: Office of Indian Education Programs. PDF Download.
The Canadian Aboriginal AIDS Network: CAAN (2000). AIDS & Two-Spirited. Internet: -
"Two spirited (gay) Aboriginal males show a higher rare of HIV infection than any other Aboriginal group. Men who have sex with men constitute 52.4% of infections among Aboriginal males... Homophobia is defined as a fear or hatred of homosexuals. Service providers must learn to address this problem in our communities."
CDC (2006). YRBSS: Youth Risk Behavior Surveillance System. Internet: .
Chandler MJ, Lalonde CE (1998). Cultural Continuity as a hedge against suicide in Canada's First Nations. Transcultural Psychiatry, 35(2), 193-211. Full Text.
List of Aboriginal Suicide Related Papers & Full Text Download: .
Charles G, Matheson J (1991)Suicide Prevention and Intervention with Young People in Foster Care in Canada. Child Welfare, 70(2): 185-191. PubMed Abstract.
Note: It is argued that children/youth in foster care would be at risk for suicide but statistics related to this possibility are not given. "Many of the young people coming into state care have life histories that mirror the life histories of individuals who have attempted or committed suicide. Poor problem-solving skills, poor social skills or the inability to reach out to others, anger, hostility, and a sense of psychological isolation are common to both groups. Family turmoil, common to suicidal individuals, is present for most if not all young people coming into care..." Grant Charles and Jane Matheson are both from Alberta, Canada.
Clark, WM., and Seovich, JM. (1997). Twenty years and still in the dark? Content analysis of articles pertaining to gay, lesbian, and bisexual issues in marriage and family therapy journals. Journal of Marital and Family Therapy, 23(3), 239-53. (PubMed Abstract) (Full Text: In Sections)
"To what extent do marriage and family therapy journals address gay, lesbian, and bisexual issues and how does this coverage compare to allied fields? To answer these questions, a content analysis was conducted on articles published in the marriage and family therapy literature from 1975 to 1995. Of the 13,217 articles examined in 17 journals, only 77 (.006%) focused on gay, lesbian, and/or bisexual issues or used sexual orientation as a variable. Findings support the contention that gay, lesbian, and bisexual issues are ignored by marriage and family therapy researchers and scholars... Furthermore, only two studies included bisexuals, indicating a dearth of knowledge in this area."

Note: Although the authors mentioned that "efforts were made to code variables such as sample size, mean age/ income/education/gender/ethnicity/sexual orientation of participants," nothing is mentioned about the likely fact that almost all papers spoke to white GLB issues and that GLBTTs people of color had likely been ignored.

Cutcliffe JR (2005). Toward an understanding of suicide in First-Nation Canadians. Crisis, 26(3): 141-5. PubMed Abstract.

D'Augelli, Anthony R (2003). Coming Out in Community Psychology: Personal Narrative and Disciplinary Change. American Journal of Community Psychology, 31(3/4): 343-54. (PubMed Abstract)
The paper is part of a special GLBT Issue in American Journal of Community Psychology, 31(3/4). D'Augelli describes the lack of coverage of GLB issues in community psychology: "...little work was done by community psychologists on LGB issues until the very late 1990s."  See also Harper and Schneider (2003).
de Castell S, Jenson J, and others (2002). No Place Like Home: Final Research Report on the Pridehouse Project. PDF Download.
"This {Vancouver, B.C.] project was made possible through the support of Human Resources Development Canada and by the Status of Women Canada whose strong support of the video-based component of the research greatly expanded our access to research tools. The views expressed are those of the author and do not necessarily reflect the views of the Government of Canada...

It is important to keep in mind the extreme overrepresentation of youth of colour and aboriginal youth among street active and homeless populations.5 For service providers the challenge in providing support to gender and sexual minority youth will entail remaining sensitive to not only their ambivalent identifications and disidentifications with “western” signposts of gay culture (Munoz 4-8) but to culturally specific articulations of cross gender identities that may or may not resemble queer or trans sexualities, genders or cultural practices...

The ethnicity of the respondents was primarily Caucasian, although it is important to note the relatively higher representation of Metis youth, and in particular, young Aboriginal women. Here it is worth noting that whereas over half (56%) of males identified as queer or gay, less than a quarter (23%) of the females identified as queer or lesbian. As the qualitative aspects of the project illustrate, this difference may stem from the fact that, among the represented population, there seems to be more males involved in homosexual “survival sex” than females - this is, however, merely one interpretation of the figures...

Even for those services specified for the LGBT community, the youth who responded to our survey didn’t necessarily feel those services to be “QQ positive”, and this was especially true among minority respondents. Users of the Youth center found it “queer positive”, while those who use aboriginal services, immigrant services, community centers and services, food services and legal aid services overwhelmingly reported that they were not LGBT positive. The most queer-positive places were identified as the LGBT center, community health center, and bars and clubs. Where people found they got the most support was, surprisingly, from service industry locations, such as bars and pubs – perhaps because of the lack of authority and subsequent degree of freedom found therein...

In terms of institutionally provided support for this most vulnerable group, least tolerated means most overlooked. Accordingly, in relation to social service provision, the most overlooked populations among sexual minority youth are likely to be aboriginal and “of colour” transgendered youth, those located at the furthest edges of the race/gender hierarchy whose normative order governs our daily lives."
Deschamps G (1998). We Are Part of a Tradition: A Guide on Two-Spirited People for First Nations Communities. Mino-B'maa:diziwin, 2-Spirited of the 1st Nations, Toronto: PDF Download. A Quebec version of the document having the same title "We Are Part of a Tradition: A Guide on Two-Spirited People for First Nations Communities" was produced by the First Nations of Quebec and Labrador Health and Social Services Commission: PDF Download N/A.
 "We, as the two-spirited community, must heal. We must re-learn that to be two-spirited is an honour. We have grown up with the single message that lesbians and gay men are sick. We are in the process of rebuilding a positive self-image as a result of this past. And if, as in the larger First Nations community, two-spirited people suffer from suicide, substance abuse and short life spans, then we must recognize this as symptom of a very different illness. We, as two-spirited people, identify ourselves very strongly as members of the First Nations. We take an interest in the future of our Nations and wish to play an active role in that future... Rejection by one's own cultural group can be psychologically devastating. “Two-Spirit[ed] People . . have experienced homophobia resulting in rejection from family and community. Some individuals experience internalized homophobia, and an inability to accept their own sexuality due to judgemental attitudes from society in general. Lack of acceptance produces ramifications of substance abuse, sexual, mental & physical abuse, no family or community support, internalized racism, sex trade, language barriers, low self-esteem, shame, fear, guilt, lack of work experience/education, lack of safer sex negotiating skills, sexual identity crisis and lack of peer counselling. This scenario has produced isolation which may result in suicide.” [McLeod, Albert, and Peterson, Treasure (1993) Care and Treatment of Aboriginal People with HIV/AIDS (Manitoba Aboriginal AIDS Task Force). Winnipeg, March 1993.] ... The affect of racism on Aboriginal peoples in Canada has been well documented. This oppression has resulted in many social ills that plague First Nations people today. Poverty, substance abuse, violence and suicide are all part of the reality for Aboriginal people. As in the larger First Nations community, two-spirited people suffer from the same adversities. However, these problems are compounded as many two-spirited people are rejected and ostracized by their own communities. In a world that does not honour indigenous people, two-spirited people suffer “triple oppression” -- as Natives, as homosexuals, and in the case of two-spirited lesbians, as women. In many cases, the internalization of negative stereotypes about two-spirited people has led to self-destructive behaviour... AIDS-Related Stigma has had dire consequences for two-spirited people. The effects of being both homosexual and Aboriginal are devastating. Two-spirited people face discrimination from inside and outside their communities. Problems of identity formation in the face of intense prejudice make being either homosexual or/and Aboriginal more than enough for one individual - particularly two-spirited youth - to cope with. Self-destructive behaviour among two-spirited youth in the forms of substance abuse, suicide, unsafe sexual practices, are very extensive..."

 "Particular risks for youth include the following" [highlighted, each being in individual frames]:

1. "Depression and Suicide: Very large numbers of youth who are struggling with issues related to sexual orientation experience mild to severe depression at some point in time. Most studies indicate that these youth are 2 to 3 times more likely to attempt suicide than heterosexual youth, and a recent study indicated that young gay men are 6 times more likely to attempt suicide than their heterosexual counterparts. Between 20% and 35% of lesbian and gay youth attempt suicide, while more than 50% experience suicidal ideation (i.e., imagine or conceive). Estimates are that 30% of completed youth suicides are lesbian or gay youth."

2. "Family Violence and Disruption:  Up to 50% of all youth report negative parental responses when their sexual identity is revealed or discovered; of those youth who experience physical violence due to their sexual orientation, up to half report it at the hands of family members. Running Away or Being Forced To Leave Home: Up to 25% of lesbian and gay youth whose parents react negatively are disowned or forced to leave home."

3. "Homelessness:  It is believed that between 20% and 40% of street youth are lesbian and/or gay. There are many risks associated with street life including: poverty, interrupted education, lack of employment and housing, poor nutrition, poor health status, prostitution, criminal involvement, anxiety and depression, pregnancy, sexually transmitted diseases, substance abuse, violence, susceptibility to exploitation, HIV infection and poor prospects for the future."

4. "Substance Abuse:  Lesbian and gay youth experience substance abuse problems 3 to 5 times as high as heterosexual youth. Adult lesbian and gay people also have substance abuse rates, which are substantially higher than their heterosexual counterparts. It is often assumed that substance abuse problems arise as a result of the prominence of the “bar scene” in lesbian and gay culture. While this may be a factor, other factors such as coping with antilesbian/gay discrimination and prejudice, depression and anxiety, homelessness, violence, exploitation, prostitution and criminal involvement are very significant. Lesbian and gay youth often begin substance abuse at a very young age."

5. HIV Infection: Research indicates that while the rate of increase of HIV infection among adult gay men has leveled out, young gay men continue to be at extremely high risk, and infection of this population continues to increase at an alarming rate."

Dorais. Michel (2004). Dead Boys Can’t Dance: Sexual Orientation, Masculinity and Suicide. Montreal & Kingston: McGill-Queens University Press. Amazon. Google Books.

Dorais M (2000). Mort ou Fif : la face cachée du suicide chez les garçons. Montréal: VLB éditeur. English Translation: Dorais, 2004. Amazon.

Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatrics & Adolescent Medicine, 153(5): 487-93. PubMed Abstract.
Full Text.

Garmaise D, de Bruyn T (2004). Story #4: Building a Sense of Connection, Belonging, and Esteem through the International Two-Spirit Gathering Movement. In: Stories of Community Mobilization. Canadian HIV/AIDS Legal Network. Internet:
PDF Download. PDF Download.

Gilley B J,. Co-Cké JH (2005). Cultural Investment: Providing Opportunities to reduce Risky Behavior among Gay American Indian Males. Journal of Psychoactive Drugs, 37(3): 293-8. PubMed Abstract. Paper is a part of Special Issue: "Faces of HIV/AIDS and Substance Abuse in Native American Communities." Brian Gilley's Web Page:
Gilley BJ (2006). Becoming Two-Spirit: The Search for Self and Social Acceptance in Indian Country. University of Nebraska Press. Amazon.

Gilley BJ (2005). Two-Spirit Powwows and the Search for Social Acceptance in Indian Country. In Powwow: Origins, Significance, and Meaning, Eric Lassiter, ed., University of Nebraska Press, 224-240.

Gilley BJ (2004). Making Traditional Spaces: Cultural Compromise at Two-Spirit Gatherings in Oklahoma. American Indian Culture and Research Journal, 28(2): 81-95.

"Anthropologist on the Case: Professor Brian Gilley's expertise in gender and sexuality among Native Americans part of Cherokee same-sex marriage case." ( By Kevin Foley, 2006).  Internet: .

Harper GW, Schneider M (2003). Oppression and Discrimination Among Lesbian, Gay, Bisexual, and Transgendered People and Communities: A Challenge for Community Psychology. American Journal of Community Psychology, 31(3/4): 243-52. PubMed Abstract.
The paper is part of a special GLBT Issue in American Journal of Community Psychology, 31(3/4). The paper reports on two studies of GLB content in major community psychology journals: no more than one percent of published articles had been related to GLB issues. Bisexuality is almost totally ignored. See also D'Augelli, 2003.
Heath KV, Miller ML, Martindale SL, Cornelisse PGA, Schechter MT, O'Shaughnessy MV, Hogg RS (1999).  Risk Factors for HIV Infection among Young Aboriginal and non-Aboriginal MSM. Abstract of paper presented at the 8th annual Canadian Conference on HIV/AIDS Research, in May 1999, in Victoria, BC. Internet: .
Jenkins R (2005). Two Spirit Organization Denied By Their Own and the City of Edmonton! PDF Download.
"The Two Spirit Circle of Edmonton Society has been overlooked, forgotten or just downright denied inclusion in the latest edition of "A Guide To Aboriginal Edmonton... Two Spirit peoples and our place in Nehiyaw culture and history in the Edmonton area is beginning to build momentum and we see this "oversight" as a bum p in our road to a full return to the Nehiyaw circle of life. "We give thanks to all the individuals who were responsible for the Guide for forgetting us and by doing so providing us this distinct opportunity to speak our own truth," says Mr. Jenkins. "We've been overlooked, forgotten, denied, bashed, beaten, murdered or ridiculed for too long and it's time to stop and the only way that'll get accomplished is by taking responsibility for ourselves. Indigenous communities throughout the Americas can no longer keep their heads in the sand about the importance of Two Spirit peoples - we need each other as much, if not more, now than we ever did before." A 1994 Health Canada report on suicide indicates that being Aboriginal or Two Spirited (gay, lesbian, transgendered, bisexual, transsexual, intersexed) are two significant risk factors for suicide. Two Spirited peoples are both and it is estimated that up to 30% of teen suicides are related to sexual orientation or gender issues... The Two Spirit Circle of Edmonton Society is a non-profit organization aimed at repatriating and enhancing our traditional roles in Indigenous communities while creating supportive environments within all societies for contemporary Two Spirit peoples. The Circle does not enjoy the luxury of core funding and relies totally on the efforts of a volunteer Board of Directors and the kindness of others."
Jorm AF, Korten AE, Rodgers B, Jacomb PA, Christensen H (2002). Sexual orientation and mental health: results from a community survey of young and middle-aged adults. British Journal of Psychiatry, 180: 423-7.  PubMed Abstract. Full Text.

Australian Bisexual Adults At Greatest Risk: Jorm, 2002

Kingsley C, Mark M (2000). Sacred Lives: Canadian Aboriginal Children and Youth Speak Out About Sexual Exploitation. Internet:
"Over a period of five months, consultations with more than 150 commercially sexually exploited Aboriginal children and youth took place in 22 communities across Canada, consisting of major cities, smaller communities, and more rural areas.
Two young Aboriginal women, Cherry Kingsley and Melanie Mark, co-facilitated the focus groups. In addition to consulting with local agencies prior to entering the communities, they each spent up to two days acquainting themselves with each community before the focus groups took place.
Familiarization consisted of walking the ‘strolls’, putting up posters, and patronizing places where the youth were ‘hanging out’. The youth who participated in the consultations agreed to have a tape recorder present, and for those unable or unwilling to attend, written questionnaires were distributed and collected at the end of each visit.
The tapes and questionnaires were then transcribed, and form the basis of this document. Youth across the country, on reserve and off, in large communities and rural areas told their stories which had common themes. They told about lifetimes of abuse, poverty and discrimination. They told why services do not work for them and what needs to be done to help them and other youth at risk..."
Kozlowicz J (2006). Learning from a tragedy: Tribes across the country taking a new look a teen suicide. Hocak Worak, 20(4), February 22: 3. Internet:

Kruks, G (1991). Gay and lesbian homeless/street youth: issues and concerns. Journal of Adolescent Health 12: 513-8. PubMed Abstract.

Mallon GP (2001). Sticks and Stones Can Break Your Bones: Verbal Harassment and Physical Violence in the Lives of Gay and Lesbian Youths in Child Welfare Settings. Journal of Gay and Lesbian Social Services, 13(1/2): 63-81. Abstract.

Mallon G (1992). Gay and No Place to Go: Assessing the Needs of Gay and Lesbian Adolescents in Out-of-Home Care Settings. Child Welfare, 71(6): 547-556. PubMed Abstract.

"There are many double standards for dealing with gay or lesbian adolescents. Adolescents discovered to be engaged in same-sex encounters are treated differently by the staff than adolescents who are discovered to be engaged in opposite-sex encounters; in some cases, the police have been called in to deal with two same-sex partners. Verbal harassment or physical violence, ordinarily not tolerated by workers in out-of-home care, may be permitted or even encouraged by some staff members when it is directed to the lesbian or gay resident. The common theme, "Oh, we couldn't place a gay resident with the other boys, they would beat him up," is often seen as an acceptable reason for denying gay adolescents a placement.

Gay youths placed in psychiatric facilities for diagnostic assessment or treatment have had to remain long past the usual time for transfer to other placements because no program could be found that was willing to accept males described as effeminate; staff members report that finding an appropriate facility for young lesbians is almost impossible. In other instances, workers have found excellent prospective foster parents for lesbian and gay youths only to have the placements disallowed by supervisors because the prospective foster parents were gay or lesbian couples; some agencies will not consider screening gay and lesbian couples for foster parenthood.

Gay and lesbian youngsters in out-of-home care, like most youngsters in such settings, have painful family histories, often having experienced serious maltreatment. Many of these young people come into placement because they were thrown out of their homes when they revealed their sexual orientation, or they voluntarily and prematurely left their own homes because of their isolation, confusion, or shame about their sexual orientation. In a society that unquestionably expects children to be heterosexual, gay and lesbian adolescents are unprepared for their emerging identity, and there is no readily available framework in which young homosexuals can come to understand and accept their sexual orientation [Hetrick and Martin 1983; Schneider 1988; Savin-Williams 1990; Whitlock 1988]."
Massachusetts Department of Education (2006). Youth Risk Behavior Survey: Index page. Internet: .
McAndrew S, Warne T (2004). Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse. Journal of Psychiatric and Mental Health Nursing, 11(4): 428-34. PubMed Abstract.

McDaniel JS, Purcell D, D´Augelli AR (2001). The relationship between sexual orientation and risk for suicide: Research findings and future directions for research and prevention. Suicide and Life Threatening Behavior, 31: 84–105. PubMed Reference.

McIntyre S (2005). Under the Radar: The Sexual Exploitation of Young Men. PDF Download. Executive Summary. Executive Summary.

McIntyre, S. (2007). Under the Radar: The Sexual Exploitation of Young Men - Manitoba Edition. PDF Download.

McIntyre, S. (2009). Under the Radar: The Sexual Exploitation of Young Men - Western Canadian Edition. PDF Download. PDF Download.

Meyers T, Calzavara LM, Cockerill R, Marshall VW, Bullock SL (1993). Ontario First Nations AIDS and Healthy Lifestyle Survey. National AIDS Clearinghouse, Canadian Public Health Association: Ottawa, Ontario.

Mignone J, O'Neil J (2005). Social capital and youth suicide risk factors in First Nations communities. Canadian Journal of Public Health, 96 Suppl 1: S51-4. PubMed Abstract.
Full Text.

Miller J (1998). A narrative interview with Ann Hartman. Part One: Becoming a social worker. Reflections: Narratives of Professional Helping, 4(3), 56-69.
Ann Hartman reports: “"I remember one of my friends overheard several of the male deans at a social work Dean's meeting communicating with each other saying, 'The lesbians are taking over the field.' I am sure there is still plenty going on underground, as you can imagine. For instance five or six years ago there was a concerted, but rather quiet effort led by some of the deans to keep homosexuality out of the Council on Social Work Education guidelines"
Miller ML, Weber AE, Martindale S, Chan K, Tigchelaar JW, Schechter MT, Hogg RS (1999). Comparison of HIV Incidence and Risk Behaviours between Male Sex Trade Workers and Other Young MSM in an Ongoing Prospective Study. Paper Presented at the 8th annual Canadian Conference on HIV/AIDS Research, in May 1999, in Victoria, BC. Internet: .
Monette L, Albert D, Waalen J (2001). Voices of Two-Spirited Men: A Survey of Two-Spirited Men Across Canada. Internet: -
"The results are based on the surveys from 189 respondents returned during the period April 2000 through February 2001.  The respondents are from British Columbia (n=69), Saskatchewan (n=2), Manitoba (n=62), Ontario (n=41), Quebec (n=9), and Eastern Canada (n=6). The age of the participants ranged from 17 to 62 years (average=34 years, SD=8). The length of time respondents reported residing in their current town or city ranged from 1 week to 49 years (average=12 years, SD=10)."

"The Aboriginal Healing Foundation funds some 953 projects across Canada to assist Aboriginal people to heal from the intergenerational traumas caused by residential schools. It has identified “gays and lesbians” as one of its target groups, having reached approximately 1,500 participants according to an evaluation conducted in 2001. It is disturbing to note that one of the project’s “Expected Outcomes” is
(To) have Two-Spirited aboriginal people speak on traumas which may have led to their sexual preferences/orientations."
"Other factors that place Aboriginal people at risk are outlined in the Ontario Aboriginal HIV/AIDS Strategy (1996). They include the high rates of sexually transmitted diseases, non-consensual sex (sexual assault, incest, abuse), lack of self-esteem, intravenous and injection drug use (IDU), the abuse of alcohol especially in conjunction with other drugs, and limited safer sex education. "For two-spirit people, and in particular two-spirit youth, whose identity may be repeatedly assaulted by racism and homophobia, the risk for suicide is dangerously high" (Manitoba Aboriginal AIDS Task Force, 1998)... our focus group interviews seem to show that urban Aboriginal gays do not seem to identify themselves as two-spirited but rather as "gay"... In a small study of transsexuals (n=40), half of whom were of Aboriginal ancestry, Rekart et al. (1993) found that this group faced serious social difficulties including homelessness, discrimination, physical abuse, racism and homophobia. HIV risk behaviours were common including unprotected receptive anal intercourse (85%), prostitution (90%), and infection drug use with needle sharing (62%).." [Manitoba Aboriginal AIDS Task Force (1998). 11th Annual Two Spirit Gathering. Winnipeg, MB: Manitoba Aboriginal AIDS Task Force. - Rekart ML, Manzon LM, Tucker P (1993, June 6-11). Transsexuals and AIDS. International Conference on AIDS, 9(2). Abstract]

Some Study results: 
"Over 70% have lived on a reserve [72%] and half [49%] have experienced homelessness.  One third have lived in a foster home [34%] [Group Home = 26%, in a Detention Facility: 18%, On The Street - Homeless = 49%].  A small percentage (14%) report that they have lived at a residential school... Three-quarters of our respondents have been affected by unemployment [76%] and almost half have lived in poor housing [45%], been exposed to racism [44%], and experienced poverty {40%].  About one-third have been affected by homophobia [38%], suicide [32%], HIV discrimination [32%], physical [32%] and sexual abuse [31%], and gay bashing [31%]."

Morrow SL (2003). Can the Master’s Tools Ever Dismantle the Master’s House? Answering Silences With Alternative Paradigms and Methods. The Counseling Psychologist, 31(1): 70-77. Abstract.
It is no surprise that lesbian, gay, and bisexual (LGB) people of color, bisexual women and men, lesbian women, LGB people with disabilities, and transgendered people remain underrepresented in the LGB literature at a time when gains are steadily—although admittedly not with overwhelming speed— being made in counseling psychology’s social justice agendas. Why is it that these populations continue to be underrepresented and marginalized in an already sparse literature base, and how might counseling psychologists remedy existing oversights in the next decade? ... Phillips et al. (2003) suggested that racism in psychology and the LGB community, as well as heterosexism in cultures of color, have contributed to the marginalization of LGB people of color in the LGB and multicultural literatures. I would agree, and I further propose that because LGB people of color are such a small minority in both communities, that these scholars are in a particular bind characteristic of individuals who hold multiple identities. Smith (1997) argued that the LGB person of color, having “survived the battles of other forms of oppression” over which he or she has no control, “may proactively choose not to take on yet another hardship by coming out” (p. 288). In addition, for many LGB scholars of color, race as a visible marker of one’s minority status may be more salient than sexual orientation. In academic environments where conducting research on either race or minority sexual orientation may result in marginalization, to do both in tandem may doubly jeopardize the individual’s professional standing..."
Smith A (1997). Cultural diversity and the coming-out process: Implications for clinical practice. In B. Greene (Ed.), Ethnic and cultural diversity among lesbians and gay men (pp. 279-300). Thousand Oaks, CA: Sage.
New York State Office of Children and Family Services (2006). Manual: Working Together: Health Services for Children in Foster Care. Internet: . See Chapter 3: Special Health Care Services, Part 3: Services for gay, lesbian, bisexual, transgender, and questioning youth. Internet: 3 Special HC Services.pdf.
Note: In Chapter 3, the following is stated: "Be aware of cultural issues related to sexual orientation and self-identification." However, no related information is given and American Indians are not mentioned. It should be noted, however, that American Indian Children are apparently not overrepresented in foster care (1%), while African American children are overrepresented (46%). See: Foster Care 1999. Internet: .
O'Brien CA, Travers, R, Bell L (1993). No Safe Bed: Lesbian, Gay and Bisexual Youth in Residential Services. Toronto: Central Toronto Youth Services. Abstract.
Olson LM, Wahab S (2006). American Indians and suicide: a neglected area of research. Trauma, Violence and Abuse, 7(1): 19-33.  PubMed Abstract.
Paul JP, Catania J, Pollack L, Moskowitz J, Canchola J, Mills T, Binson D, Stall R (2002). Suicide attempts among gay and bisexual men: lifetime prevalence and antecedents. American  Journal of Public Health, 92(8): 1338-45.  PubMed Abstract. Full Text: PDF Download. PDF Download.
The Sample (N = 2,881 males, age range = 18–86 years, median age= 37 years): "The data reported here were derived from the Urban Men’s Health Study, a household probability-based sample of MSM (operationalized as either having had sex with a male since age 14 or self-identifying as gay or bisexual) in 4 US cities (Chicago, Ill; Los Angeles, Calif; New York, NY; and San Francisco, Calif)." Native Americans had the highest lifetime incidence for having attempted suicide (30% vs. approx. 12% for other MSM males) and the highest incidence for having attempted suicide before the age of 25 (25% vs approx. 8% for other MSM males). The mean age of the first suicide attempt for white males = 23.7 years, for Native American males = 18.2 years, and for African American, Asian/Pacific Islander, and Latino males = 18.9-20.0 years.

"This study provides further epidemiological evidence that gay and bisexual males--particularly younger gay and bisexual males--constitute a high-risk group for attempted suicide. Although our prevalence estimates for suicidal ideation and behavior are somewhat lower than those from prior research cited in the introduction, the seriousness of this health concern remains. Any population in which 21.3% report ever making a suicide plan and 11.9% report prior suicide attempt(s) demonstrates much greater risk than the general population. By comparison, in 2 different US population-based studies focused on mental health (the National Institute of Mental Health Epidemiologic Catchment Area study and the National Comorbidity Survey), the prevalence levels for lifetime suicidal ideation among males were 8.87% (± 0.44%) and 14.66% (± 0.81%), respectively.(58) The prevalence levels for lifetime suicide attempts were 1.52% (± 0.19%) and 3.19% (± 0.40%), respectively. Despite the need for caution in comparing data from different sources, these rates suggest that US gay and bisexual males have more than a 3-fold increased risk of ever attempting suicide in comparison with their heterosexual male counterparts." P. 1342

58. Weissman MM, Bland RC, Canino GJ, et al (1999). Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, 29(1): 9-17. PubMed Abstract.
Other Studies Published on the Urban Men's Health Study:
Paul JP, Pollack L, Osmond D, Catania JA (2005). Viagra (sildenafil) use in a population-based sample of U.S. men who have sex with men. Sexually Transmitted Diseases, 32(9): 531-3.  PubMed Abstract. PDF Download.

Arreola SG, Neilands TB, Pollack LM, Paul JP, Catania JA (2005). Higher prevalence of childhood sexual abuse among Latino men who have sex with men than non-Latino men who have sex with men: data from the Urban Men's Health Study. Child Abuse and Neglect, 29(3): 285-90. PubMed Abstract.

Greenwood GL, Paul JP, Pollack LM, Binson D, Catania JA, Chang J, Humfleet G, Stall R (2005). Tobacco use and cessation among a household-based sample of US urban men who have sex with men. American Journal of Public Health, 95(1): 145-51. PubMed Abstract. PDF Download. PDF Download.

Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA (2003). Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. American Journal of Public Health, 93(6): 939-42. PubMed Abstract. PDF Download. PDF Download.

Stall R, Paul JP, Greenwood G, Pollack LM, Bein E, Crosby GM, Mills TC, Binson D, Coates TJ, Catania JA (2001a). Alcohol use, drug use and alcohol-related problems among men who have sex with men: the Urban Men's Health Study. Addiction, 96(11): 1589-601. PubMed Abstract.

Binson D, Woods WJ, Pollack L, Paul J, Stall R, Catania JA (2001). Differential HIV risk in bathhouses and public cruising areas. American Journal of Public Health, 91(9): 1482-6.  PubMed Abstract. PDF Download. PDF Download.

Mills TC, Stall R, Pollack L, Paul JP, Binson D, Canchola J, Catania JA (2001). Health-related characteristics of men who have sex with men: a comparison of those living in "gay ghettos" with those living elsewhere. American Journal of Public Health, 91(6): 980-3. PubMed Abstract. PDF Download. PDF Download.

Catania JA, Osmond D, Stall RD, Pollack L, Paul JP, Blower S, Binson D, Canchola JA, Mills TC, Fisher L, Choi KH, Porco T, Turner C, Blair J, Henne J, Bye LL, Coates TJ (2001). The continuing HIV epidemic among men who have sex with men. American Journal of Public Health, 91(6): 907-14. PubMed Abstract. PDF Download. PDF Download.

Catania JA, Canchola J, Pollack L, Chang J (2006). Understanding the Demographic Characteristics of Urban Men Who Have Sex with Men. Journal of Homosexuality, 51(3): 33-51.  - Catania JA, Canchola J, Pollack L, Chang J (2006). Understanding the Demographic Characteristics of Urban Men Who Have Sex with Men. Paper presented at Proceedings of the Annual Meeting of the American Statistical Association, August 5-9, 2001. Internet:

Paul JP, Catania J, Pollack L, Stall R (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men's Health Study. Child Abuse and Neglect, 25(4): 557-84.  PubMed Abstract.

Stall R, Pollack L, Mills TC, Martin JN, Osmond D, Paul J, Binson D, Coates TJ, Catania JA (2001b). Use of antiretroviral therapies among HIV-infected men who have sex with men: a household-based sample of 4 major American cities. American Journal of Public Health, 91(5): 767-73. PubMed Abstract. PDF Download. PDF Download.

Relf MV, Huang B, Campbell J, Catania J (2004). Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men. Journal of the association of Nurses in AIDS Care, 15(2): 14-26. PubMed Abstract. PDF Download. PDF Download.

Greenwood GL, Relf MV, Huang B, Pollack LM, Canchola JA, Catania JA (2002). Battering victimization among a probability-based sample of men who have sex with men. American Journal of Public Health, 92(12): 1964-9.  PubMed Abstract. PDF Download. PDF Download.

Dolcini MM, Catania JA, Stall RD, Pollack L (2003). The HIV epidemic among older men who have sex with men. Journal of Acquired Immune  Deficiency Syndrome, 33, Supplement 2: S115-21. PubMed Abstract. PDF Download.

Mills TC, Paul J, Stall R, Pollack L, Canchola J, Chang YJ, Moskowitz JT, Catania JA (2004) . Distress and depression in men who have sex with men: the Urban Men's Health Study. American Journal of Psychiatry, 161(4):776. PubMed Abstract. Full Text: PDF Download.
Pedersen W, Hegna K (2003). Children and adolescents who sell sex: a community study. Social Science and Medicine, 56(1): 135-47. PubMed Abstract.

Phillips JC, Smith GS, Mindes EJ (2003). Methodological and content review of lesbian-, gay-, and bisexual-related articles in counseling journals: 1990-1999. The Counseling Psychologist, 31(1): 25-62. Abstract
Remafedi (1999). Suicide and sexual orientation: nearing the end of controversy? Archives of General Psychiatry, 56(10): 885-6. PubMed Reference. Full Text. Note: This was in response to two major papers published in the same issue of Archives of General Psychiatry. One paper reported on the lifetime greater risk for having attempted suicide by adult homosexually oriented males [Herrell R, Goldberg J, True WR, Ramakrishnan V, Lyons M, Eisen S, Tsuang MT (1999). Sexual orientation and suicidality: a co-twin control study in adult men. Archives of General Psychiatry, 56(10): 867-74. PubMed Abstract. Research Results. Full Text.] and the other paper reported on the "at risk" status of homosexually oriented male and female youth in a longitudinal study carried out in New Zealand: Fergusson DM, Horwood LJ, Beautrais AL (1999). Is Sexual Orientation Related to Mental Health Problems and Suicidality in Young People? Archives of General Psychiatry, 56(10): 876-880. PubMed Abstract. Research Results. Full Text.  In addition to Remafedi's commentary, the following were also published: Friedman RC (1999). Homosexuality, psychopathology, and suicidality. Archives of General Psychiatry, 56(10): 887-888. PubMed Reference. Bailey JM (1999). Homosexuality and Mental Illness. Archives of General Psychiatry, 56(10): 883-884. PubMed Reference.
Herrel et al. (1999) Research Results: "Same-gender sexual orientation is significantly associated with each of the suicidality measures. Unadjusted matched-pair odds ratios follow: 2.4 (95% confidence interval [CI], 1.2 - 4.6) for thoughts about death; 4.4 (95% CI, 1.7 - 11.6) for wanted to die; 4.1 (95% CI, 2.1 - 8.2) for suicidal ideation; 6.5 (95% CI, 1.5 - 28.8) for attempted suicide; and 5.1 (95% CI, 2.4 - 10.9) for any of the suicidal symptoms. After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7 - 8.81)."
Fergusson et al. Research Results: "Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3)."
Robin L, Brener ND, Donahue SF, Hack T, Hale K, Goodenow C (2002). Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatric and Adolescent Medicine, 156(4): 349-55. PubMed Abstract. PDF Download.

Alltempted Suicide, Past 12 Month, Robin et. al., 2002
Attempted Suicide Incidence = In The Past 12 Months

Rothblum ED (1994). "I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men. Journal of Consulting and Clinical Psychology, 62(2), 213-20. PubMed Abstract.

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"2-Spirited People of the 1st Nations (TPFN) became an organization in Toronto in 1989. They recently released a report titled, “Voices of Two-Spirited Men: A Survey of Two-Spirited Men Across Canada” (Monette, Albert & Waalen, 2001). This initiative demonstrates the new paradigm of Aboriginal community based research, being that Aboriginal people ask the questions, own the research agenda, and ensure that the community is aware of the findings. The survey had 189 respondents from six regions of Canada. Half reported that they were HIV-positive and most identified as Two Spirits (58%) or gay (48%), some using both terms. The report concludes, "The core issue of homophobia must be addressed if we seriously hope to see a reduction in risk-taking behaviour among Two-Spirited men. There are too many Two-Spirits who are excluded from the circle, estranged from their traditions, families, and communities. Our survey respondents have shown us their deep craving for self-esteem, familial love, community belonging, and spiritual connection. If their families and reserves reject them – if their traditional healers, elders, and teachers denounce them – they will try to find what they are seeking elsewhere. More than any other factor, it is the sense of alienation that contributes to engaging in the high-risk activities that make them vulnerable to HIV/AIDS. The painkiller used, and the dosage, is as individual as the pain and the pain threshold.""
Saewyc EM, Bauer GR, Skay CL, Bearinger LH, Resnick MD, Reis E, Murphy A (2004). Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys. Journal of Adolescent Health, 35(4):345.e1-e15.  PubMed Abstract. PDF Download. PDF Download.

Saewyc EM, Skay CL, Bearinger LH, Blum RW, Resnick MD (1998). Demographics of sexual orientation among American-Indian adolescents. American Journal of Orthopsychiatry, 68(4): 590-600. PubMed Abstract. PDF Download.
SIEC Alert 52 (2003). Suicide Among Canada's Aboriginal Peoples. Centre for Suicide Prevention, Calgary, Alberta. Internet: .

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Strickland CJ, Walsh E, Cooper M (2006). Healing fractured families: parents' and elders' perspectives on the impact of colonization and youth suicide prevention in a pacific northwest American Indian tribe. Journal of Transcultural Nursing, 17(1): 5-12. PubMed Abstract.

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Van Voorhis R, Wagner M (2001). Coverage Of Gay And Lesbian Subject Matter In Social Work Journals. Journal of Social Work Education, 37(1): 147-159. Abstract. Full Text

Van Voorhis R, Wagner M (2002). Among the Missing: Content on Lesbian and Gay People in Social Work Journals. Social Work, 47(4): 345-54. PubMed Abstract. Full Text.

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Vernon IS, Jumper-Thurman P (2002). Prevention of HIV/AIDS in Native American communities: promising interventions. Public Health Reports, 117 Supplement 1: S96-103. PubMed Abstract. PDF Download.

"Homophobia is a social factor that may increase HIV infection. Levels of acceptance, tolerance, and discrimination toward gay and bisexual tribal members may vary somewhat from location to location, but in many Native American societies the treatment of gays coincides with the attitude of the dominant society - discrimination. When associated with homosexuality, HIV/AIDS can become hidden, with devastating results. These results include participating in risky sexual behavior because of a lack of information about the risk, failure to seek medical treatment, and spreading the disease unknowingly. To address homophobia, Native American communities will need to change community norms and attitudes; that is a difficult task."
Vinnerljung B, Hjern A, Lindblad F (2006). Suicide attempts and severe psychiatric morbidity among former child welfare clients - a national cohort study. Journal of Child Psychology and Psychiatry, 47(7): 723-33. PubMed Abstract.
"Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18–27. Results: Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood... Sex and year of birth standardised risk ratios... follow a similar pattern for suicide during adolescence (13-17) and young adulthood (19+). We find a four- to five-fold excess risk for the child welfare groups compared to the general population, and these risks are about twice as high as the risks for inter-country adoptees. When parental psychosocial risk, socio-economic factors and ethnicity are adjusted for in model 2, risk ratios are lowered to around twofold for all child welfare groups, in both age periods."

"Sex-specific results: Child welfare boys tended to have higher adjusted relative risks than girls for hospitalisations in adolescence with any psychiatric diagnosis after adjustmentsin model 1. The in-home-care boys had a RR of 7.6 while in-home-care girls had a relative risk of 3.6 compared with same-sex peers in the general population (p < .001). For former residents of shortand long-term care the pattern was similar: a relative risk of 7.9 for boys versus 4.6 for girls (p < .001) in the former group and 9.8 for boys versus 6.4 for girls (p < .05) in the latter. The boys in the in-home-care group also had an almost threefold excess relative risk compared to in-home care girls for having been hospitalised in young adulthood with a psychiatric diagnosis (RRs 6.2 versus 2.2; p < .01). For other outcomes examined in model 1 (suicide attempts, psychosis and depression), there were no statistically significant sex differences, and no reasonably strong consistent tendencies. When adjusting for socio-economic background and parental risk factors in model 2, no statistically significant sex differences or consistent sex-specific tendencies remained."
Walters KL (2006). “My Spirit In My Heart”:  Identity Expressions and Challenges Among American Indian Two-Spirit Women - Mixed Methodology: The Honor Project -: Two-Spirit Health Study: 5-Year Multi-Site National Study 2002-2007. PowerPoint Presentation N/A. Walters K, Evans-Campbell T, Simoni J, Ronquillo T, Bhuyan R ( 2006). “My Spirit in My Heart”: Identity Experiences and Challenges among American Indian Two-Spirit Women. Journal of Lesbian Studies, 10(2/3): 125-149. Abstract. Full Text.
Overview: There is little research addressing the health and mental health concerns as well as HIV risks and prevention needs of American Indians and Alaskan Natives who are lesbian, gay, bisexual, transgendered, or two-spirited (two-spirit). Overall epidemiological data point to this group  as one at potentially high risk for HIV, poor mental health, and high rates of suicidality because of adverse socio-demographic indices, and high rates of traumatic stressors, including sexual and physical trauma.

Colonization and Two Spirit Roles: Ceremonial and social roles deteriorated with intrusion of non-AI/AN belief systems and Christianity. - Boarding school experience has stripped many Nations from traditional understandings of sexuality and gender roles. - Migration of two-spirits to urban centers seeking mutual support and connections. - Many urban two-spirits (especially 3rd and 4th generation) and many heterosexual AI/ANs have little to no ancestral information regarding their two-spirit relatives.

Discrimination and Two-Spirits... Racism in non-AI/AN LGBT communities: Objectification or eroticization of Native - images, terms, etc. - Denial of admittance to gay bars: Asked for multiple pieces of identification. - Invisibility in LGBT settings & Dominance of Eurocentric worldviews... Heterosexism in AI/AN communities: Denial of existence and history: Same sex relations is a “white thing”. - Shunning or being kicked/harassed out of communities or ceremonies (e.g., Native woman and Sun Dance). - Avoidance of discussing the subject. - Cultural beliefs that nonheterosexual behavior is sinful, immoral or against traditions (e.g., uninvited to sweat).

Literature Review: 2-Spirit Trauma & Mental Health: Significantly high rates of traumatic stress and abuse in preliminary studies with two-spirit populations. - Significant differences between heterosexual Natives and two-spirits with respect to Child abuse exposure, historical trauma, mental health indicators (anxiety, depression, PTSD). - Early onset of alcohol use, drinking styles (improve sociability and manage mood), and lifetime illicit drug use. - Findings suggest that a triangle of risk consisting of trauma, AOD use, and sexual risk exist for Natives in general, with two-spirits having very high levels of stress exposure and subsequent health and behavioral consequences.

To 2003, 73% of American Indian AIDS cases have been Native 2-spirit MSMs: 56% MSM Non-Injection-Drug-Users & 17% MSM IDU Users.

Honor Project Participants N=178 (Males = 64%, Females = 35%), Sexual Orientation: 95% GLBT and 5% Hetero/MSM/WSW, 17% had been adopted and 22% experienced foster care. Boarding School 21% attended Indian boarding schools.

Attempted Suicide: 52/170 = 30.6% - About the same for males and females. Respondents whose parents went to boarding school were more likely than the respondents whose parents did not go to boarding school to report higher levels of suicide attempts (X²=14.52**). Domestic violence was associated with suicide attempts. Sexual assault by a stranger was associated with lifetime suicide attempts and suicidal thoughts in the last year. These are preliminary findings.
Some Traumatic Events (More Given)
Preliminary Findings

Traumatic Event
Males, N =  108
Females, N = 60
Non-sexual assault by a family member or someone you know
Non-sexual assault by a stranger
Sexual assault by a family member or someone you know 44%
Sexual assault by a stranger
Sexual contact when you were younger than 18 with
someone who was 5 or more years older than you.

Walters KL (1997). Urban lesbian and gay American Indian identity: Implications for mental health service delivery. Journal of Gay and Lesbian Social Services, 6(2): 43-65. Abstract. Also published as a part of the book "Two Spirit People: American Indian Lesbian Women and Gay Men" edited by Brown (1997).

Walters KL, Simoni JM (2004). HIV Prevention Issues Among American Indian and Alaska Native “Two-Spirits.”  The Linkage: Newsletter of The Behavioral and Social Science Volunteer Program. Summer, 2004. PDF Download.
Traditionally, “two-spirit” peoples were American Indians or Alaska Natives who occupied a third or fourth gender role in their society and who often were responsible for esteemed cultural, social, and ceremonial roles. Contemporarily, the term “two-spirit” has come to signify the fluidity of gender identity (beyond the dualistic notion of male/female) and of sexuality (beyond the Western notion of nonheterosexual) that characterizes some American Indians and Alaska Natives (hereafter referred to as “Natives”). In urban settings, many gay, lesbian, bisexual, and transgendered (GLBT) Natives identify as “two-spirited.” There is a paucity of research and few culturally relevant services addressing the health concerns and HIV risk and prevention needs of two-spirits. In this article, we overview elements of an indigenist stress-coping model for use in HIV prevention research and practice, CDC surveillance data on Natives, key research findings related to two-spirits and HIV risk, and our current research project on the topic....

Specific research on sexuality and sexual orientation among two-spirits is limited to a few recent studies (i.e., Saewyc et al., 1996; 1998). Findings indicate that, compared to non-Natives, Native youth have a higher prevalence of self-reported GLBT identities and a higher prevalence of sexual risk factors (e.g., histories of abuse or running away); earlier onset of heterosexual intercourse; and, among Native lesbian and bisexual girls, more frequent intercourse. Additionally, Native MSM’s frequent intercourse, ineffective use of contraception, and exposure to physical abuse were associated with involvement with pregnancy (Saewyc et al., 1998). There are no published studies of adult two-spirits and HIV risk.... Recent anecdotal and empirical evidence suggests that, indeed, two-spirits are at higher risk for trauma than their Native heterosexual and non-Native GLBT counterparts. Two-spirits not only contend with racism and colonization from non-Natives (heterosexual as well as GLBT) but also must deal with pervasive heterosexism or homonegativity in Native  communities...

Our NIMH-funded HONOR Project is the first study to focus on HIV risk among urban two-spirits. Grounded in the indigenist stresscoping model, it examines the interrelationships among traumatic stress exposures, substance use, mental health, and HIV risk behaviors among 72 two-spirit community leaders and 400 two-spirit individuals across six sites: Los Angeles, San Francisco/Oakland, Seattle/Tacoma, Tulsa, Minneapolis/St. Paul, and New York City. The primary focus of the study is to identify the strengths of two-spirits that lead to adaptive health behaviors despite exposure to traumatic events. Additionally, the project will assist in building the research infrastructure at the local agency level in order to facilitate the design and evaluation of culturally relevant interventions and programs for two-spirits across the country..." (See: Walters, 2006)
Walters KL, Simoni JM, Horvath PF (2001). Sexual Orientation Bias Experiences and Service Needs of Gay, Lesbian, Bisexual, Transgendered, and Two-Spirited American Indians. Journal of Gay and Lesbian Social Services, 13(1/2): 133-149. Abstract.
AI GLBTT-S must contend with pervasive racism within non-AI lesbian and gay male communities (Walters, 1997) as well as homophobia within AI communities (Deschamps’, 1998; Meyers, Calzavara, Cockerill, Marshall, & Bullock, 1993; Sullivan, 1991)... Survey procedures. Data collection took place at an AI community based agency located in an urban setting in the northeastern United States. The principal investigator (the first author, who is AI) invited every employee of the Center as well as a purposive sample of AI GLBTT-S known to her from outside the Center to participate in the survey...

Findings revealed the percentages of AI GLBTT-S who had experienced various kinds of sexual orientation bias experiences were equal to or greater than those reported in studies of non-AI GLBT populations: verbal harassment (100% vs. 52-87%), target of objects thrown (36% vs. 25-38%), being chased (57% vs. 13%-38%), physical assault (36% vs. 9%-24%), assault with a weapon (36% vs. 4-10%); and sexual assault (29% vs. 5-14%)...

Invisibility. Four of the seven focus groups specifically discussed how invisibility (both as an AI in the GLBT community and a GLBTT-S in the AI community) is a general problem as well as a barrier to accessing services.Many groups contextualized the invisibility problem as stemming from the colonization process and the entrenched stereotypes that exist within the non-AI imagination. For example, one group member stated, ‘‘So many myths and stereotypes persist . . . most  [non-AI city people] think we live in the West or on a reservation.’’ Invisibility within AI communities makes it difficult for AI GLBTT-S to identify each other for social support. Many participants commented on an ‘‘automatic heterosexual assumption--where [AI] community members just don’t consider being gay or lesbian as a possibility or a Native reality.’’...

Discrimination. Dealing with the racism in the non-AI GLBT community and in society in general as well as the homophobia within the AI community were identified as critical issues. As one GLBTT-S participant pointed out, ‘‘There’s still gay stigma where you are seen as abnormal.’’... In terms of the homophobia within the AI community, many identified reservation-based attitudes as being very hurtful to AI GLBTT-S. For example, one participant stated, ‘‘Some say they [AI GLBTT-S] should be on an island of their own.’’ Others gave specific examples of AI people being asked to leave their reservation when they publically disclosed their sexual orientation... Several participants stated that AI GLBTT-S youths who run away or are exiled from the reservation come to the city for support but only encounter more trauma. As one participant said, ‘‘Runaways from the rez and Mexico are easy targets for gay porn, prostitution, and survival sex. For transgender youth, there is major job discrimination.’’

Trauma. Nearly all participants stated that dealing with historical and cumulative traumas is a serious concern. Fear of anti-gay violence specifically was palpable in the two-spirits’ focus group and was broached in other focus groups as well. Openly gay AI men were seen as particularly vulnerable. Domestic violence within the AI GLBTT-S  community was also identified as another concern facing AI GLBTT-S, with one participant commenting, ‘‘Mental and emotional abuse are forms of domestic violence that are not addressed in the general population and especially not addressed among gays, lesbians, or bisexuals.’’ Many focus group participants identified binge drinking as a way to deal with trauma: We drink to ‘‘numb the pain of being gay’’ and to ‘‘deal with parental and cultural anti-gay attitudes.’’...

Identity. All focus groups mentioned identity as a critical issue. Some of the two-spirited participants indicated feeling lost. One stated, ‘‘Because of colonization, many of us have lost the social and spiritual context of who we are. We are always in a crisis mode in [the city], trying to hold onto traditions while dealing with the [city’s] gay scene.’’...

Weber AE, Craib KJP, Chan K, Martindale S, Miller ML, Schechtera MT, Robert S. Hogg RS (2001). Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men. International Journal of Epidemiology 2001, 30: 1449-1454. Internet: .

Wensley KH (2006). Aboriginal Children and Child Welfare: An Overview of Recent Changes. Internet: . [Kim Hart Wensley: UVIC Faculty of Law]

1980-1981: 4.6% of all First Nations children are in agency care. In contrast, only 0.96% of all children in Canada are in agency care.
1992-1993: 4.1% of all First Nations children are in agency care. In contrast, only 0.6% of all children in Canada are in agency care.
Alberta - 1994: 9% of children in province are First Nations; 50% of children in care are First Nations.
Manitoba – 2001: 21% of children in province are First Nations; 78% of children in care are First Nations.
British Columbia- 2002: 8% of children in province are First Nations; 43% of children in care are First Nations.

White, Jennifer & Jodoin, Nadine (2003). Aboriginal Youth: A Manual of Promising Suicide Prevention Strategies. Centre for Suicide Prevention/
Suicide Prevention Training Programs, Calgary, Alberta. Internet:  - .
"Sexual orientation or “two-spirited” issues Traditionally, two-spirited persons (lesbian, gay, transgendered and bisexual) were valued in many Native communities as they were considered to have a great gift of vision that went beyond most people’s abilities. Two-spirited people were not only considered normal, but a crucial and much needed part of the natural world and of the community as a whole. Like the non-Aboriginal community, First Nations, Inuit and Métis communities have grown to fear and reject members who are sexually different. As a result, most two-spirit and transgendered Aboriginal young people live with high levels of discrimination and intolerance which often prompts them to leave their community and move to a larger urban setting where they experience loneliness, isolation and are vulnerable to victimization. We know that gay, lesbian, and bisexual youth are at greater risk for suicide problems than their heterosexual counterparts.10 Recent studies in Canada and the United States suggest that homosexuality issues are involved in up to one third of young men under 24 who commit suicide. Relevant data also suggest that Aboriginal gay youth are often subjected to high levels of homophobia and have serious suicidality problems.11"
10. Remafedi G. (1999). Sexual Orientation and Youth Suicide (Review). Journal of the American Medical Association, 282, 1291-1292.

11. Bagley C, Tremblay P (1997). Suicidality problems of gay and bisexual males: Evidence from a random community survey of 750 men aged 18 to 27. In C. Bagley & R. Ramsay, (Eds.). Suicidal Behaviours in adolescent and adults: taxonomy, understanding and prevention. Brookfield, Vermont: Avebury. [Note: The peer reviewed paper was published as: Bagley C, Tremblay P (1997). Suicidal behaviors in homosexual and bisexual males. Crisis, 18(1): 24-34. PubMed Abstract.]

Wilber S, Ryan C, Marsamer J (2006). Best practice guidelines : serving LGBT youth in out-of-home care. Child Welfare League of America, Inc. Washington, D.C. Internet: PDF Download.

Wilson A (1996). How We Find Ourselves: Identity Development and Two-Spirit People. Harvard Educational Review, 66(2). Internet: .

Wilson JF (2000). Two-Spirited Youth Program. Healing Words, 2(4): 33. Internet: .
"Since the 1998 announcement of Gathering Strength - Canada’s Aboriginal Action Plan and the subsequent creation of the Aboriginal Healing Foundation, many worthwhile projects have emerged across the country to allow the process of healing to begin. The Two-Spirited Youth Program (TSYP) is one such project.The TSYP has been in operation since July 1999, specifically designed to focus on “intergenerational” impacts, as referenced in the Aboriginal Healing Foundation’s mission “to encourage and support Aboriginal people in building and reinforcing sustainable healing processes that address the legacy of physical and sexual abuse in the residential school system, including intergenerational impacts.” The program is administered under Vancouver’s Urban Native Youth Association by Gil Lerat, a chemical dependency specialist by profession.“The statistics are out there,” says Mr. Lerat, “Just look at the number of teen suicides on reserves. It’s really hard for two-spirited youth to ‘come out’ and the statistics show that approximately 70 percent of the Aboriginal teen suicides that are happening on reserves today is by two-spirited youth. That’s startling! In a small close-knit community when somebody is two-spirited, because of the homophobia and the ridicule that they may go through, the only natural thing for them, they believe, is death. This is very sad, because most of the First Nation two-spirited people that I have met are very intelligent, smart people. It’s scary to think that we are allowing our youth to die because of who they are.”"
Zoccole, A, Ritock, J, Barlow K, Seto J (2005). Addressing Homophobia in Relation to HIV/AIDS in Aboriginal Communities: Final Report of the Environmental Scan 2004-05. Canadian Aboriginal AIDS Network. Internet: .