Vignette

The bus was late again. Sari was used to this. Since ‘hitting’ the streets, she needed the bus to get around. Aged 16, Sari had been homeless for three months. Originally, she stayed at a young people's shelter, but ran away when slurs like “queer bitch” from other young people became too much. The staff knew and did not seem to care.

Sari preferred staying on her own, sometimes couch-surfing with her girlfriend or making enough money selling marijuana to stay in a cheap motel. Sari did not have to sleep in an alley yet. She refused to sell her body, but she knew more than anything that she did not want to return to her mother's home.

Her mother couldn't understand why Sari was ‘different’. Sari referred to herself as female but disliked labels; she felt the same about ‘lesbian’ or ‘straight’. Her very religious mother thought Sari's lifestyle was against God's will, and reacted by verbally and physically abusing Sari. On the street, Sari was determined to make it on her own. Yet quietly, she was not always sure how.

Introduction

Although Sari is fictional, her experience at the youth people's shelter, meant to be a safe haven, is common. Lesbian, gay, bisexual and trans (LGBT) young people in the United States (US), despite advances in legal protections and cultural visibility, still face barriers in accessing culturally competent care throughout service delivery systems. Trans young people, homeless LGBT young people and LGBT young people involved in child welfare and juvenile justice systems are highly vulnerable to stigmatisation, victimisation and inadequate, insensitive service delivery. The US lags behind other countries in applying a human rights framework in assessing social, cultural and economic policies (Reichert, 2007). Human rights language is absent from the Institute of Medicine's report on the health of LGBT Americans (IOM, 2011) and from Healthy People 2020 – the federal government's 10-year national health promotion agenda (USDHHS, 2010). However, both reports draw attention to social determinants associated with physical and mental health disparities affecting LGBT citizens (that is, stigmatisation, violence, oppression and discrimination).

LGBT young people frequently experience policies and practices within US service delivery systems that violate the Convention on the Rights of the Child (UN, 1989), which the US has not ratified.