LGBTQ2S (lesbian, gay, bisexual, transgender, transgender, queer,  questioning, two spirit) youth experiencing homelessness are in a particularly vulnerable state when it comes to managing their sexual and reproductive health. In addition to the obstacles they face as youth and individuals experiencing homelessness, they face discrimination as a sexual and gender minority. The risks associated with each of these factors interfere with their ability to maintain their sexual and reproductive health. Oftentimes, they have limited access to healthcare services when they experience health problems. That is, if they can access healthcare services at all.

Sexual and Reproductive Health of Individuals Experiencing Homelessness

For those experiencing homelessness, it is incredibly difficult, and at times impossible, to access healthcare services. Without a permanent address, they are unable to obtain a health card or to make a healthcare appointment. Additionally, they cannot afford items that aren’t covered by provincial medical or drug insurance plans. Often they do not receive sufficient care from providers who might discriminate against them based on their homelessness. Even if they are able to access services, they may not have a safe or appropriate space for recuperation after a hospital stay, or have someone to give them care if they are in an especially fragile state.

Additionally, for those experiencing homelessness who menstruate, there exists an additional financial need that cannot be met with their lack of funds. Not only is it a matter of hygiene and dignity, but the inability to upkeep menstrual hygiene can lead to damage to reproductive and gynecological health. Those who are forced to choose cheaper homemade menstruation products, rather than the safer store-bought products, can experience chemical irritation and yeast infections. Moreover, they are at a significantly higher risk of life threatening conditions such as toxic shock syndrome.

Furthermore, those experiencing homelessness who are also pregnant face increased reproductive health risks due in part to their inability to access prenatal programs. This lack of access can result in serious complications going unnoticed and the additional strain of being pregnant while homeless can be life threatening.

LGBTQ2S youth experiencing homelessness            

It is important to consider the unique experience of LGBTQ2S youth experiencing homelessness, as rates of homelessness are disproportionately high within this population. In the United States, 40% of homeless youth identify as LGBTQ2S. In Canada, the rate ranges from 25-40%; meanwhile, only 5-10% of the total population identifies as LGBTQ2S. It is shocking to note that on average, at only 14.4 years of age, youth identifying as LGBTQ2S find themselves without a home. This is about the same age they should be starting high school. Even more troubling is that this average age drops to 13.5 years for transgender youth. As such young people, being faced with hardship so early in their lives, their sexual and reproductive health risks are compounded.

Sexual health Risks of LGBTQ2S Youth

To start, those who are low income earners are twice as likely not to use contraceptives as high income earners.  Meanwhile, youth experiencing homelessness must face financial strain as well as their increased tendency to behave impulsively. At the adolescent stage of their cognitive development, they tend to be thrill seeking, meanwhile, their cognitive system to regulate these impulses is slow to mature. This finding suggests that youth are more likely to partake in risky behaviour; including risky sexual behaviour. Therefore, along with the financial burden of contraceptives, increased exposure to sexual activity, and the inability to access family planning programs, youth experiencing homelessness are even more vulnerable to STI exposure and unplanned pregnancy.

Among the population of those experiencing homelessness, there is a higher incidence of HIV/ aids, when compared to the general population, due to their compromised immune systems, poor nutrition and hygiene, and frequent overcrowding at shelters. LGBTQ2S youth are at a higher risk for HIV as well. Meanwhile, the risk is even higher for LGBTQ2S youth experiencing homelessness, because they bear both the risk for those experiencing homelessness and those of the LGBTQ2S community.

Public Health Canada has found that a high proportion of street youth have reported not using condoms with both male and female partners. However, males were least likely to report using condoms with their same sex partners; though little is known about why this is the case. Regardless, it is important to understand that the risk of serious sexually transmitted illnesses is particularly high within this population.

Unfortunately, when LGBTQ2S youth do reach out for health care services, they are particularly likely to receive unfair treatment and stigmatization because they belong to a sexual or gender minority. What’s more is that Indigenous LGBTQ2S individuals face additional stigmatization and discrimination due to racism. Transgender youth are particularly at a disadvantage as they report obstacles in accessing supportive and knowledgeable health care. The healthcare needs of transgender youth differ greatly from that of others. For instance, They may choose to start hormones which require monitoring and regular blood work. Lack of supports has lead to trans youth turning to street suppliers for transition-related treatments which can cause severe health complications. 

Needs for the Sexual Health of LGBTQ2S youth experiencing Homelessness

In light of these findings, LGBTQ2S youth who are experiencing homelessness have a specific set of supports that they require to protect their sexual and reproductive health; though it must be noted that this is not an exhaustive list. First, they need access to contraceptives, to protect them from STIs and pregnancy. They require access to health care services if they do become pregnant or ill, to prevent the worsening of their conditions. This healthcare must not require a health card, as it is unlikely that an individual experiencing homelessness will have the permanent address necessary to acquire such documentation.

Moreover, it is necessary that health care providers have the knowledge to support them; this is especially urgent for the supports of Transgender and Indigenous LGBTQ2s youth. Indigenous communities have healing methods that differ from the western medical model prominent in Canada. It is important to take this into consideration when discussing the health of Indigenous youth experiencing homelessness.

First and foremost, there needs to be continued progress in policy targeting the issue of homelessness. Individuals require housing and finances for the overall health and safety. This study finds that those who are housed have greater physical and mental health outcomes. Additionally, another study shows that those with HIV who are housed tend to better adhere to their prescribed medical regimes. So while short term solutions like providing contraceptives and healthcare access are important, housing is a solution that will ease the healthcare obstacles faced by those experiencing homelessness in the long term.

Anika RakResearch AsisstantThe Canadian Observatory on Homelessness