APPENDIX C

Meeting the Challenges: Case Studies of Community Responses

Michael Callen-Audre Lorde Community Health Center

The Michael Callen-Audre Lorde Community Health Center (Callen-Lorde), formerly the Community Health Project (CHP), was founded in 1983. CHP was established as a result of the merger of the St. Mark's Community Clinic and the Gay Men's Health Project, two clinics from the 1970's that dealt with sexually transmitted diseases. Callen-Lorde is the New York metropolitan area's only health center geared primarily to the LGBT community and those living with HIV/AIDS. Its services are vital to LGBT persons because, as mentioned previously in this report, these individuals often face discrimination in the mainstream medical community and, as a result, do not receive adequate medical care.

Until the advent of the new Callen- Lorde health facility, CHP operated out of 2,500 feet of cramped space leased from the Lesbian & Gay Community Services Center in New York City. This makeshift clinic was woefully inadequate, so much so that it was not code compliant, and therefore limited in its scope of services. CHP's services were so sorely needed, however, that the clinic kept going to keep up with patient demand (CHP logged more than 20,000 patient visits in 1997). For years, CHP had dreamed of a larger, sophisticated, and more dignified facility. That dream became a reality in December 1996, when construction/renovation began on a six-story building located in the Chelsea neighborhood of Manhattan. This new building was made possible through a $7.6 million bond issued through the Primary Care Development Corporation and the Dormitory Authority of the State of New York, as well as through financial support from foundations, corporations and many donors from the LGBT community.

Today, the Michael Callen-Audre Lorde Community Health Center is the nation's largest LGBT health center. Named after two activists who championed for quality health care for the LGBT community and those living with HIV/AIDS, entertainer Michael Callen and poet Audre Lorde, Callen-Lorde, which opened to the public on March 2, 1998, is a six-story, 27,000 square foot, state-of-the-art health center. A fully-licensed Article 28 Diagnostic and Treatment Center, Callen-Lorde offers: expanded and enhanced primary and specialty medical services (including a full continuum of integrated HIV/AIDS care); laboratory services; mental health services; case management; a state-of-the-art health education resource center; and much, much more. In the near future, Callen-Lorde will offer on-site dental care and radiology. It will also be the only LGBT health center to house an on-site mammography suite. All of these services are provided in a sensitive, non-judgmental environment and, in keeping with the agency's original mission, are offered regardless of anyone's ability to pay. The need for Callen-Lorde's services are reflected in its numbers: 75% of Callen-Lorde's clients are uninsured; 80% earn under $35,000 per year; and almost 60% are people of color.

Callen-Lorde provides services for a number of LGBT subgroups such as: LGBT teens, many of whom are homeless and at an incredibly high risk for HIV/AIDS; lesbians, who have few sensitive health resources available to them which results in a lack of pap smears, mammograms and other basic women's health care; and elder LGBT people, who are often isolated and fearful of disclosing their sexual identity to their mainstream medical providers.

The facility has the capacity to serve 35,000 individuals during its first year of operation and expects this number to grow to over 60,000 by the year 2003.

Elizabeth - Callen-Lorde

Elizabeth Wallace, 27, writes on health care issues for Vogue and other magazines. As a new arrival in New York City two years ago, Liz came to CHP to volunteer at the organization's busy front desk, and had such a positive experience that she used the facility for her own gynecological care. Today, Liz volunteers at Callen-Lorde as a peer counselor.

"Peer counselors really see the range of issues that people bring to Callen-Lorde," she said. "On a single Monday night, we heard from a gay man who wanted help with cocaine abuse, but needed to find a place that would be sensitive and welcoming. Next, I spoke to a woman on the brink of a panic attack, she had been putting off her screening and now was convinced she had breast cancer. I tried to calm her down, and gave her some referrals, and an appointment to come in. Another call came from a man who had cerebral palsy and HIV. He needed nutritional information, because of the HIV, but he was having trouble expressing that need because the cerebral palsy made him difficult to understand."

"A lot of calls that come to the peer counselors are from people who need help talking to their partners about sexually transmitted diseases or HIV. We hear a lot from people with other crises in their relationships that do not have to do with sex at all. And we hear from a lot of people who have not gotten health care for a while because they have not found a gay sensitive doctor. People who come here are looking for a provider who will be sensitive to their particular needs, whether it is about sexual orientation or sexually transmitted diseases, or any sensitive area. We make sure they know that they are welcome here. And whatever people are calling for, I make sure to tell them that we have a sliding scale, and that you do not have to have insurance, or be wealthy, to be seen here."

"I think it is notable that so many people, like nurse practitioners, volunteer their services at Callen-Lorde. Healthcare is very expensive and very exclusive, and a lot of people cannot afford it. The fact that people give it for free here says a lot about Callen-Lorde and what it is trying to do for LGBT people, and for non-LGBT people, too."

The Audre Lorde Project

Small, struggling groups of LGBT people of color find a safe meeting place, advice on building their organizations, and support for organizational growing pains at The Audre Lorde Project (ALP). The Brooklyn-based project, named for the famed African American poet, has a simple but overwhelming distinction - it is the only center for lesbian, gay, bisexual, two-spirit (the Native American term for gay and lesbian) and transgendered people of color in the United States.

With four staff members and 100 volunteers, ALP serves over 30 lesbian, gay, bisexual, transgendered, and two-spirit organizations and individuals from its home in space leased from the Lafayette Avenue Presbyterian Church in Fort Greene, Brooklyn.

"Our mission is to promote the physical, spiritual, mental health and political well-being of African-American, Caribbean, Asian, Pacific Islander, Latino/Latina, Native, and multi-racial LGBT people," says Sheila Stowell, the Project's Director of Community Education and Organizing. "Depending on an organization's needs, ALP provides meeting space, support in recruiting volunteers and developing boards of directors, or help in learning the ins and outs of fundraising and business plan development. We serve as an incubator, an advisor, and home base to our various organizations."

"The organizations and individuals that come to ALP reflect the incredible diversity of New York's lesbian and gay communities - many are very small, but all of them are incredibly important in providing a stable base for their communities."

Member organizations include GRIOT Circle, a group for LGBT elders of color, and Other Countries, a black gay male writers' group. Incubator projects include: Gays & Lesbians of Bushwick Empowered, a group that provides safe space for LGBT young people of color; Iban, a group for Korean and Korean American LGBT people; Caribbean Pride, a group for LGBT people of Caribbean descent; and FANMI, a group of LGBT people of Haitian descent.

Sometimes incubator projects like the GRIOT Circle, an organization serving gay and lesbian senior citizens of color, grow strong and stable enough to become member organizations of ALP's. "That's one of our greatest accomplishments," says Stowell. "When one of the organizations that came here needing the most basic kinds of support can become strong enough to start offering advice and support to others."

The need for ALP’s support is enormous. "If you figure that 700,000 of New York City’s 7,000,000 residents are gay or lesbian, and consider that 40%, a modest estimate, are people of color, then our potential audience is 280,000 New Yorkers."

Because New York City traditionally offers a home to recent immigrants, ALP also serves many gay, lesbian, and bisexual immigrants. "In many immigrant communities, as in the U.S., homophobia can run high. Language barriers can also present a problem for gay and lesbian immigrants trying to find their way in a new country. They have few places to turn for community and support."

Plans are on the drawing board for ALP to expand its staff, and create a series of health and wellness programs. "It is often very hard for people of color, and immigrants, to find appropriate health care. Sensitivities about their identity, values, class status, language barriers, and sexual orientation can clash. Borderline care becomes even worse when these issues collide."

Men of Color Health Awareness

"The real challenge for black gay men is the lack of opportunities for community-building, to create bonding and support, outside of the bars," comments Eric Jennerson, Director of Rochester's Men of Color Health Awareness (MOCHA) program.

MOCHA is a peer-driven project for gay men of color. The organization provides HIV prevention services, street outreach, safer sex education, and community resource and information tabling, from a small office in Rochester's Center for Independent Living.

"We're trying a number of approaches to reach gay men, provide support, and give out information that helps keep people healthy. We're organizing picnics, football trips, any safe space that allows for socializing as well as education and outreach."

"There is not much support available for men of color who are gay," says Eric Jennerson, who founded MOCHA just one year ago. "When we started MOCHA, we were primarily concerned that the lack of community could prevent gay men of color from receiving HIV prevention information. We wanted to promote healthy living in a variety of ways, through peer to peer outreach." Judging from their first year of operation, Jennerson's hunch about unmet information and support needs was on the mark.

In its first year, MOCHA's health education outreach in clubs, street fairs, workshops, and conferences has reached 5,000 people, 80% African American and 20% Latino. In the past year MOCHA has become a valued part of health education in central New York. Perhaps it should not have been surprising, then, when Jennerson received a call asking for MOCHA to put together a workshop on preventing teen pregnancy.

"I didn't think they would ask a gay organization for help with pregnancy prevention, but they said it's because of the quality of our HIV prevention outreach," says Jennerson. "Our program is based on peer education, which means we know how to talk one on one to people at risk, and help them find support to stay healthy. That's a logical way to approach teen pregnancy too, and we're happy to do it." In the near future MOCHA plans to start case management for HIV-positive men of color with drug or alcohol problems. And more social support activities are planned as well. "Anything that provides our community with a chance to come together and talk and stay well, we'll do it."

New York City Lesbian and Gay Anti-Violence Project

"Where do you go when you've been the victim of a violent crime, or when you're being harassed every day on your street, and the police or hospitals won't give you the help you need because you're gay or lesbians " asks Clarence Patton of New York City's Anti-Violence Project (AVP). "We hope people will come to us."

"Violence can be a particular problem for gay and lesbian people," adds Patton, who notes that gay and lesbian people are "more often targets of violence, are less likely to report assaults against them, and frequently do not find the support they need from the police."

With 16 employees and 200 volunteers, AVP has worked since 1980 to prevent violence against gay men and lesbians, provide services to victims of assault, prevent and address domestic violence, and train police and medical officers to understand and respond appropriately when gay or lesbian people are victimized.

"We began in lower Manhattan because attacks against gay people were increasing there, and the police weren't responding. We pushed to get into the police stations, to hold meetings, to provide trainings." Today, AVP provides training to every domestic violence prevention officer in every borough in the city. AVP also trains hospital ER personnel, Department of Social Services staff, and outreach workers from Victim Services and AIDS Service organizations.

"As soon as AVP opened its doors, it became clear that violence against the gay community was an enormous and growing problem. AVP works to increase gay and lesbian safety and community awareness of violence, to improve police response to this danger, and to provide desperately needed services, including counseling and legal advocacy to victims of anti-gay violence."

AVP's volunteer-staffed hotline, established in the mid 1980's, provides free 24 hour bilingual information and counseling to callers from all parts of New York City and State. Three out of five hotline calls come from outside Manhattan, and AVP now provides outreach and services in all of New York's five boroughs.

"AVP works with local communities and police departments to help ensure that they're aware of gay and lesbian communities, and that gay and lesbian citizens receive equal protection under the law. We try to ensure that local communities are engaged with their police as much as possible."

The organization established its first satellite office in Queens, which has several large gay and lesbian communities, one of which is located in Jackson Heights. "The Queens communities were galvanized by the brutal murder of a gay man there. AVP's Jackson Heights office is now a well-established part of the Queens community."

Patton notes that gay and lesbian communities and needs are not all the same. "Our Queens facility deals with a lot of domestic violence," he notes. "Domestic violence affects gay and lesbian couples in equal numbers as heterosexual couples. But protecting an abused partner in a gay relationship is more difficult, because the police may take these complaints less seriously, and because it is much harder to get an order of protection for an abused gay or lesbian partner than it is for a straight, married person. In Jackson Heights, we see a lot of people who can only be out of their homes safely for a short time. They don't have time to come to Manhattan to seek help."

"LGBT communities are thriving in Queens and Brooklyn," notes Patton. "There's tremendous energy there. AVP has become a regular presence in Park Slope, Boreum Hill, and Carroll Gardens. We're searching for permanent space in Brooklyn now because the need for our services there is enormous. We're also doing more to reach out to gay and lesbian people in the Bronx and Staten Island."

What's the biggest challenge they face? "Violence breeds isolation," Patton states simply, "and breaking isolation and getting help to people in need takes time, persistence, and a lot of hard work. If we want to be trusted by individuals who have been victimized, we need to be there, working in a visible way in their neighborhood every day of the year, and that takes a lot of resources."

"Dennis", AVP

On the night of February 8th, a friend and I were going home from an evening out in Chelsea. While we were crossing the street, a van ran the red light and almost hit us. Then the van began following us. After a short time, the van stopped, its doors opened and the occupants screamed "fags" at us. Following that, they chased us on foot continuing to yell "faggot" as well as other anti-gay epithets.

We began to run away from the van and our attackers followed us. When I got to my home, I realized that my friend was no longer with me. I went back to check on him and was physically attacked, beaten in the head repeatedly with beer bottles. By the time my attacker stopped, my skull was fractured, my brow was broken, and I had lost an eye. After arriving at the hospital, as soon as I was able to, I had a friend call AVP for me.

Almost immediately a counselor, Maureen, came to see me in the hospital. She was, without a doubt, one of the most compassionate and helpful people I have ever met. Her willingness and ability to counsel me, and advocate for me in dealings with the New York City Police Department were extraordinary. During our initial dealings with the police, Maureen addressed the errors which the Precinct made in handling my original complaint. Incredibly, the Bias Unit of the NYPD refused to classify the case as a bias crime. Their rationale that the incident began as a traffic dispute, and that's all it could be, was yet another blow. Any possibility of a bias classification was rejected.

For the police to make a bias classification is important because it names the nature of a crime. It also gives a government stamp to the reality of homophobia in this city. Finally, it affirms our experiences and sends a message that the police believe us, work for us and understand the dangers we face and will therefore advocate for us. To be denied that classification is to tell a victim that their pain is not valid.

After many phone calls to and meetings with the NYPD and its Bias Unit by Maureen and AVP's Executive Director, Christine Quinn, the Department still refused to reclassify the case despite the fact that our attackers called us every name in a hatemonger's vocabulary.

AVP and its staff did not give up. To demonstrate how wrong the Department was, Maureen and the rest of the staff cited the Department's own rules and regulations for classifying a case as bias to the NYPD. Those regulations state that a case will be classified as bias if it is found to be motivated 'in whole or part' by bias. Nevertheless, after two months, it was clear that the Department had no intention of giving a bias classification to this or another case in which a man was chased, attacked and stabbed after being called a 'faggot'.

Nevertheless, AVP kept fighting and held a press conference decrying the Department's unwillingness to justly classify the cases and questioning the motivations for their inaction. Ms. Quinn appeared on television news programs and in newspapers around the city to raise the visibility of this problem and the Department's intransigence.

In response to my case and another brutal stabbing on Christopher Street, AVP organized an emergency march and rally. After you've been the victim of a crime, you feel all alone and believe that no one cares. The night of the march I knew that hundreds of lesbians and gay men I had never met cared and were willing to stand up for me. Two weeks ago, Maureen, Christine, the head of the Bias Unit and I met at AVP to discuss my case. This week, my case was reclassified as a bias crime. This reclassification is a victory for the entire community.

After an attack, the police, the hospital and others should help victims. Instead, they made me feel as though I was overreacting or should be blamed for what had happened. For the police to not acknowledge that those men attacked me in part because they thought I was gay is almost the same as telling me that I was crazy or lying. The reclassification helps my peace of mind and hopefully that of other lesbians and gay men around the city who have had similar experiences.

The absolute comprehensiveness, care, attention and tenacity that my case received was unbelievable. However, what I have since found is that this is the way that AVP works for all of its clients and the community. My experiences with AVP have in fact now enabled me to become an activist, something I never before thought I could or would ever be.

CANDLE

"The young people named this program TRUST, because that's what they needed most," says Eileen Browning of Rockland County's Community Awareness Network for a Drugfree Life & Environment, also know as the highly respected CANDLE program. "TRUST is the name of our program for gay, lesbian, bisexual, and questioning youth. Its goal is the same as all CANDLE programs, to provide young people with an outlet for discussing their concerns, and with strong adult leadership, to help them lead healthy lives based on a healthy self-image and respect for others."

Browning speaks from the CANDLE office in a rented elementary school classroom with no air conditioning. (The location of TRUST meetings is not publicized, to protect the youth who use TRUST).

With one full-time staff member, some part-time educators, social workers, and group facilitators, and about 40 volunteers, CANDLE has become a mainstay in the Rockland County school system's efforts to prevent alcohol and drug abuse among all youth. The organization runs a number of specific support groups to help kids stay connected and stay clean. One of them is Athletes Against Substance Abuse. Another is TRUST.

CANDLE works with every public school district and many private, Catholic, Jewish, and independent schools in Rockland County. Fifty students per year, equally divided by gender, participate in meetings of TRUST, which is funded entirely with a $6,000 grant from the State Office of Children and Family Services. "We do an awful lot with very little," Browning notes.

What's the special appeal of TRUST? "Young people with difficulties that they don't know how to cope with or resolve are at higher risk for depression, isolation, or alcohol or substance abuse," says Browning. "Youth who are struggling with understanding their sexual orientation can be at high risk. It's important for them to have a non-sexually charged drug and alcohol free space where they feel safe to talk honestly. All adolescents need to know that they are valued for who they are."

Young people who come to TRUST are from all social and economic backgrounds. Fifty-five percent are white, 10% are African-American, 20% are Hispanic, and 15% are Asian-American. The program crosses all economic lines, from families that are just scraping by to families with the resources to send their children to any colleges they choose. About 2% of TRUST youth are homeless."

Every year, TRUST members are asked what they get from the groups. Here's what some have said: "self confidence, assurance that I'm not alone," "TRUST has been extremely influential in making me feel good about myself," "people who care about me, understand me, listen to me," "The comfort is something unforgettable."

"The feedback tells us we're doing the right thing," says Browning. But it's hard not to focus on what TRUST has yet to do. "TRUST should be reaching out and making our services available at every single school and every agency. There are lot of young people who need TRUST, and we haven't reached them yet."

"Michael", TRUST client

Michael is a twenty year old Rockland County resident who discovered TRUST when he was 17. "I started to notice I was attracted to men, and when I looked around, it seemed like that's not 'normal.' I felt very alone. My parents were divorced, and that was a big issue for me. Something had to give in my life, and it ended up being my schoolwork. I was hurting myself, sleeping too much, screwed myself up at school. I felt like my heart was in chains. It caused a lot of fights between my mother and myself."

"It was a struggle to look in the mirror and say 'this is me.' I felt like it's not right to be gay in our society, and you couldn't have a normal life. There was no one to say 'there's a future for me.'"

"A big issue of coming out is safety, there's an issue of violence, and that scares me now, kids have to be safe, without the threat of being thrown out of their house or being beaten up or killed for saying this is a part of me."

"A school counselor brought TRUST up to me, but it took six months for me to go. The first time there I was wary, I didn't know what I'd find. What I did find was people like me, other kids just struggling with trying to be themselves. That's common for all kids, but I think there's an added pressure when you're gay, lesbian, or bisexual."

"I've seen a lot of gay youth and the use of alcohol and drugs is very high. Part of the reason is it's painful to live in a place where people aren't going to love you for who you are."

"People at TRUST made me feel that I wasn't damaged, that I was just Michael, myself. Accepting myself is a continuing process. Now I look at kids coming into TRUST and I like to feel I could help them in some way. It doesn't have to be a place of hurting to be gay, it's just your life."

"TRUST really helped me. It's important to have mentors, and be in touch with people who know things and have resources. Eileen is heterosexual - without straight support, I would be nowhere."

Bronx Lesbian and Gay Health Care Consortium

The Bronx is the poorest of New York City's five boroughs. Eighty percent of the borough's 1.2 million residents are Hispanic or African American, and half live at or below twice the Federal poverty level. For those who are LGBT the disenfranchisement can be even more severe. "The Bronx shows you how race, class, and sexual orientation combine to really limit access to health care," says Dr. Peter Meacher of the Bronx Lesbian and Gay Health Consortium.

In June 1997, the Consortium, a volunteer association of concerned activists and health care professionals, held a "Health Care Jam," attended by over 300 LGBT individuals and their families. "The turnout showed us there's a very high level of interest in and need for expansion of access to health care services in our community," says Dr. Meacher.

The Jam included a detailed survey of the backgrounds and health practices of attendees. Of those who attended the Jam, the majority were living at poverty levels, 83% were racial minorities, 41% were women raising children. Twenty-seven percent reported current or past drug addiction, 39% reported a history of depression, and 68% smoked cigarettes. Even among the 28% of men and 39% of women attending the Jam who were receiving Medicaid, 31% had never gone for health care when they were not acutely ill. "That really demonstrates the need for health outreach to overcome the barriers of race, class, and sexual orientation," Dr. Meacher notes.

The Consortium has applied for state funding to develop a new program, the Health Link Line, which will help the Bronx LGBT population obtain supportive and effective health care. Central to the program design is a free telephone number, to be staffed by trained volunteers, which will provide a supportive, confidential environment for clients to obtain basic health information. Health Link Line volunteers will refer callers to LGBT-friendly services, and volunteer physicians will be on call to address any urgent medical concerns. The Link Line will be available 20 hours per week in evening hours, with at least one session per week staffed by a Spanish-speaking volunteer. Patient education materials will also be mailed to callers, as appropriate.

To increase the effectiveness of the free telephone line, the Consortium is currently planning to update its database of LGBT-friendly health and social service providers. Additional funds will be used for educational seminars for health and social service providers, as well as advertisements and outreach to the targeted LGBT population.

"Our objective is to make this service as accessible as possible," says Dr. Meacher. "Many of the people we serve are not open about their sexuality and they're hard to reach, so a significant part of our outreach campaign involves advertising on subways and MTA buses.

We're also working to solicit volunteers and a Project Coordinator from the targeted population," Meacher adds. The statistics from our Health Care Jam show that this community has tremendous needs for access to care and for clear health care information that speaks directly to them. We think the Health Link Line is the start of something that will make a real difference for the Bronx."

Gay and Lesbian Youth Services of Western New York

Gay and Lesbian Youth Services of Western New York estimates that its home counties of Buffalo and Erie have a gay, lesbian, bisexual, and transgendered population of approximately 10,000. "That includes a significant number of young people ages 14 to 21 who have either come out, are in the process of coming out, or are questioning their sexuality," notes Mark Boser. "They are often victims of ridicule, hostility, rejection, and violence from peers, parents, teachers, and counselors. In response, they have very high rates of drug and alcohol use and running away. They are also at high risk for sexual victimization and sexually transmitted diseases, including HIV."

Boser notes that, since many mainstream social service agencies are unwilling to address the needs of gay, lesbian, bisexual, transgendered, or questioning youth, they frequently have nowhere to turn for much needed health care, mental health counseling, and training in important life skills. Skills like "how to survive, and find a job, and not get infected with HIV," Boser adds.

Located within the YMCA in downtown Buffalo, Gay and Lesbian Youth Services of Western New York (GLYS) is the only organization in the Buffalo/Erie area that targets these youth and their families. The organization's programming includes an evening drop-in center, support and coming out groups, individual counseling, an information and help line, and advocacy efforts.

More than 2,000 callers contact the GLYS information line each year, and the organization serves 180 youth and their families every year in their youth program. Their speakers' bureau reaches an additional 750 youth, usually in small groups. All of the agency's clients are between the ages of 13 and 22. About half are white and nearly half are African American, with 5% being Latino, and 1% Native American and Asian American/Pacific Islander. Nearly half are female.

"The vast majority of our clients and their families are very low income," adds Boser. About 60% are uninsured, and 30% are on Medicaid. A small number of GLYS clients have children of their own. And, Boser adds, 15% of their young clients are homeless at some time throughout the year.

Demand for GLYS services continues to grow and to greatly outweigh the available resources. With no paid marketing or outreach, the demand for services from 1997 to 1998 increased by 20%. Staff is overwhelmed and much of the equipment is in poor condition. The organization is currently seeking funding to expand programming for lesbian, gay, bisexual and transgendered youth through direct service to youth and families, and provider education and training.

Working in partnership with Planned Parenthood's New Voices Project, GLYS is increasing its outreach to middle school, high school, and college youth by speaking to community-based agencies, tabling in shopping malls, participating in health fairs, and continuing the organization's existing street outreach. GLYS also plans to distribute brochures and wallet cards with the organization's hotline number, promotional key chains and pens, and fact cards on HIV and STD's, and to reach out through yellow page advertising and public service announcements. To reach area college youth, GLYS plans to develop a new gay-sensitive outreach curriculum for college use and to train up to 100 professionals in the first year.

New helpline volunteer training is also in the works, and hotline hours are being expanded. "One of our greatest concerns is what happens to the young person who has found our number or has finally gotten the courage to ask for help who calls when our Helpline is closed," Boser adds. "With additional funds we will expand our hours, and the system will be programmed so that when it is not staffed, callers will be informed of other immediate resources."

GLYS also hopes to hire a full-time, masters level counselor to provide individual crisis counseling and short term therapy to help youth identify and carry out goals to improve their daily functioning and assist them in decision making and planning for their futures. Group counseling will include issue focused groups that will address improving relationships with parents and surviving sexual abuse. Group support will also be provided for family members.

Boser points out that a number of the young people served by GLYS need more intensive services and the organization plans to provide case management service to young people with the greatest needs. Young women who lack medical care will be referred to a planned parenthood clinic and young men to the Erie County Health Department. Youth who need temporary housing will be linked to Compass House.

"We also need to improve provider education and training," adds Boser. "Most teachers, counselors, or other authority or helping figures that young people encounter have little or no training in how to respond to the needs of lesbian, gay, bisexual and transgendered youth. Even if they want to respond sensitively, these adults may not have the tools or the information." GLYS plans to hire a full-time community educator who will develop educational programs for youth groups, schools, churches, human services agencies, and health care providers throughout Erie county.

"Every good parent knows that young people need a tremendous amount of support to grow up strong, with a good future," says Boser. "For the kids who come to GLYS, the needs can be even greater and the resources less. But most people who work or volunteer here will tell you, once you've had the experience of making a real difference for a young person, you can't say no again."

Case Study, "Beth"

"Beth" is an 18 year old Hispanic woman who lives on the City of Buffalo's east side. She has a son, "Clay", who is three years old. Beth considers herself to be a lesbian and is currently involved in a relationship with a woman whom she met about a year ago. They live together in a small apartment along with Clay. Due to the many difficult situations she was experiencing in her life at the time, Beth dropped out of school during her junior year. She presently works part-time at a fast food restaurant. Beth receives very little support from her family; occasionally they will watch the baby for Beth. The young father of Clay was physically abusive to Beth, and Beth, over the past few months, has experienced some physical altercations with her girlfriend whom she describes as very "controlling". A neighbor recently contacted Child Protection because they felt that "Clay" was being left alone. Beth has recently said that she is feeling depressed and very unsure as to how she should proceed with her life.

Beth has been involved with GLYS for about one month. At GLYS, she has been able to find support and meet some new friends who have experienced similar situations in their lives. The counseling program at GLYS has been able to provide some case management services for Beth, linking her to appropriate resources in the community and assisting her in beginning to identify options and to sort things out. She has participated throughout the month in a weekly support group and in the on-going social activities that GLYS provides.

Case Study, "Bill"

"Bill" is a sixteen year old African American youth who lives with his parents on the City of Buffalo's west side. Bill was referred to GLYS by a counselor at a local residential program for young people who have substance abuse problems. When he was fourteen, Bill says he "became unable to deal with his gayness" and stopped going to school, withdrew from his friends and eventually started drinking. His parents took him to the "R" agency where he lived for about six months. While there, he became sober and got back on track at school.

Bill has been involved with GLYS for about one year. During this time, he has made many friends and learned that he is not alone in his struggle to understand his sexuality. Bill has stayed in school and has been able to stay away from the alcohol. Bill's parents, although reluctant at first, have supported Bill's involvement at GLYS and have actually participated in some events at GLYS for parents and their children. They have also since connected with P-FLAG, Parents and Friends of Lesbians and Gays.

Human Services Coalition of Tompkins County

Ithaca's Rape Crisis Center, along with its Project Access, is familiar with the dangers that LGBT people face from rape and sexual violence. "We know that LGBT people can have limited access to all types of medical care and support services, because they fear, or have already experienced, hostile treatment from the medical and human services system," says Fran Spadafora. "Sometimes it's blatant discrimination such as when police or care providers refuse to acknowledge or respond to a same sex rape situation.

Sometimes it's more subtle. But it's not hard to recognize when your concerns aren't being taken seriously. And with an issue like sexual violence, there usually isn't a second opportunity to connect someone with the help they need."

With 96,000 residents, and three area colleges, Ithaca, New York is known as a progressive community with a relatively well organized lesbian and gay community. Yet, health and human services in largely rural Tompkins County have remained unpredictable in their attention to issues of access to the area's large LGBT community. And, notes Fran Spadafora, many LGBT individuals in the area are isolated, "especially those who live outside Ithaca in our rural communities."

"Frequently, LGBT victims of sexual assault and other violent crimes have been victimized because of bias or hate related to their sexual orientation. They are often hesitant to report their victimization due to fear of mistreatment by the criminal justice system or of not being believed. LGBT sexual assault survivors may not come forward due to the fear of having their experience degraded or dismissed because it was a same sex assault."

Ithaca Rape Crisis Center’s new Project Access is responding by working with a series of "project partners," including AIDSwork, the Alcoholism Council of Tompkins County, Cayuga Medical Center, Family & Children's Services, Ithaca Lesbian, Gay and Bisexual Task Force, Ithaca Rape Crisis, and the Tompkins County Health Department to develop a comprehensive needs assessment and provide critically needed services.

Rainbow Aging Awareness Project

"Older gay men and lesbians face some enormous barriers to care," notes Ellen Ensig-Brodsky, executive director of the Pride Senior Network. "Today's elderly came of age during a time of extreme anti-gay bigotry by legal, health, and religious institutions. Today many gay and lesbian seniors are isolated, invisible, and difficult to reach. Many have internalized their society's homophobic messages, damaging their self-worth and causing them to turn away from help. The dual stigma of ageism and homophobia further compounds the barriers to care. We refer to this self-isolation as 'silence for survival’."

"The fact that lesbian and gay seniors are afraid to disclose their sexual orientation means that the people providing services for seniors don't even know gay and lesbian seniors exist, and certainly don't understand their backgrounds or needs," Ensig-Brodsky adds. "It becomes a version of 'don't ask, don't tell.'"

The aging process is difficult for many people, but the difficulties can be intensified for gay or lesbian people. As a person ages, they may lose mobility, and need to rely on others for help. It is a time when individuals must be comfortable with their health care and with senior services. But Ensig-Brodsky points out a major challenge for elderly gay men and lesbians: "Many support systems for older people are based on a validation of their lives," she notes. "If a person's life is hidden, it is very difficult to receive that validation."

Rainbow Aging Awareness Project (RAAP) is a partnership of four community-based organizations, Senior Action in a Gay Environment (SAGE), SAGE-Queens, Pride Senior Network, and GRIOT Circle, that will provide non-HIV services for older gay and lesbian New Yorkers. Ensig-Brodsky notes that if just 10% of the 1.3 million elderly in New York City are gay or lesbian, approximately 130,000 older men and women can benefit from RAPP's services. Yet, the current combined population served by the four RAPP partners is less than 5% of this subset of the population.

The four partner organizations of RAAP are joining together to form a collaborative project that will reach out to isolated LGBT seniors and work to increase the knowledge and sensitivity in the older population and in the larger gay and lesbian population to the needs of older gay men and lesbians, as well as in the mainstream health and human services providers.

Joan and Bertha, Pride Senior Network

Joan, 76, and Bertha, 78, life partners for over 40 years , were both becoming increasingly physically frail when their social worker referred them to a neighborhood senior center home delivered meal program. During the first year on the meal program, they became friendly with the program’s social worker who noticed Bertha's increasing mental deterioration and Joan's mounting anxiety. The social worker, having worked with Pride Senior Network on several programs, was aware of the possibility of more than a friendship between the two women and opened the door to discussion around the issue of a possible nursing home placement for Bertha.

Joan was relieved in being able to discuss her concerns over what would happen with a "straight" nursing home. If Bertha made a slip, would they force a discharge, neglect her or ridicule her in front of the other residents or staff? Through the recommendations of Pride Senior Network, the social worker was able to recommend a supportive Greenwich Village facility, which was of great relief to Joan. Furthermore, this social worker, being attuned to the married equivalence of the women's relationship, could give Joan the kind of support she will need when her long-term partner is gone.

Were this social worker oblivious to the nature of the women's relationship, referral to an appropriate nursing home, support of the abandoned partner and an understanding of the complexities of this "family's" relationships would not have been a reality. More likely, the guidelines of an assumed heterosexuality would have been applied, and, once again, "don't ask, don't tell" would rob Joan and Bertha of vital end of life affirmation.