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cents (Coleman, 1982). By raising the issue, counselors can help identify problems and concerns before they complicate an individual's life or threaten health and well-being. If same-sex feelings are a concern, the counselor can help clarify and understand them. It should be noted that assessment of sexual orientation during adolescence may be difficult. Either pushing for premature sexual orientation identification or dismissing the relevancy of homosexual feelings could be damaging (Coleman, 1981/1982, 1987).

The counselor's attitude toward homosexuality is critical to the adolescent's treatment. Positive attitudes assist recovery from the damage of negative stigmatization that has occurred and continues to occur (Coleman, 1981/1982). It is very difficult for some counselors to acquire positive attitudes within the context of our culture. Although some counselors are intellectually positive, their emotional responses hinder them from conveying full acceptance and encouraging homosexual or bisexual adolescents to explore or experiment with their sexuality in the same ways that they help other adolescent clients focus on their opposite-sex feelings. In some communities, advocating homosexual self-exploration would be risky for the professional. In some countries (e.g., England), it is simply illegal. Many states still retain sodomy laws, recently upheld by the Supreme Court in Bowers v. Hardwick. This ruling came in spite of amicus curia briefs provided by the American Psychiatric and Psychological Associations. Thus the task of the counselor has, in some ways, become more difficult. . . but not impossible. The challenge remains. Children will grow up to be gay, lesbian, or bisexual regardless of society's acknowledgment or acceptance. The challenge is to integrate these individuals into the social fabric and to help them become fully functioning members of society. This is not just a challenge for counselors but for entire societies and cultures. If this challenge is not met, the process of stigmatization and the subsequent harm will continue to occur. Beyond positive affirmation, the counselor must be ready to address the common psychological problems that result from stigmatization: psychological maladjustment, impaired psychosocial development, family alienation, inadequate interpersonal relationships, alcohol and drug abuse, depression and suicidal ideation, and concerns about HIV infection and other sexually transmitted diseases (Coleman, 1988).

HIV INFECTION AND OTHER SEXUALLY TRANSMITTED DISEASES

As indicated earlier, the risk of HIV infection and other sexually transmitted diseases is a growing concern. In particular, it seems that many adolescent clients are overanxious about or feel invulnerable to contracting the HIV virus. Prevention and educational activities are imperative. Gay, lesbian, or bisexual adolescents should be specifically targeted for HIV infectionreduction activities, and information should specifically address some of their concerns (i.e., anal intercourse, stigmatization). Responsibility should not be abdicated to other health care professionals. Many counselors are often in a better position to address these issues and possess the communication skills to deal with these sensitive topics. Therefore, it should be the responsibility of all counselors to ensure that their adolescent clients have sufficient information to protect themselves from HIV infection. If they are already infected, they must learn how to take care of their own health needs and to protect others. Adolescent clients need realistic, clear, nonjudgmental, cul-

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turally sensitive, and positive educational information (Solomon & DeJong, 1986).

A "just say no to sex and drugs" approach is not sufficient. We know too well that adolescents are sexual beings and experiment with drugs. We can say that abstinence is the "safest" protection, but this does not address the reality of the situation. We have too many unwanted pregnancies and sexually transmitted infections to prove that the "no-talk" and "don't" method of prevention has failed. Educational activities must assume that many adolescents will be sexual and experiment with drugs. We need to be able to describe explicitly "unsafe" and "safe" sex techniques and the importance of not injecting drugs with shared needles and syringes. Social responsibility comes from open communication rather than from concealed information. The counselor must be able to openly and freely discuss sexuality in comfortable and nonjudgmental terms, including homosexuality and homosexual behavior.

The adolescent needs to feel comfortable discussing issues such as fear of HIV exposure, the need for HIV testing, HIV testing results, "safe" sex practices, sexual orientation concerns, alcohol and drug use, and means of protecting oneself and others from HIV infection. This situation (at an unreasonable cost) has provided counselors with the opportunity to promote concepts of healthy sexuality and to address the issue of the abuse of alcohol and other drugs. Although each counselor takes a risk, the risk of not taking advantage of this opportunity is too great. At this moment in history, we must assume that all of our adolescent clients are at risk for HIV infection-and once infected, our task of helping them is made woefully difficult. This article does not permit space for discussing how to address HIV-infected homosexual adolescents. If our prevention activities do not accelerate quickly, however, this will become a lively topic in the future.

HELPING FAMILY MEMBERS

Family members who become aware of an adolescent's homosexuality need special attention. Because of cultural stigmatization, family members often want to ensure a heterosexual outcome for their child. After understanding the clinical and ethical limitations of this type of therapy, they may raise other concerns about the present and future health of their son, daughter, brother, or sister. Finally, they may admit concerns about themselves. Family members must cope with the stigma of having a homosexual or bisexual family member ("We are a family that does not fit the normative expectations of society'). Or, in more pragmatic terms, they ask the following:

What did I do wrong?

Isn't it possible to change someone's sexual orientation? What will happen to him or her in the future?

What can I do now?

Should we tell the rest of the family?

Should we tell mom or dad? What if the relatives find out?

It must be recognized that families go through their own process of coming out and integrating the child's and family's "new" identity (see Borhek, 1983; Coleman, 1981/1982). This process is especially difficult when the family member is an adolescent. It is difficult for the same reasons that adolescents themselves struggle with their own emerging sexual orientation: uncertainty, ambiguity, cultural stigma, and fears of the future. Unfortunately, some families who have sought help for

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themselves have found that the general counselor did not seem to be sufficiently informed to be helpful (Niesen, 1987). Counselors can only help family members if their own attitudes toward homosexuality are positive and consistent with current scientific knowledge of homosexuality-as a normal variation of sexual expression. Family members benefit almost immediately with information and education regarding psychological, sociological, and anthropological research that dispels the myths and stereotypes about homosexuality. This information presents a more realistic, less frightening, and more encouraging picture of the quality of life that many gay men, lesbians, and bisexuals can expect (Hammersmith, 1987). Counselors can also be effective by identifying community resources such as parent support groups (see the resources section at the end of the article on page 40). These groups have been found to be helpful to many parents and family members (Niesen, 1987).

ASSISTING IN SEX EDUCATION

Beyond the counseling situation, counselors can have an indirect and, possibly, broader impact if they become involved in educational activities. We suggest that counselors participate in or develop general sex education classes for adolescents that address the aforementioned issues. Because most emerging homosexual and bisexual individuals first become aware of their sexual feelings during adolescence and experiment with those feelings in sexual ways, the impact of primary prevention activity is obvious. The opportunity exists to help adolescents understand the confusing nature of developing sexual orientation and to address the sociocultural underpinnings that result in cultural stigmatization, homophobia, and discrimination.

IMPACTING ON A COMMUNITY

AND NATIONAL LEVEL

Counselors can assist primary prevention activities by becoming involved in or supporting public and institutional policy decisions regarding homosexuality, particularly as these decisions relate to youth. Counselors should support community centers where gay, lesbian, and bisexual adolescents find refuge from an often antagonistic environment. It is hoped that these segregated community support centers will be unnecessary in the future as sexual minority groups are better integrated into society.

CONCLUSION

There are indications that counselors are examining the issues of gay, lesbian, and bisexual youth and are ready to deal with this sensitive topic. Progress is being made with the simple affirmation that adolescent homosexual activity and identity do indeed exist. The mental health of young lesbian, gay, and bisexual persons is no longer an issue for special interest groups or for students of sexual deviance but a psychological and public health imperative for every counselor working with young people. The American Association for Counseling and Development should follow the example of the American Academy of Pediatrics in advocacy for sexual minority youth. If the association is committed to health, welfare, and positive identity formation, then counselors in the association must encourage and sponsor educational and counseling programs for gay, lesbian, and bisexual youth and for all young people struggling with the questions and problems of sexual expression.

Gay, Lesbian, and Bisexual Adolescents REFERENCES

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Borhek, M.V. (1988). Helping gay and lesbian adolescents and their families: A mother's perspective. In G. Remafedi (Ed.), Special section on adolescent homosexuality. Journal of Adolescent Health Care, 9(2), 123-128.

Browning, C. (1987). Therapeutic issues and intervention strategies with young adult lesbian clients: A developmental approach. Journal of Homosexuality, 14(1/2), 45-52.

Centers for Disease Control. (1988, November). AIDS surveillance statistics.

Coleman, E. (1978). Toward a new model of treatment of homosexuality: A review. Journal of Homosexuality, 3, 345-359. Coleman, E. (1981/1982). Developmental stages of the coming out process. Journal of Homosexuality, 7(2/3), 31-43. Coleman, E. (1982). Changing approaches to the treatment of homosexuality. American Behavioral Science, 25, 397-406. Coleman, E. (1987). Assessment of sexual orientation. Journal of Homosexuality, 14(1/2), 9-24.

Coleman, E. (Ed.). (1988). Psychotherapy with homosexual men and women. New York: Haworth.

Coleman, E. (in press). The development of male prostitution activity among gay and bisexual adolescents. Journal of Homosexuality, 17(1/2). Erikson, E. (1963). Childhood and society (2nd ed.). New York: Norton. Glasser, M. (1977). Homosexuality in adolescence. British Journal of Medical Psychology, 50, 217-225.

Gonsiorek, J.C. (1988). Mental health issues of gay and lesbian adolescents. In G. Remafedi (Ed.), Special section on adolescent homosexuality. Journal of Adolescent Health Care, 9(2), 114–122. Hammersmith, S.K. (1987). A sociological approach to counseling homosexual patients and their families. Journal of Homosexuality, 14(1/2), 173–190.

Hein, K. (1988, April). AIDS in adolescence: Exploring the challenge. Presented at the National Invitational Conference on AIDS and Adolescents, New York City.

Jay, K., & Young, A. (Eds.). (1979). The gay report: Lesbians and gay men speak out about their sexual experiences and lifestyles. New York: Simon & Schuster.

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Martin, A.D. (1982). Learning to hide: The socialization of the gay adolescent. Adolescent Psychiatry, 10, 52-65.

Niesen, J.H. (1987). Resources of families with a gay/lesbian family member. Journal of Homosexuality, 14(1/2), 239-251.

Remafedi, G. (1987a). Homosexual youth: A challenge to contemporary society. Journal of the American Medical Association, 258(2), 222–225. Remafedi, G. (1987b). Male homosexuality: The adolescent's perspective. Pediatrics, 79(3), 326-330.

Remafedi, G. (1987c). Adolescent homosexuality: Medical and psychological implications. Pediatrics, 79(3), 331-337.

Remafedi, G. (1988a). Meeting the health care needs of lesbian and gay youth. In Shernoff M. & Scott, W.A. (Eds.), The sourcebook on lesbian and gay health care (2nd ed.) (pp. 86-90). Washington, DC: National Lesbian and Gay Health Foundation.

Remafedi, G. (1988b). Preventing the sexual transmission of AIDS during adolescence. Journal of Adolescent Health Care, 9(2), 139–143. Roesler, T., & Deisher, R.W. (1972). Youthful male homosexuality: Homosexual experience and the process of developing homosexual identity in males, aged 16 to 22 years. Journal of the American Medical Association, 219, 1018-1023.

Saghir, M.T., & Robins, E. (1973). Male and female homosexuality: A comprehensive investigation. Baltimore: Williams & Wilkins. Savin-Williams, R.C. (1988). Theoretical perspectives accounting for adolescent homosexuality. In G. Remafedi (Ed.), Special section on adolescent homosexuality. Journal of Adolescent Health Care, 9(2), 95-104.

Solomon, M.Z., & DeJong, W. (1986). Recent sexually transmitted

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