"I've always been a lifelong patient of a case study because I’ve had renal health issues since I was born, but I never really ran into the issue of having my identity be a problem. I really started to question it when I was 12 when my physician told me, 'you know, there’s a risk for people with your condition because there’s a chance that you might not be able to have children.' And I thought ‘so what?’ because the people that I’m interested in wouldn’t have children anyway. And it slowly started to click with me as I went through my middle school years, where people kind of assumed who you liked and who you like-liked before you even had the chance to say it out loud yourself.
I’m from small town Minnesota, and when I came out there were two other people that I knew were gay; one of them being my ex-boyfriend, and the other being my older brother’s best friend from when they were kids. I knew both of them intimately, but because it was a small town, we quickly became intertwined with one another. It felt like my options were limited, especially because I was not out to face that “small town, small mind” kind of judgment. I was afraid of who I could’ve reached out to, and that’s something that I really hope the current and future generations have an easier time with.
It wasn’t until years later when I was a sophomore in high school that my parents finally decided to let me see a counselor, because at that time during puberty I didn’t feel comfortable opening up to my parents. That third party really made the difference for me. While I was seeing my counselor, he regularly talked about my boyfriend at the time, something that my parents were still completely in the dark about. What bothered me, though, was that he referred to my boyfriend as a “special friend.” At that moment, I took a step back and said, “no, my boyfriend.”
'Yes, your special friend.'
In that instance I didn’t realize how negating that was really him negating my identity. In that moment it wasn’t like I could turn around to my parents and be like, 'you know what? I don’t feel like I’m being heard,' because I hadn’t come out to them yet. So then that kind of sparked that first aha moment. Fortunately, that was the only negative experience I’ve had in healthcare because, moving forward, I took care to establish that, 'no, he’s my boyfriend.'
When I think back on that interaction with my counselor, he always considered me to be the expert outside of the exam room because there were so few people with my particular issues. I wish he didn’t assume that I was the expert in my identity at 12 years old and didn’t put that much responsibility on me. I find it difficult to believe that someone who’s that old is going to be intelligent enough to understand invalidation as much as they will in adulthood, especially in my position as a white male. In a small town in Minnesota, how often am I going to be invalidated? I’m not gonna be able to understand that concept as well as some of my peers who may not be white, male, or cis. It was very flattering and kind for him to sort of jump to that conclusion, but for the stage I was at - developing mentally, going through puberty, where I was socially in middle school - it was kind of hard to say exactly who I was without having explored that part of me.
I know there are a lot of studies today that state children know from a very early age that they’re cis or non-binary- they may identify as boys and like the classmates who look like them or not. I don’t think those things were really well-known to the people around me when I was younger, so how was I supposed to vocalize the thoughts I didn’t have words for? I still stood my ground despite not really knowing how to move forward from that, and I understand that even just doing that is really hard for some people.
And then when it came to physicals for sports, I started engaging with my physicians in private and saying that, 'yes, I am interested in men,' although I wasn’t engaging in sex with anyone at all. At 16 I shouldn’t have had to say anything, but I did because it was prompted in an un-open way and I think that’s a pervasive issue for a lot of teens. Especially for queer people, we’re so curious about our identities and about other people who are like us that when the opportunity for sex presents itself, it can feel less like an opportunity and more like an obligation. For some people that can be damaging if they’re not actually ready for it.
Now, I am working at a local public health/public service agency in Indiana as a PrEP Coordinator trying to get people on PrEP, testing people for STIs and STDs, and normalizing conversations about safe sex practices. A majority of people that we see are underserved or may not necessarily have the funds to regularly access healthcare. This includes students from the local universities, teens, and sometimes much older people. But target populations identified by the state that are disproportionately affected include: men who have sex with men, Transgender individuals, African American women, and Hispanic or Latino/a/x individuals. A lot of the people we see either don’t have health insurance or they have health insurance that won’t cover the medications that they need. We also see people who have histories of using and abusing injectable substances. And we can provide resources and help for those people. Having free screenings and testing is really more about serving the public, and the issue that I run into is that I worry coverage doesn’t include everybody who I think we need to be cautious about because sexual health affects everyone. Even for people who don’t engage in sex, these issues still affect them.
Now my responsibilities have expanded as a PrEP Coordinator to talking with people and pointing them towards relevant resources. Honestly, coming from a household where those topics were and thought of as 'inappropriate,' it was difficult at first to have those conversations. But the more I engaged in them, the easier it became. It’s not where I imagined where I’d be, but the communities here have a very high need for people who are willing to have these conversations.
As a Psychology major in undergrad I was taught very specifically that a key point in any relationship with your patients or clients is building respect and rapport. When establishing those relationships, it is important to understand your own biases or beliefs, but this is something a lot of people still have to learn. You see people in healthcare throwing in their own biases into conversations and it is detrimental to the provider-patient relationship. This is something I work on all of the time, and why I think there needs to be continuous education for people so that they make sure they’re catering their interactions toward the benefit of the individuals they take care of.
The work I do is fulfilling in the sense that we’re making a difference in the community, but there is a still room to grow. Unfortunately, though, there are so many people who desperately need this service that don’t receive it; whether it's because they don’t qualify or because they don’t even know about it at all. We can have people come in and get tested, and we can do it for free even if they’re not presenting any symptoms, but so much of the access is conditional. If someone comes in presenting as non-binary with female sex at birth and has sex with men, I think that they should qualify for a series of screenings because they are at risk. Unfortunately, because of specific qualifiers, they can’t receive those screenings. So even though we are doing so much good in our organization, the current lack of comprehensiveness represents how queer populations are still underserved. We can still be more comprehensive and more inclusive in LGBTQ+ health and sex education in this country.
What advice would you like to give the readers of Dx:Q?
First, I’d like to address patients, especially people who don’t like the label “patient” because of the feelings of different power dynamics. I definitely encourage anyone who wants testing or wants to know more about community health to take initiative and seek out information. Your local health department can always help, and a google search always helps to find organizations in your area. There’s never anything wrong in asking questions, and if anyone ever makes you feel bad for it, then that’s a reflection on them. If the people in your life are doing that, at a certain point you don’t need to explain what you’re doing for your personal health.
For people working in mental, community, public, or sexual health, my biggest piece of advice is to make yourself a priority. I know it’s tiring and exhausting, especially in a world where people are denying science. Feel free to ask for support from others around you for those harder days or weeks. If you ever want to take a break and explore something else, even if it’s the little things, then go for it. Sometimes all you need is a break to realize what you truly love." -Tyler Pyle, South Bend, Indiana (he/him/his)