Last year, Adrianne,* 23, had a week-long fling while she was vacationing on New York’s gay resort Fire Island.

Since August 2002, J.R.,* 24, who lives in San Francisco, has been heavily involved in a new relationship that looks promising for the future.

For the past several months, Rochelle,* 20, has been having frequent sex with her girlfriend in their Denver apartment.

On the surface, these stories are relatively unremarkable. But the fact that Adrianne, J.R. and Rochelle are biologically female and their partners are biologically male — and they all identify as “queer” — poses a unique challenge to health-care and social-service providers across the country who have had to rethink their notions of “queer sex” in order to serve their target populations.

Coast to coast, youth and gay-oriented agencies have slowly been realizing that what may be defined as “heterosexual” relations by textbooks and public officials in fact happens quite often in younger queer circles, labels and genitalia be damned. As a result, many of these organizations — from HIV/AIDS groups to pregnancy counseling centers — have had to adjust their agendas to include populations they never before realized needed their services.

“Reproductive health and birth-control issues are often overlooked in queer youth organizations, just as queer identities are often overlooked in organizations that supply information about reproductive health and birth control,” says Jessie Gilliam, a program manager with Advocates for Youth, a Washington, D.C., organization dedicated to helping young people make responsible and healthy choices. “However, an increasing number of LGBTQ youth organizations are understanding that queer-identified young women are likely to have sex with queer-identified young men, and they are making major efforts to inform young people that they need to protect themselves.”

Maybe Babies as a Result?

Without necessarily discounting the experiences and identities of bisexual-identified women, lesbians have long known and accepted that their fellow dykes engage in sexual intercourse with biological men. Whether an early attempt to be straight, or an occasional recreational affair, this kind of intercourse has often been thought of as an expected part of a “coming out” process or “experimental” phase. And then there is the reality that many lesbians make their living from sex work with heterosexual male clientele.

But as gender and identity continue to expand — particularly within lesbian circles, where masculine labels such as “boy” and “daddy” are not necessarily considered taboo by women’s communities — so too do acceptable forms of relationships that fall under the larger queer umbrella.

When Adrianne, a self-identified butch dyke, last year chose to have sex with Tom, a gay man, it was to affirm her masculine identity, a role she covets within lesbian culture.

“He was a guy; I was his boy,” explains Adrianne. “We didn’t see it as a man-woman thing at all. We were both fags.”

J.R., on the other hand, was lesbian-identified until recently, when he began to see himself more as male. Never one to consider himself heterosexual, J.R.’s sexual relations continue to be queer, even as he now chooses to partner with other guys. “I’ve never been straight,” he says. “Not as a woman, and not as a man.”

And Rochelle, who has dated women since she came out at the tender age of 16, is dating Tammy, a male-to-female transgendered lesbian whose body is still equipped with male genitalia. While they consider themselves to be a dyke couple, their sex often involves intercourse. “It’s the type of intercourse that doesn’t need any attachments,” Rochelle explains. “I’ve always had all kinds of sex with women, and my girlfriend is just a different kind of woman.”

Lesbians having intercourse may be nothing new, but the fact that many lesbians view this sex as queer — and not heterosexual — is a piece of the story that is just beginning to be told, and is shaping the future of public-health approaches to sex education.

In May 2002, the National Youth Advocacy Coalition (NYAC) in Washington, D.C., an organization dedicated to LGBTQ youth, hosted its annual national conference, attracting more than 300 people. Among the conference’s offerings, such as activism, art, and spirituality seminars, the event also featured, for the first time, a queer youth pregnancy prevention workshop, facilitated by Jessie Gilliam of Advocates for Youth.

Gilliam says she was motivated to lead the workshop at the NYAC conference after coming across some startling new data. Namely, that lesbian-identified young women are not only just as likely as heterosexual women to have intercourse, but are even more likely than their heterosexual peers to become pregnant.

According to a 1999 study published in Family Planning Perspectives, a secondary analysis of a 1987 Minnesota Adolescent Health Survey showed that of the 3,816 students interviewed, about 30 percent of young women of all sexualities report having intercourse. Yet women who are bisexual or lesbian have twice the rate of pregnancy than their heterosexual peers (12 percent versus 6 percent, respectively). Moreover, the study also found that lesbian and bisexual teens are more likely than their heterosexual peers to have early intercourse (before the age of 14), frequent intercourse, multiple partners, and multiple pregnancies.

Advocates for Youth cites another study showing that 21 percent of lesbians report having high-risk sexual contact, including sexual intercourse with men who have had sex with men. (For bisexual women, that number jumps to 49 percent.) Overall, numerous studies have concluded that about 30 percent of lesbian and bisexual women have been pregnant at some point in their lives.

The Resource Center for Adolescent Pregnancy Prevention summarizes this data as “staggering,” especially “when you consider that most health-care providers do not counsel young women who claim a lesbian or bisexual identity about common STD prevention and family planning.”

Such oversight can probably be traced to several factors, according to Jessica Meyer, program director of Health Initiatives for Youth (HIFY) in San Francisco.

“I’m sure there is friction between staff and clientele at some of these organizations,” Meyer speculates. “Queer girls saying, ‘I don’t need that,’ and thinking that providers who want to talk to them about birth control are negating their lesbian and queer identities. And providers skipping it for girls who identify as lesbians, but then missing the boat.”

Meyer also notes that as more queer organizations offer pregnancy-prevention services, this information is probably targeted more toward females, “though the stats show that queer boys are getting people pregnant, so they should know as well.” And Meyer has yet to hear of a situation where a provider “starts with a pregnant teen, and then asks her about her sexual orientation. It is assumed a pregnant teen is heterosexual.”

Gilliam agrees that assumptions and expectations about identity and behavior are the biggest obstacles to obtaining information. “I think a lot of community-based organizations are pretty good about offering a full range of sex education for young people,” she says, noting that queer youth organizations have for years been attentive to bisexual women and lesbians who have what is known as “survival sex.”

“The problem comes when lesbian and women’s organizations assume that lesbian-identified women are not going to be having sex with men, or when young women who go to a lesbian health clinic may feel that asking for birth-control information would take away points from their ‘lesbian gold star.’”

Such reasoning rings true for Adrianne, who got pregnant and had an abortion as a result of her encounters with Tom. It had been years since either of them had used birth control, and since both were reportedly disease-free, “I think using protection might have made us feel straight, or silly,” explains Adrianne. “If we took the time to get a condom or something, we would have had to admit what we were doing.”

Similarly, Rochelle and Tammy met through queer youth circles, and both came out in an environment that emphasized safer sex from an AIDS transmission perspective. So while the couple often uses condoms, it is fear of disease that helps to enforce this habit, and they view the occasional slip as permissible under HIV harm-reduction guidelines. Pregnancy rarely crosses Rochelle’s mind, as she dismissed birth-control information during high-school sex education classes as irrelevant to her own sexual practices.

“Many young people are embracing a more fluid role in terms of their sexual orientation and gender identity, and as they become more comfortable with that, they won’t necessarily follow what they’re expected to do as lesbians or gay men,” says Gilliam. “A lot of people are armed with great information about how to have safer sex based on a past or evolving identity that may not ring true for how they identify now. So we need to start talking about things like pregnancy prevention through a queer lens.”

Relearning STD Risk

The fact that women who have viewed safer sex through a lesbian lens are having sex with men also translates into the need for greater STD-prevention services. And as more lesbians assume male identities, whether as boy dykes or as female-to-male transgenders, more are also dating men in a very queer fashion.

Recognizing this, San Francisco’s Stop AIDS Project began offering its “Trannyfags” workshop series two years ago to women and former women who are, or who are thinking about, partnering with gay men. Interestingly, it was a lack of data and statistics that prompted the creation of the program.

“When we received our data from the [San Francisco] Department of Public Health, it identified transgenders as a high-risk group, but focused mostly on male-to-female transgenders,” explains Paul Miller, workshops manager for the Stop AIDS Project. “The insufficient data raised a lot of red flags. We basically decided we weren’t going to wait for a problem to show up in the data to do something.”

Identifying what may otherwise be considered male-female sex as queer sex, says Miller, was key to reaching the high-risk population.

“Although our general programming has always been open to everyone, we know target interventions that specifically invite and address particular populations work better,” says Miller. “Somebody coming from a lesbian identity may not know where to go to get information about safer gay male sex.”

Other issues affecting trannyfags include learning how to affirm their own bodies and identities without putting their health at risk. The thrill of being male enough to attract gay men, for instance, might override the impulse to protect themselves.

“Trannyfags like myself aren’t naturally equipped to ‘top’ other gay men,” says J.R. “And bottoming — or receiving — puts us at higher risk for getting HIV and other diseases.”

The Trannyfag series has been promoted and assisted by many high-profile queer activists, including Patrick Califia, who made his name as a dyke sex writer and later partnered with a gay man and transitioned into a full-time male identity. And the success of the workshops — Stop AIDS estimates that over 500 people have attended since they first began — “speaks to the fluidity of gender,” says Miller. “At some of our workshops, people will fill in registration forms and we’ll have 24 different gender identities in attendance.”

For Miller, expanding his organization’s mission to seek out guys with lesbian backgrounds is par for the course, and something that every queer organization should consider.

“We’re more enlightened now,” says Miller, “We want to meet people where they’re at today, to promote their health and well-being for tomorrow.”

*Names have been changed at the request of those interviewed.

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