“Anywhere but Here”: Querying Spatial Stigma as a Social Determinant of Health among Youth of Color Accessing LGBTQ Services in Chicago’s Boystown

Abstract

The link between stigma and negative health outcomes is established, yet available research infrequently considers the complex intersection of place, race, and class-based stigma and how this stigma shapes opportunities and health among marginalized groups. Furthermore, scholarship on the relationship between stigma and health often fails to include the voices of the stigmatized themselves. This exclusion renders their lived-experiences hidden and their insight devalued, producing findings with limited validity to promote health equity and social change. In this article, we explore intersecting place, race, and class-based stigmas, or spatial stigma, as a social determinant of health among youth of color (YoC) accessing LGBTQ-specific services in the Chicago’s White, middle-class gay enclave, Boystown. Qualitative data were collected within the context of a youth participatory action research study with 11 youth researchers (ages 18 – 24). Data sources included critical autoethnography, focus groups with current and former LGBTQ service patrons, and individual interviews with LGBTQ service providers. Emergent thematic patterns illuminate how the stigmatization of YoC based on place, race, and class (i.e., being from poor and low-income, racialized South and West sides communities) impacts their opportunities in the neighborhood and access to health-supporting resources. These findings may be useful for practitioners and policy makers who aim to promote health equity among marginalized young people and add to the growing body of literature on health effects of spatial stigma among marginalized communities.

1. Introduction

1.1. Place and Health in Chicago

It is well-established in public health that “place matters” (Schaff et al., 2013) meaning economic and social conditions of geographic communities impact residents’ health beyond individual “risk factors,” ultimately shaping inequities across groups (Barber, Hickson, Kawachi, Subramanian, & Earls, 2016; Diez Roux & Mair, 2010; Macintyre, Maciver, & Sooman, 2009). Chicago is a case study in the influence of place on health on the United States, with its history of ethnoracial segregation across the city’s 77 “community areas” and 3 “sides” (i.e., Northside, Southside, Westside), each with distinct identities, differences in health status, and experiences of housing, economics, education, and justice (Henricks, Lewis, Arenas, & Lewis, 2017; Hirschtick, Benjamins, & Homan, 2017). Today, Chicago remains among the most segregated U.S. cities. White residents live predominately in neighborhoods on the Northside and surrounding downtown; Black residents in South and West side neighborhoods, and Latinx residents in Southwest and Northwest neighborhoods (Henricks et al., 2017).

Racial segregation in Chicago has been tied to myriad inequities, with poor and low-income, non-white neighborhoods often hit the hardest by overall disadvantage, negative health outcomes, and layered stigmatization of both people and place (e.g., Bechteler, 2016; Hirschtick et al., 2017; King, 2015; Winter & Sampson, 2017). One of the most definitive examples is the 1996 Chicago heat wave, initially characterized as an unfortunate environmental disaster resulting in excess mortality across the city. Upon further analysis, however, the soaring heat and excess deaths served to highlight pronounced social-spatial disadvantage, with mortality concentrated in Black, low-income neighborhoods where older residents were socially isolated in poor housing conditions (Klinenberg, 1999).

In their landmark 2017 report, Henricks and colleagues (p.1) describe inequities by place and race across Chicago as “pervasive, persistent, and consequential”, and not only “spatial”, but with “deep historical roots […] embedded in our social, economic, political, and cultural institutions; [with] powerful effects on the experiences and opportunities of all Chicagoans”. These inequities are rooted in a history of racist practices like predatory lending and reverse redlining (i.e., an illegal practice of offering exploitive, high-interest loans to people of color in minority communities) which have isolated many Black Chicagoans within disinvested and publicly disparaged communities, ingraining enduring perceptions of “difference” and “disorder” of the city’s non-white South and West sides (Bechteler, 2016; Henricks et al., 2017; King, 2015; Rothstein, 2017; Sampson & Raudenbush, 2004; Winter & Sampson, 2017).

Racial segregation is so endemic to Chicago that anyone presumed to live on the South or West side is vulnerable to the stigmatization associated with those parts of the city (Henricks et al., 2017). Thus, when low-income youth of color (YoC), predominately from the South and West sides of Chicago, access the multiple lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) services available in the city’s “Northside” White, middle-class gay enclave, Boystown, they likely confront stigma based not only on their skin color and perceived class, but also place-based stigma of their home communities (Daniel-McCarter, 2012; Rosenberg, 2017; Turner, 2009). In this article, we analyze how this stigma of place, or spatial stigma, intersects with race and class-based stigma, shaping health inequities among YoC accessing LGBTQ resources in Boystown.

1.2. The Northside and Boystown

While there are several other gay areas in the city, Boystown is widely-regarded – both locally and across the U.S. -- as the gay enclave in Chicago (Dai, 2014; Orne, 2017). Housed within the “Lakeview” community area, Boystown is racially diverse relative to other Northside neighborhoods, though is majority White (84.9%) and middle-class (median household yearly income of $75,882) (U.S. Census Bureau, 2015). Boystown is known for its LGBTQ community-based organizations providing access to social services and “safe space” for LGBTQ people and allies (Greene, 2014; Orne, 2017; Rosenberg, 2017). For LGBTQ youth, programming provided by these organizations may be a respite from school and home, where they disproportionally experience discrimination and violence relative to their cisgender, heterosexual peers (Choi, Wilson, Shelton, & Gates, 2015; Kosciw, Greytak, Giga, Villenas, & Danischewski, 2016). Though available across the city, LGBTQ-specific resources are generally perceived as predominately available in and around Boystown, drawing LGBTQ youth from the South and West sides to the area (Greene, 2014).

Boystown’s reputation as a hub for LGBTQ socialization and services should mean that it is a space where people from the “LGBTQ community” are not stigmatized. However, several scholars have documented the exclusion of people of color within gay enclaves in Chicago (Ghaziani, 2014; Orne, 2017) as well as Manhattan (Andersson, 2015; Irazábal & Huerta, 2016), South Beach (Kanai & Kenttamaa-Squires, 2015), San Francisco (Reck, 2009), and outside the U.S. (Giwa & Greensmith, 2012; Held, 2016). These analyses suggest that, ironically, gay enclaves – spaces created in response to sexual minority stigma and discrimination – are now new sites for socio-spatial stigmatization of low-income, LGBTQ people of color.

Two studies have examined manifestations of the stigma of LGBTQ YoC in Boystown. Per Daniel-McCarter (2012), following publicly violent events around the time of the 2011 Chicago Pride Parade, Boystown residents complained via social media posts about violent “outsiders” in their neighborhood, using the racially coded language of “thugs” and “hoodlums.” Posters also derided the presence of “South and West side youth” in the neighborhood -- a descriptor “any resident of Chicago knowns is code for Black and Latin[x] youth” (Daniel-McCarter, 2012, p.5). In another study, Rosenberg (2017), a former service provider in Boystown, describes the othering of LGBTQ YoC through autoethnographic vignettes. For example, Rosenberg recounts being asked by White, lesbian manager “Erika” to closely monitor youth patrons at a second-hand clothing shop housed within an LGBTQ organization in Boystown because the youth patrons are known to steal (despite her never having caught a youth stealing in four years). Rosenberg also describes, from their vantage across the street, overt policing of the front door of an LGBTQ organization in the neighborhood,

Three security guards, broadly built White cis[gender] men in heather grey uniforms, [stand] guard outside of the front doors […] They stand adjacent to the anti-loitering and smoking signs […] installed outside of its building […] pushing many of the youth who use their services further away from the organization.

(Rosenberg, 2017, p. 143)

The studies by Daniel-McCarter (2012) and Rosenberg (2017) and those in other gay enclaves do not directly tie this culture of exclusion and stigmatization of people of color to health. They do, however, suggest that the homonormative culture of gay enclaves, in which White, middle-class, gay, male identities are considered normative, stigmatizes “outsiders” (i.e., those who are non-White, poor or low income, and queer or transgender), blocking their opportunities and access to resources (Duggan, 2003). To extend this literature and to connect health to the socio-spatial stigmatization of YoC in gay enclaves, we draw on data from a polyvocal, qualitative, youth participatory action research (YPAR) study conducted by 11 youth accessing LGBTQ services in Boystown and one adult research partner.

1.3. Spatial Stigma and Health

Stigma, defined by Goffman’s seminal work, occurs when an individual is blocked from acceptance within society, reducing them from a whole person, to a “tainted, discounted one” (Phelan, Link, & Dovidio, 2008, p. 358). Stigma takes place at the convergence of labeling, stereotyping, separation, status loss, and discrimination within an inequitable power situation, with the stigmatized systematically rejected and excluded from opportunities such as employment, housing, education, and medical care (Link & Phelan, 2001). Scholarship on the relationship between stigma and health inequities is prolific, consistently suggesting that stigma (e.g., based on race, class, sexual orientation, or HIV-status) -- because of its function as a significant source of social stress and influence on overall social disadvantage – is “a central driver of morbidity and mortality at a population level” (Hatzenbuehler, Phelan, & Link, 2013, p. 813; Krieger, 1999; Link & Phelan, 1995; Nazroo, 2003).

In their conceptual model, Keene & Padilla (2010, 2014) connect negative representations of place or, spatial stigma, with health. This model of spatial stigma and health inequity draws on a growing body of research expanding inquiry into the “risks and resources that are contained within bounded spaces” (Keene & Padilla, 2014, p. 392), by centering inquiry on the social construction of place and the symbolic meanings attached to places (Graham et al., 2016; Keene & Padilla, 2010, 2014; McNeil, Cooper, Small, & Kerr, 2015; Wacquant, 2016). Spatial stigma is thought to mark both place and person, mutually reinforcing and unfairly structuring opportunities for health among predominately low-income, racialized communities.

Per the model, spatial stigma impacts health via three pathways. First, impeding access to health-promoting resources (e.g., employment) among those in or from poor and low-income racialized communities. Second, subjecting the stigmatized to interpersonal discrimination and systematic exclusion from material resources, leading to psychosocial stress and negative health outcomes. Third, shaping identity formation among the stigmatized based on an embodied stigma of place, leading to distancing oneself from stigmatized others, ultimately blocking the health benefits of engagement in social support and “collective life” (Keene & Padilla, 2014, p. 400).

A relatively unexplored aspect of spatial stigma relates to how residents of stigmatized places carry with them an embodied spatial stigma as they move across spaces and to new, unblemished places (For an exception see: Keene & Padilla, 2010). In this article, we examine this embodied spatial stigma as a social determinant of health inequity among YoC accessing LGBTQ services in Boystown. Our aims are threefold: (1) to describe the ways in which embodied spatial stigma shapes opportunities and health among YoC accessing LGBTQ services in Boystown and how perceptions of racialized communities shape YoC’s experiences in Boystown, (2) to facilitate youth telling their own stories, and (3) to promote a focus in research on the health equity concerns of a group that is systematically marginalized within a neighborhood that was itself created in response to stigma.

2. Research Setting and Methods

2.1. Partnering with Youth

In 2014, the lead author began volunteering at a youth program for 13 to 24 year olds housed within an LGBTQ organization in Boystown. After more than two years building relationships with youth patrons and program staff, she collaborated with 11 current youth patrons to form a research collective (“the Collective”) to examine youth’s experiences using and aging-out of LGBTQ youth services. The Collective employed a YPAR approach aimed at promoting a collaborative process between members, valuing youth’s expertise, and working towards collective action for social justice (Cahill, 2004; Cammarota & Fine, 2008). The process spanned more than five months (though some activities are ongoing), positioning the “youth researchers” as both participants and researchers in the study—examining simultaneously their own experiences and the experiences of their peers.

The youth researchers, including the second author, were 18 to 24 years old at the time of the study, most identifying as people of color and all as LGBTQ. Many were raised on Chicago’s South or West sides. The Collective’s adult partner (the first author) is White, straight/heterosexual, cisgender, in her thirties, and grew up in the Southeastern U.S.

The YPAR process incorporated multiple research questions, methods, and participant samples. We began with an autoethnographic exploration of the youth researchers’ lived-experiences (Denzin, 2014) accessing services in Boystown. Though initially interested in “aging out of LGBTQ services”, this autoethnographic exploration yielded new research questions focused on the stigmatization and negative treatment of YoC in Boystown. These questions drove the selection of additional methods, including focus groups with youth and “young adults” of color accessing LGBTQ services (we use “young adults” to acknowledge that those over 25 are not typically considered youth by community-based organizations) and individual interviews with LGBTQ service providers. Youth researchers were compensated $20 cash for each Collective meeting attended (N=27 meetings) and for note-taking or co-facilitating focus groups or interviews (N=14 focus groups/interviews). These methods were supplemented by field notes (Emerson, Fretz, & Shaw, 2011) collected by the adult partner/first author during meetings, data collection events, and “hanging-out” with the youth researchers. The methods, data sources, and information on the full sample are provided in Table 1.

Table 1.

Methods, Data Collection, and Sample Overview

Method	Sampling Frame	Sample Referred to as	Goal of Method	Sample Size	Data Collection Period	Data Collector(s)	Data Produced
Critical Autoethnography	Youth researchers (YRs)	YRs	To explore YRs’ lived experiences	11	10/11/16 – 10/25/16	YRs (Co-facilitated by adult research partner)	Audio recordings, Notes
Focus Group	Current and former LGBTQ youth service patrons	Focus group participants	To explore current and former LGBTQ youth service users’ live-experiences in Boystown and within CBOs	26	12/16/16 – 01/07/17	YRs	Audio recordings
Individual Interview	Service providers (across 6 organizations)	Interview participants	To explore service providers’ perceptions of youth’s experiences accessing resources within LGBTQ organizations/Boystown	10	01/31/17 – 02/20/17	The Collective	Audio recordings
Participant-Observation/Field Notes	Meetings of the Collective, Data collection events, “Hanging-out” with YRs and in Boystown	N/A	To document and analyze the process of conducting participatory action research with youth; to explore the settings in which YoC access LGBTQ services in Boystown	35+	9/20/16 – 03/14/17	Adult research partner	Field notes

2.2. Focus Groups with Current and Former Youth Service Patrons

Using convenience sampling techniques, we recruited focus group participants via fliers placed in locations where the youth researchers knew their peers to congregate – e.g., shops, restaurants, and community-based organizations in Boystown, local universities, and public transportation. Eligible participants were 18 or older and were current or former patrons of LGBTQ youth services in Chicago.

We engaged in several weeks of data collection preparation, including development of a semi-structured focus group guide based on research questions and constructs of interest, training by the adult partner on qualitative data collection, and ethics in human subjects research. Each focus group (N=4) was conducted by two youth researchers. Each focus group had between 4 and 10 participants (ages 20 to 29; N=26) and lasted between 54 and 70 minutes. Focus group conversations were structured around the benefits and draw-backs of LGBTQ services, and participants’ experiences accessing resources, including racism within LGBTQ organizations and in the neighborhood. Focus group participants who were over 25 and thus ineligible for most youth services, were asked to reflect on their time accessing youth services and current experiences using “adult” services in and around Boystown. Recruitment ended when discussions no longer yielded substantively new information (Corbin & Strauss, 2015).

2.3. Individual Interviews with Service Providers

We identified the six most commonly used LGBTQ youth services (e.g., emergency shelters and youth drop-in spaces) among the youth researchers and focus group participants from which to recruit social service providers to participate in interviews. We planned to triangulate findings from the interviews our critical autoethnography and focus groups, assessing the extent to which service providers’ perceptions of youth’s experiences diverged from or aligned with youth researchers’ and focus group participants’ experiences.

We employed purposive sampling techniques to invite at least one service provider (volunteer or paid staff) from each of the six service programs identified to participate, with a goal of generating a sample with diverse work experience (e.g., therapists, program directors, drop-in center volunteers). Of the 11 service providers invited, 10 agreed to participate.

We created a semi-structured interview guide focused on participants’ perceptions of youth’s experiences as well as their own experiences in the neighborhood, as many shared identities with the youth they served. Interviews occurred at locations convenient for participants, lasting between 39 and 73 minutes.

Focus group and interview participants received a $20 cash incentive for their time. Focus groups and interviews were recorded using two digital audio recorders, transcribed verbatim, and managed using qualitative analysis software Dedoose (2016). All study activities were approved by the institutional review board at the University of Illinois at Chicago.

2.4. Data Analysis and Interpretation

The Collective engaged in an eclectic, iterative analysis process, informed by constructive grounded theory (Charmaz, 2014) and participatory analysis (Dill, 2015; Hebert-Beirne et al., 2018). We developed a holistic understanding of YoC’s experiences accessing LGBTQ services in Boystown through iterative cycles of group-level analytic discussions, identification of initial codes based on emerging categories (e.g., “policing youth in the community”), and manual line-by-line coding of transcripts and field notes. We used code reports to identify patterns across categories, identifying themes relevant for improving youth-specific policy and practice at LGBTQ organizations (Charmaz, 2014; Ryan & Bernard, 2003; Saldaña, 2015). We presented preliminary findings to groups of key stakeholders at a local LGBTQ organization and youth leadership conference in spring 2016, with attention to member-checking our interpretations to ensure internal validity (Creswell, 2014).

Guided by preliminary findings and member-checking feedback, the second stage of analysis focused on experiences of place, race, and class-based stigma and health among YoC accessing LGBTQ services in Boystown guided by the model of spatial stigma and health inequality (Keene & Padilla, 2014). We developed a priori focused codes based on aspects of the model -- e.g., “blocked access to resources”, and additional codes grounded in the data -- e.g., “tokenization of youth”. We engaged in another iterative process of line-by-line coding and memoing (Charmaz, 2014; Saldaña, 2015) using qualitative data analysis software (Dedoose, 2016). We identified thematic patterns through discussions of code relationships and memos, considering alternative interpretations and contradictions to emergent findings (Antin, Constantine, & Hunt, 2014; Miles, Huberman, & Saldaña, 2013).

3. Results

Focus group participants (N=26) had an average age of 25 years old (range: 20–29). The majority were Black and/or African-American (80%), male (58%), LGBTQ (77%), and had attended some college (54%). Individual-level data for each focus group participant is summarized in Table 2. We display disaggregated data to highlight participants’ intersecting identities and to avoid conflation of sexual orientation and gender identity. Demographic information was not collected from interview participants (n=10) to protect their privacy given the small community of LGBTQ organizations in Chicago, though we know them to be diverse in terms of ethno-racial, sexual, and gender identities, and professional experience. The majority have advanced degrees in social work, counseling, and related fields.

Table 2.

Descriptive Data of Focus Group Sample

N=26*	Age	Gender Identity	Sexual Orientation	Race/Ethnicity	Highest Level of Formal Education
1	25	Gender Fluid	Sexually Fluid	Multi-racial (Hispanic/Latino, Black, White)	Some College
2	23	Male	Bisexual	Black	High school graduate
3	26	Female	Bisexual	Multi-racial (Black, White)	Some college
4	20	Female	Bisexual	Black	Some college
5	24	Female	Gay	African American (AA)	High school graduate
6	29	Male	Gay	AA	Some college
7	23	Male	n/a	AA	Less than high school graduate
8	24	Male	Straight/Heterosexual	Black	High school graduate
9	23	Female	Straight/Heterosexual	Black/AA	High school graduate
10	23	Male	Bisexual	Black	High school graduate
11	28	Male	Queer	Black	Some college
12	26	Female	Pansexual	AA	Some college
13	24	Male	Bisexual	Black	High school graduate
14	26	Male	Gay	Black/AA	Less than high school graduate
15	26	Female	Bisexual	AA	High school graduate
16	28	Transgender Female	Pansexual	Multi-racial (Black, Native American)	Some college
17	24	Male	Bisexual	Black/AA	Some college
18	27	Male	n/a	Black	Some college
19	29	Transwoman	Straight/Heterosexual	Multi-racial (Latino, White, Native American)	Some college
20	26	Male	Gay	Multi-racial (Latino, Black/AA)	Some college
21	26	Transgender	Bisexual	AA	Some college
22	28	Male	Pansexual	Black	Some college
23	23	Male	Straight/Heterosexual	AA	Less than high school graduate
24	28	Male	Straight/Heterosexual	Jamaican	High school graduate

^*missing=2

3.1. Outsiders in Boystown

In Boystown, YoC accessing LGBTQ services are deemed “others” because of their race, class, and perceived relationship to the stigmatized South and West sides of Chicago. Indeed, several youth researchers and focus group and interview participants suggested that, in Chicago, race is encoded in place such that Black and Brown people in Boystown are assumed to be from the South or West side, regardless of their actual home community. This status as South and West side “outsiders” engenders a sense among YoC that they are unwanted and unwelcome in Boystown and should “stay away” from the Northside:

Up here, you’ve got White people providing you a service. Mainly Black people come and receive the services, but [the locals] want you to stay away from up North. They want you to go somewhere else – South, West, anywhere that’s not…. anywhere but here.

(Focus Group 3)

A primary way in which YoC’s outsider status is communicated is through regular policing of their behavior. For example, youth research DeAndre (all names are pseudonyms) explained that local police treat YoC differently than they do White residents or visitors:

[I]f the cops stop us, they want to know what we’re doing in the neighborhood, or, “we heard there was a noise complaint in the neighborhood,” telling us to be quiet, versus 16 Cubs fans walking down the street drunk, happy about the game and stuff.

(DeAndre, Youth Researcher)

This sentiment was shared by other youth researchers and echoed by focus group participants, many of whom shared a belief that their safety was not a priority in the neighborhood:

I definitely think [the way people are treated here is] a racial thing. There’s a police station right there off of Addison. They do not like us. They do not like us because we Black, we transgender, we this and that. It is your job to protect us. You’re already right there letting us know that you’re not going to protect us.

(Focus Group 4)

Youth of color also are policed by local residents who monitor their behavior and movement, “starting rumors” about what their presence in the neighborhood signifies:

They hate our young people, they have these awful websites that people start rumors all the time. One time there was a person in the neighborhood where, [one of our young people] who was sleeping on the steps [of our building], like bundled up, not bothering anybody, just sleeping, she took a picture and posted it on Facebook about how the neighborhood is going down or something, just like really awful. And all he was doing was sleeping.

(Interview 6)

Policing also emerged in discussions of “Taking Back Boystown”, a social media campaign (and associated local initiatives) geared towards ridding the neighborhood of crime and returning the community to its roots. Taking Back Boystown has been widely regarded as a movement to push out people of color and was considered an overt form of racism among the youth researchers:

Taking Back Boystown is where you use this website [to raise funds] to actually have an ordinance [in] place to say that a certain amount of certain looking people cannot -- Negroes, n***** -- cannot come up to [Boystown]. And, [law enforcement] could basically racial profile you and have you [get] back on the train if you get off [at the stop in Boystown].

(Marcos, Youth Researcher)

Marcos’ understanding interpretation of the campaign highlights its intersecting racial and spatial undertones -- an effort to prevent Black people from “coming up to” Boystown from the South and West sides of the city. An interview participant also discussed Take Back Boystown as a deliberate attack on people of color from the Southside of Chicago, citing personal experiences of racism in Boystown and suggesting that local organizations are not addressing these problems:

What I’ve experienced working [at an LGBTQ organization in Boystown], like, we’re not talking about me being called a n***** on my way down the street, or we’re not talking about, “Take our Boys Town back,” or, “Let’s get some of these south siders out of here,” or, “South side trash.”

(Interview 1)

Not only were LGBTQ organizations criticized for neglecting to address issues of racism and stigmatization of people from the South and West sides, but they were also described as intentionally policing and controlling the behavior of YoC in Boystown. Among the most discussed examples were policies mandating youth be banned from accessing services if they threatened or were involved in physical or verbal fights with peers or staff. Several focus group participants had been banned from accessing LGBTQ resources, as was at least one of the youth researchers during the study. While some acknowledged that their ban was “justified”, others were adamant that they had been banned for unfair reasons, e.g., physically protecting themselves when faced with violence.

Banning can result in a temporary or permanent loss of resources and can prohibit access to a building even to just spend time in common areas with peers. Once banned from LGBTQ services, youth often must go outside Boystown to have their needs met, requiring dependence on services that are not “LGBTQ-friendly” or which they deem subpar. A focus group participant who had been banned from most of the LGBTQ organizations in Boystown explained their struggle accessing services in Boystown after time spent in jail:

I ended up in jail -- going back and forth. And then on top of that, I’m banned from these places because of my attitude. I had to go about the city looking and searching for these places [to get resources]. When I did come back to the LGBTQ community, find a little crack or a loophole or something that I was able to like get in, I got some type of help, you know, every now and then you do your make up the right way, you be able to slide past security and get a little help for the day. So, it’s like, it’s been a constant struggle, you would think that an organization would understand, ‘here’s a youth that’s traumatized, is still, you know, tryin’ to remove themselves from the oppression of society and stuff like that. Here I am, I’m young, and I’m Black, I’m trans, and looking for resources in the straight community.

(Focus Group 2)

Some focus group participants discussed their experiences accessing LGBTQ services outside of Boystown, suggesting that these options were unacceptable or inferior. For example, one focus group participant described accessing an LGBTQ organization’s resources on the Southside after being banned from the organization’s Boystown location:

I was banned from [organization] which is why they had me go to [the office] on 63^rd. Going into that one on 63rd make you feel like you goin’ to the Aid Office and you finna wait for the check […] I walked in and there was a basement and then I had to walk around to this other [place], I felt like I was going to re-apply for my [food stamps]. They’re good -- don’t get me wrong! Their services are excellent and not too many people jump on that, but honey you will feel like you just finna wait on your baby daddy to send the child support money and you don’t know why your mail ain’t comin’ through.

(Focus Group 2)

In this excerpt, the participant suggests that a building housing LGBTQ services on the Southside is akin to a place to access government financial assistance than. This is a stark contrast to the buildings housing LGBTQ services in Boystown, many adorned with brightly colored pride flags and other markers of LGBTQ inclusion. The participant did indicate, however, that the services, despite being in an unwelcoming building are “excellent” and underutilized.

3.2. We’ll Use Your Picture for the Website, but you Can’t Work Here

In contrast to being cut-off from LGBTQ services after having been banned, YoC experience tokenization by organizations in order to bring in donations and generate programmatic funding. Several focus group and interview participants suggested that LGBTQ organizations in Boystown are motivated to serve marginalized groups, such as YoC, primarily to keep the organizations afloat:

They just doing it for the funding so they can get some more money. That’s all that is. And they don’t want the youth [there].

(Focus Group 3)

There were times when one of these organizations was about close, my friends and I had to write letters to [the City Mayor] or whoever the man was. That’s how these places stayed open. I felt like I was being cheated. You used me to keep your organization open, to keep getting money and here I am still having to walk through the rain.

(Focus Group 2)

An example of this tokenization is the use of photos of YoC in LGBTQ organizational fundraising efforts. Many of the youth researchers had had their photographs used in promotional materials and posted on websites. These photos were sometimes used even after a young person had aged-out of “youth”-specific services and were no longer engaged with the organization. The Collective initially discussed this tokenization during the autoethnographic exercises and later explored it in interviews with service providers:

Service provider: [The organizations are] profiting. I’m sure you have experience of this too and profiting off of pictures of you. Yeah, like your face is on the housing program. Your face is on the website.

Youth Researcher/Interviewer: And I don’t receive a check or nothing.

Service provider: Yeah, just talking about the idea that a lot of times it’s more of a marketing piece or the idea that it’s more of with not-for-profit it is about making money to have these programs still exist, but I mean what’s the point of having the programs exist to make money [if] they aren’t doing anything to really help the group that they’re trying to service?

(Interview 4)

Discussions of the tokenization of YoC often led to another aspect of their limited, proscribed roles within LGBTQ organizations: limited jobs opportunities within those organizations. The youth researchers as well as some focus group and interview participants explained that it is difficult, if not impossible, for YoC who have accessed services through an LGBTQ organization to secure employment within that organization. While some LGBTQ organizations have policies preventing youth patrons from becoming employees within a few years (typically three) of accessing youth services, others have more nebulous polices against hiring youth. These practices were regarded by focus group and interview participants and youth researchers as discriminatory and counterproductive to LGBTQ organizations’ missions:

Service Provider: They will plaster people up [on the wall] – it’s a marketing tool because people feel bad about poor black gay kids. But, when you turn around, and you want to look at the people providing services, there’s only one or two gay black boys who work there. But yet, they’re the face of the organization on the outside.

Youth Researcher/Interviewer: They trying to be working here…

(Interview 3)

Several focus group participants explained that such hiring practices were one of many ways organizations “teach youth to be stagnant” (focus group 2), or, over-reliant on LGBTQ services, resulting in limited opportunities for economic and social mobility within the neighborhood:

Like a lot of these programs, you have to age out before you can actually go back to work there to help other people who need the resources. They’ll say “we have all these problems with staff” and “we don’t like the staff” -- what if we become the staff there? We change the norm for what the staff do? That way we could be happy and take pride [in the work]?

(Focus Group 4)

This ironic juxtaposition of tokenizing youth to generate money for the organizations, while preventing them from employment within the organization was perceived by the youth as a means of exclusion from full membership in the “LGBTQ community”. It was also perceived as a way to prevent YoC from elevating their status within LGBTQ organizations and in Boystown. Despite the limited opportunities, several youth researchers were determined to be hired by LGBTQ organizations in Boystown. Youth researcher DeAndre – who was intimately involved in programming, volunteering, and other opportunities at several LGBTQ organizations --attempted on multiple occasions both before and during our study to get a job within a large LGBTQ organization (not directly serving youth). His attempts were futile, however, as he was continuously informed that organizational polices forbade managers from hiring him due to his current utilization of youth services. At least one LGBTQ organization hired two of our youth researchers over the course of the study, however -- a departure from the organization’s former hiring practices. This hiring was a source of pride for those hired and for the Collective, as it suggested a subtle shift away from YoC’s stigmatized status as outsiders, to full members of Boystown. Youth researcher Angelo reflected on his new opportunity:

It’s been such a long journey [to get this job]; like, coming out of five years of homelessness, you know my daddy telling me that the path I’m choosing in my life isn’t the right way, all my family telling me like, “no you need to go for something more solid, ‘go do construction, go get a UPS job” […] I knew that you just follow your path and f*** what everybody else has to say […] you just gotta put in the work.

(Angelo, Youth Researcher)

3.3. “The Belmont Lifestyle” and “The Blame Game”

As highly stigmatized outsiders in Boystown, some YoC accessing LGBTQ services may look for ways to manage their own stigmatization through differentiating themselves from their peers in effort to “clean up” their own identities. At the beginning of our YPAR process, the youth researchers appeared to engage in this intra-group stigmatization through racialized narratives of youth accessing resources and lacking motivation to improve their lives. Within these discussions emerged two concepts coined by the youth researchers -- “the Belmont Lifestyle” and “the Blame Game”.

“Belmont” is a street and a public transit train stop in the heart of Boystown. The Belmont Lifestyle refers to youth who come to Boystown from outside the neighborhood to “hang out” -- often while using alcohol and drugs and who do not access resources towards an end-goal of self-sufficiency and financial stability. Integral to the Belmont Lifestyle is the Blame Game in which youth censure peers for over-reliance on LGBTQ services. The Blame Game and the Belmont Lifestyle are akin to racialized tropes of “individual responsibility” and emerged throughout focus group participants’ discussions:

They go up north, wanna hang in Boystown. This is the time to use your resources and move on in your life and better yourself. Most of them just go up there to hang-out, smoke all day, walk the streets.

(Focus Group 1)

Focus group participants who had already aged out of LGBTQ services frequently discussed their own motivation vis-à-vis their peers:

Some people, they just like sit there and use [the services provided by the organization] for like as long as they can. But me, I use it for motivation -- it helped me to be independent, so when I become independent, I won’t need them. I won’t miss them or nothing like that. But some people play -- they’ll stay in [organization name] and just play all day. Use the resources while you can because when you age out, then you’re going to be out by yourself.

(Focus Group 3)

Unlike focus group participants, interview participants rarely suggested that youth were over-reliant on LGBTQ services or lacking in motivation. Instead, suggesting that more important than individual-level motivation is access to basic resources and interpersonal support:

People make assumptions that young people who have been here a long time are not trying whereas I work with people and I know that they’re trying really hard and stuff takes a long time. To be motivated to be successful in ways that society say -- to go to school, find a job, have a house – [you’re] not gonna be able to focus on those things when your basic needs can’t be met.

(Interview 6)

Though the youth researchers initially participated in the Blame Game, their framing of motivation and blame shifted during analyses of the focus group and interview data when they began to identify the fallacy of focusing on marginalized actor’s individual responsibility rather than on the power structures unfairly shaping opportunities. This re-framing pushed the Collective to acknowledge how intra-group (re)stigmatization among YoC accessing resources in Boystown ultimately feeds the narrative of unmotivated, irresponsible others and limits opportunities for collective action among youth.

4. Discussion

In Boystown, and across Chicago, “South and West side youth” is synonymous with “Black and Brown youth” (and vice versa) (Daniel-McCarter, 2012), such that any YoC in Boystown is presumed an outsider, carrying with them the stigma of racialized South and West side communities. Our findings suggest that YoC accessing LGBTQ resources in Boystown experience this stigmatization of place and race, positioning them as others who are not full members of Boystown’s “community”. This stigma is communicated and realized through policing YoC’s behavior, tokenizing their presence to generate money for local LGBTQ organizations, and excluding them from opportunities for employment and social mobility. Our findings also suggest that to manage their own stigmatized identities, some YoC invoke a discourse of personal “motivation” and “individual responsibility”, distancing themselves from and re-stigmatizing YoC in Boystown.

In Keene and Padilla’s model (2010, 2014), spatial stigma impacts health via three pathways -- blocked access to resources, psychological stress and negative coping, and identity formation and stigma management. Our findings support these pathways, though for our purposes, the first two pathways -- (1) blocked access to resources and (2) psychological stress and coping -- are so intertwined and mutually reinforcing that we believe they need not be distinct. For example, YoC who access LGBTQ services in Boystown are directly (e.g., “youth can’t work here”) and indirectly (e.g., the backdoor policy) blocked from opportunities and health-promoting resources because of their stigmatized identities. YoC also perceive their presence as unwanted in Boystown, a feeling reinforced as their opportunities and resources are blocked. These experiences of exclusion and marginalization engender stress -- e.g., DeAndre’s profound disappointment after being barred from employment at an organization where he regularly accessed services and which used his photographs for fundraising -- likely negatively impacting YoC’s mental health and fostering a sense that LGBTQ organizations, and Boystown, are not for them. As the neighborhood is perceived as not theirs, and their access to resources and opportunities are decreased, negative coping may occur and use of available resources may decrease, together resulting in poorer health outcomes.

In the third pathway, to resist or cope with a stigmatized identity, the stigmatized distance themselves from the stigmatized group, resulting in social isolation and intra-group (re)stigmatization. Discursive distancing and the rhetoric of “individual responsibility” and “motivation” among YoC accessing resources in Boystown emerged strongly within our focus group discussions and initially, among the youth researchers. This intra-group stigmatization has two important implications for health. First, when dominant beliefs about South and West side Chicago neighborhoods are attached to YoC from those communities, negative tropes about them and the places from which they come are reified, leading to further stigmatization of both people and place. Second, by distancing themselves from and denigrating their peers, YoC become socially isolated in Boystown effectively limiting their opportunities to buffer against stigma-related stress and discrimination (Hatzenbuehler et al., 2013). This discursive distancing is perhaps one of the ways in which stigma of others continues to permeate gay enclaves and within LGBTQ organizations. This intra-group stigmatization may fracture opportunities for collective action, pitting the stigmatized against one another, thereby reinforcing power within a White, middle-class, homonormative culture (Duggan, 2003).

Our findings support research documenting exclusion of people of color from gay enclaves, LGBTQ organizations, and other social settings (Ghabrial, 2017; Giwa & Greensmith, 2012; Ward, 2008) each of which have clear implications for health via the pathways outlined by Keene and Padilla (2010, 2014). For example, several of our themes aligns with Reck’s (2009, p. 236) analysis of youth “outsiders” in San Francisco’s “the Castro” who experienced over-policing and community harassment -- “Because we’re young and we’re of color, we’re drinkin’ … and [police officers] wanna come and bother us”. Our findings also support others’ inquiry of spatial stigmatization and health among poor and low-income non-White, racialized community members, including spatial stigma constraining opportunities for social mobility among youth in Detroit (Graham et al., 2016) and opportunities for employment and housing in eastern Iowa among former residents of “defamed Chicago neighborhoods” (Keene & Padilla, 2010).

Our study is not without limitations. First, data were collected from purposive and convenience samples of youth and service providers. Future research may benefit from diverse samples gathered through sophisticated techniques (e.g., Respondent-Driven Sampling). Future studies should also include LGBTQ organizations’ leaders and adult patrons, local business owners and residents, allowing for a wider array of perceptions of the influence of stigma on health. Second, we exclusively employed qualitative methods, which are not generalizable to all gay enclaves, LGBTQ organizations, or youth accessing LGBTQ services. We believe, however, that our findings represent themes existing in other geographical and organizational settings. Lastly, we did not strategically focus on YoC’s resistance in Boystown – an important consideration for promoting health equity and in participatory research. Future studies should engage in deeper inquiry into marginalized people’s resistance as a social determinant of health and provide youth increased opportunities to shape, drive, and create action from research.

5. Implications for Policy and Practice

These data suggest that YoC are stigmatized because of their perceived home communities (the South and West sides) and their ethno-racial identities within Boystown’s homonormative culture. As stigmatized community “outsiders”, their opportunities, access to health-promoting resources, and social support are limited. Given that LGBTQ organizations have missions to provide care to LGBTQ people, it is critical that these organizations create meaningful opportunities for all to achieve optimal health and well-being -- both internally and in the “LGBTQ community” at large. Without intentional efforts to include and create opportunities for people of color, including youth, the larger goal of LGBTQ health equity and an inclusive community will be unachievable. It is the role of LGBTQ organizations and leaders to change the norms around who is a part of the “community” – a task that should not fall on the shoulders of those already locked-out of participation.

Highlights.

• Participatory action research with youth accessing LGBTQ resources in Boystown.

• Youth of color from Chicago’s South and West sides are outsiders in Boystown.

• Youth of color experience spatial stigma at the nexus of place, race, and class.

• This stigma manifests through policing, tokenization, and peer (re)stigmatization.

• Spatial stigma shapes youth of color’s opportunities and access to resources.