Hektoen International

A Journal of Medical Humanities

“Do I look gay to you?”

Elena Hill
New York, United States


Portrait of an asylum seeker
Joaquim, Refugee, Tijuana 2020. Richard Hill.

When I first went to Tijuana to the US-Mexican border to volunteer as a physician, I was expecting to see women fleeing abuse, men escaping gang violence, and families pursuing a better life. I was not expecting to see a large LGBTQ population.

In retrospect, it makes perfect sense that many LGBTQ individuals are pursuing asylum. Many Central and South American countries still battle extreme homophobia, and there are many LGBTQ patients in Tijuana for this reason. Many of them stay at LGBTQ-designated shelters in the city, forming their own communities. They populate our clinic—Refugee Health Alliance (RHA)—frequently. We provide for them psychiatric support and general medical care. Through their stories, I learned how many of them had escaped their countries after a lifetime of extreme physical, mental, and sexual abuse.

Joaquin was a sixteen-year-old boy who visited our clinic. He and his mother arrived from El Salvador to seek asylum just a few months earlier. He asked me if he could tell me something.

“Sure,” I said, “you can tell your doctor anything. It helps me to take care of you as best I can.”

He said he was gay, and had never told a doctor. In fact, other than his mother, he had never told anyone before. He had come to be tested for HIV because he had heard that “gay boys get that” and that its “really bad.”

He asked me about a hundred questions about HIV: “What do the symptoms feel like? I’m tired a lot and I’m not sleeping well in the shelter—is that a sign of HIV? How do I get HIV? Can you get it from the toilet bowl? That’s what one guy said. Can you get it from kissing? Cuz that’s all I’ve ever done—I kissed a boy one time. But that’s it—I promise!”

We had a lot of misconceptions to cover, and we spoke for about an hour. I wanted to give him the chance, for the first time, to ask freely. He was eager to finally have a safe space to ask. I obliged with joy.

Over the hour, he revealed years of hiding his sexuality, and years of abuse both verbal and extremely physical from classmates. It was toward the end of the hour when he confessed his uncle had been sexually molesting him since he was nine years old.

“I want to ask—I mean, I wanted to know . . . is that why I’m . . . is that why I like other boys? Did my uncle turn me gay?”

This was why he was really here. Sixteen years old, and he had never been able to ask anyone this question, a question that had been gnawing at him his entire life. In El Salvador, they don’t discuss these things.

My heart broke for him. “Joaquin, of course not. How you feel about men or women is not a choice, and it is not your ‘fault’— ever. I am so sorry no one has told you this before. I am so sorry you had to wait this long to get an answer to this question.”

As we were wrapping up, he stopped me before I opened the door. “Doctora, una pregunta—do I look gay to you?”

“You mean do you physically look gay? Like I thought you were gay based on the way you look?” I asked.

“Yes,” he said, “Can people tell? It might get me into trouble here. I don’t want to get hurt anymore. If you can tell, you tell me so I can keep me and my mother safe.”

This boy was sixteen and brutalized so badly that his mother packed him up and took him across multiple countries to protect him and now he was protecting her.

I wanted to hold him and tell him that the answer was no—he did not “look gay.” He did not look like anything at all except a sweet boy who loved his mother and had a bright sense of humor. To me he just looked like a human being.

There is a crisis of LGBTQ asylum seekers at the border, and there they will continue to wait. Until then, Refugee Health Alliance and other not-for-profit organizations are filling that gap and doing what they can to provide health care to this population.


For more information on RHA and their mission to provide care to the Tijuana asylum community, please visit refugeehealthalliance.org.



  1. Solis G. “Remain in Mexico has a 0.1% asylum grant rate. Los Angeles Times.” December 15, 2019 (https://www.latimes.com/world-nation/story/2019-12-15/remain-in-mexico-has-a-0-01-percent-asylum-grant-rate. opens in new tab).



ELENA HILL, MD/MPH, is a family medicine physician who trained at Boston Medical Center and now works in the Bronx, NY. Her clinical interests include international/immigration health and underserved populations.


Highlighted in Frontispiece Volume 13, Issue 1 – Winter 2021

Fall 2020  |  Sections  |  Doctors, Patients, & Diseases

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