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214 Cultural Competence in Health Education and Health Promotion

INTRODUCTION
There are some who might argue against including the lesbian, gay, bisexual, and
transgender (LGBT) community in a multicultural health education book. Indeed, they
might argue that LGBT individuals do not constitute a cultural group. This argument
would narrowly confine culture to race and ethnicity. Restricting culture to race, eth-

nicity, or heritage narrows its scope and breadth. Culture involves behaviors and
beliefs characteristic of a particular social, ethnic, or age group. Culture can go beyond
behaviors and beliefs and present a dynamic set of shared values, customs, communi-
cation patterns, and norms often influencing the behaviors and action of the group

(Campinha - Bacote, 1999; Smith, 1998). Indeed culture can guide people ’ s behavior
along shared paths.
These shared behavioral paths can become the shared attributes of a group of
people and then their culture. People, particularly the LGBT community, can share a
culture regardless of their race or ethnicity, in the same way that workers in the automo-
bile industry share a culture regardless of race or ethnicity. So it is important for health

educators to extend their definition of culture beyond race and ethnicity to include
socioeconomic status, physical abilities and limitations, religious beliefs, and political

affiliation, as well as sexual orientation. The LGBT culture is an undeniable fact, as evi-
denced by the symbol of the rainbow flag, pride parades, and drag queens.

All health educators and health professionals should strive to provide culturally
competent services. Yet the majority of LGBT people do not feel they are receiving
culturally competent care (Meyer, 2001). The high profile assigned to human immuno-

deficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) has led

many health educators and health professionals to conclude that this is the only health
issue affecting the LGBT community. There is a lack of knowledge and appreciation
for the extent of the problems facing this unique cultural group. This lack is further
complicated by the fact that as previously discussed, certain segments of the U.S. pop-
ulation do not wish to recognize LGBT people as a cultural group. It is imperative that
health educators and professionals recognize that the gay culture is made up of a col-
lective of LGBT populations that are as diverse as their members.
Members of the LGBT community have significant health disparities in areas such

as substance abuse, teen suicide, health care access, and hate - crime violence (Dean
et al., 2000). The most significant health disparity is the comparative lack of research.

Information about transgender health is extremely limited and on some issues com-
pletely absent. Several well - recognized health agencies have acknowledged the inade-
quate research on LGBT health. The National Institute of Mental Health, the Centers for
Disease Control and Prevention, the American Medical Association, the American Pub-
lic Health Association, and the Institute of Medicine have all released reports indicating
that health care research in lesbian, gay, bisexual, and transgender communities is
largely inadequate (Shankle, 2006). Despite the need for increased research among this
population group, federal research dollars remain narrowly focused on HIV and AIDS.
This chapter addresses the health behaviors of the LGBT community. We will
explore cultural factors and myths, offering culturally sensitive information for health

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