Page 244 - Cultural Competence in Health Education

222 Cultural Competence in Health Education and Health Promotion

anorexia (characterized by self - starvation) and bulimia (characterized by binging and
purging food), can lead to kidney damage, cardiovascular disorders, dental damage,
and in severe cases, even death. Although women with eating disorders still outnum-
ber men with eating disorders, men ’ s eating disorders often develop at a later age. One
study suggests that for the general population, the average age for men developing an
eating disorder is 21, compared to an age of 17 for women (Braun, Sunday, Huang, &
Halmi, 1999).

HEALTH ISSUES OF TRANSGENDER COMMUNITIES
Transgender individuals remain the most misunderstood and underrepresented mem-
bers of the LGBT communities. Transgender patients also have unique health care
needs. Unlike nontransgender lesbian, gay, and bisexual people, transgender people
may want or need medical intervention in order to obtain hormone therapy or sex
reassignment surgery.
One of the biggest barriers to obtaining adequate health care services for transgen-
der people is lack of health insurance or having health insurance without allowable
“ trans ” health services. There are very high rates of unemployment and poverty in
transgender communities, especially in transgender communities that are racially and
ethnically diverse (Amnesty International USA, 2007). As a result, transgender people
often do not see health care providers regularly to screen for cancers, high blood pres-
sure, sexually transmitted diseases, and other illnesses. Transgender health services
(including hormone therapy and sex reassignment surgery) are rarely covered by insur-
ance providers. These procedures are very expensive and put transgender people in the

difficult position of trying to obtain them illegally when they are not affordable
(National Coalition for LGBT Health, 2004).
In order to receive services from a lot of health care providers, transgender patients
must admit to having gender identity disorder (GID). This presents problems on sev-
eral levels. First, it requires that transgender people admit they have a psychiatric dis-

order, as GID is still classified as such by the American Psychiatric Association. Also,
there is a rather lengthy evaluation system that accompanies diagnoses of GID. There-
fore transgender people must often wait for extended periods of time before they can
obtain services. Mental health providers then make decisions about who can obtain
hormone therapy and sex reassignment surgery and who cannot. This lengthy process
and fear of being judged by mental health care providers often puts transgender people
in the position of either not taking advantage of services at all or going to the street to
obtain hormones or surgery.
Often the lack of access to health care options results in the practice of dangerous
procedures. Many transgender women participate in injection silicone use (ISU for
short). This means that they inject silicone (or have someone else inject it) directly
into their breasts. Studies in cities across the United States have indicated that as many
as 33 percent of transgender women have reported participating in ISU (Reback,
Simon, Bemis, & Gatson, 2001). There are several health risks associated with ISU,

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