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Culture and Sexual Orientation 223

including the spread of viral infections (such as HIV and hepatitis). It can also lead to
systemic illness and disfigurement and even death in some cases. The use of hormones

acquired illegally on the street is also extremely dangerous (National Coalition for
LGBT Health, 2004).
Along with not obtaining health care because of lack of insurance or not wanting
to be diagnosed with GID, there are other reasons why transgender people do not
obtain health care. Health educators and professionals may be transphobic in addi-
tion to homophobic. Additionally, not all transgender people are aware of the health
needs that are important for them to address, given their identity and whether or not
they have used hormones or had surgery. (Table 12.2 summarizes transgender health
needs.)

HEALTH ISSUES OF LGBT RACIALLY AND
ETHNICALLY DIVERSE COMMUNITIES

In this section we will focus primarily on African American and Latino (or Hispanic) les-
bian, gay, bisexual, and transgender people. Although these ethnic and racial groups do
not represent all of the LGBT racially and ethnically diverse communities, the majority

of the research in this field is focused on African Americans and Latinos. Fourteen per-
cent of the U.S. population is Latino and 13 percent is African American (Berstein,
2007). If we use the more conservative estimate of the LGBT percentage in a commu-
nity and say that 5 percent of ethnic and racial populations are LGBT, this could translate
to as many as 2 million Latino and 2 million African American people who are LGBT
(National Coalition for LGBT Health & Boston Public Health Commission, 2002).

Racially and ethnically diverse LGBT people have some significant cultural fac-

tors contributing to their identity. Cultural factors influencing identity for African

TABLE 12.2. Cultural Alert: Transgender Health Needs.

Always Prehormones After
Applicable Presurgery Hormones After Surgery

Male to Prostate exams Routine Breast exams Clinical vaginal
female (MTF) Sigmoidoscopies testicular exams Mammograms exams

Female to Breast exams Uterus and Blood pressure, Pap smear
male (FTM) Mammograms ovaries exams cholesterol Breast exams (though
Sigmoidoscopies Heart health not as often)
Clinical penis exams

Source: Long, 2005. Reprinted with permission of the author.

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