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224 Cultural Competence in Health Education and Health Promotion

American and Latino LGBT individuals include the importance of family and of
traditional gender roles, conservative religious values, and widespread homophobia
(Rosario, Scrimshaw, & Hunter, 2004). All of these factors would influence the forma-

tion of an LGBT identity and the coming out process.
Another issue that primarily affects African American and Latino LGBT commu-
nities is the interaction between homophobia and racism. A case study in Boston found
that African American and Latino LGBT people often encounter several forms of
oppression and discrimination (National Coalition for LGBT Health & Boston Public

Health Commission, 2002). The study addresses the specific combination of homopho-
bia and racism and how it can lead to negative outcomes, such as violence. For exam-
ple, in the year 2000, a disproportionate number of victims of reported LGBT hate
crimes were African American or Latino.
African American and Latino LGBT people face unique issues in the health care
system. Research has shown that they are more likely to have poor health than other

LGBT populations (Kirby, 2001; Lisotta, 2004). A significant reason for this gap is
lack of access to health care. A case study conducted in Washington, D.C., found that
47 percent of African American transgender people were without health insurance
(Xavier, 2000). Additionally, Latina and non - Hispanic white lesbian and bisexual
women in Jamaica Plain, Massachusetts, about twice as likely to be without health
insurance as their heterosexual female counterparts (National Coalition for LGBT
Health & Boston Public Health Commission, 2002). Health care costs are not afford-
able. Not having health insurance hinders access to preventive health care services and
means that LGBT individuals do not see health care providers regularly.
Other issues that affect African American and Latino LGBT communities are car-
diovascular diseases, diabetes risks, and HIV/AIDS. According to a Los Angeles –
based case study, African American and Latina lesbian and bisexual women are much
more likely to be overweight than heterosexual African American and heterosexual
Latina women. Obesity can lead to cardiovascular disease and diabetes. Additionally,
women who are overweight or obese are less likely to be tested for breast and cervical
cancer by their primary health care provider (Mays, Yancey, Cochran, Weber, & Field-
ing, 2002). HIV and AIDS affect racially and ethnically diverse LGBT people at a dis-
proportionate rate as well. According to a seven - city survey, the new HIV infection
rate is substantially higher for young African American gay and bisexual men than it is
for their gay and bisexual white and Latino counterparts (Centers for Disease Control
and Prevention, 2000). In another study conducted in San Francisco, 63 percent of
African American male - to - female transgender participants were living with HIV (Cle-
ments - Nolle, Guzman, & Katz, 2001).

INCREASING CULTURAL SENSITIVITY TOWARD
THE LGBT COMMUNITY
Initially, health educators may be invited to believe that the health care needs of the
LGBT community are no different from those of the general population. Indeed,
everyone needs age - appropriate health education and treatment as well as information

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