_____________________________________________ Promoting the Health of Gender and Sexual Minorities
DIVERSITY IN THE GSM COMMUNITY The GSM population, like the general U.S. population, is a diverse group that may be defined as a subculture, which includes all ages of gay men, lesbian women, bisexual and transgender individuals, and those questioning their sexual identity. Ethnic or racial and cultural backgrounds, educa- tion, income, and places of residence further diversify this subculture. One’s intrapersonal acceptance or rejection of societal stereotypes and prejudices, the acceptance of one’s self- identity as a sexual minority, and how much one affiliates with other members of the GSM community varies greatly among individuals [8]. Some authors stress the diversity within the GSM community by discussing “GSM populations” [9]. For example, it is understandable that a GSM population living in rural areas of the United States would have little in common with a GSM population living in urban areas or “gay-friendly” neighborhoods. Additionally, mental health experts have suggested that “GSM community” symbolizes a single group of individuals who express their sexuality differently than the majority of heterosexual individuals. However, four distinct communities have been identified: lesbian, gay, bisexual, and transgender [10]. Each community is different from the other as well as different from the heterosexual community. A cultur- ally competent healthcare provider should keep this diversity in mind so that vital differences among these smaller groups are not lost when thinking of the GSM population in general. Commonalities exist among the GSM communities as well. For example, many adolescents, whether gay, lesbian, bisexual, transgender, or questioning their sexual identity, lack sexual minority role models to assist with successful psychosocial development [10]. PROFESSIONAL LITERATURE AND THE GSM POPULATION Until recently, most professional literature about the GSM population was limited to psychology and sociology publica- tions, with a focus on the prevalence of illnesses in the GSM community, such as depression, suicide, chemical dependency, and human immunodeficiency virus/acquired immunodefi- ciency syndrome (HIV/AIDS) [8]. Though some information has been gathered, researchers have indicated that much more research and literature development must be done [10]. A body of knowledge related to sexual minority youth has been developed, but scant knowledge exists that addresses aging sexual minorities. Textbooks and curricula in some professional education programs have begun to include information about the GSM community and its health needs, both medical and psychoso- cial. Illustrations used in classroom discussions about special populations include GSM populations as well as examples drawn from racial, ethnic, and other diverse groups. In the United States, the media has been presenting healthy portray- als of gay characters (younger characters more so than elderly,
INTRODUCTION The gender and sexual minority (GSM) population has been acknowledged in healthcare professional literature as “invisible,” “hidden,” “stigmatized,” and “marginalized” and recognized as having difficulty accessing health care, receiving inferior care, or actually being denied care [1; 2]. However, changes in our society have increased awareness about and visibility of the GSM community. Perhaps as a result of these changes, more individuals are “coming out” to their families and friends. GSM youth are questioning their identity or com- ing out at younger ages than before. As we learn more about the GSM community, the image of a GSM person is changing from an image of one who is lonely, depressed, or ill to one who is a well-adjusted, contributing citizen. More GSM individuals and their families want culturally appropriate information as well as support and referral. This course brings no expectation that the reader change personal values or beliefs about sexuality or sexual identity. However, it is the hope of the author that reading this course will contribute to the professional’s ability to provide culturally competent care for GSM individuals while meeting profes- sional, legal, and ethical responsibilities. CULTURALLY COMPETENT CARE Because the GSM population has been considered a subculture in professional literature, a discussion of culturally competent care is fitting. Culturally competent care has been defined as “care that takes into account issues related to diversity, mar- ginalization, and vulnerability due to culture, race, gender, and sexual orientation” [3]. A culturally competent person is someone who is aware of how being different from the norm can be marginalizing and how this marginalization may affect seeking or receiving health care [3]. To be effective crosscul- turally with any diverse group, healthcare professionals must have awareness, sensitivity, and knowledge about the culture involved, enhanced by the use of crosscultural communication skills [4; 5]. Healthcare professionals are accustomed to working to pro- mote the healthy physical and psychosocial development and well-being of individuals within the context of the greater community. For years, these same professionals have been identifying at-risk populations and developing programs or making referrals to resources to promote the health and safety of at-risk groups. But, because of the general assumption that individuals are heterosexual, and because of social stigmatiza- tion and marginalization, GSM individuals remain compara- tively invisible in the healthcare system [4]. GSM youth and GSM elderly, for example, have been called “hidden” [6; 7].
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