Promoting the Health of Gender and Sexual Minorities _ ____________________________________________
These older LGBTQIA individuals grew into adulthood dur- ing the Pre-Stonewall Riots period. This was a very oppressive time period for the LGBTQIA community and one during which there were no hate crime laws and no research on the incidences of antigay hate crimes. LGBTQIA individuals had to learn how to manage homophobia and heterosexism over a lifetime, an effort that requires tremendous daily emotional energy. The healthcare community might never know the full effect that internalized homophobia has had on older GSM Americans [154]. Having lived through years of stigma, before the ascendance of more positive attitudes toward homosexu- ality, older GSM individuals may think that disclosure to a healthcare provider cannot or should not be done. LGBTQIA individuals also disagree within their community about self-disclosure, and they do so for a variety of complex rea- sons. For example, older GSM individuals who do self-disclose may view it as necessary to override heterosexist assumptions about non-straight sexuality. Or, they may feel that disclosure makes discrediting them more difficult [41]. The subculture’s self-examination and discussion about self-disclosure has been dynamic and across intergenerational and intragenerational lines. As a result, healthcare professionals can anticipate that not all GSM individuals will be able to self-disclose. At any rate, asking older patients about their sexual orientation may not always be the best approach. By not asking, trust may be more likely to develop between the healthcare professional and the patient. At the same time, it is helpful to know the sexual orientation of the patient. In bereavement work, for example, the older patient should be free to reminisce about his or her life partner within a comfortable, trusting environ- ment without fear of critique [152]. Clearly, this is an extremely difficult issue to navigate. Intergenerational differences related to practical concerns also exist. For example, older LGBTQIA individuals have identi- fied legal strategies for protecting property as an important concern. A home care option that would offer protection from homophobic atmospheres in nursing homes, allowing more care from significant others and friends, has been identified as another important issue. Emotional needs, such as trust, hope, worries about loss, spirituality, family rejection, and loneliness, have also been identified. Though topics of concern are similar among the LGBTQIA generations, manifestation of these topics may vary widely at different times over the individual’s life span [151]. Health and loneliness may be more intertwined in the older LGBTQIA community [134]. For example, because older gay adults often have been closeted most of their lives, they may not know how to connect with existing health support systems provided by the GSM community [155]. Many older LGBTQIA individuals must also face the impact of HIV/ AIDS on aging. AIDS has left many in this population with fewer friends and support networks. Many GSM community members do not have children, who are a major source of support for the heterosexual population. The fear of develop-
ing poor health and experiencing illness may lead the GSM individual to concerns about poor quality and quantity of care by healthcare providers who are unaware and insensitive to the gay subculture’s unique healthcare needs and concerns [134]. Older gays and lesbians have many strengths, among them the learned importance of personal independence in planning for their own futures [154]. Growing older brings greater maturity, wisdom, and experience, resulting in a sense of empowerment for many [134]. Because of experiencing a lifetime of managing the many social stresses related to prejudice and discrimination, older gays and lesbians may be more prepared to cope with social discrimination and losses that accompany aging than are their heterosexual peers [79]. CROSSCULTURAL COMMUNICATION Only when the healthcare professional remains sensitive and aware can culturally competent care be provided for the LGBTQIA individual. LGBTQIA patients’ concerns about sexual identity or sexual orientation may exist or be deeply denied. Healthcare professionals are seeing LGBTQIA indi- viduals of all ages but may not know who these patients are unless the patient realizes his or her sexual identity and is comfortable enough to disclose it. In many health interactions, it is not necessary for the healthcare professional to know who is gay or questioning, but a comfortable setting should be created in which individuals may seek support and help for their concerns. The healthcare professional can utilize a variety of strategies to promote personal sensitivity, awareness, and knowledge of the LGBTQIA population. Borrowing from the discipline of crosscultural counseling, four communication skill areas may provide a framework for strategies that the healthcare profes- sional can use to be more culturally competent when interact- ing with the LGBTQIA subculture. The skill areas are [156]: • Be able to explain a problem or issue from another person’s perspective. • Know what causes the other person to become defen- sive and resistant. • Take actions to reduce defensiveness and resistance. • Know recovery skills to use when communication errors occur. Use of these skill areas may serve as a bridge to meeting pro- fessional and legal responsibilities when interacting with the LGBTQIA subculture [87]. APPLICATION OF SKILL AREAS AND CULTURALLY APPROPRIATE STRATEGIES The first crosscultural communication skill is to be able to articulate and present a problem or issue as it is seen from another’s perspective. To do this, the healthcare professional must learn about the culture in question. Studying the sexual
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MDDC1026
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