_____________________________________________________________ Cultural Competence: An Overview
Homophobia : A negative attitude or fear of non-straight sexuality or GSM individuals. This may be internalized in the form of negative feelings toward oneself and self-hatred. Called “internalized homophobia,” it may be manifested by fear of discovery, denial, or discomfort with being LGBTQIA+, low self-esteem, or aggression against other lesbians and gay men. Homosexuality : The “persistent sexual and emotional attrac- tion to members of one’s own gender” as part of the continuum of sexual expression. Typically not used to describe people. Intersex/intergender : Encompasses a diverse set of congenital differences relating to gonads, chromosomes, and genitals that fall outside the typical parameters of male or female sex. Although intersex falls under the umbrella of LGBTQIA+, many do not identify with that label. LGBTQIA+ : An acronym used to refer to the lesbian, gay, bisexual, transgender/transsexual, queer/questioning, inter- sex/intergender, asexual/ally community. In some cases, the acronym may be shortened for ease of use, although a + usu- ally always follows to represent other identities not included in the other letters. Queer : An umbrella term to describe persons with a spectrum of identities and orientations that are outside of the hetero- normative standard. Sexual identity : The inner sense of oneself as a sexual being, including how one identifies in terms of gender and sexual orientation. Sexual orientation : An enduring emotional, romantic, sexual, and/or affectionate attraction to another person. Individuals may experience this attraction to someone of the same gender, the opposite gender, both genders, or gender-nonconforming. Transgender : An umbrella term describing a number of dis- tinct gender positions and identities, including crossdressing, transsexual, non-binary, and intersex. One’s intrapersonal acceptance or rejection of societal ste- reotypes 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 indi- viduals. Some authors stress the diversity within the GSM community by discussing “GSM populations.” 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, many distinct communities have been identified, including lesbian, gay, bisexual, and transgender. Each community is different from the other as well as different from the heterosexual community.
safety, and performance, all of which tie into men’s perceptions of their roles as providers and protectors [54; 55]. Women tend to have a higher level of health literacy but should still be involved and active participant with their own healthcare and/or treatment plans [53]. GENDER AND SEXUAL MINORITY POPULATIONS The gender and sexual minority (GSM) population, also referred to as the transgender and gender nonconforming population, is a diverse group that can be defined as a sub- culture, accounting for 7.6% of the U.S. population in 2023 [3]. This group includes gay men, lesbian women, bisexual persons, transgender individuals, and those questioning their sexual identity, among others. The GSM population is diverse, representing all ages and all socioeconomic, ethnic, educational, and religious backgrounds. The population has been described as “hidden and invisible,” “marginalized,” and “stigmatized.” As a result, the unique health and safety needs of the population have often been overlooked or ignored. Clear definitions of the concepts related to sexual identity will be helpful. The following is a glossary of terms used in discussions of this group [50; 51; 52]: Asexual/aromantic : An individual who does not experience sexual attraction. There is considerable diversity in individuals’ desire (or lack thereof) for romantic or other relationships. Bisexual : An adjective that refers to people who relate sexually and affectionately to both women and men. Coming-out process : A process by which an individual, in the face of societal stigma, moves from denial to acknowledg- ing his/her sexual orientation. Successful resolution leads to self-acceptance. Coming out is a lifelong process for lesbian, gay, bisexual, and transgender persons and their families and friends as they begin to tell others at work, in school, at church, and in their communities. Gay : The umbrella term for GSM persons, although it most specifically refers to men who are attracted to and love men. It is equally acceptable and more accurate to refer to gay women as “lesbians.” Gender and sexual minorities (GSM) : A term meant to encom- pass lesbian, gay, bisexual, trans, queer/questioning, intersex/ intergender, asexual/ally (LGBTQIA+) people as well as less well-recognized groups, including aromantic, two-spirited, and gender-fluid persons. Heterosexism : An institutional and societal reinforcement of heterosexuality as the privileged and powerful norm. Heterosexuality : Erotic feelings, attitudes, values, attraction, arousal, and/or physical contact with partners of the opposite gender.
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