Carolina Ramos has seen the struggle over and over again. She is the Latino/a services coordinator for the LGBT (Lesbian, Gay, Bisexual and Transgender) Community Center in San Diego, where she sees families torn and battered, as they try to come to grips with a child who has a different sexual orientation.
"A lot of people think LGBT issues are one thing, and Latino issues are another," Ramos said. "But for many people, you cannot separate them."
Ramos traveled to Sacramento recently to testify at an Assembly hearing on the subject. In general, she said, health risk factors increase in severity with societal pressures -- and Latinos in the LGBT community have multiple stressors, Ramos said.
For instance, lower-income people have difficulty accessing health care. Language can be a barrier. Distance from health care facilities is a barrier. Gay patients have an additionally difficult time communicating with providers. Immigrants face discrimination. Gay Latinos face discrimination from family, from friends, from church. There is the social pressure of machismo. All of those pressures add up, Ramos said.
"Everything from low income to race are stressors," she said. "You know, I've had parents say, 'Hey, they're your responsibility now, your responsibility if they die,' and that [kind of situation] was very painful."
That's the kind of situation often faced by gay Latinos and one reason for convening the recent hearing, according to Assembly member Ricardo Lara (D-South Gate), who also is chair of LGBT issues for the California Latino Legislative Caucus.
"We have individual and unique circumstances that LGBT Latinos face," Lara said, "not only in mainstream society but in the Latino community, as well."
That culture clash within the Latino community is the biggest barrier to cross for many people, according to Lara -- himself included.
"At the end of the day, you can't take away my rice and beans," he said with a laugh. "But how I feel is, you shouldn't have to choose between your culture and your sexual orientation."
More than a dozen legislators attended the legislative hearing, including Assembly member Tony Mendoza (D-Artesia).
"The Latino community is very reluctant to discuss these issues," Mendoza said. He said he makes a point to talk to his children about being inclusive, to make sure they keep their minds and hearts open. "Latinos continue to stereotype those in the LGBT community," he said. "This [hearing] is just a beginning."
Assembly Speaker John Pérez (D-Los Angeles) said he aims to expand the scope of one state agency that could help. "We want the Office of Multicultural Health to include the LGBT community, to expand its focus," Pérez said. "It has done good work in terms of addressing the different impacts on communities of color, and [we would like it to move] toward the importance of cultural competency, and to identify the multiple sets of barriers to health care faced by Latinos in the LGBT community."
Sen. Christine Kehoe (D-San Diego) added that physicians bring their own biases to the exam room, even if they do not intend to.
"We'd like to see two to five hours of [provider] training on LGBT issues," Kehoe said of her proposed legislation. "We haven't linked it with language yet. We think it's a gap that needs to be addressed. There are gaps in knowledge and in approach."
For Assembly member Norma Torres (D-Pomona), the biggest gap is the need for the mainstream community to accept gays, instead of trying to get the LGBT community to fit into the mainstream.
"We don't need to teach folks how to be gay; we need to teach folks how to be respectful," Torres said. "Tolerance is not a word I can tolerate. I don't want to be tolerated for being a woman, I want to be respected for who I am. And I think the same is true for the LGBT community."
Family Bridges To Cross
In Latino culture, family is important. When it comes to being gay, that can be good or bad, according to Octavio Vallejo of the AIDS Project Los Angeles.
"I know firsthand what it's like to be gay and not to be taken care of," Vallejo said. "When you grow up gay in a Latino family, you grow up with very, very low self-esteem."
That social dynamic has public health repercussions, he said. "That sense of worthlessness and lack of self-esteem brings this community into high risk for a number health concerns."
Gay Latinos are at risk for high blood pressure, depression, obesity, diabetes, sexually transmitted infections and stress-related conditions, he said.
"The level of homophobia is so high in the Latino society that people have to live in a double life, a hidden life," Vallejo said. That discrimination, he said, means that "mental health issues are an overwhelming health concern facing the Latino LGBT community. Depression, mental distress, self-exile, these become much more prevalent in the Latino community, as people are isolated from family, and isolated from support."
Caitlyn Ryan runs the Family Acceptance Project at San Francisco State University, a program that looks at how acceptance or rejection by families affects individuals in the LGBT community.
"For Latinos, family is the heart of the culture," Ryan said. And acceptance by family is at the core of health in the LGBT community, she said.
"We look at the experiences of individuals in the LGBT community, and in families that are not accepting of them, 60% are thinking about taking their lives, compared to 8% in families that are very accepting," Ryan said. "We found a high relationship between rejecting behaviors and suicide attempts. We also found that a young person's ability to feel there is a future is linked to accepting behaviors in the family."
The Family Acceptance Project, she said, is a little different. "We're not ideological, so our approach is to accept values and faith values," Ryan said. The idea, she said, simply is to present the data to faith-based organizations or families and let them see how much of an effect their acceptance or rejection has.
"It's quite impressive the change that can take place," Ryan said. Family members think they're helping a child by trying to get them to change their sexual orientation -- through shunning or talk or prayer -- and most of them are stunned to see the negative effects their rejection can have on a child, according to Ryan.
A Paradigm Shift
Most people in the LGBT community who have mental health or stress issues are served alone or within the LGBT community, Ryan said. She would like to see a different approach.
"We're creating a paradigm shift," Ryan said. "We want to take the structural approach of the family. Latino families, in particular, are well-suited to accept this work."
Ramos said she has a similar approach in the San Diego LGBT Community Center -- except that it's Latin-centric. "We do it in the Latino way," she said. For instance, because food is the cultural center of gatherings, she always makes sure LGBT gatherings also are a bit of a feast.
The results of focusing on the family, she said, are dramatic.
"Really, just to have Latino dads in a support group is an amazing thing," she said. "And what they say is, 'I love my children and that's why I'm here.' It's amazing."
For many families, it's a journey toward acceptance, Ramos said. But the feeling for the child almost always seems to trump the feelings of rejection.
"We are finding that working with the families is the key," Ramos said. "Moms, dads, grandmas, aunts. That's where we're seeing the change. If the family supports them, that's all the acceptance they need. They think, 'Coming out to my parents is so scary, but if they accept me, I don't care if anyone else does.' And I think that's the key."
That makes complete sense to Jorge Sanchez, a coordinator at the Family Acceptance Project. And it's more than making people's lives more comfortable, or more fun, he said.
"What we're witnessing here can actually save lives," Sanchez said.
"Latino families understand discrimination. We see a lot of discrimination," he said. "And so many parents have come to us and said, 'Our home is a discrimination-free zone for our child,' and there's so much power in that statement. They are unwilling to pass that discrimination onto their children, and I think that saves lives."