Collectivism: It is the tendency to place group needs and goals above the goals and desires of the individual.
Relational orientation: It is a cultural frame in which the self is defined in terms of its essential and continuing interdependence with others.
Familism: It defines a hierarchically organized extended family system as the basic social unit.
Family obligation: It includes both attitudinal and behavioral responsibilities in which children are expected to (a) show respect and affection for older family members, (b) seek their advice and accept their decisions, and (c) maintain propinquity, instrumental assistance, and emotional ties with parents across the life span.
Hu (2012) suggests that the most notable aspect of the modern Asian model minority stereotype is that they are academic overachievers. Clearly, not all Asians fit this pattern. The level of achievement of Asian students can be attributed primarily to the basic notion of the family and the central role that education plays. Education is the most valued way of achieving position, and success in education is viewed as an act of filial piety (respect for parents), a highly important principle (Africa and Carrasco 2011; Hu). Another modern stereotype is that of the silent, unassertive Asian, uncomplaining, unemotional, docile, and cooperative. Because the well-being of the larger group is most important in Asian culture, great importance is placed on maintaining harmony. Thus, the greatest virtue that one can achieve is fulfilling his or her role in the whole of the family or group, and individual achievement is seen as the result of the effort of the family or group. Maintaining harmony also creates a bias against change, which is opposite of American values to encourage change. In following these principles, Asians may hesitate to initially accept invitations, may choose items of lesser value when given the choice, and may not be assertive in situations where they might speak out (Hu; Sue and Sue 2013).
Asian culture emphasizes consideration of others; thus, benevolence and obligation must be present to reinforce relationships. As a hierarchical society, Asian relationships involve a lot of obligation, which might be viewed as dependence or domination. In essence, a substantial amount of responsibility and benevolence is expected in return. For individuals of equal position, there is still the principle of reciprocity, goodness given out will come back and kindness should be paid back (Hu 2012). Overwhelmingly, Asian culture has a male-dominated power structure. Equally as important is birth order, especially for males who are expected to take on more unique responsibilities as they grow into adulthood (e.g., oldest son assists the father).
The principles of endurance and sacrifice are highly applicable to early immigrants who worked under extreme conditions in the USA and endured racism because of their willingness to work hard for so relatively little. Endurance at all costs is central to the extent to which all other Asian values are carried out and what distinguishes Asian values from values in other cultures that look at first similar. Sacrifice means that one’s own situation is secondary to that of the group as a whole. Endurance is a measure of self-control and inner strength, and complaining is seen as a sign of weakness (Hu 2012). Hu believes that these values may lead to the perception of Asians as being uncomplaining and less vocal than other ethnic minority groups.
Many Americans are familiar with the concept of losing face among Asians. Maintaining good face is essential because shame and honor go far beyond the individual and reflect directly upon one’s family, nation, or related group. The extent to which an individual is able to maintain good face is a kind of measurement of how well one has kept faith to traditional values and one’s social standing among others. It is a strong control mechanism, which reinforces all other Asian values (Hu 2012). The act of keeping face and suppressing or not admitting embarrassing situations in the family history often manifests itself in the reluctance of Asians to seek mental health services (Sue and Sue 2013).
Many AAPIs rely on traditional health beliefs and practices (Africa and Carrasco 2011). To illustrate this point, several Native Hawaiian cultural values are presented (Mau 2010). These values are often relevant in the healthcare setting and are not intended to be an exhaustive list of Hawaiian beliefs. First, lokahi (balance/harmony) sometimes referred to as “Lokahi Triangle” (i.e., physical body, environment, relationships with others, family members, ancestors, the Gods, and mental and emotional states) is central to understanding of health. A person’s physical body cannot heal without setting right any problems within the mental or spiritual realm. Moreover, the person has to be willing to take responsibility for the healing and make amends for any wrongs that he or she might have caused in the past (Mau 2010). The second value is ohana (family), including the extended family or multigenerational homes, which is the primary social structure for an ethnic Native Hawaiian. Because illness affects the entire family, family members need to be involved in decision-making and treatment plans. The value of ohana is closely tied to the values of laulima (cooperation/helping) and kuleana (responsibility). Finally, the values of aloha (love, compassion) and malama (to care for) can influence the recipient–provider relationship because Native Hawaiians need to feel that they are being respected and cared for if they are to be willing partners in the helping relationship. Thus, a service provider must establish trust with the person. Native Hawaiians feel a strong responsibility to take care of their loved ones (Mau).
Many of the cultural characteristics of AAPIs have served them well as buffers against discrimination. However, it is important for service providers who work with AAPIs to look behind the success myth and to understand the historical and current experiences of AAPIs (Sue and Sue 2013). In fact, it is even more pressing when we realize that LGBT AAPIs underutilize healthcare and mental health services. Yet, for LGBT AAPI immigrant elders who are unprepared for the culture shock in the USA, the need for culture-specific diagnostic impressions and interventions are paramount. Efforts to assist them to integrate their different identity dimensions (e.g., race/ethnicity, sexual orientation, gender expression, culture, age) should be made with an awareness of self-perception and cultural perception.
Asian Americans and Pacific Islanders’ Attitudes About LGBT Persons
Currently, limited research on the attitudes and perceptions of AAPIs toward LGBT persons exists, especially that which is both culturally relevant and linguistically appropriate (Tseng 2011). In response to this dearth of research, Tseng initiated a study of the attitudes of Asian Americans , especially Chinese-speaking Americans, toward LGBT persons using in-language interviews and using culturally specific questions. The results indicated that for Chinese-speaking Americans, gender is the most salient lens through which they define, perceive, and form their attitudes toward LGBT persons and their attitudes in relation to prominent issues including children, culture, marriage, and family. Overwhelmingly, the majority of interviewees described LGBT persons as those whose gender characteristics (e.g., appearance, gender roles in relationships, behavior) do not conform to the gender characteristics of heterosexuals. “Gender nonconformity is both the most cited definition for being LGBT and the strongest source of discomfort with LGBT persons” (Tseng, p. 4). Moreover, strict adherence to traditional gender roles manifests itself in how they conceptualize LGBT persons in relationships. When asked to describe their perceptions of LGBT persons, the majority of interviewees described GBT men. Interviewees also described LGBT persons as people who are confused about their gender identity, and some admitted extreme discomfort with LGBT persons who are neither masculine nor feminine. The interviewees expressed greater negative attitudes toward GBT men, indicating that it is worse for men to be GBT than for women.
Tseng (2011) also found that the interviewees framed the “born that way” versus “choice” in two ways. First, a majority of interviewees did not believe the causes could be narrowed down to either of the two. Second, their beliefs in either of the two concepts were not correlated with specific attitudes (i.e., acceptance versus rejection) toward LGBT persons, even for those who were certain about the causes of being LGBT. Culturally, the majority of interviewees believed that there have always been LGBT in their home countries and observed that LGBT persons are afraid to be open in their countries of birth because the culture is not accepting of them. In addition, they believe that the relatively more open and liberal nature of American and Western cultures make it possible for LGBT persons to be more open about their sexuality; consequently, the culture is an enabler of LGBT persons being open about their identities (Tseng 2011).
The attitudes of the vast majority of Chinese-speaking Americans in Tseng’s (2011) study were anti-same-sex marriage. These attitudes can be categorizes as follows: (a) LGBT persons should be able to have the same rights but not to call it marriage; (b) the function of marriage is reproduction and passing down the family name; and (c) same-sex marriage is a violation of tradition, and only heterosexual marriage is recognized around the world. As parents, the interviewees indicated that they would grudgingly accept a LGBT child but not before making attempts to “correct” the child. In addition, they expressed two types of concerns. First, they were concerned about being labeled as ineffective parents who had done a poor job of raising their children. Second, they felt that it would be difficult to face close friends and relatives who may ridicule them, and they would feel a high degree of self-blame if their children turned out to be LGBT. On the question of the role that religion plays in their attitudes about LGBT person, the majority of Chinese-speaking Americans indicated that it only played a small role (Tseng). It should be noted that the majority of Chinese Americans identify as not religious (Dang and Hu 2005). Dang and Hu found that of the LGBT AAPIs in their survey, a large majority claimed to be atheist, agnostic, or without religion. Of those who did identify as having involvement in religion, on average, they said that their church or religion views being LGBT negatively and as wrong and sinful. Only 16 % said that their religion fully accepted LGBT persons. See Chapter “The Role of Religious and Faith Communities in Addressing the Needs of LGBT Elders” for further discussion of religion.
Boulden (2009) found a clash of culture between older generation and younger gay Hmong men. In this study, the researcher found that the participants described the attitudes of their parents and the older Hmong generation concerning the existence of LGBT persons as the older generation not acknowledging that lesbians and gays exists. Hmong elders have never known a Hmong who identified him or herself as gay or lesbian; thus, it was not an Asian issue, but rather a White disease and a White issue. Participants indicated that if their parents knew that they are gay, it would “break their hearts” for not having children to carry on the bloodline. Therefore, to avoid bringing shame to the family, they moved away and separated themselves. Some participants spoke of trying to manage the multifaceted conflicts and different aspects of their daily lives of being “out” at work, acting straight in public, and being and talking Hmong at home. In summary, nowhere in their multiple environments did the participants have the luxury of interacting with others while acknowledging their complete identity (Boulden 2009).
LGBT AAPIs strongly agree that homophobia and/or transphobia is a problem within the Asian-American community (Dang and Hu 2005). The perception was consistent among women, men, and transgender persons. For example, in India, being gay, the term, a recent addition to the Indian cultural dictionary, is challenged with substantial resistance. The Indian Penal Code #377 states:
Whoever voluntarily has carnal intercourse against the order of nature with any man, woman, or animal, shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to ten years, and shall also be liable to fine (Indian Law Info, n.d.)
The phrase, “against the order of nature,” refers to any non-heterosexual relationship (Bhattar and Victoria 2007, p. 40). Clearly, alternative sexuality is defined only in terms of sexual behavior, not identity, and is compared to acts of beastiality. In both Indian tradition and pop culture, gay is still defined as abnormal and evil. LGBT persons are portrayed stereotypically in Indian society in the form of a very feminine male of hijra. The term hijra is used to define transgender, intersex, and “third gender” people who live in communities outside of society. Consequently, a fear exists among Indians that if a person identifies as gay, he will soon start to dress and act as a woman. The acceptance of the Western ideology of LGBT persons is slow among more progressive Indians, and Indian communities in the USA find it hard to accept sexual differences because sexuality is a taboo topic in India (Bhattar and Victoria).
In general, AAPIs hold negative and prejudicial attitudes toward LGBT persons. However, as with all groups, varying degrees of acceptance exist. LGBT AAPIs report experiences that are equally negative and positive within in different contexts such as family and LGBT and non-LGBT organizations (Dang and Hu 2005). One interesting result of the survey by Dang and Hu is that despite their experiences with racism in the LGBT community, LGBT AAPIs are more comfortable working in predominately White LGBT environments than they are working in predominantly straight homophobic AAPI environments.
Asian American and Pacific Islander LGBT Elderly
The US Census has numerous limitations, including but not limited to specifically asking about sexual orientation or gender identity, individuals in same-sex relationships who are not living together, and homeless LGBT persons, which does not reflect the actual full diversity of LGBT persons in the USA (Dang and Hu 2005). However, other data suggest that of the Asian and Pacific Islander population, 2.8 % of adults identify as LGBT, including 3,246,000 in the USA, 32,931 of whom are AAPIs in same-sex couples, and that 25.9 % of AAPI same-sex couples are raising children. The majority of LGBT AAPI adults live in geographic locations where there are higher proportions of AAPI persons as opposed to areas with higher proportions of the broader LGBT population. Approximately, one-third of AAPI same-sex couples live in California, Hawaii, and New York. LGBT AAPIs are much younger than both the non-LGBT population and AAPI persons in same-sex couples. Approximately, 4 % of AAPI persons in same-sex couples are aged 65 and over (Kastanis and Gates 2013). Other characteristics of LGBT AAPIs include lower rates of college completion (42 %) as compared to AAPI non-LGBT adults (59 %); however, AAPIs in same-sex couples (58 %) have higher rates of educational attainment than their different-sex counterparts (54 %). Unemployment rates are higher for LGBT persons (11 %) compared to non-LGBT AAPIs (8 %). AAPIs in same-sex (81 %) couples are more likely to be employed than their counterparts in different-sex couples (70 %). Overall, AAPI persons in same-sex couples (40 %) are more likely to be US citizens by birth than those in different-sex couples (14 %), and same-sex couples are more likely than different-sex couples to have at least one partner with US citizenship status (Kastanis and Gates).
As with many other ethnic minority populations, not all LGBT AAPIs identify with the terms lesbian, gay, bisexual, and transgender because of cultural differences, internalized homo/bi/transphobia, and the dissociation between identity and behavior (Mangton et al. 2002). Because of cultural pressures and expectations that exist in Asian and Pacific Island cultures, lesbians and gay men and women and men who engage in same-sex behavior are required to stick to family values, marry, and have children, or place shame on their families, neighbors, and community (Boulder 2009). In fact, many Asian cultural norms render women invisible and silent. Compared to heterosexual AAPI women and both heterosexual and gay AAPI men, lesbians have a higher prevalence of tobacco use, binge drinking, marijuana, and other drug use. AAPI lesbians are less likely to adhere to traditional family-orientated gender roles, unable or unwilling to gain and receive emotional support from their families, and more likely to compete with men for masculine privileges in order to escape sexist oppression (Hahm and Adkins 2009).
In the USA, LGBT persons view “coming out” as a final revelation of their sexual orientation or gender identity. For AAPI LGBT persons, the integration of their ethnicity and their nationality as an American is known as “coming home,” in which they allude to their sexuality to a family member who may not challenge it, as long as the status quo within the family is maintained (Hahm and Adkins 2009). AAPI LGBT persons tend to have a high degree of internalized biases about minority sexualities, which frequently cause them to be isolated, serve as a barrier to accessing services, and increase high-risk behavior. The internalization of homophobia by AAPI LGBT persons can serve as a direct health risk (Mangton et al. 2002). In a discussion of the LGBT Filipino community, Alcedo (2014) shared some perspectives on what LGBT elders confront with being “out” as ranging from not feeling comfortable to being forced to make connections with more people because of the need to keep healthy and being well situated in an intergenerational lesbian community. Jim Toy and George Takei are two examples that illustrate the public role of AAPI LGBT elders as activists (see Table 8.2 for their profiles).
Table 8.2
Profile of AAPI LGBT elder activists
Jim Toy is a Chinese American activist, social worker, and a pioneer of the LGBT movement in Michigan. He is considered as the first person to come out publically as queer in Michigan, which he did at an anti-Vietnam rally in 1970. He is the founding member of several organizations, including the Ann Arbor and the Detroit Gay Liberation Movements, PFLAG/Ann Arbor, Transgender Advocacy Project, Washtenaw Rainbow Action Project, LGBT Retirement Center Task Force, and GLSEN Ann Arbor. Mr. Toy co-authored a non-discrimination policy around sexual orientation for the city and the university and the first LG Pride Week Proclamation from a governing body in the USA. He is well known for his work in establishing University of Michigan’s Lesbian-Gay Male Program Office, the first LGBT center in an institution of higher learning in the USA, where he served as coordinator from 1971–1994. |
George Takei is an actor, comedian, personality, and activist. He was born in Los Angeles to Japanese American parents. In 1942, he and his family were forced to move into an internment camp in Arkansas. When the war ended, he returned to California, where he completed high school and attended UCLA. He received both a bachelors and masters of art degrees in theater. He later attended the Shakespeare Institute at Stratford-upon-Avon in England and Sophia University in Tokyo. In 1959, his first professional debut as an actor on television was an episode of Playhouse 90, and Ice Palace was his first film debut. He was cast in his most well-known role, Mr. Sulu, in the Star Trek franchise, including six films. In the last 50 years, Mr. Takei has appeared in over 40 feature films and hundreds of guest-starring roles. He was presented the Order of the Rising Star and Gold Rays with Rosette for his work on USA–Japanese relations. In addition, he has an asteroid named after him, a star on Hollywood’s Walk of Fame, and received an LGBT Humanist Award. Mr. Takei is well known for his community and political activism in support of the AAPI and LGBT communities. |
Dang and Hu (2005) surveyed LGBT AAPIs to determine the extent to which they consider their sexual orientation and gender identity or expression as important. The results revealed that LGBT AAPIs ranked their sexual orientation or gender identity/expression as the second identity that most heavily influence their daily lives. Race/ethnicity was ranked as the most influential. Although LGBT persons often mask their sexual orientation or sexual expression and behaviors to avoid alienating their family and parents’ communities, in their relationships with others, they frequently have to decide which identity will take precedence—an ethnic or sexual identity (Eng and Hom 1998). The feeling of being caught between two separate or non-integrated identities was summarized in a dialogue between two Asian American gay men as, “though we are both Asian American and gay, our surroundings rarely allow these identities to coexist” (Bhattar and Victoria 2007, p. 39). When asked to identify political issues and attitudes that are most important, LGBT AAPIs ranked immigration, hate violence/harassment, media representation, HIV/AIDS, marriage/domestic partnership, and health care as the most pressing for them compared to immigration, media representation, the economy/jobs, health care, and language barriers for Asian-Americans in general.
The survey project, A Census of Our Own, gathered data from 364 LGBTQ Southeast Asian Americans from across the USA and found several main points (Queer Southeast Asian Census 2012). First, coming out narratives and data suggest that an alternative coming out model and culturally competent programming are needed, which addresses the unique experiences and challenged faced by LGBTQ Southeast Asians. The ability to communicate in their native language is challenging because, for example, there are no positive words within the Hmong, Khmer, Lao, or Viet languages to describe alternative sexual orientation. Second, a strict adherence to and policy of confidentiality is needed among service providers to ensure safety and garner trust of AAPI LGBT persons. In light of the role of family in the lives of elders, this may prove both difficult and necessary. Third, Southeast Asian Americans are coming out at a young age (before the age of 18). Because the process of coming out is often accompanied with psychological and emotional stress, education and safety should be essential components of any program or service. Finally, there are harsh realities of income disparities and limited economic opportunities for Southeast Asian in the USA, which adds to the pressure to contribute toward the family incomes.
While there is limited research on AAPI LGBT persons, much less research exists on transgender AAPIs. Thus, transgender (trans) and nonconforming gender (NCG) AAPIs are deserving of a closer examination within this chapter. One of the most important findings of the National Transgender Discrimination Survey (NTDS) of 2013 was that the combination of anti-transgender bias and structural and interpersonal racism meant that trans and NCG AAPI transgender persons of color, including AAPIs, experience particularly devastating levels of discrimination (Grant et al. 2011). Of the 6456 trans and NCG persons in the survey, 212 respondents identified themselves as Asian or Pacific Islander, or Asian or Pacific Islander and multiracial. The majority of the AAPI respondents were US citizens (84 %). The key finding of the survey revealed that AAPI transgender and NCG persons often live in extreme poverty (18 %), which is higher than the rate for trans and NCG persons of all races (15 %). It is six times the general AAPI population (3 %) and over four times the general US population rate (4 %). AAPI trans and NCG persons are affected disproportionately by HIV at a rate of 5 % compared to 2.64 % for trans and NCG persons of all races. Forty four (44 %) of AAPI trans and NCG persons have experienced significant family acceptance, with those persons being much less likely to face discrimination. Finally, 56 % of AAPI trans and NCG persons have attempted suicide due to discrimination. Other areas in which AAPI trans and NCG persons have experienced discrimination are presented in Table 8.3. In particular, discrimination in the area of health care is discussed in the following section.
Table 8.3
AAPI trans and nonconforming gender discrimination experience
Education: AAPI persons who attended school expressing a trans identity of NCG report rates of harassment (65 %), physical assault (39 %), and sexual assault (19 %) in K-12. AAPIs who were harassed and abused by teachers in K-12 settings show dramatically worse health and other outcomes compared to those who did not experience such abuse. |
Employment: AAPI trans and NCG persons have an unemployment rate nearly twice that of the general population. Twenty-one percent have lost a job due to bias, and 41 % were not hired for a job due to bias. Forty-nine percent have been harasses, 8 % physically abused, and 10 % sexually assaulted at work. Twenty-three percent have been compelled to sell drugs or do sex work for income at some point in their lives. |
Housing: AAPI trans and NCG persons have experienced various forms of discrimination ranging from being refused a home or apartment to being evicted due to bias. They have experienced homelessness at some point in their lives at nearly twice the rate of the general US population. AAPI trans and NCG persons are less likely than other races to own homes. |
Health Status, Barriers, and Service Delivery for Asian American LGBT Elderly
Several barriers prevent obtaining a full and accurate picture of access to services and service delivery for Asian American LGBT elders . First is the barrier of the omission of data reports on Asian American participants from some of the largest national health studies and surveys, along with differentiation among various ethnic subgroups in particular (Holland and Palaniappan 2012). Second, research methods for sampling respondents are often limited to persons who may have limited English proficiency and/or low socioeconomic status (SES). Finally, concerns about the validity of chosen measures for use with a particular Asian ethnic group arise because many measures are rarely validated on Asian Americans , and even fewer have been validated on the various Asian ethnic subgroups (Sorkin and Ngo-Metzger 2014). Moreover, measures have not been validated on either the Asian American elderly or LGBT population among them. Two areas in which Asian Americans consistently report low-quality care include preventive screening and detection and treatment of mental health disorders (Haviland et al. 2005). The contextual factors that impact the health of elders are influenced by the diversity within the AAPI communities with respect to health-seeking behavior and knowledge, SES, educational level, cultural traditions, and specific healthcare needs and issues (Trinh-Shervin et al. 2009).
Related posts:
African-American and Black LGBT Elders
The Intersection of Identities of LGBT Elders: Race, Age, Sexuality, and Care Network
American Indian, Alaska Native, and Canadian Aboriginal Two-Spirit/LGBT Elderly
End-of-Life Issues for LGBT Elders
Disabilities and Chronic Illness Among LGBT Elders: Responses of Medicine, Public Health, Rehabilitation, and Social Work
LGBT Elders in Nursing Homes, Long-Term Care Facilities, and Residential Communities
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