Activists and members of Austin’s LGBTQ+ community gather on the steps of the Texas Capitol in 2017 to commemorate the anniversary of the Stonewall uprising, a key moment in the birth of the modern LGBTQ+ rights movement in America. Credit: Austin Price for The Texas Tribune

Gallup estimated that 5.6% of Americans identified as lesbian, gay, bisexual or transgender in 2020. But according to the U.S. census from the same year, four Texas counties had no same-sex households and 93% had fewer than the national average.

Official surveys like the census undercount the size of the LGBTQ+ population, in part due to people’s fears of disclosing their sexual orientation or gender identity to neighbors or the government, said Jack Jen Gieseking, a cultural geographer who studies gender and sexuality at Mount Holyoke College in Massachusetts.

“There are definitely always LGBTQ people everywhere, no matter what the state,” said Gieseking.

Undercounting the LGBTQ+ population makes it difficult for health care providers to deliver appropriate care, for service organizations to raise funds and for governments to allocate resources. These challenges are especially relevant in Texas, where a conservative culture makes people less likely to disclose their sexual orientation or gender identity on official surveys.

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“One risk of undercounting is the assumption then that the population or the problem doesn’t exist,” said Brett Cooper, a specialist in adolescent medicine and member of the Texas Medical Association’s LGBTQ Health Section.

The U.S. census is severely limited in its ability to represent the LGBTQ+ population, according to Amy Spring, a demographer at Georgia State University. The survey asks only whether respondents live in same-sex households, and Spring said that this ignores gay and lesbian people who live in other arrangements and doesn’t address sexual and gender identity directly.

The American Community Survey, which is administered by the Census Bureau each year and is intended to provide more timely data than the decennial census, is also limited to asking about same-sex households. However, because this survey is given to only a sample of households, the picture it provides can be even fuzzier than the census. For example, between 2019 and 2021, the survey estimated that 75 Texas counties had no same-sex households, although estimates vary widely between years, especially for counties with small populations.

By contrast, a 2022 Gallup poll estimated that 7.1% of Americans identify as LGBT.

These limitations are exacerbated by LGBTQ+ people’s fear of disclosing their status, especially in rural and more conservative parts of Texas.

Amber Pérez, executive director of Borderland Rainbow Center, a LGBTQ community space in El Paso, said that she knows “quite a few” people who are afraid to disclose their sexual orientation and gender identity, especially in West Texas and other heavily Catholic areas along the border.

“Nobody really talks about it,” said Pérez. “And I think that people are concerned that if they mark specific things on the census or on surveys, they’re afraid it’s going to get back to people.”

While more urban parts of the state, such as Harris and Travis counties, show up in census data as having above-average rates of same-sex households, more rural areas, especially in West Texas and the Panhandle, show much lower rates.

“I am sure that you would not tell someone out where Lyndon Johnson grew up in the prairie that, yes, I’m gay, I’m a gay man living by myself,” said Gieseking.

As executive director of Texas Pride Impact Funds, Ron Guillard travels across the state to meet with LGBTQ+ service organizations. He said that LGBTQ+ people in many rural areas still hide their identities, even while the need for LGBT-specific services is clear.

“When you visit the small nonprofits that we fund in the Panhandle, it’s evident they serve large populations for counties and counties around them,” Guillard said. “Unfortunately, the Stonewall generation really just is largely living Don’t Ask, Don't Tell lifestyles, and they’re not engaged with the emerging needs of their communities.”

Demonstrating need

The undercounting of LGBTQ+ Texans can make it hard for the organizations that serve them to acquire funding and provide care.

According to Guillard, services for LGBTQ+ people are concentrated in the state’s urban centers and drop off rapidly in more rural areas.

Pérez said that her El Paso Borderland Center, which provides support groups and education and connects LGBTQ+ people with appropriate health care providers, serves people 300 miles away, some of whom are willing to drive in to receive treatment from a provider who understands their experience.

However, due to the challenges of counting LGBTQ+ people, Pérez said that illustrating the need for the services her center provides can be difficult.

In addition to undercounting, part of the problem is that sexual orientation and gender identity aren’t included in the census in the same way that categories such as race and gender are. For example, Pérez said that statistics such as income or food insecurity might describe the population of El Paso as a whole, but the experiences of her staff tell her that the situation for LGBTQ+ people can be much worse.

“We have numbers, but we don’t have great numbers,” said Pérez.

Amy L. Stone is a professor at Trinity University in San Antonio and co-director of Strengthening Colors of Pride, an organization studying LGBTQ+ health and resilience in San Antonio. They echo the challenges that insufficient data pose for organizations’ fundraising.

“You really need data,” Stone said. “If you’re going to write a grant, you can’t just say, well, I just know a lot of people who need this thing, right? You really need to say definitively, we need this resource.”

In order to address this need, in 2019, Strengthening Colors of Pride conducted a survey of LGBTQ+ people in the San Antonio area. The survey revealed the kind of statistics that Pérez said she needs, showing, for example, that LGBTQ+ people in the area have lower incomes and high rates of unemployment, are more likely to avoid seeing a medical professional, and report three times the national rate of family trauma and adverse childhood experiences.

Using the data produced by the survey, Stone said that Pride Center San Antonio was able to demonstrate the need for additional space to provide counseling and mental health care. Other organizations serving LGBTQ+ people in the area have been able to use the data in similar ways.

Providing care

Research shows that LGBTQ+ people in the United States face distinct health problems and have distinct challenges accessing care. They have higher rates of trauma, cancer, HIV and AIDS and are also more likely to have trouble finding a health care provider, to delay care or to not receive care at all.

According to the Centers for Disease Control and Prevention, it is essential for health care providers to collect information about patients’ sexual orientation and gender identity in order to avoid health disparities and provide important services. However, the CDC also notes that many facilities lack the capabilities to collect this information.

Instead, many health care providers, especially those who are cisgender and heterosexual, are likely to assume that their patients are not LGBTQ+, said Gieseking.

Cooper gives the example of a pediatrician in a suburban area who claimed to have no LGBTQ+ patients. However, Cooper points out, looking at national data on trends related to LGBTQ+ youth, the pediatrician should assume that between 1% and 5% of his patients likely identify in that way.

“He’s just not asking,” said Cooper. “And so then he’s like, I don’t need to ask these questions. I don’t need to provide these services because if I have these supplies, I’m only going to use them on no one, so why would I pay for them?”

The lack of accurate data also impacts health research funding, said Cooper, who argues that government funds are more likely to go to areas that can demonstrate a greater impact. If an area in Texas appears to have few LGBTQ+ people on an official survey, that money is more likely to go to an area in another state where cultural factors make disclosing various sexual orientations or gender identities more likely.

“We need better ways of finding accurate counts of LGBTQ+ people in the country just to make sure that when we’re doing good policy, good funding allocations, we have accurate data,” said Cooper. “To be able to make sure that those dollars are spent in a prudent way and in a way that’s going to have the biggest impact versus just guessing.”

Stone said that the difficulty of obtaining appropriate health care in Texas is made worse by the prevalence of Catholic hospitals in the state and by the conservative state government’s tendency to rely on services from the nonprofit sector, where religious organizations are common.

Looking forward

While the decennial census and the American Community Survey ask respondents only if they live in a same-sex household, the Census Bureau’s American Pulse Survey began, in July 2021, to include questions on sexual orientation and gender identity. The survey, which was created to provide data on experiences of the COVID-19 pandemic, revealed that LGBT respondents were more likely to feel anxious and depressed and to experience loss of job-related income.

The Census Bureau received $10 million in its 2023 budget for research related to adding questions about sexual orientation and gender identity to the American Community Survey. New survey questions must be approved by the Office of Management and Budget before they can be added to the American Community Survey.

The National Science and Technology Council also released, in January, a Federal Evidence Agenda of LBGTQI+ Equity, which highlights the lack of national data on the LGBTQ+ population and includes specific recommendations for improving data collection.

If questions about sexual orientation and gender identity were included on national surveys, Stone said, “it’d be mind-blowing because we actually would finally have a somewhat accurate count of how many LGBT people are in the U.S. We don’t even know that number. We’ve got no sense of what that number is.”

In the meantime, Stone said, organizations in Texas often must rely on imperfect data or conduct their own surveys.

“Without any data on your community, it’s really hard to say, ‘Yes, we absolutely need funding for this critical health care in our community,’” Stone said.

Daniel Carter is the co-director of Texas Community Health News.

Disclosure: Texas Medical Association has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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