The Invisible Minority — Sage Perspectives Blog

by isabel francis

The number of people self-identifying as LGBTQ is increasing in the United States, reaching a new high of 7.1% in 2022 according to a Gallup poll. The same poll found that 1 in 5 (20%) of adult members of Gen Z identify as LGBTQ – also known as sexual and gender diverse (SGD). This may have serious implications for our health systems and providers, as SGD people suffer disproportionately from many health problems, and are at greater risk for anxiety, suicidal ideation, certain cancers, and cardiovascular disease due to difficulty accessing health services and avoidance of primary care.

One of the most powerful and enduring barriers to health-care access and utilization for SGD people is the phenomenon of sexual minority stigma. Sexual minority stigma has been defined by sociologists, psychologists, and other medical professionals in a number of ways. Combining definitions from these sources, a contemporary definition of this stigma is offered as, “a form of social rejection resulting from an imbalance in power and lack of knowledge, in which the process of labeling, stereotyping, and discrimination excludes an individual or group from normed privileges.”

Several preconditions to stigma exist which include an imbalance of power and a lack of knowledge. Societal power resides in the cisgender, heterosexual majority. In addition, politicians and medical providers are often under the misconception that sexual orientation and gender identity are choices that a person makes rather than biologically based unique, personal characteristics. This combination of power imbalance and lack of knowledge leads to stigmatizing behavior by the societal majority. The root of stigmatizing behavior has been described as the desire to exploit or avoid others, and to keep them within societal norms. The majority group exercises this power by enacting laws and policies. There has been a backward shift in societal policy making intended to protect SGD people from health-care related discrimination, most evident in the removal of protections for LGBTQ people from the Affordable Care Act in 2020, leaving them even more vulnerable.

The result is that SGD people frequently experience discrimination in medical encounters, and the fear of discriminatory treatment prevents them from accessing services until symptoms become more severe. Although it is known that this results in negative health outcomes, the extent of the problem is hidden as many health-care systems and providers do not collect demographic data regarding sexual orientation and gender identity.

There is some good news, however. Emerging research suggests that, rather than looking at stigma as a negative, we can reframe the conversation around sexual minority stigma as an opportunity to generate new ways to improve health-care system interactions for SGD people. This in turn can improve access to and delivery of services. The time is now to act, as more and more members of Gen Z become eligible for necessary primary care screening for cancer and other preventable diseases. Nurses and nursing researchers are well-positioned to take action and advocate for equitable health-care access and treatment for SGD people.

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Article Details
The Invisible Minority: Stigma and Sexual and Gender Diversity in Health Care
Isabel Francis, Charles Buscemi
First Published November 13, 2023 Review Article
DOI: 10.1177/10784535231212476
Creative Nursing

About the Author

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Isabel Francis, RN is a PhD student studying Nursing Science at the University of South Florida. She received a bachelor's degree in nursing (BSN) and master’s degree in public administration (MPA) from Northern Michigan University. She also received a master’s degree in nursing from Capella University. She is active in the Florida Nurses Association as a member of the Political Action Committee. Her research and advocacy interests include nursing ethics, nursing education, and improving access to care and outcomes for marginalized patient populations.