Striving Towards Health Equity: Understanding the Impact of Discrimination on LGBTQ+ Communities

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UPDATED June 27, 2022

By Eliseo J. Pérez-Stable, M.D.
Director, National Institute on Minority Health and Health Disparities

NIMHD Director, Dr. Eliseo J. Pérez-Stable

Sexual and gender minority (SGM) populations, including those who are lesbian, gay, bisexual, transgender, or queer (LGBTQ+)1, experience health disparities and face barriers to accessing health care.  SGM populations have higher burdens of certain diseases, such as depression, certain cancers, and tobacco-related conditions. But the extent and causes of health disparities are not fully known, mechanisms remain unclear, and more research on how to close these gaps is needed.

Stigmatization, hate-related violence, and discrimination are still major barriers to the health and well-being of SGM populations. SGM individuals who are also from racial, ethnic, and/or immigrant minority communities may be even more vulnerable because they face similar barriers, discrimination, and health challenges that are unique to those experienced by all minority populations.

The National Institute on Minority Health and Health Disparities (NIMHD) is dedicated to understanding the effects of these complex and dynamic intersections and supports research on the role discrimination plays in SGM health disparities. For example, in a recently published study, NIMHD researchers examined whether race and ethnicity influenced any associations that may exist between sexual minority status and substance use (tobacco, cannabis, and alcohol) disorders. Overall, sexual minority adults showed a higher prevalence of substance use and disorders. Racial and ethnic minority individuals who were bisexual showed an even stronger association than heterosexuals. In addition, African American or Black bisexual persons were more than twice as likely to be using tobacco. These results underscore the importance of studying the intersectionality of race and ethnicity with sexual orientation, and the need for increased screening and treatment of substance use disorders among sexual minority adults, especially those from racial and ethnic minority groups.

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While NIMHD continues to delve into the factors of health disparities experienced by SGM populations, large gaps in the understanding of SGM health continue to persist, in part, due to the lack of adequate, consistent, and standardized data collection of sex, sexual orientation, gender identity, and sexual behavior in research studies, administrative records, surveillance databases, and clinical settings.

The “Don’t Ask, Don’t Know” approach to SGM populations has been a challenge in health care and clinical research. In recent years standardized sexual orientation and gender identity questions have been increasingly incorporated into epidemiological surveys and in electronic health records, so that the era of hidden from sight is ending for SGM populations in clinical and public health studies.

In addition, the National Institutes of Health Sexual & Gender Minority Research Office, NIMHD, and 17 other components of the agency commissioned a recently published study, “Measuring Sex, Gender Identity, and Sexual Orientation.” This report serves as an important cornerstone for the scientific community to enhance its data collection and improve measurements to fully reflect community experiences and recognize the diversity of the SGM population.

With enhanced sexual orientation and gender identity (SOGI) data collection, researchers can better track health outcomes and develop tailored prevention strategies, interventions, and treatments to ultimately improve the health and well-being of SGM individuals across the nation. We now ask and will learn to reduce disparities in the SGM community.

NIMHD envisions an America in which all populations will have an equal opportunity to live long, healthy, and productive lives. By understanding biological, behavioral, environmental, cultural, and structural components that affect SGM health, as well as the role clinical care can play, we can best address health disparities and identify interventions that improve the overall health of the SGM community.


1 Sexual and gender minority (SGM) populations include, but are not limited to, individuals who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex. Individuals with same-sex or -gender attractions or behaviors and those with a difference in sex development are also included. These populations also encompass those who do not self-identify with one of these terms but whose sexual orientation, gender identity or expression, or reproductive development is characterized by non-binary constructs of sexual orientation, gender, and/or sex. [This study was retracted in March 2018. Details ]





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