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13 Lesbian and gay people’s awareness of biases against sexual minorities, even in the absence of personal experience with bias, can be described as “felt stigma.” 3,14 Through felt stigma, living in a biased society can influence the health of even those lesbian and gay people who have personally experienced little discrimination.įelt stigma can prevent sexual minority patients from disclosing their sexual orientation to their providers, 15 despite the fact that this information can help providers identify health risk. Stigma is the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a situation in which power is exercised.
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11 In a study of the Veterans Health Care Administration, 25% of sexual minority veterans reported avoiding seeking services because of concerns about stigma. In one study, one quarter of lesbian patients reported that they delayed seeking timely Papanicolaou screening because they feared discrimination. 6 Similar to racial and ethnic minority and overweight patients who experience discrimination in health care and delay seeking care, 9,10 sexual minority patients who experience discrimination also delay seeking care. 7,8ĭespite elevated health risk, lesbian women are more likely to avoid medical care and less likely to engage in preventive cancer screening than their heterosexual peers. 5,6 Evidence suggests that discrimination, such as peer and family rejection and unfavorable legal decisions about the rights of sexual minorities, contributes to elevated health risk among sexual minorities. 5 Chronic stress attributable to minority status, legal barriers to health insurance, providers who receive little training in culturally competent care of LGBT individuals, and experiences and expectations of discrimination within the health care system can all marginalize the health of LGBT people. The Institute of Medicine commission found that LGBT people are more likely than heterosexual people to smoke, use alcohol and illegal substances, attempt suicide, and experience depression. In our review of the literature, we use the terms for the population studied described in each report, resulting in variation in terminology. 1–4 The Institute of Medicine commission on lesbian, gay, bisexual, and transgender (LGBT) health recognizes that the sexual minority community is diverse and that the term LGBT is often used as a blanket term. Lesbian and gay individuals are typically mentally and physically healthy however, sexual minority status is a marker of elevated risk for mental, physical, and sexual health problems. Future research should investigate how implicit sexual prejudice affects care. Implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers. Among all groups, explicit preferences for heterosexual versus lesbian and gay people were weaker than implicit preferences.Ĭonclusions. Heterosexual nurses held the strongest implicit preference for heterosexual men over gay men (Cohen d = 1.30 95% confidence interval = 1.28, 1.32 among female nurses Cohen d = 1.38 95% confidence interval = 1.32, 1.44 among male nurses). Implicit preferences for heterosexual women were weaker than implicit preferences for heterosexual men. Among heterosexual providers, implicit preferences always favored heterosexual people over lesbian and gay people. We characterized the sample with descriptive statistics and calculated Cohen d, a standardized effect size measure, with 95% confidence intervals. We examined attitudes toward heterosexual people versus lesbian and gay people in Implicit Association Test takers: 2338 medical doctors, 5379 nurses, 8531 mental health providers, 2735 other treatment providers, and 214 110 nonproviders in the United States and internationally between May 2006 and December 2012.
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We examined providers’ implicit and explicit attitudes toward lesbian and gay people by provider gender, sexual identity, and race/ethnicity.