Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.

The relationship between minority stress and biological outcomes: A systematic review

Research shows that sexual minorities (e.g., lesbian, gay, and bisexual individuals) experience higher levels of discrimination, stigma, and stress and are at higher risk of some poor health outcomes and health behaviors compared to their heterosexual counterparts. However, the majority of studies have examined sexual orientation disparities in a narrow range of health outcomes and behaviors using convenience samples comprised of either men or women living in restricted geographic areas. To investigate the relationship between sexual orientation identity and health among U.S. women and men, we used Poisson regression with robust variance to estimate prevalence ratios for health behaviors, outcomes, and services use comparing sexual minorities to heterosexual individuals using 2013 and 2014 National Health Interview Survey data (N = 69,270). Three percent of the sample identified as sexual minorities. Compared to heterosexual women, lesbian (prevalence ratio (PR) = 1.65 [95 % confidence interval (CI): 1.14, 2.37]) and bisexual (PR = 2.16 [1.46, 3.18]) women were more likely to report heavy drinking. Lesbians had a higher prevalence of obesity (PR = 1.20 [1.02, 1.42]), stroke (PR = 1.96 [1.14, 3.39]), and functional limitation (PR = 1.17 [1.02, 1.34] than heterosexual women. Gay men were more likely to have hypertension (PR = 1.21 [1.03, 1.43]) and heart disease (PR = 1.39 [1.02, 1.88]). Despite no difference in health insurance status, sexual minorities were more likely than heterosexual individuals to delay seeking healthcare because of cost; however, members of this group were also  more likely to have received an HIV test and initiated HPV vaccination. Sexual minorities had a higher prevalence of some poor health behaviors and outcomes.

/pdf/sexual-orientation-identity-disparities-in-health-behaviors-5eud90r2r9.pdf

Sexual orientation identity disparities in health behaviors, outcomes, and services use among men and women in the United States: a cross-sectional study

Minority stress processes have been shown to have significant associations with negative mental health outcomes among sexual minority populations. Given that adversity may be experienced growing up as a sexual minority in heteronormative, if not heterosexist, environments, our research on resilience among sexual minority male youth proposes that positive identity development may buffer the effects of a range of minority stress processes. An ethnically diverse sample of 200 sexual minority males ages 16 to 24 (mean age, 20.9 years) was recruited using mixed recruitment methods. We developed and tested 2 new measures: concealment stress during adolescence and sexual minority-related positive identity development. We then tested a path model that assessed the effects of minority stressors, positive identity development, and social support on major depressive symptoms. Experience of stigma was associated with internalized homophobia (β =.138, p Language: en

/pdf/minority-stress-positive-identity-development-and-depressive-7tv30dknh0.pdf

Minority stress, positive identity development, and depressive symptoms: implications for resilience among sexual minority male youth.

Background 
The authors examined associations between structural characteristics and HIV disease management among a geographically diverse sample of behaviorally and perinatally HIV-infected adolescents and young adults in the United States.


Methods 
The sample included 1891 adolescents and young adults living with HIV (27.8% perinatally infected; 72.2% behaviorally infected) who were linked to care through 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions Units. All completed audio computer–assisted self-interview surveys. Chart abstraction or blood draw provided viral load data. Geographic-level variables were extracted from the United States Census Bureau (e.g., socioeconomic disadvantage, percent of Black and Latino households, percent rural) and Esri Crime (e.g., global crime index) databases as Zip Code Tabulation Areas. AIDSVu data (e.g., prevalence of HIV among youth) were extracted at the county-level. Using HLM v.7, the authors conducted means-as-outcomes random effects multi-level models to examine the association between structural-level and individual-level factors and (1) being on antiretroviral therapy (ART) currently; (2) being on ART for at least 6 months; (3) missed HIV care appointments (not having missed any vs. having missed one or more appointments) over the past 12 months; and (4) viral suppression (defined by the corresponding assay cutoff for the lower limit of viral load at each participating site which denoted nondetectability vs. detectability).


Results 
Frequencies for the 4 primary outcomes were as follows: current ART use (n = 1120, 59.23%); ART use for ≥6 months (n = 861, 45.53%); at least one missed HIV care appointment (n = 936, 49.50); and viral suppression (n = 577, 30.51%). After adjusting for individual-level factors, youth living in more disadvantaged areas (defined by a composite score derived from 2010 Census indicators including percent poverty, percent receiving public assistance, percent of female, single-headed households, percent unemployment, and percent of people with less than a high school degree) were less likely to report current ART use (OR: 0.85, 95% CI: 0.72–1.00, p = .05). Among current ART users, living in more disadvantaged areas was associated with greater likelihood of having used ART for ≥6 months. Participants living in counties with greater HIV prevalence among 13–24 year olds were more likely to report current ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), ≥6 months ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), and to be virally suppressed (OR: 1.50, 95% CI: 1.20–1.87, p = .001); however, youth in these areas were also more likely to report missed medical appointments (OR: 1.32, 95% CI: 1.07–1.63, p = .008).


Conclusions 
The findings underscore the multi-level and structural factors associated with ART use, missed HIV care appointments, and viral suppression for adolescents and young adults in the United States. Consideration of these factors is strongly recommended in future intervention, clinical practice, and policy research that seek to understand the contextual influences on individuals’ health behaviors.

/pdf/structural-determinants-of-antiretroviral-therapy-use-hiv-1njh3fq1zs.pdf

Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV

The present study examines the intersection of race and sexual orientation in the experience of discrimination among lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. The results of the study suggest that while a majority of LGBTQ individuals report being victims of anti-LGBTQ discrimination, racial minorities experience even greater levels of anti-LGBTQ discrimination than do White LGBTQ people. The findings suggest that the intersection of race and sexual orientation creates elevated levels of discrimination risk beyond the already elevated rates of discrimination experienced by members of the LGBTQ community for LGBTQ racial minorities.

Queer Is the New Black? Not So Much: Racial Disparities in Anti-LGBTQ Discrimination

Structural characteristics are linked to HIV/STI risks, yet few studies have examined the mechanisms through which structural characteristics influence the HIV/STI risk of young men who have sex with men (YMSM) Using data from a cross-sectional survey of YMSM (ages 18-29) living in Detroit Metro (N = 328; 9 % HIV-positive; 49 % Black, 27 % White, 15 % Latino, 9 % Other race), we used multilevel modeling to examine the association between community-level characteristics (eg, socioeconomic disadvantage; distance to LGBT-affirming institutions) and YMSM's HIV testing behavior and likelihood of engaging in unprotected anal intercourse with serodiscordant partner(s) We accounted for individual-level factors (race/ethnicity, poverty, homelessness, alcohol and marijuana use) and contextual factors (community acceptance and stigma regarding same-sex sexuality) YMSM in neighborhoods with greater disadvantage and nearer to an AIDS Service Organization were more likely to have tested for HIV and less likely to report serodiscordant partners Community acceptance was associated with having tested for HIV Efforts to address YMSM's exposure to structural barriers in Detroit Metro are needed to inform HIV prevention strategies from a socioecological perspective

Where You Live Matters: Structural Correlates of HIV Risk Behavior Among Young Men Who Have Sex with Men in Metro Detroit.

Discrimination has been linked to negative health outcomes among minority populations. The increasing evidence regarding health disparities among sexual minorities has underscored the importance of addressing sexuality discrimination as a public health issue. We conducted a web-based survey between May and September of 2012 in order to obtain a diverse sample of young men who have sex with men (ages 18–29; N = 397; 83 % gay; 49 % black, 27 % white, 15 % Latino) living in the Detroit Metro Area (Michigan, USA). Using multivariate regression models, we examined the association between overall health (self-rated health, days in prior month when their physical or mental health was not good, and limited functionality) and experiences of sexuality-based work discrimination. Fifteen percent reported at least one experience of sexuality-based work discrimination in the prior year. Recent workplace discrimination was associated with poorer self-rated health, a greater number of days when health was not good, and more functional limitation. We discuss the importance of addressing sexuality-related discrimination as a public health problem and propose multilevel intervention strategies to address these discriminatory practices.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/106620/Sexuality-related%20work%20discrimination%20and%20its%20association%20with%20the%20health%20of%20sexual%20minority%20emerging%20and%20young%20adult%20men%20in%20the%20Detroit%20Metro%20Area.pdf;sequence=1

Sexuality-Related Work Discrimination and Its Association with the Health of Sexual Minority Emerging and Young Adult Men in the Detroit Metro Area

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Where You Live Matters: Structural Correlates of HIV Risk Behavior Among Young Men Who Have Sex with Men in Metro Detroit.

Sexuality-Related Work Discrimination and Its Association with the Health of Sexual Minority Emerging and Young Adult Men in the Detroit Metro Area