Experiences of violence, discrimination, stigma, and neglect based on a minority status can lead to chronic stress.5 Because it is not part of the majority experience, minority stress is often overlooked or invalidated, leading to the internalization of negative attitudes, beliefs, and discriminatory actions of others that may be accepted as something to be experienced as a “normal” part of one’s day-to-day life.10; 11 We must be mindful that patients with one or more minority statuses may present with minority stress, possibly manifest as a lack of engagement, anger, anxiety, depression, or warmth. Minority stress can be compounded for SGM patients with multiple marginalized identities. Some examples you might encounter in your primary care practice are a Latinx lesbian from a socially conservative community, a transgender woman living in a remote, rural community with few financial resources, a bisexual American Indian cisgender man negotiating both Tribal and Christian beliefs regarding sexuality, or a gay African American cisgender man with conservative Christian parents.
Research on the healthcare-seeking experiences of SGM people indicates that minority stress can lead patients to suffer anxiety to the point of delaying or avoiding services for fear of stigma and discrimination by providers.12-15 For these reasons, it is necessary for providers and staff to be aware of intersectional identities and their influences on patients,6 to create safe, trauma-informed, and supportive environments for SGM patients and their families,3 and to make clinical decisions and provide optimal quality care in ways that are “respectful of, and responsive to, individual patient preferences, needs, and values.”16 Finally, the composition and diversity of clinic staff and providers are important considerations since SGM patients may seek care based on the accessibility of providers sharing identities similar to the patients themselves.17