In conducting this study, the committee used a variety of sources: five formal committee meetings, including four public meetings with presentations from researchers, individuals, advocacy groups, and service providers; a literature review; commissioned papers; and consultants. The committee’s work was guided by four conceptual frameworks:

  • The life-course framework acknowledges that events at each stage of life influence subsequent stages and recognizes that experiences are shaped by one’s age cohort and historical context.

  • The minority stress model posits that sexual and gender minorities experience chronic stress as a result of their stigmatization.

  • Intersectionality examines an individual’s multiple identities and the ways in which they interact.

  • The social ecology perspective emphasizes that individuals are surrounded by spheres of influence, including families, communities, and society.

These frameworks complement each other and structured and informed the committee’s deliberations.


The committee believed that to examine the health of LGBT people, it was important to understand the contextual factors that influence their lives. Some of those factors include the history of LGBT people in the United States, the effects of stigma, laws and policies, demographic factors, and barriers to care. These factors are interrelated. For example, many historical events have contributed to the stigmatization of nonheterosexual and gender-variant individuals. The inclusion of homosexuality in the Diagnostic and Statistical Manual of Mental Disorders until 1973 shaped sexual-minority patients’ interactions with the health care system. Likewise, the legal landscape affects aspects of people’s lives that influence health. For instance, laws prohibiting marriage between same-sex individuals often affect the access of lesbians, gay men, and bisexual people to employer-sponsored health insurance. Other barriers to care include the limited availability of providers with adequate training to treat transgender patients in a culturally competent manner and LGBT patients’ previous negative experiences with the health care system.

The HIV/AIDS epidemic resulted in the deaths of thousands of gay and bisexual men; at the same time, it created a resilient and more unified LGBT community. HIV/AIDS remains one of the most critical health issues faced by some subgroups within LGBT populations in the United States—

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement