leading to elevated levels of the stress hormones (McEwen, 1998; Powch and Houston, 1996). Although the precise health effects of stress on lesbians have not yet been examined systematically, some hypotheses can be made about their possible health risk based on information about both the stress effects of discrimination on other groups and the stress effects of socioeconomic status.9 It can be hypothesized that lesbians who experience such forms of psychosocial stress sustain negative effects similar to those of other groups that experience discrimination.

It can also be hypothesized that stress effects may be greatest for lesbians who are subject to multiple forms of discrimination, for example, lesbians who are also members of racial or ethnic minority groups. In addition to experiencing racism encountered by members of racial and ethnic minority groups in general, minority lesbians can also encounter racism in the lesbian community (Savin-Williams, 1996). Racism may thus compound the negative effects that homophobia potentially has on health. The combination of homophobia, racism, and sex-based discrimination has been referred to as being in "triple jeopardy" (Greene, 1994b; Greene and Boyd-Franklin, 1996).

A study of depressive distress in a nationally recruited homosexually active sample of African-American men and women showed that lesbians and bisexual women in the sample exhibited higher levels of distress than gay men, except for those with HIV infection (Cochran and Mays, 1994). The authors suggest that individuals who carry multiple lower social statuses (i.e., being lesbian, being a racial or ethnic minority, and being female) may be particularly at risk for stress-induced depression.

Racial discrimination has been found to be a potent source of stress and to be associated with stress-related negative health effects (Krieger and Sidney, 1996). To assess the role of racial discrimination in explaining disparities in elevated blood pressure, a common reaction of people who


A very notable and important exception to the lack of research in this area is a recent study by Krieger and Sidney (1997), which examined associations between self-reported experiences of discrimination based on sexual orientation among black and white women and men participating in a longitudinal multisite study of cardiovascular risk factors. Meaningful analyses of systolic blood pressure in relation to reported experiences of discrimination were precluded by the small number of participants for whom data were available, particularly black women and men (Krieger and Sidney, 1997).

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