Trends in Sexual-Orientation-Based Discrimination in the United States

Background: Sexual minority (SM) related health disparities are largely attributed to anti-SM stigma and discrimination, which have been linked to a variety of physical, mental, and behavioral health outcomes. Since the early 2000s, there have been a remarkable number of changes to local, state, and national policies and laws protecting SM people in the US. These shifting policies also coincided with and contributed to a reported increase in favorable attitudes towards SM people. In 2002, for example, 52% of US adults indicated that relations between gay and lesbian adults should be legal, compared to 64% in 2013. Considering the association between discrimination and the health of SM people, it is important to evaluate whether societal shifts result in decreased discriminatory experiences for SM individuals.

Method: We used data from two nationally representative datasets of U.S. adults, NESARC II (2004-2005) and NESARC III (2012-2013). We restricted the sample to SM individuals (based on reports of same-sex attraction, same-sex behavior, or lesbian, gay, or bisexual identity), aged 18-65 (NESARC II n=2089; NESARC III n = 2993). We used weighted time-varying effect models (TVEMs) to estimate prevalence of past-year general discrimination, healthcare discrimination, and victimization attributed to sexual orientation for the two NESARC cohorts.

Results: Overall, prevalence of discrimination—regardless of type—increased from 2004/2005 to 2012/2013 (general discrimination: 9% to 13%; healthcare discrimination: 4% to 9%; victimization: 9% to 13%). When evaluated across age, significant differences were observed. SM in their 20s and 40s were more likely to reports healthcare discrimination in 2012/2013, compared to 2004/2005. Reports of victimization were significantly more prevalent in 2012/2013, relative to 2004/2005, but only among SMs in their 20s and 50s. Reports of general discrimination did not different across years.

Discussion: Among SMs in the US, reports of sexual-orientation based discrimination increased between 2004/2005 and 2012/2013. These increases were significant for SMs in their 20s with respect to healthcare discrimination and victimization, for SMs in their 40s for healthcare discrimination, and for SMs in their 50s for victimization. Despite significant favorable changes in laws, policies, and reported attitudes toward SMs across the same time span, SMs continue to report experiencing discrimination. Given the well-documented association between discrimination and health among this vulnerable population, the up-tick in experiences of discrimination and victimization, particularly among young SMs, requires focused attention from the public health community.