Contextualizing Heterosexism: An Intersectional Approach to Sexual Minority Health Inequalities

Abstract

A well-established body of research across academic disciplines has systematically documented the diverse ways sexual orientation is linked to a wide range of life outcomes from early childhood to the tomb. Yet, less well-understood is how diverse heterosexist contexts generate these inequalities. Building on prior work that links contexts to health, the overarching research question of this dissertation is: how do diverse heterosexist contexts influence health disparities? I focus on three heterosexist contexts: racial/ethnic communities, the neighborhood, and the state via three studies. In the first study, I examine the diverse roles (direct, indirect, intervening, and interacting) of the sexual minority stress continuum within racial/ethnic communities using national data of diverse US sexual minorities. I take an intersectional approach to propose a new comprehensive conceptual model by combining theories and perspectives on stress, minority stress, life course, gender and sexuality, race/ethnicity, nativity, identity, socioeconomic status, social connections, and social support. In the second study, I use national data of diverse US sexual minorities to examine the diverse roles (direct, indirect, intervening, interacting) of the sexual minority stress continuum within the neighborhood context by employing a similar conceptual model proposed in the first study. However, I add theories and perspectives on nativity status. In the third study, I examine the diverse roles (direct, indirect, interacting) of two indicators of structural heterosexism (social climate and laws and policies) on HIV infection rates among multiple groups (the general state population, women, all men, and sexual minority men) at the state level using publicly available data from multiple sources. I examine these processes by proposing a new conceptual model that draws on theories and perspectives on stigma (structural stigma and associative stigma), income inequality, gender, and sexuality. The findings of the three studies of this dissertation illustrate the diverse ways heterosexist contexts generate health inequalities.