The Invisible Minority: Stigma and Sexual and Gender Diversity in Health Care.

This analysis elucidates the concept of stigma in the sexual and gender diverse population, and how it impacts interactions with the health-care system. Significant research into social determinants of health has given rise to a greater understanding of their impact on health-care accessibility and utilization. The impact of stigma experienced by persons with diverse gender identities and sexual orientations has not been similarly studied. Utilizing Walker and Avant's method of concept analysis and the Minority Stress Model, this article explicates stigma in an inclusive manner that directly addresses health care. Records retrieved from PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsychINFO were screened for inclusion, supplemented by editorials and seminal earlier works. Review of the literature clarified the power imbalance perpetuating stigma, its defining attributes, antecedents, and consequences. Although the preponderance of consequences are negative outcomes, positive interactions with providers can empower sexual and gender diverse individuals to disclose their identity more willingly, navigate the health system effectively, and experience greater well-being. Nurses can combat stigma by acknowledging and respecting diverse identities; creating trusting, co-equal relationships; and advocating for sexual and gender diverse persons at both practice and policy levels.