Research shows that open and honest communication during medical encounters can provide valuable opportunities for health-care utilization, including screening and treatment management (Garcia et al. 2012). Yet, studies document that for sexual minority individuals, negative interactions with medical professionals can impede open communication during medical appointments, as well as affect future health-care utilization (Durso and Meyer 2013). Given that the average medical visit lasts between 10 and 16 min (Nouri and Rudd 2015), effective communication can be significant in ensuring that appropriate diagnosis, treatment, and management of disease occur among health-vulnerable communities.

I use data collected from interviews as examples to understand how stigmatization impacts decision making about sexual identity disclosure in patient–provider communication among sexual minority Latino men. To do so, I rely on semi-structured in-depth interviews with 16 sexual minority men and pose the following research question: How do Latino sexual minority men make decisions about disclosure of sexual identity and sexual practices to medical professionals?

In focusing on the experiences of Latino gay and bisexual men, I highlight the obstacles and risks they confront in their interactions with medical professionals as racial and ethnic and sexual minorities. Rather than downplaying the different cultural expectations and assumptions that Latino men encounter in their communities, I highlight how heteronormative expectations and fear of rejection among the Latino community in nonmedical contexts shape choices about disclosure to medical providers. Although this article illuminates the challenges that Latino sexual minority men face in medical contexts, I also emphasize that choosing when and how to disclose a sexual identity can be seen an act of empowerment.

Navigating health care

Negotiating a stigmatized sexual identity

Goffman’s work on stigma highlights strategies people use to navigate their socially unaccepted identities by managing or avoiding hostile reactions. Goffman theorizes that it is through information management that the stigmatized can manage the visibility of their stigmatized identity (1963). Since the time of Goffman’s theoretical investigation into sexual minority status as a stigmatized identity, there have been political and cultural changes in society’s treatment of sexual minority people. In 1973, the diagnosis of homosexuality was removed from the Diagnostic and Statistical Manual (DSM), keeping the psychological and medical community from treating non-heterosexuality as a disease (Drescher 2015). Additionally, in 2003, the Supreme Court invalidated sodomy laws in the United States, and in 2015 it ruled the Defense of Marriage Act (DOMA), which legally denied marital rights to same-sex couples, unconstitutional (GLAAD 2019).

While there have been legal and cultural shifts in the treatment of the LGBT community, variation remains in how states have approached legal protection against discrimination based on sexual identity (Movement Advancement Project 2022). In fact, only 20% of the LGBT population resides in states where there is antidiscrimination legal protection (Movement Advancement Project 2022). Research also shows that, while attitudes toward sexual minority populations have changed in the US over the past 50 years, relatively few LGBT individuals (19%) report that there is currently “a lot” of acceptance for the LGBT population (Pew Research Center 2022). Data also indicates that a significant portion of the US population believes that “homosexuality should be discouraged” (35%) and that same-sex marriage should not be legal (42%) (Pew Research Center 2022). Altogether this indicates that, while social acceptance may be on the rise, there is evidence of continued social hostility and stigmatization toward individuals who do not identify as heterosexual.

A large body of scholarship has also extended Goffman’s work on stigmatized sexual identity and the impact of navigating this stigma across a variety of social spheres. Yoshino’s work on “covering,” the act of “toning down a disfavored identity to fit the mainstream,” extends Goffman’s conceptualization to outline how “covering” of race, sex, and sexual identity encourages people to assimilate to a certain type of presentation of self (2006, p. ix). Yoshino describes the different approaches to this process of assimilation over time and emphasizes the negative impact of “covering” on the civil liberties of minoritized individuals (2006). Other work has examined the impact of stigmatization of sexual identity on political engagement and community participation (Lee 2021; Choi et al. 2011). This work has found racial and ethnic differences in how sexual identity stigma encourages and discourages certain type of behaviors such as membership in organizations, attendance of social events, and political participation.

Research on experiences of stigmatization by sexual minority Latino/a/x adults point to the significance of familism, a cultural component in which the well-being of the larger collective group is valued over individualism (Muñoz-Laboy 2008; Gaines et al. 1997). Studies indicate that family support is highly valued in Latino communities, and therefore Latino/a/x individuals strategize how to avoid conflict regarding their sexual identity to mitigate stigma and receive benefits from their family units (Vega 1995). Scholarship also documents a reliance on the notion of “respectability,” in which subjects present themselves as “acceptable” to society by minimizing their sexuality to adhere to white heteronormative expectations of behavior and values (Lee 2021; Acosta 2010).

Medical (dis)comfort

Within the medical field, research on the impact of a stigmatized sexual identity on well-being has shown the deleterious effect of stigma on healthcare-seeking behavior, health status, and health behavior among sexual minority individuals (Ryan et al. 2009; Almeida et al. 2009). Evidence suggests that stigma contributes to discrimination and social isolation and can become a source of stress that negatively affects conceptions of self and contributes to health disparities across sexual identity (English et al. 2018; Jackson et al. 2020). For example, Ryan and colleagues examined how stressors from family rejection after “coming out” predicted negative mental health outcomes and increased substance abuse among Latino/a/x sexual minority young adults (2009). Another study by Almeida et al. (2009) found that perceived discrimination due to a stigmatized sexual identity was associated with increased risk of depressive symptoms among sexual minority youth.

In addition to the documented impact of stigma on health status and health behavior, ample evidence highlights the negative impact of stigma on healthcare utilization among sexual minority individuals. Research emphasizes the importance of quality of medical interaction, since it is significantly related with adherence to treatment guidelines (Manary et al. 2013; Tabaac et al. 2020). Studies also document a link between greater healthcare utilization and disclosure of sexual orientation to medical providers (Mosack et al. 2013). Given that studies indicate that sexual minority patients believe their health care would be of higher quality if they could safely disclose their sexual identities, it is important to evaluate the factors that discourage sexual identity disclosure (Makadon 2006).

Within medical contexts, the power differential between medical provider and patient creates a status imbalance that can contribute to tension and hesitation in disclosing a stigmatized sexual identity. For many sexual minority patients, in disclosing their sexual identity in medical contexts, they risk harassment, discrimination, and rejection (Durso and Meyer 2013). In fact, studies document that expectations of heterosexuality within the healthcare environment among sexual minorities can result in feelings of isolation and marginalization (Hayman et al. 2013). This heterosexual presumption is highlighted through actions by medical professionals, including the assumption of different-sex partners when referencing sexual intercourse (Davis et al. 2016).

Although trust and support are integral in the provider–patient relationship for future healthcare seeking behavior, studies point to difficulty in maintaining open communication from both medical professionals and sexual minority patients (Klitzman and Greenberg 2002). Research on the experiences of medical providers suggest that while discussing sexual history of patients can be an integral part of a medical assessment, many providers are hesitant to inquire about sexual identity or behavior because of discomfort with the topic (Politi et al. 2009). Previous studies have found low rates of sexual identity disclosure among sexual minorities and low rates of being asked about sexual identity by many medical providers (Brotman et al. 2002).

In omitting discussion of certain aspects of their health, like sexual behavior, patients may risk obtaining timely and relevant medical care, which can have severe and serious long-term ramifications for their health. Yet, established scholarship points to the deleterious impact of discrimination and uncomfortable medical encounters for physical and mental well-being among sexual minorities (Hayman et al. 2013; Shim 2010). Thus, the embodiment of the act of sexual identity disclosure can also have significant harmful consequences for the well-being of sexual minority patients.

Open and honest communication between patient and provider may include disclosure of sexual identity. Yet, it may not be necessary or relevant in all medical encounters. While an individual may be “out” in some contexts, low disclosure rates to medical professionals reflect that they may not be “out” in all medical settings. This is not surprising, given that for many individuals, disclosing their sexual orientation or sexual practices to their medical provider forces them to “come out,” many times to a provider they have just met. Despite benefits to disclosing sexual identity in medical contexts, it may be that the decision about disclosure does not have to be framed as an “all or nothing” decision. Choosing when and to whom to disclose a stigmatized sexual identity can be perceived as a form of agency in identity management rather than as an act of concealment. Deciding not to disclose their sexual identity in all medical encounters, or only in ones they consider relevant, can create the sense of privacy about sexual practices that most heterosexual patients are afforded.

To avoid a simplistic framing of sexual identity disclosure, it is important to evaluate whether sexual identity disclosure is perceived to be necessary across all medical contexts by sexual minority patients. A more nuanced examination of how sexual minority patients navigate sexual identity stigma in medical settings is necessary to avoid a binary framing of sexual identity disclosure as “all or nothing.” More information is needed to fully understand how perceptions and experiences of stigma within medical settings impact decisions regarding sexual identity disclosure. Much of the work on sexual identity disclosure in medical settings focuses on the experiences of white sexual minority populations (Mosack et al. 2013; McNair et al. 2012). Thoughtful consideration of racial and ethnic differences in experiences of stigma can provide a further understanding about the factors and conditions that sexual minorities of color rely on to make decisions about sexual identity disclosure within medical settings. A uniform framing of sexual identity disclosure as necessary in all medical contexts and with all medical providers may be simplifying the complexity of stigma for multiply marginalized individuals. Missing from the literature are more in-depth understandings of the medical experiences of sexual minority patients who are also racial and ethnic minorities.

Latino LGBTQ+ health

Sociological studies that examine the experiences of LGBTQ+ Latino/a/x adults indicate that the intersection of racism and stigma produce unique exposures to distressing social interactions and discriminatory practices (Almeida et al. 2009; Diaz and Ayala 2011). Health research on LGBTQ+ Latino/a/x populations point to differential treatment by medical providers, high rates of engagement in health risk behaviors, and difficulty receiving adequate and timely medical care services (Akerlund and Cheung 2000; Garcia-Perez 2020). An increase in intersectional work that emphasizes structural constraints in navigating healthcare systems as a doubly marginalized person enhances work that points to individual-level factors as sources of inequality. A subset of the work examining health disparities among LGBTQ+ Latino/a populations focus on healthcare experiences. This work documents perceived lack of cultural competence, uncomfortable patient/provider communication, and anticipation of harassment as central components for many Latino/a sexual-minority patients (Schmitz et al. 2019).

For example, work that examines the communication breakdown between LGBTQ+ patients and medical providers find that a lack of understanding of health-relevant issues regarding sexual orientation contributes to inadequate medical care services (Schmitz and Tabler 2021). Often, sexual minority patients feel as though they must educate their providers with health concerns related to same-sex contact (Rossi and Lopez 2017). Additionally, a subsection of the work on Latino/a/x medical experiences focuses on language barriers between patients and medical providers (Garcia and Duckett 2009). This work finds that a lack of open communication between limited-English-speaking patients and health providers may prevent information sharing and deliberation about treatment options (Wilson et al. 2005). Work on Latino/a/x sexual minority patients suggest that these linguistic barriers may also hinder disclosure of sexual orientation. For example, family or friends of limited-English-speaking Latino/a/x patients often act as translators in clinical encounters, which may impede patients from feeling open to discussing sexual orientation with their providers (Baig et al. 2016). This may be particularly straining for individuals if they have not previously disclosed their sexual identity to their family and friends.

Health literature on Latino/a/x populations also point to the impact of cultural values such as familism and religiosity on medical decision making. Familism, a cultural value defined by familial support, emotional interconnectedness, and familial honor, has been shown to be critical among Latinos/as/xs (Calzada et al. 2012). While some work notes the positive impact of protection and support provided through familism (Patron 2020), other studies document tension in the coming out process for many sexual minority individuals because of the pervasiveness of heterosexist structures that affect Latino/a/x families (Patron 2020). Research has documented a range of responses to sexual identity disclosure from familial ties. While some individuals receive unwavering support and acceptance, others may experience rejection and exclusion, with some even noting a conditional type of support in which a limited type of acceptance is provided (Harris et al. 2018; Robinson 2018). Health research indicates that many Latino/a/x LGBTQ+ patients may be forced to make medical decisions on their own without family support and in turn increase their reliance on providers in the decision-making process (Baig et al. 2016).

Studies also suggest that faith and religion often play integral roles in Latino/a/x patients’ decisions regarding health and medical treatment. Scholars argue that assumptions about medical providers’ religious beliefs, along with internalized religious conflict, may hinder communication among Latino/a/x LGBTQ+ patients (Baig et al. 2016). Researchers find that for many Latino/a/x sexual minority adults, the religious community remains a central source of support, with many strategically integrating religious ties within their networks (Pastrana 2015). This work points to a more nuanced relationship between the church and many Latino/a/x sexual minorities that requires a framing of religious integration beyond a binary explanation.

While much of the health disparities research points to individual-level factors that shape healthcare experiences, an established body of work documents contextual-level factors that maintain and reproduce health inequities in medical contexts. Patients that contend with the legacy of racial discrimination and stigma as sexual minorities of color navigate intersecting suppressive systems that maintain and reproduce health inequities. Latino/a/x sexual minority patients are exposed to a combination of racial and sexual orientation discrimination that often overlaps to produce a unique type of social disadvantage (Moore et al. 2020). Discriminatory practices motivated by homophobia and racism impede equal access to medical resources for Latino/a/x sexual minority populations to care for their bodies. Studies have repeatedly shown how discrimination against sexual minorities contributes to unequal treatment and distribution of medical resources.

For instance, studies document how provider-held bias and discrimination can impact clinical judgment and harm provider–patient interactions (Mateo and Williams 2020). A specific example is how the historical pathologizing of sexual minorities has produced long-lasting emotional and physical harm against LGBTQ+ individuals. Medical mistrust stemming from the classification of a sexual minority identity as a medical illness in need of treatment has strained the provider–patient relationship for many sexual-minority communities.

Yet, the mechanisms that reproduce disparities in health outcomes across sexual identities are not confined to the medical encounter. Much of the health literature demonstrates how economic and sociopolitical forces impact medical decisions by both the medical provider and the patient (Metzel and Hansen 2014). For example, for many decades same-sex partnerships were not afforded the same health insurance coverage extended to different-sex couples (Bachmueller and Carpenter 2010). Through the lack of legal recognition of same-sex partnerships, many sexual minority individuals were not granted access to medical care coverage equal to that of their heterosexual counterparts. More recently, controversy over access to medical services such as preventative medication for HIV (such as PrEP) for individuals in same-sex relationships demonstrate the suppressive power that policies have on sexual minority bodies (Human Rights Campaign 2022).

The combination of individual and structural factors that contribute to health inequality, in addition to the intersections of homophobia, xenophobia, and racism, complicate our understanding of how Latino/a LGBTQ+ patients experience, perceive, and navigate medical systems. Additionally, the assumed homogeneity of a Latino/a pan-ethnic identity minimalizes important heterogeneity in medical experiences and access to resources. Although many Latinos/as share core cultural values, physicians should be aware of the significant diversity among this population (Juckett 2013). More intersectional examinations of medical interactions can add to the growing health literature that is attempting to disentangle the unique Latino/a sexual minority lived experience.

In this article, I examine how Latino sexual minority men navigate sexual identity stigma within medical contexts. I inquire about the conditions under which they disclose sexual identity to medical providers and how this impacts their interactions with medical institutions. While I ask about experiences and anticipation of discrimination and homophobia, I also address culturally specific factors that have been shown to impact sexual identity disclosure among sexual minority Latinos such as reliance on strong family networks and the notion of “respectability” among people of color (Almario et al. 2013). Overall, I highlight how the Latino sexual minority men I interviewed navigate sexual identity stigma to engage in comfortable patient–provider communication.

Data collection: Centering Latino experiences

For this study, semi-structured in-depth interviews were conducted on 16 Latino sexual minority men from a large urban city in the Southwest United States. This study utilized a non-probability purposive sample, and participants were recruited using gatekeepers in the Latino/a/x sexual minority community, posts on social media websites, and from Spanish and English fliers posted in various LGBT health and community centers around the city. To qualify, participants needed to be over the age of 18 and self-identify as a sexual minority and as either Hispanic or Latino. Respondents were not given any monetary incentives. Pseudonyms are utilized throughout to maintain confidentiality. IRB approval was requested and granted for completion of this study.

Participants in this study ranged in level of outness to their networks. Therefore, because of requests from the participants not to disclose the specific city in which the study was conducted, I do not provide detailed information that would reveal identifying information about the location of the study. I also avoid divulging certain specific descriptive information on request of several respondents. Participants varied in nationality and legal and generational status. However, per the request of several participants to omit information about citizenship or foreign-born status out of fear of retribution (despite the use of pseudonyms), I do not disclose information about nativity status or country of origin. The level of anonymity requested from my respondents is telling with regard to concerns about outness and disclosure within Latino sexual minority populations. For this study, respondents were eligible if they self-identified as Hispanic or Latino. Given the diversity of the pan-ethnic group that composes Hispanics/Latinos, in addition to the variation in how organizations categorize ethnic groups, relying on self-identification attempted to circumvent the “fuzziness” in classification systems.

Data collection was conducted over a 5-month period between January and May 2017. Interviews were conducted in English and Spanish, depending on the comfort and preference of respondents. As a bilingual researcher fluent in both English and Spanish, I translated the interview guide, recruiting materials, and transcriptions. Table 1 includes the language the interview was conducted in for each respondent. All respondents spoke English, and most also spoke Spanish. However, two respondents requested that their interview be conducted in Spanish. Respondents were asked to share their medical experiences and perspectives about interactions with a variety of medical providers. The interview guide consisted of questions about various topics related to sexual identity and sexual practice disclosure in medical provider–patient interactions. All interviews were audio-recorded and transcribed verbatim. Interviews lasted between 60 and 90 min on average and took place in locations of the respondent’s choosing. Memos were created from data collected from field notes and then analyzed for key themes. Coding categories were created utilizing Atlas.ti that identified emerging patterns regarding the strategies utilized by Latino sexual minority men in their medical experiences. I engaged in multilevel coding. First, I coded the transcript line by line to create categories and subcategories. I then proceeded with pattern coding to identify emerging patterns.

Table 1 Participant demographics
Full size table

Table 1 shows the range in ages of the participants, as well as their level of education, income, and sexual identity. All participants identified as cisgender men. The ages ranged from 23 to 37; this was a relatively young sample. Most of the sample identified as gay except for two men who identified as bisexual. In terms of education and income, although the majority of the sample was fairly educated and had bachelor’s degrees, income levels ranged from less than $30,000 to between $80,000 and $90,000, reflecting an economically diverse sample.

Provider–patient communication in medical encounters

This study examined medical experiences of 16 Latino sexual minority men in a large urban city. Specifically, I inquired about medical provider–patient communication. Focusing on my research question about how these men make decisions about sexual identity disclosure to medical providers, generally, I found that they rarely chose to disclose their sexual identity or sexual behavior. Respondents pointed to three key reasons that heavily influenced decisions to disclose: lack of perceived relevance of sexual identity to the medical encounter, expected negative reaction from medical providers, and tension arising from heteronormative assumptions in medical settings.

Relevance of sexual identity

Relevance of sexual identity in medical contexts was an important factor in decisions to disclose sexual identity during patient–provider interactions. I found mixed opinions about whether information about sexual identity and sexual behavior was essential for medical providers to know about their patients. While some participants held strong beliefs about whether sexual identity information was relevant in medical contexts, others were unsure about the importance of disclosure. Some reasons cited for hesitating to disclose sexual identity and behavior were the relevance to the medical context and the different approaches to sexual health by medical providers that lead to uncomfortable medical interactions. Various respondents explained how the type of medical encounter (i.e., dental, optical, or medical) influenced decisions to disclose. For example, Jose, a 33-year-old gay man, explained that only certain medical providers, like his urologist, should know about his sexual identity or practices, but for others, like optometrists and dentists, it “wasn’t any of their business.”

Similarly, Gustavo, a 27-year-old gay man, explained that he felt the relevance varied by medical context. Lucas, a 30-year-old gay man, also explained that he did not disclose his sexual identity to certain types of medical providers. Like Gustavo, he emphasized the importance of blood work as a marker of whether he should mention his sexual identity. He stated that the last time he went to the emergency room was for a broken ankle, and he chose not to disclose his sexual identity because “there was no blood being drawn so I didn’t feel like it was important for them to know.”

Both Gustavo and Lucas believed that the association between sexual identity and HIV transmission made disclosure relevant in certain medical contexts, but generally, they did not see the need to routinely disclose their sexual identity to providers. Antonio, a 24-year-old gay man, also explained why his decision to disclose varied between types of medical appointments. “I think it depends on what you are going in for. If I am going for strep throat, something that has nothing to do with my sexual orientation, I’m not going to be like by the way I’m gay—I don’t know if this is going to determine my bacterial swab.”

For these men, both the type of medical provider and the medical context were important factors in whether they felt the need to disclose their sexual identity. While they agreed that it was important to disclose their sexual identity in certain medical encounters, they did not feel it was necessary to routinely disclose to most providers.

Other respondents like Armando, a 25-year-old bisexual man, did not believe that his sexual identity was relevant for any medical provider to know. Armando explained, “I don’t think my sexual orientation is relevant. I think that what is more relevant than sexual orientation is personal health.” For Armando, sexual identity was not a relevant or integral factor for a medical provider to know about their patient, regardless of the medical context.

Yet, there were also respondents who firmly believed that sexual identity information was essential knowledge for any medical provider. Ricardo, a 23-year-old gay man who received medical services from a community LGBTQ sexual-health clinic, claimed that he always discloses his sexual identity and sexual practices to medical providers. Respondents like Ricardo felt that by disclosing their sexual identity, they would be able to get more informative and health-specific treatment and preventative options to fit their health needs.

Decisions to disclose sexual identity and sexual behavior were also influenced by perceived relevance of their sexual orientation to their overall identity. For many participants, sexual orientation was not perceived as a pervasive and integral part of their overall identity. Antonio described how he felt about his opinion of sexual identity. “I think it is a fragment of who I am—it is not in my entirety. I don’t go around introducing myself as a gay person—I’m just myself and that just happens to be an aspect of my life which I don’t share off the bat. If you get to know me, then obviously you will find out.”

For respondents like Antonio, their sexual minority identity was not a salient component of how they perceived their overall identity. Sexual identity was only a part of who they are—and not the most important part at that. As Latino men, they had additional axes of identities that played more integral roles in how they perceived themselves. Therefore, they did not believe their sexual identity to be an important or essential aspect to routinely disclose in all medical contexts.

Expected negative reactions

Respondents also pointed to expectations of negative reactions from medical providers as reasons they chose to avoid sexual identity disclosure during patient–provider interactions. Stigma and avoidance of possible rejection and discrimination from medical providers were also cited as driving forces for not choosing to disclose their sexual identity or sexual behavior. Several respondents spoke about discrimination toward gay men by the medical community with regard to blood donations. Oscar was concerned when he learned that, as a gay man, there were guidelines about his ability to donate blood. He explained that he felt that it was discriminatory. His distrust about being treated equally by medical providers was further enhanced by his perceptions of uncaring medical providers.

Additionally, almost all men talked about the fear of rejection from their family because of their sexual identity and sexual behavior, which was reproduced in their narratives about disclosure to medical providers. Violating the heterosexual norm by talking about their sexual minority identity for these Latino men was described as tense and straining. For example, Marcos, a 30-year-old gay man, described his concerns about disclosing his sexual identity to his long-time primary care physician:

It was a big deal to tell my doctor partly because he also treats my family. My family does not exactly know about my sexual orientation, so I had to makes sure that the laws about him disclosing sexual orientation to others was illegal. I asked him to keep it between us and he confirmed that whatever we talked about was between us and we could move on.

Secrecy within Latino families was constantly brought up by several respondents throughout their interviews as a strategy to negotiate acceptance. Many respondents indicated that, as long as they didn’t talk about their sexual identity or behavior, there was no conflict—even if they had come out to their family before. Many participants discussed how they avoided verbalizing any references to same-sex relationships or attraction in familial settings—a strategy that allowed them to circumvent tense and uncomfortable interactions. Secrecy in medical contexts was replicated by avoiding or choosing not to disclose their sexual orientation or discussing same-sex behavior to avoid possible discrimination or uncomfortable medical interactions.

Several respondents also described the stigma of being sexual minority males who existed within Latino communities, especially their family units, that created social barriers to coming out and to maintaining safe sexual practices. As a result, they failed to disclose their sexual identities and sexual practices to medical providers and therefore failed to request HIV and STD testing. Mateo, a 28-year-old gay man, described the tense experience of coming out to himself and his family and his opinion on the influence of fear and stigma on higher HIV infection rates for the Latino community:

Getting the courage to say to yourself that you are gay, particularly the strict Latino culture, you know traditional—it just made it extra hard. I think being from those types of minorities—Latino and Black—it is something that is not celebrated. I feel like there is a lot of sneaking around you know being rebels or what have you and being unsafe and uneducated because you are so scared to be who you are. I feel like maybe that is why the HIV rate is so high. Where I am from, it is definitely not accepted.

For many respondents, choosing to disclose their sexual identity to medical providers mirrored decisions to disclose within their own familial and social networks. Thus, for several respondents, their approach to their sexual-identity disclosure in their everyday lives outweighed their belief about whether their sexual identity was an important factor for their medical provider to know. Medical providers with Latino patients must be aware of culturally specific strategies that may be shaping disclosure decisions. Latino patients may not be used to proactively discussing their sexual minority identities and therefore may not feel comfortable in doing so in medical settings. This must be considered if medical providers want to engage in open, honest, and comfortable provider–patient interactions.

Navigating heteronormative assumptions

Finally, respondents also pointed to heteronormative expectations by medical providers as a significant factor in their sexual identity disclosure decisions. Respondents discussed the different ways in which they encountered heterosexual definitions and assumption about their health and relationships in medical contexts. Many pointed to the way medical health forms and interactions with medical staff and providers highlighted heterosexual normativity. This normative expectation of heterosexual sexual behavior reinforced that their sexual identity was what Jose referred to as “irregular.” Throughout the interviews, respondents shared specific experiences in which they had to confront these heterosexual assumptions that lead to uncomfortable negative encounters. Several respondents mentioned that the questions about marital status or relationships on medical forms were geared toward different-sex partnerships.

Respondents also shared concerns about the different approaches medical providers utilized with sexual minority patients compared to heterosexual patients, especially regarding questions about sexual health or partnership. Several respondents questioned the intrusiveness of the types of sexual behavior questions that sexual minorities were asked and the assumptions of hypersexuality. They noted that they did not believe heterosexual patients were asked such personal questions about their sexual practices. Several men highlighted that it was the way the topic was discussed that made the interactions tenser. For example, Juan, a 30-year-old gay man, described the types of intrusive questions he is asked by medical staff, which result in uncomfortable appointments:

Some of the questions you do get asked are very specific. It gets too personal because sometimes these questions get asked by someone who isn’t a doctor, and they can be very graphic. They ask you if you have any fetishes that you completed in the past, if you have been involved in threesomes or orgies, if you have been penetrated by a man, if you let them use a condom or not, if you let them finish inside or swallow semen … anything.

Juan explained that, in addition to the questions seeming quite personal, he was uncomfortable that many times he was asked these questions by office staff in addition to the medical provider. This made him feel more uncomfortable, as he found himself having to disclose personal information several times during one medical appointment. Similarly, Rudy, a 27-year-old gay man, shared how the wording of the questions on medical forms used to inquire about sexual practices contributed to uncomfortable medical experiences. Like Rudy, Pablo, a 29-year-old gay man, described an uncomfortable medical interaction he had with a primary care physician regarding communication about his sexual health. He stated,

He was kind of like judgmental. I was trying to get prescribed medication to prevent the transmission of HIV and I had to go to three different doctors so one of them would prescribe it to me because they were like, oh, why don’t you just use condoms? Like, well, condoms aren’t 100% effective, so why don’t you give me the medication.

However, not every respondent spoke of negative or uncomfortable medical experiences. Ricardo, a 23-year-old gay man, shared that his transition to an LGBTQ-specific clinic addressed uncomfortable moments in medical appointments. Several respondents like Ricardo found that by seeking LGBTQ-specific medical clinics or LGBTQ-friendly providers, they were able to avoid uncomfortable or stressful patient–provider interactions in discussing their sexual health.

Respondents also pointed to positive interactions with providers in non-LGBTQ-specific medical clinics. Rudy, a 27-year-old gay man, described his interaction with a medical provider in which he was directly asked about his sexual identity. Surprisingly, he found that it contributed to a more effective and open relationship with his provider. Rudy was surprised at the direct way his medical provider asked about his sexual identity. It wasn’t until after his appointment that he realized that his provider, despite being a heterosexual man, was LGBTQ friendly. Rudy mentioned that he was unaware that the doctor was an LGBTQ-friendly provider when he made his appointment and found it more comfortable to “answer the question rather than offering it unasked.”

Other respondents discussed the added comfort in the patient–provider relationship when medical providers treated their same-sex relationships as normative. For example, Judas, a 37-year-old gay man, discussed his positive relationship with his heterosexual primary care physician. He described how, “he goes right in, and he makes you feel like you’re friends.” For several respondents, medical encounters were perceived as positive not only if they felt comfortable in discussing their sexual health but also if they felt that their providers treated them in a similar way they treated heterosexual patients—with ease, understanding, and genuine concern.

Constraints and challenges in seeking and receiving medical care

Results highlight several constraints that interview respondents navigate when managing sexual identity stigma during medical encounters. Overall, three key findings are highlighted. First, results emphasize experiences of discomfort, tension, and anxiety relating to sexual identity disclosure to medical providers, with many respondents indicating that they rarely choose to disclose their sexual identity in medical contexts. Respondents pointed to stigma attached to a sexual minority identity as a reason for their decisions of nondisclosure. Throughout the interviews, participants described how disclosing a sexual minority identity involved risk of rejection, harassment, and discrimination from medical professionals. Respondents noted that, in highlighting their sexual identity as non-heterosexual, they were forced to challenge heteronormative assumptions by medical providers. Having to pause the medical interaction to note that they were not heterosexual centered the appointment on their marginalized status.

To avoid making these challenges, many chose to omit or minimize references to their sexual minority identity. For example, Antonio emphasized how his sexual identity was only a component of who he was and not the defining factor. His sexual identity was, therefore, not an important factor to disclose to medical providers, as it was only a “fragment” of who he was and thus not perceived as always necessary to share. These findings are consistent with previous research that documents low rates of sexual identity disclosure in medical settings among sexual minority adults (Sherman et al. 2014).

My interview findings not only indicated assumptions of heterosexuality by medical providers as a key motivator in avoiding sexual identity disclosure, but also emphasized anticipation of discrimination based on their stigmatized sexual identity. For example, Mateo and Oscar pointed to the stigma against gay men and HIV transmission upheld by the medical community in banning blood donation from men who have sex with men as an example of the discrimination against sexual minorities that he wished to avoid. Like Mateo and Oscar, Gustavo and Lucas also alluded to the emphasis on HIV transmission and the stigma attached to a sexual minority identity in medical contexts as reasons for their hesitancy to disclose their sexual identity. Their perceptions that the medical needs of sexual minority men, specifically Latino sexual minority men, centers around HIV transmission are reflected in the vast amount of scholarship on HIV and AIDS focusing on Latino men in the health literature (Rhodes et al. 2017; Beougher et al. 2011).

Discriminatory practices in their social environments were believed by participants to seep into the medical encounter. For many respondents, the stigma that was attached to a sexual minority person and the poorer treatment of that person was evident in policies that differentially surveilled and punished gay men. Anticipation of harassment and rejection on behalf of medical providers was driven by the stigmatizing policies that existed beyond the four walls of the medical office. These experiences also align with findings from previous studies, which show that, for many sexual minority patients, fear of discrimination, poorer medical treatment, and judgement about their sexual behavior influenced their decisions to disclose sexual identity (Politi et al. 2009; Sinclair 2003). Given that many sexual minority patients believe their health care would be of higher quality if they could safely disclose their sexual identities and sexual practices, health professionals that work with patients to enhance communication in a nonjudgmental manner can enhance medical comfort (Makadon 2006). Within the medical context, honest and comfortable communication requires that medical professionals be not only open, but also mindful of the risks involved for sexual minority patients in disclosing sexual identity or sexual practices.

Work that calls for a wider consideration of individual and structural factors that shape medical interactions emphasizes greater attention by medical providers to external oppressive systems that shape stigma within medical contexts (Metzel and Hansen 2014). Specifically, this shift requires more attention to and training in how social determinants of health shape inequities in medical school curriculum. In connecting the mechanisms by which institutionalized stigma constrains access to quality medical care services in provider–patient interactions, providers can better address the alienation and discomfort of Latino/a LGBTQ patients in medical settings (Ghabrial 2017).

Second, interview findings reinforce previous work that documents how disclosing sexual identity to medical providers forces participants to come out, which often contributes to uncomfortable and negative experiences (Brotman et al. 2002). While open communication between patient and provider can contribute to timely and effective medical care, sexual minority patients may be increasingly burdened if they feel they must disclose their sexual identity in ways that are not required or expected of heterosexual patients. Several respondents, like Oscar and Mateo, pointed to nondisclosure of sexual identity as a successful strategy for managing stigma and avoiding confrontation in their familial and social networks. This code of silence had served as a successful strategy in mitigating stigma related to their sexual identities in their familial networks and therefore were relied on with medical professionals as well.

Like Yoshino’s conceptualization of “covering,” my findings emphasize how avoidance and decentering of sexual identity were useful strategies for avoiding rejection and harassment within participants’ networks. Thus, nondisclosure of sexual identity may be an extension of a type of “covering” of sexual identity to medical contexts, rather than a specifically targeted strategy caused only by medical mistrust (Yoshino 2006). These findings also coincide with previous research that documents increased concealment of sexual identity within networks among sexual minorities of color (Bridges et al. 2003). Scholarship indicates that family and community support is highly valued in Latino communities, motivating members to avoid conflict to receive support from their networks (Mulvaney-Day et al. 2007). Given the experiences of familial rejection and difficulty maintaining connections with families after coming out that many sexual minorities face, it is important to understand the weight of the risk being taken for many in being open with their sexual identity in a variety of social settings (Bridges et al. 2003; Johnson and Staples 2005).

Yet, it is also important to extend our understanding of how a sense of familial obligation impacts medical decision making. Framings of familism as a solely positive or negative cultural trait of Latino family units oversimplify the complicated relationships between family dynamics and external systems (Patron 2021). Oppressive systems have direct impact on family units that manifest in ways that may further marginalize queer individuals. For example, scholars have highlighted how dimensions of familism differentially impact queer Latinos/as/xs in ways that are replicated in an array of social contexts (Abreu et al. 2020; Mendez-Luck et al. 2016), including medical settings. Recently, work has focused on how heterosexism and homophobia push and pull queer Latinos/as/xs to avoid and minimize interactions with familial ties as a type of protective buffer (Tuthill 2022). For sexual minority Latino men, medical providers should consider how strategies for managing stigma in external social contexts may impact decisions to disclose sexual identity and the perceived risk involved in them doing so.

Third, interview data suggests that lack of relevance of sexual identity was a significant driver in nondisclosure decisions. This aligns with previous studies that document that reasons for nondisclosure to medical professionals include the perception of the relevance of sexual orientation and sexual practices to the appointment (Sinclair 2003; Meyer 2007; Rossman et al. 2017). Yet, my interview data highlighted the variation in respondents’ perceptions about the relevance of sexual identity across medical context. This point has been minimized in previous empirical approaches to studies of sexual identity disclosure, which often focus on only one type of medical provider or one specific medical context (Law et al. 2015; Durso and Meyer 2013). While some men like Jose, Gustavo, and Lucas thought it necessary to disclose sexual identity only when medically relevant, others like Ricardo felt that disclosure to all providers was necessary in order receive effective medical treatment. Yet, it must be noted that while Ricardo emphasized the importance of always disclosing his sexual identity, he received his medical care from an LGBT-centered clinic and sought LGBT-friendly providers. This context most likely provided more comfortable spaces for sexual identity disclosure.

It is also important to continue to consider what is deemed “medically relevant” by sexual minority patients. For example, for Gustavo, a medical encounter that involved the drawing of blood prompted the need for sexual identity disclosure. Gustavo’s rationalization of blood as a significant marker for disclosure reinforced the emphasis on HIV in sexual minority health. More studies that further our understanding of how sexual minority patients frame what constitutes “medically relevant” will better contextualize the decision-making process for sexual identity disclosure.

The disproportionate health risks that contribute to health disparities across sexual orientation, especially among sexual minorities of color, must not be minimized (Gonzalez et al. 2016). An increasing body of work documents how members of sexual minorities who are also racial and ethnic minorities have higher rates of risky health behaviors, poorer health, and more limited access to health-promoting resources than white sexual minorities (Tuthill et al. 2020; IOM 2011; Landers and Gilsanz 2009). Promoting ways for sexual minorities of color to have access to increased opportunities for preventative screening, accurate diagnosis, and adequate treatment is essential for addressing health inequities across population groups. Improved patient–provider communication for sexual minority patients can be a way to contribute to more effective medical encounters and address the gap in quality of care. Yet, it may not be as simple as urging for more disclosure from members of marginalized communities.

Despite the potential benefits of sexual identity disclosure in more open communication between patients and providers, it is important to question the traditional framing of coming out. An established body of work has characterized coming out as a key step in sexual identity development and as a positive milestone in self-acceptance that posits disclosure as an inherently “good” and necessary thing (Rust 1993; Cass 1984). Yet, more work has pushed against this traditional discourse of coming out to challenge the lack of nuance of this characterization of sexual identity formation, which overlooks ambivalence and complexity for many sexual minority individuals (McLean 2007). The binary framing of disclosure as “good” and nondisclosure as “bad” may be an outdated approach in understanding how diverse experiences of sexual minorities are shaped by an array of external social factors.

Scholars also point to the way traditional framings of coming out may reinforce experiences of white sexual minorities in ways that minimize the racialized experiences of racial and ethnic LGBTQ adults (Snorton 2014). This line of work is beginning to also question the assumed relationship between concealment of sexual identity and poorer well-being, asking whether concealment is in fact harmful (Huang and Chan 2022). Medical providers and members of the medical community more generally (including health researchers) pushing for more open communication should be mindful of the over-reliance on one framing of sexual identity disclosure, one that may be outdated. Further work that pushes conceptualizations of coming out to be more inclusive of an array of lived experiences can inform medical providers about the conditions under which disclosure is helpful—or necessary.

While this article promotes increased honesty within the patient–provider relationship, particularly through sexual identity disclosure, it does not take for granted that disclosure is inherently a good thing. It could be that in choosing not to disclose their sexual identity, participants are resisting the hyper-sexualization of sexual minority Latino men in the medical encounter by refusing to reduce their identity to their sexual behavior. It is not surprising that after decades of oversurveillance of Latino communities as well as the pathologizing of the sexual minority community, Latino sexual minority men are cautious in highlighting their stigmatized sexual identity. Deciding whether to disclose information about sexual identity because of a fear of discrimination or poorer treatment is an issue that many sexual minority patients must contend with and one that many heterosexual patients can avoid.

Yet, nondisclosure can also be perceived as an act of empowerment. Rather than framing nondisclosure solely as a reaction to a negative experience, it may be possible that it is can also be an act of resilience. A more holistic approach to mitigation of stigma among marginalized communities can provide a broader understanding of adversity by highlighting both constraint and agency. The men in my study were pushed to protect themselves from rejection in medical contexts but also pushed back by being more selective in disclosure. Being more reserved about their sexual identity may not simply be a result of internalized homophobia, but rather a strategic proactive choice to reduce their exposure to negative encounters.

Although my findings provide important empirical contributions, they have three key limitations. First, in not disclosing specific information about immigrant status and country of origin, I am limited in my discussion of the role of nativity. Previous studies have found lower rates of disclosure among foreign-born sexual minorities, which indicates that nativity status may play a significant role in disclosure decisions (Durso and Meyer 2013). While the request of my participants made me unable to delve into a more detailed discussion of impact of the immigrant experience in sexual identity disclosure, future studies should consider how foreign-born status shapes communication between sexual minority patients and medical providers. Second, the size of the interview sample was small, and relatively young. As a result, the findings may be specific to a particular subset of sexual minority adults. Finally, the underrepresentation of transgender men and nonbinary people preclude me from making strong conclusions about cisnormativity in experiences and perceptions of medical interactions. This does not mean, however, that they do not exist. Previous data suggests that there are meaningful differences in exposure to stigma and discrimination for gender minorities. More direct strategies that recruited for transgender men could have provided a more inclusive sample.

Studies suggest that individuals who feel comfortable with medical professionals are more likely to ask questions and express concerns about their health, which increases engagement in health-promoting behavior (Jenerette and Mayer 2016). Patients with poor perceptions of communication with their providers are more likely to report lower quality of medical care, and evidence points to health disparities in quality of care across both race/ethnicity and sexual identity (IOM 2015). Yet, disclosure of sexual identity or practices may not be necessary in all medical contexts, and more in-depth examinations of when, why, and under what circumstances sexual minority patients disclose their sexual identity and behavior to their providers is needed to better understand their medical experiences.

Although it is the right of every patient, heterosexual or not, to choose when and to whom to disclose sexual identity or sexual practices, it is also the right of every patient to have equal access to quality health-care services, satisfactory provider–patient communication, and overall medical comfort. For many sexual minority patients, including many I interviewed, decisions to disclose sexual identity to medical professionals were shaped by anticipation of rejection or discrimination due to the stigmatization of sexual minority identities. By being conversationally open to and sympathetic toward the experiences of stigmatization of sexual minority patients, medical professionals can contribute to a more comfortable and positive medical experience for members of marginalized communities.