Outlook: Newsletter of the Society of Behavorial Medicine

Spring 2021

Two Landmarks in Sexual Health: Looking Back to 1981

Brett Millar, PhD; Eric Layland, PhD; Kimberly Nelson, PhD, MPH; and Lisa Eaton, PhD; HIV & Sexual Health SIG Leadership

In 2021, we look back 40 years to two distinct, seemingly unrelated, sexual health landmarks. First, on July 3, 1981, the New York Times published a story entitled “Rare Cancer Seen in 41 Homosexuals." This article marked the first public announcement of what would later become known as acquired immunodeficiency syndrome (AIDS) arising from untreated human immunodeficiency virus (HIV), although we are now aware that numerous cases long preceded that date.  Also, in 1981, Dr. Virginia R. Brooks’ seminal work on Minority Stress Theory was published in her groundbreaking book entitled Minority Stress and Lesbian Women.  Though these two landmarks may have emerged separately 40 years ago, the connection between minority stress and sexual health has become increasingly evident.

Dr. Brooks (1938-2008), later known as Dr. Winn Kelly Brooks, expanded upon the findings of her 1977 doctoral dissertation in Social Work and Social Welfare at University of California-Berkeley, with her 1981 book Minority Stress and Lesbian Women (Lexington Books, currently out-of-print). Her work was groundbreaking in a number of ways, as described in an excellent and long-overdue celebration of her work by Rich and colleagues (2020) in LGBT Health.

The scope of Brooks’ work far surpassed that of existing studies at the time and generated a truly multilevel model detailing the various sources of stress (cultural, social, economic) to which sexual minority women are chronically exposed and their downstream effects on psychological and physical health.

Brooks’ visionary work repudiated the existing discourse that sexual minority individuals’ distress was caused by inherent pathology, dysfunction, or trauma, and set a foundation for subsequent work on stigma, discrimination, and stress (e.g., DiPlacido, 1998). Later her work would be applied to sexual minority men (Meyer, 1995) and gender minority populations (Hendricks et al., 2012), as well as integrated with intersectional approaches to stigma research. Meyer’s extension of minority stress energized an entire field and subsequent minority stress research has proliferated, with applications for HIV-related stigma (Logie et al., 2012; Rendina et al., 2017) and HIV prevention (Layland et al. 2020). According to Rich and colleagues (2020), Minority Stress Theory “informed the landmark 2011 Institute of Medicine (IOM) report on sexual and gender minority health... [leading] to the establishment of the National Institutes of Health Sexual and Gender Minority Research Office in 2015 and subsequent designation of sexual and gender minority people as a health disparity population for research purposes in 2016” (p.3).

Now, 40 years after both the 1981 “rare cancer” headline and Brooks’ pioneering work on minority stress, we see that, although they initially seemed unrelated, the latter has meant so much for the former. Since Brook’s foundational work, ever-growing evidence of minority stress continues to inform possibilities for intervention and testifies to the importance of eradicating stigma and discrimination for the ongoing health of marginalized populations.



Brooks, V.R. (1981). Minority Stress and Lesbian Women. Lexington, MA: Lexington Books.

DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Psychological perspectives on lesbian and gay issues, Vol. 4. Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (p. 138–159). Sage Publications, Inc. https://doi.org/10.4135/9781452243818.n7

Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the Minority Stress Model. Professional Psychology: Research and Practice43(5), 460-467.

Layland, E. K., Carter, J. A., Perry, N. S., Cienfuegos-Szalay, J., Nelson, K. M., Bonner, C. P., & Rendina, H. J. (2020). A systematic review of stigma in sexual and gender minority health interventions. Translational behavioral medicine10(5), 1200-1210.

Logie, C. H., Newman, P. A., Chakrapani, V., & Shunmugam, M. (2012). Adapting the minority stress model: associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India. Social Science & Medicine, 74(8), 1261-1268.

Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 38-56.

Rendina, H. J., Gamarel, K. E., Pachankis, J. E., Ventuneac, A., Grov, C., & Parsons, J. T. (2017). Extending the minority stress model to incorporate HIV-positive gay and bisexual men's experiences: A longitudinal examination of mental health and sexual risk behavior. Annals of Behavioral Medicine51(2), 147-158.

Rich, A. J., Salway, T., Scheim, A., & Poteat, T. Sexual minority stress theory: Remembering and honoring the work of Virginia Brooks. LGBT Health, 7(3) 124-127. DOI: 10.1089/lgbt.2019.0223