👁️‍🗨️Minority Stress

According to the World Values Survey data, negative attitudes towards LGBTQIA+ people in Malaysia remain one of the highest in Southeast Asia at 58.7%. Social conditions characterized by prejudice, rejection, and discrimination are stressful. Added to this, legal criminalization and medical pathologization of LGBTQIA+ people result in not only poor health outcomes but also serve as barriers to accessing healthcare services. This is referred to as minority stress.

😫 The relationship between discrimination and stress

Minority stress is a common phenomenon in minority groups, including LGBTQIA+ people, who exhibit high levels of stress due to discrimination. This results in a variety of health issues including poor coping mechanisms. Discrimination alters the physiology of stress and results in wide-ranging negative health impacts; from immunological, reproductive, and cardiovascular-related health impacts, to increased vulnerability to high blood pressure, obesity, and cancer.

A 2021 survey on the impact of COVID-19 and anti-LGBT narratives on LGBTQIA+ people in Malaysia found that 55.9% of respondents experienced increased stress and mental health burdens due to the anti-LGBT narratives in the country. Online hate speech and the proposed anti-LGBT legislation revealed a higher incidence of direct discrimination among the respondents. At the same time, they also experienced a higher degree of stress as a result of anti-LGBT political remarks and media sensationalism.

The discrimination results in barriers to healthcare services amongst LGBTQIA+ people. A study by CERIA with 26 Muslim gay men and men who have sex with men (MSM) found that issues like criminalization, discriminatory laws and policies, fear of arrest and to express identity, societal double discrimination, and stigma towards HIV and LGBTQIA+ people, and religious patriarchal interpretations of nonheteronormative sexualities contributed to poor health-seeking behavior or reluctance to see a doctor.

🔍Analyzing SDOH using an LGBTQIA+ lens within Malaysia’s context

SDOH aspect	How does it affect LGBTQIA+ people in Malaysia
Mental Health	LGBTQIA+ people experience criminalization, stigma, and violence that leads to minority stress which negatively impacts their mental health.
Substance use	Like other marginalized populations, LGBTQIA+ people may use alcohol and other substances to cope with the trauma caused by social exclusion, stigma, discrimination, and violence. Some may develop harmful substance use and dependence as coping mechanisms. It is important not to shame or judge their coping mechanisms.
Physical Health	Discrimination, stigma, and non-affirming healthcare services cause barriers that lead to higher risk of LGBTQIA+ people developing health problems and diseases. It also contributes to ignoring the higher risk of developing certain diseases, e.g. cervical cancer amongst LGBTQIA+ people.
Social Support	The lack of social support, especially from family, arising from stigma and discrimination negatively impacts the health of LGBTQIA+ people. This can cause feelings of unworthiness and low esteem among LGBTQIA+ people, lead them to be further victimized and marginalized, and increase their vulnerability to diseases and poor health.
Employment	The employment discrimination faced by LGBTQIA+ people based on their SOGIE and other intersecting identities, such as HIV status, religion, nationality, and the economic marginalization and precarity it creates, increase the psychological impact on their mental health and well-being. Criminalization of sex work also increases the vulnerability of trans women sex workers to harassment and arbitrary arrests.
Poverty	Loss of material and financial support from families places LGBTQIA+ people at higher economic risk. Stigma and discrimination in employment add to this risk, thus placing LGBTQIA+ people more vulnerable to poverty.
Education	Stigma, discrimination, and violence against LGBTQIA+ people lead to reduced access to education, and an increased likelihood of LGBTQIA+ people not continuing their education. Young LGBTQIA+ people who face family abuse often face restrictions on education and movement.
Housing and Homelessness	Economic and financial precarity, together with a lack of support systems (i.e. being disowned by their family), increases the risk of LGBTQIA+ people losing their homes .
Violence	Stigma and discrimination result in LGBTQIA+ people facing higher risk of forced marriages, physical violence, hate speech, harassment, surveillance, and restriction of movement, including by family members.