Implicit sexual health stereotypes and their relation to diagnoses and management recommendations.
Rivera L, Qureshi R, Mbadugha N, Lelutiu-Weinberger C • Health psychology : official journal of the Division of Health Psychology, American Psychological Association • 2025
Strong implicit sexual health stereotypes predicted less correct diagnoses and management recommendations only when a male patient had been sexually involved with a male versus a female partner, supporting an implicit bias-in-action hypothesis among nurse practitioner and physician assistant professionals and trainees.
Key Findings
Results
NPPA participants exhibited implicit sexual health stereotypes associating sexual minority men (SMM) with sexually transmitted infections.
The study used a sample of nurse practitioner and physician assistant (NPPA) professionals and trainees.
This was described as 'the first of its kind' experiment testing an implicit bias-in-action hypothesis in this professional population.
Participants completed a measure of implicit sexual health stereotypes before reviewing clinical case studies.
Results
Strong implicit sexual health stereotypes predicted less correct diagnoses and management recommendations when the male patient had a male sexual partner.
The effect for the male-male partner case was statistically significant: B = -.12, 95% CI [-.21, -.06].
The effect for the male-female partner case was not statistically significant: B = -.03, 95% CI [-.15, .08].
Participants provided diagnoses and management recommendations for a male patient presenting with a sexually transmitted infection.
The patient's history varied only in whether the new sexual partner was male or female.
Results
Implicit bias-in-action was demonstrated, meaning implicit stereotypes influenced real clinical decision-making outcomes differentially based on patient sexual behavior.
The implicit bias-in-action hypothesis posits that implicit stereotypes manifest in clinical behaviors such as diagnoses and management recommendations.
The bias effect was specific to the sexual minority male patient condition, not the heterosexual patient condition.
The authors conclude this 'may be one causal reason underlying the health inequities that disproportionately target SMM.'
Discussion
Educating health care providers about implicit bias-in-action in health care settings may reduce the influence of implicit stereotypes on clinical decisions.
The authors suggest education 'can circumvent the influential role of implicit stereotypes in diagnoses and management recommendations.'
The proposed outcome of such education is 'improving the quality of provider-patient health care encounters.'
This implication is drawn from the experimental findings regarding how implicit stereotypes affected clinical outcomes.
Background
Sexual minority men are disproportionately affected by health inequities, and implicit provider bias is proposed as one contributing mechanism.
The paper frames SMM health disparities as a backdrop motivating the study.
The study situates provider-held implicit stereotypes as a plausible causal factor in these documented disparities.
The experimental design tested whether implicit stereotypes translate into differential clinical care for SMM versus heterosexual male patients.
What This Means
This research suggests that health care providers — specifically nurse practitioners and physician assistants — hold unconscious (implicit) stereotypes linking gay and bisexual men with sexually transmitted infections, and that these stereotypes can negatively affect the quality of medical care those patients receive. In the study, providers reviewed a clinical scenario about a male patient with an STI whose recent sexual partner was described as either male or female. Providers with stronger implicit stereotypes made less accurate diagnoses and treatment recommendations, but only when the patient's partner was male — not when the partner was female. This pattern is what researchers call 'implicit bias-in-action,' meaning the bias showed up in actual clinical decisions rather than just in attitudes.
This matters because sexual minority men already experience higher rates of certain health problems and face barriers to quality health care. This study provides experimental evidence suggesting that unconscious provider bias may be a direct cause — not just a correlate — of unequal treatment. The finding is notable because it isolates the effect of a single variable (the sex of the patient's partner) on clinical outcomes, suggesting the disparity in care is driven by provider bias rather than differences in the clinical presentation itself.
The research also points toward a potential solution: educating health care providers about the possibility that their unconscious biases can influence clinical decision-making may help reduce those effects and improve care for sexual minority patients. This suggests that awareness-based training programs in medical and nursing education could be an important tool for addressing health disparities in this population.
Rivera L, Qureshi R, Mbadugha N, Lelutiu-Weinberger C. (2025). Implicit sexual health stereotypes and their relation to diagnoses and management recommendations.. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. https://doi.org/10.1037/hea0001440