Healthcare Discrimination Drives Mistrust and Delayed Care Among Young LGBTQ+ Adults in Spain

Spain is often celebrated as one of Europe’s most progressive countries on LGBTIQ+ rights, with sweeping anti-discrimination legislation and a publicly funded universal health system. Yet new research suggests that legal equality has not translated into equal treatment at the doctor’s office. A study published in the journal Archives of Sexual Behavior finds that sexual and gender minority (SGM) young adults in Spain report more perceived discrimination in primary care, greater psychological distress, lower trust in health care providers, and more delays in seeking care than their cisgender heterosexual peers. The findings challenge a comfortable assumption: that universal coverage and progressive laws are enough to guarantee equitable health care.

The research, conducted by Andrea Miranda-Tena, Francisco J. Sanmartín, and Judith Velasco, took the form of a cross-sectional online survey of 217 young adults aged 18 to 40, recruited through social media, mailing lists, and LGBTIQ+ community organizations across Spain. Of the participants, 144 identified as cisgender heterosexual and 73 as sexual and gender minority, including gay, lesbian, bisexual, transgender, and non-binary individuals. Data were collected between January and April 2025, and the average participant age was 21.5 years. Alongside structured questionnaires, participants answered an open-ended question inviting them to describe any discrimination they had experienced in primary care, responses that were analyzed using reflexive thematic analysis.

The quantitative results were striking. SGM participants scored significantly higher on measures of perceived personal and systemic discrimination. On the single-item measure of personal discrimination in health care, group differences were highly significant, and on the General Discrimination Scale the effect size was moderate to large, with SGM participants reporting markedly greater perceived discrimination. They also reported significantly higher psychological distress on the 12-item General Health Questionnaire, lower trust in physicians on the Trust in Physician Scale, and a greater tendency to delay or avoid seeking medical care they believed they needed. Interestingly, no significant group differences emerged for physical health complaints, and on a multi-item discrimination scale measuring interpersonal treatment in medical settings, the difference between groups did not reach statistical significance.

The study then pushed the analysis further, asking whether discrimination could predict health outcomes statistically. When the three discrimination measures were entered simultaneously into multiple regression models alongside psychological distress and somatic symptoms as outcomes, none of the models reached overall significance. Although perceived discrimination correlated with poorer mental health, lower trust, and delayed care at the bivariate level, it did not emerge as an independent predictor in the multivariate analyses. The authors interpret this cautiously rather than dismissively. Drawing on minority stress theory, they suggest that discrimination may operate less as a discrete, measurable predictor and more as a pervasive background stressor that accumulates over time, interacting with structural and individual-level variables. The modest size of the SGM subgroup may also have limited statistical power, attenuating effects that were visible in simpler analyses.

It is the qualitative accounts that give the numbers their human texture, and they are often uncomfortable reading. Participants described misgendering and the systematic use of incorrect pronouns or former names, with one respondent reporting the repeated use of a name and feminine pronouns that were simply wrong. Others described medical paternalism, with clinicians issuing directives about patients’ private lives while ignoring the care they actually needed. One participant recounted being told how to conduct their personal life as if the physician were a parent, forcing them to argue to prove the clinician wrong. Condescending communication, moralizing remarks about sexual behavior, and outright denial of preventive interventions such as vaccines and PrEP also appeared in the responses.

Some accounts illustrate how bias can translate directly into clinical harm. One participant described living with a Mycoplasma genitalium infection for more than two years while being treated as if it were a urinary infection. Only when they casually mentioned that a former partner was a man did the clinical approach change completely: a full sexually transmitted infection screening was finally performed, the mycoplasma was detected, and treatment began, though symptoms were suspected to have become chronic and no referral to infectious disease specialists was ever made. Another participant, after receiving an HIV diagnosis, was told they should have been more careful and was asked, during an assessment for a monkeypox vaccine, how they were handling their promiscuity. A third requested a publicly funded vaccine protecting against certain STIs and was refused because the doctor assumed a monogamous relationship made it unnecessary; the participant remained unvaccinated.

The thematic analysis also revealed subtler mechanisms. Participants reported gaps in provider knowledge, from unfamiliarity with STI prevention protocols to a partial or complete ignorance of what it means to be a transgender person. Many described deliberate concealment of their sexual orientation or gender identity as a protective strategy, anticipating stigma or discomfort before it even occurred. Weight-based stigma surfaced as well, with one participant describing years in which a skin condition was blamed on their weight until a new doctor finally made the correct diagnosis. Notably, cisgender heterosexual participants also reported negative experiences, particularly weight-related stigma and moral judgement, but they tended to frame these as isolated incidents of unprofessional conduct, whereas SGM participants more often situated similar encounters within a broader pattern of systemic discrimination.

These patterns fit established theoretical frameworks. Minority stress theory conceptualizes discrimination-related stressors as cumulative processes operating through both external events and internal mechanisms such as the anticipation of rejection. The psychological mediation model highlights vigilance, rumination, and avoidance as the pathways through which stigma gets under the skin, shaping how patients approach clinical encounters. The health equity promotion model situates individual experiences within structural contexts, emphasizing how institutionalized discrimination erodes trust, continuity of care, and long-term engagement with health services. Erosion of trust in early adulthood is particularly concerning, the authors note, because it may establish lasting patterns of disengagement from preventive care at precisely the age when such habits form, compounding the disproportionate burden of chronic illness already documented among SGM populations.

The Spanish context makes the findings especially pointed. Previous national data had already signaled trouble: a survey by the Spanish Federation of Lesbians, Gays, Trans, Bisexuals, and Intersex People found that 21.7 percent of transgender respondents accessed primary care only occasionally and 5.8 percent avoided it altogether, citing misgendering, deadnaming, and moral judgements. A 2024 study by the Carlos III Health Institute reported that 80 percent of transgender and non-binary individuals experienced fear or discrimination when accessing primary care. The new study adds a comparative dimension, showing that even within a universal health system in a country recognized internationally for LGBTIQ+ legal protections, SGM young adults remain more wary of their doctors than their peers.

The authors argue that the policy implications are clear. Universal coverage and anti-discrimination law are necessary but insufficient; what is required is affirming, culturally competent care embedded in everyday clinical practice. At the provider level, this means integrating SGM health content into medical education and continuing professional development, following models such as Harvard Medical School’s Sexual and Gender Minority Health Equity Initiative. At the institutional level, it means accountability mechanisms including anonymous reporting systems, equity audits, and systematic patient feedback, alongside visible signals of inclusivity such as gender-neutral language, inclusive intake forms, and affirming signage. Routine collection of sexual orientation and gender identity data could support service planning and the detection of inequities, and the authors stress that meaningful involvement of SGM communities in policy development and program evaluation is essential to ensure reforms are grounded in lived experience.

The study has limitations that temper its conclusions. Its cross-sectional design precludes causal inference, the sample was recruited by convenience and was predominantly White and university-educated, and the qualitative component rested on a limited number of open-text responses that the authors describe as illustrative rather than representative. The SGM subgroup of 73 participants limited statistical power in the multivariate models, and intersectional dimensions such as race, socioeconomic status, and disability could not be examined. Future research, the authors say, should adopt longitudinal and explicitly intersectional designs to capture how discrimination accumulates over time and across overlapping identities. Still, the core message stands: in a country with some of the strongest legal protections in the world, young sexual and gender minority adults still brace for mistreatment when they seek care, and that anticipation alone is enough to erode trust, delay treatment, and widen health disparities. Closing the gap between formal equality and lived experience, the study concludes, will require health systems to actively counteract stigma rather than merely prohibit it.

Subject of Research: Perceived healthcare discrimination, mistrust, and delayed care among sexual and gender minority young adults in Spain

Article Title: Perceived Healthcare Discrimination and Its Impact on Mistrust and Delayed Care Among Sexual and Gender Minority Young Adults in Spain

Article References: Miranda-Tena, A., Sanmartín, F. J., & Velasco, J. (2026). Perceived Healthcare Discrimination and Its Impact on Mistrust and Delayed Care Among Sexual and Gender Minority Young Adults in Spain. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-026-03516-z

Image Credits: AI Generated

DOI: 10.1007/s10508-026-03516-z

Keywords: healthcare discrimination, sexual and gender minority, LGBTIQ+ health, primary care, medical mistrust, delayed care, minority stress, misgendering, psychological distress, Spain, health equity, culturally competent care