Due to a range of factors—including stigma, discrimination, and lack of access to gender-affirming healthcare—members of sexual and gender minoritized (SGM) populations experience poorer health outcomes than cisgender and heterosexual communities in a number of areas, including mental health issues, substance use, and chronic diseases such as cancer and heart disease.

Over the past decade, the National Institutes of Health (NIH) has undertaken a number of steps to strengthen research and advance the health outcomes of SGM populations, including the establishment of a dedicated Sexual and Gender Minority Research Office (2015), the formal designation of SGM individuals as a health disparity population (2016), and the development of a strategic plan to advance SGM health research in the future (2019).

Despite these steps, however, a new study from the University of Minnesota School of Public Health (SPH) shows that when it comes to one of NIH’s core functions—research funding—the picture is more mixed. Using NIH’s RePORTER database, researchers analyzed NIH-funded awards between 2012 and 2022 to identify research that focused on SGM populations.  The study, published in the American Journal of Public Health, found:

• 1,093 unique NIH awards concerning SGM health, totaling $491.7 million in first-year funding (in 2022-inflation-adjusted dollars). The funding for SGM-related research represented 0.8% of NIH’s funding portfolio of $60.1 billion in first-year funding from 2012 to 2022.
• NIH funding for SGM health research nearly tripled during this period, rising from 61 awards in 2012 to 172 in 2022. Funding dollars also increased, from $23.6 million in 2012 to $83.2 million in 2022.
• NIH’s research awards for SGM populations are heavily skewed toward HIV/AIDS projects. Over 65% of research support went to funding HIV/AIDS prevention studies.
• Stark funding disparities persist across SGM subgroups. Sexually minoritized men were the subject of study in 67.8% of the funding awarded, while transgender women (18.1%), sexually minoritized women (13.9%), transgender men (8.2%), and nonbinary people (4.4%) were underrepresented. Additionally, only 42.2% of studies explicitly referenced racial and ethnic identities, indicating a lack of intersectional approaches.

SPH researcher and lead author Ben Weideman noted that increases in the proportion of research awards and funding involving SGM populations has been outpaced by overall increases in the proportion of people reporting SGM identities in the U.S., and that particular SGM subgroups have been persistently underfunded.

“NIH research awards for SGM health research increased between 2012 and 2022, which underscores NIH’s laudable efforts to address the health disparities experienced by SGM populations,” says Weideman. “Unfortunately, even with these increases,  SGM health remains grossly underfunded given overall increases in SGM population size in the U.S., and certain groups—sexually minoritized women, transgender and nonbinary people—remain understudied.”

The paper calls for policy changes to ensure more equitable funding, including prioritizing underrepresented SGM subgroups, incorporating intersectionality in research design, and increasing federal funding.

“In the current political climate we are also concerned that research on SGM populations will be subject to disinvestment, which could further endanger the health of SGM people in the U.S.,” says Weideman.