(Re)conceptualizing structural stigma: Insights from a qualitative study of sexual minority men in a longitudinal, population-based cohort.

A growing body of evidence has documented the adverse health consequences of structural stigma across multiple marginalized groups, including sexual minorities. In light of these advancements, scholars have urged the field to refine conceptualizations of structural stigma to guide future empirical work. We heed this charge by analyzing two sets of qualitative data among gay and bisexual men obtained from a probability-based panel: 1) responses to an open-ended survey question about structural stigma (<i>n</i>=385) and 2) in-depth interviews about their subjective experiences of structural stigma (<i>n</i>=60). Our findings revealed three key dimensions underlying structural stigma. First, participants described structural stigma using metaphors conveying that their freedom had been severely constrained; structural stigma was variously portrayed as a "<i>cage</i>," a "<i>prison</i>," and a "<i>net"</i> where "<i>there is no exit</i>." Second, structural stigma communicated a lack of recognition by others, whereby participants were treated as "<i>sub-human</i>" and "a <i>second-class citizen</i>." Third, in contexts with high levels of structural stigma, participants reported a lack of social safety, including that their sense of belonging had been threatened; for one participant, structural stigma felt "<i>like knocking on a door and being able to see people on the other side laughing at you for trying to get in.</i>" Based on these themes, we offer a revised definition: Structural stigma is manifest when institutional policies, practices, and cultural norms produce societal conditions that create unfreedom, engender failures of recognition, or undermine social safety. Implications for structural stigma measurement, and for research with other stigmatized groups, are discussed.