How many sexual minorities are hidden? Projecting the size of the global closet with implications for policy and public health.

Because sexual orientation concealment can exact deep mental and physical health costs and dampen the public visibility necessary for advancing equal rights, estimating the proportion of the global sexual minority population that conceals its sexual orientation represents a matter of public health and policy concern. Yet a historic lack of cross-national datasets of sexual minorities has precluded accurate estimates of the size of the global closet. We extrapolated the size of the global closet (i.e., the proportion of the global sexual minority population who conceals its sexual orientation) using a large sample of sexual minorities collected across 28 countries and an objective index of structural stigma (i.e., discriminatory national laws and policies affecting sexual minorities) across 197 countries. We estimate that the majority (83.0%) of sexual minorities around the world conceal their sexual orientation from all or most people and that country-level structural stigma can serve as a useful predictor of the size of each country's closeted sexual minority population. Our analysis also predicts that eliminating structural stigma would drastically reduce the size of the global closet. Given its costs to individual health and social equality, the closet represents a considerable burden on the global sexual minority population. The present projection suggests that the surest route to improving the wellbeing of sexual minorities worldwide is through reducing structural forms of inequality. Yet, another route to alleviating the personal and societal toll of the closet is to develop public health interventions that sensitively reach the closeted sexual minority population in high-stigma contexts worldwide. An important goal of this projection, which relies on data from Europe, is to spur future research from non-Western countries capable of refining the estimate of the association between structural stigma and sexual orientation concealment using local experiences of both.