Most posts on this page deal with topics that are in some way related to main or primary partner relationships. This one examines the somewhat broader interpersonal context between individual sexual and gender minority people and the LGBTQ+ community. Two decades of research – including work on HIV, COVID-19, and mpox – now suggest that sexual and gender minority people who believe in their community’s capacity to cope with (or respond to) a chronic illness engage in more prevention behaviors and have better mental health.
Community efficacy, and perceptions of collective capacity for united action
Consider the extent to which you agree with the following statements:
- The LGBTQIA+ community can cooperate in the face of difficulties to reduce the spread of HIV/COVID-19/mpox.
- In the LGBTQIA+ community, we can handle mistakes and setbacks without getting discouraged.
- The people of the LGBTQIA+ community can continue to work together, even when it requires a great deal of effort.
These statements are three items included in the United Action subscale of the Collective Efficacy Scale used in many psychological studies of this construct (Carroll et al., 2005). (The first statement appears in a modified form used in some studies to refer to specific infections or conditions of interest.) If you feel strongly that these statements are correct, then you likely have relatively strong confidence in the LGBTQ+ community’s capacity for collective action. If you disagree or have doubts about statements like these, then you may be someone who has relatively limited confidence in the community’s ability to cope with adversities.
Assessed in this way, collective efficacy refers to an individual’s subjective belief about their community’s capacity to work together to solve problems. Rather than an objective measure of actual collective coping success, it is a measure of how much individual members believes the LGBTQ+ community can rise to meet a challenge.
Associations with infections disease prevention and mental health
Studies of sexual minority men spanning two global pandemics – HIV and COVID-19 – as well as the most recent mpox outbreaks in the United States and United Kingdom all suggest that faith in the LGBTQ+ community’s capacity to cope is an indicator of resilience.
Better mental health in the face of public health challenges. Most recently, Cain and colleagues including myself (2025) surveyed cisgender sexual minority men (n = 2514 adults) during the mpox outbreak of 2022. Perceptions of collective efficacy to respond to mpox were negatively associated with anxiety and depression. Their finding mirrors earlier work on the HIV pandemic. Collective efficacy is negatively associated with mental health problems and positively associated with well-being among sexual minority men living with HIV (Lyons & Heywood, 2016). Complementary work from South Africa suggests it is also negatively associated with alcohol use in samples that include men living with HIV and those at risk of infection (Cain et al., 2013; Leslie et al., 2015).
More prevention engagement. Initial work on HIV established that perceptions of collective efficacy were positively associated with preventive behaviors, including having fewer sexual partners (Browning et al., 2008; Cain et al., 2013). Even though HIV prevention is behaviorally different from that required by COVID-19 and mpox, recent studies suggest that those who believe in the LGBTQ+ community’s capacity to cope are more likely to take steps to reduce their infection risk. It has been positively associated with the use of social distancing to reduce COVID-19 infection during the first months of the pandemic in the United States (Gupta et al., 2021) and positively associated with mpox vaccination during the 2022 outbreak in the US (Cain et al., 2025).
Some possible lessons
The studies cited here are uniformly survey studies. As with any such studies, caution is warranted when drawing conclusions about cause. It is possible that faith in community motivates reduces anxiety and activates hope in the face of challenges like the collective health threats of HIV, COVID-19, or mpox. It might also motivate people to take actions that reduce risk for themselves and reduce the spread of these infections within their community. It is also possible that some third variable – like community engagement – explains these findings. Perhaps those who are more active and engaged in the LGBTQ+ community are more aware of community-level efforts to address health challenges and also less worried and more hopeful in general.
Even though these studies cannot determine causal direction or mechanism, they do make clear that faith in community is associated with resilience for sexual and gender minority people in the face of infectious disease. Beliefs about the LGBTQ+ community are derived through experience. Seeking out community connections, learning about the community’s history, and getting engaged with current activities all provide potential opportunities to update beliefs about what the community is capable of. Those who volunteer, organize, and serve their communities may have to face the reality of tough challenges. That can be hard. They may also have a direct sense of just how much is possible through collective action and community engagement. That might be an important source of hope and comfort in the face of adversity.
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