GENERAL HEALTH AND PERCEIVED/FEARED DISCRIMINATION IN THE LGBT+ COMMUNITY

to analyze the relationship of perceived and feared discrimination with general health in LGBT+ people according to schooling level, gender identity and socioeconomic level.

Method:

a cross-sectional and correlational study was conducted. The sample consisted of 120 participants of legal age from the Maule region (Chile) who belonged to the LGBT+ community and answered an online survey due to the SARS-CoV-2 pandemic. The survey also included an open question for the participants to share discrimination experiences regarding the treatment received from the Nursing personnel. The quantitative data were examined by means of descriptive and inferential analyses (means difference and correlation tests). The results extracted were analyzed following the thematic and discursive analysis techniques.

Results:

although perceived discrimination had low prevalence in the sample, 44.17%, 38.33% and 32.51% manifested fear of not being loved, of not finding a job and of being rejected by their family for being part of the LGBT+ community, respectively. Likewise, discrimination was higher in the group of trans people and was mainly reflected in unjustified dismissals, difficulties finding a job or ill-treatment in the provision of health services. Finally, it was found that the participants exposed to more discrimination also reported worse general health.

Conclusions:

discrimination is a problem that affects the LGBT+ community, particularly the trans collective. The severe implications of discrimination for people's health evidence the need to design strategies, policies and regulations aimed at fostering tolerance and integration.

DESCRIPTORS:
Gender analysis in health; Social discrimination; Health; Sex and gender minorities; Nursing care

Situations of discrimination	Frequency level (%)					M*	SD^†
Situations of discrimination	Nothing	A little	Pretty much	A lot	Totally	M*	SD^†
I'm afraid that they stop loving me.	27.50	28.33	16.67	14.17	13.33	2.58	1.38
I'm afraid that they find out.	40.83	29.17	10.83	8.33	10.83	2.19	1.34
I'm afraid that they will tell other people.	50.83	23.33	10.83	7.50	7.50	1.98	1.27
I'm afraid that my family rejects me.	50.00	17.50	6.67	9.17	16.67	2.25	1.55
I'm afraid that they fire me.	45.00	25.00	9.17	7.50	13.33	2.19	1.42
I'm afraid that they gossip about me.	39.17	22.50	20.83	10.00	7.50	2.24	1.28
I'm afraid that they kick me out my house.	70.00	12.50	6.67	3.33	7.50	1.66	1.21
I'm afraid that my friends stop talking to me.	68.33	12.50	6.67	6.67	5.83	1.69	1.21
I'm afraid that my mom/dad find out.	66.67	10.00	5.00	5.00	13.33	1.88	1.46
I'm afraid of not finding a job.	44.17	17.50	14.17	10.83	13.33	2.32	1.46

Situations of discrimination	Frequency level (%)					M*	SD^†
Situations of discrimination	Nothing	A little	Pretty much	A lot	Totally	M*	SD^†
They don't share social activities with me.	70.83	21.67	5.83	0.83	0.83	1.39	0.71
They don't let me speak.	70.00	19.17	5.83	3.33	1.67	1.48	0.88
My neighbors criticize me.	62.50	26.67	6.67	0.83	3.33	1.56	0.91
I was fired.	82.50	8.33	2.50	2.50	4.17	1.38	0.97
They don't want to come close to me.	71.67	21.67	5.00	1.67	0.00	1.37	0.66
They withdraw.	75.00	19.17	3.33	1.67	0.83	1.34	0.70
They don't respect me and don't take my opinion into account in my house.	60.83	20.00	6.67	5.83	6.67	1.78	1.21
They don't respect me and don't take my opinion into account in my social circle.	77.50	14.17	4.17	1.67	2.50	1.38	0.85
I'm ill-treated when I attend appointments at the CESFAM or Hospital.	68.33	20.00	5.83	4.17	1.67	1.51	0.91
They don't treat me at the CESFAM or Hospital.	85.00	8.33	4.17	1.67	0.83	1.25	0.69
My peers look at me badly.	69.17	22.50	5.00	1.67	1.67	1.44	0.81
They kicked me out of the house.	84.17	5.83	4.17	1.67	4.17	1.36	0.96

Situations of discrimination	Percentage frequency
Who?	Strangers	64.17%
	Other family members	38.33%
	Parents	30.00%
	Health personnel	16.67%
	Neighbors	10.83%
	Nobody	4.17%
	Work colleagues	2.50%
	Study peers	1.67%
	Friends	1.67%
	LGBT+ community	0.83%
Where?	In the neighborhood	22.50%
	In your parents'/family members' house	20.00%
	At work	18.33%
	In your house	15.83%
	In the health center	13.33%
	On the street	10.83%
	Nowhere	8.33%
	Social networks	3.33%
	Educational institution	2.50%
	Shops	1.67%
When?	When they find out that I belong to the LGBT+ community	29.17%

Feared discrimination	Gender identity				p*	Schooling level		p*
Feared discrimination	Cisgender man	Cisgender woman	Non-binary person	Trans person	p*	No Higher Education	Higher Education	p*
I'm afraid that they stop loving me.	2.73	2.45	2.79	3.00	N.S.^†	2.69	2.49	N.S.^†
I'm afraid that they find out.	2.15	2.17	2.36	2.17	N.S.^†	2.46	1.99	0.0538
I'm afraid that they will tell other people.	1.82	2.02	2.00	1.83	N.S.^†	2.23	1.78	0.0527
I'm afraid that my family rejects me.	1.91	2.34	2.36	2.17	N.S.^†	2.69	1.91	0.0056
I'm afraid that they fire me.	2.18	2.15	2.36	3.17	N.S.^†	2.23	2.16	N.S.^†
I'm afraid that they gossip about me.	2.24	2.23	2.21	2.17	N.S.^†	2.33	2.18	N.S.^†
I'm afraid that they kick me out my house.	1.33	1.81	1.78	1.83	N.S.^†	1.94	1.44	0.0242
I'm afraid that my friends stop talking to me.	1.39	1.77	1.79	2.50	N.S.^†	1.90	1.53	0.0925
I'm afraid that my mom/dad find out.	1.48	2.00	2.07	2.00	N.S.^†	2.33	1.54	0.0031
I'm afraid of not finding a job.	2.27	2.31	2.21	4.17	0.0231	2.44	2.22	N.S.^†

Experienced discrimination	Gender identity				p*	Schooling level		p*
Experienced discrimination	Cisgender man	Cisgender woman	Non-binary person	Trans person	p*	No Higher Education	Higher Education	p*
They don't share social activities with me.	1.39	1.40	1.50	1.33	N.S.^†	1.42	1.37	N.S.^†
They don't let me speak.	1.33	1.48	1.50	1.67	N.S.^†	1.67	1.32	0.0303
My neighbors criticize me.	1.36	1.54	1.79	2.83	0.0020	1.63	1.50	N.S.^†
I was fired.	1.24	1.33	1.29	2.50	0.0301	1.54	1.25	N.S.^†
They don't want to come close to me.	1.24	1.35	1.43	1.83	N.S.^†	1.42	1.32	N.S.^†
They withdraw.	1.15	1.29	1.50	2.33	0.0002	1.46	1.25	N.S.^†
They don't respect me and don't take my opinion into account in my house.	1.30	1.98	2.07	2.33	0.0366	2.06	1.56	0.0249
They don't respect me and don't take my opinion into account in my social circle.	1.30	1.40	1.36	1.67	N.S.^†	1.42	1.34	N.S.^†
I'm ill-treated when I attend appointments at the CESFAM or Hospital.	1.33	1.50	1.43	3.17	0.0001	1.62	1.43	N.S.^†
They don't treat me at the CESFAM^‡ or Hospital.	1.12	1.33	1.00	1.50	N.S.^†	1.27	1.24	N.S.^†
My peers look at me badly.	1.33	1.29	1.71	2.67	0.0001	1.56	1.35	N.S.^†
They kicked me out of the house.	1.15	1.50	1.50	1.17	N.S.^†	1.40	1.32	N.S.^†

Feared discrimination	General Health
Feared discrimination	GH1	GH2	GH3	GH4	GH5	Global GH
I'm afraid that they stop loving me.	-0.33^‡	-0.33^‡	-0.34^‡	-0.35^‡	-0.35^‡	-0.42^‡
I'm afraid that they find out.	-0.20^†	-0.24^‡	-0.26^‡	-0.24^‡	-0.29^‡	-0.31^‡
I'm afraid that they will tell other people.	-0.27^‡	-0.21^†	-0.26^‡	-0.25^‡	-0.30^‡	-0.32^‡
I'm afraid that my family rejects me.	-0.18^†	-0.10	-0.18^†	-0.12	-0.23^†	-0.20^†
I'm afraid that they fire me.	-0.29^‡	-0.20^†	-0.29^‡	0.35^‡	-0.31^‡	-0.36^‡
I'm afraid that they gossip about me.	-0.17*	-0.21^†	-0.26^‡	-0.33^‡	-0.27^‡	-0.31^‡
I'm afraid that they kick me out my house.	-0.19^†	-0.13	-0.30^‡	-0.16*	-0.27^‡	-0.26^‡
I'm afraid that my friends stop talking to me.	-0.23^†	-0.12	-0.35^‡	-0.28^‡	-0.33^‡	-0.33^‡
I'm afraid that my mom/dad find out.	-0.14	-0.17*	-0.22^†	-0.12	-0.24^‡	-0.23^†
I'm afraid of not finding a job.	-0.32^‡	-0.18^†	-0.33^‡	-0.34^‡	-0.33^‡	-0.38^‡

Experienced discrimination	General Health
Experienced discrimination	GH1	GH2	GH3	GH4	GH5	Global GH
They don't share social activities with me.	-0.12	-0.16*	-0.29^‡	-0.24^†	-0.27^‡	-0.27^‡
They don't let me speak.	-0.12	-0.15	-0.26^‡	-0.19^†	-0.24^‡	-0.24^‡
My neighbors criticize me.	-0.40^‡	-0.20^†	-0.44^‡	-0.31^‡	-0.37^‡	-0.43^‡
I was fired.	-0.32^‡	-0.15	-0.27^‡	-0.21^†	-0.25^‡	-0.29^‡
They don't want to come close to me.	-0.30^‡	-0.16*	-0.23^†	-0.23^†	-0.28^‡	-0.30^‡
They withdraw.	-0.42^‡	-0.20^†	-0.33^‡	-0.28^‡	-0.36^‡	-0.40^‡
They don't respect me and don't take my opinion into account in my house.	-0.31^‡	-0.19^†	-0.32^‡	-0.33^‡	-0.40^‡	-0.39^‡
They don't respect me and don't take my opinion into account in my social circle.	-0.18^†	-0.05	-0.25^‡	-0.05	-0.23^†	-0.19^†
I'm ill-treated when I attend appointments at the CESFAM§ or Hospital.	-0.46^‡	-0.20^†	-0.36^‡	-0.32^‡	-0.32^‡	-0.41^‡
They don't treat me at the CESFAM§ or Hospital.	-0.31^‡	0.00	-0.23^†	-0.16*	-0.15	-0.21^†
My peers look at me badly.	-0.26^‡	-0.09	-0.27^‡	-0.16*	-0.13	-0.22^†
They kicked me out of the house.	-0.33^‡	-0.25^‡	-0.12	-0.21^†	-0.27^‡	-0.29^‡

Types of covert discrimination	Brief explanation of the category and illustrative reports
1) Support of the heteronormative or gender-compliant culture/behaviors	Non-recognition of the name chosen to reflect gender identity and/or sexual orientation: In the hospital, despite having my name legally changed for a year now... They still call me by my deadname and shield themselves in that "he/she has to ask for it (the name) to be changed in the system", when my name is updated in the system since March 2020.
2) Acceptance of the sexual pathology/ abnormality	Denial of access to health spaces and social participation: The first time I was discriminated against, the one that hurts the most, was in a health center; they didn't allow me to donate blood due to my sexual orientation, that was in the [name] Hospital, nothing surprises you from then on.
3) Uneasiness/Disapproval regarding the LGBT+ experience	Level of seriousness in the dealings, discriminatory treatment through uncomfortable stares and laughs: It's really unpleasant to attend a gynecological appointment [at the hospital] and speak out my sexual orientation, they laugh at me or keep staring, they've never treated me well, they only get more serious when I tell them that I also work in health.
4) Indirect manifestation of the hate discourse*	Instances in which people speak about LGBT+ individuals in a mocking and derogatory way behind their back, although with them present so that they can hear: When I was an adolescent, a homosexual assaulted me with other guys, they broke me some teeth and, due to that, the Police took me to the hospital for care (they mocked at me in the way without even knowing that had happened and not the least interested in making justice) but, once there, it was very sad to hear everyone talking and laughing about what had happened to me. It was the worst experience by far.
5) Stigmatizing questions against the relevance principle*	Questions about the patient's sexual orientation when it is not considered a relevant aspect for clinical care: I don't generally go the CESFAM for treatment, I usually see doctors from some other health center, I don't feel discriminated with them because they're mostly people with studies and see homosexuality as normal, it's only when I go to the gynecologist that I have to speak it out and I've never had problems with male or female doctors.

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Mariana Lazzaro-Salazar lazzaromari@gmail.com