Healthcare for LGBTQIA+ People: What Do Patients Say?

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Letícia Nacle Estefan Sobral, João Pedro Venancio Lima, Amanda Madureira Silva, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5708264/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Recognising sexual and gender diversity as a social marker of difference and an indicator of vulnerability in accessing comprehensive healthcare, this research aims to explore the perceptions of self-declared LGBTQIA+ people in relation to health care received in Brazil. Methods: This was a quantitative cross-sectional observational study carried out using an anonymous online form disseminated through social media using a snowball strategy, aimed at LGBTQIA+ people living in Brazil. The instrument contained a sociodemographic questionnaire and semi-structured questions about the medical care provided and the identification of prejudiced attitudes. Results: 134 people took part, with an average age of 30, the majority black, cisgender and homosexual. The quality of care received was positive for 35.8 per cent of the participants and 47.8 per cent reported easy access to healthcare. There was a greater perception of difficulty in access among people on low incomes when compared to people on high incomes (p < 0.05). In the healthcare environment, 31.3% said they had already suffered discrimination for being LGBTQIA+, with gynaecology being the area most frequently mentioned. 63.4% believe that there should be specific environments to meet their needs and 85% perceive that health professionals are not prepared to deal with LGBTQIA+ people. Conclusions: There was a high prevalence of discrimination related to their sexuality in the healthcare environment, especially in gynaecological consultations. The majority of LGBTQIA+ participants believe that health professionals are not prepared to provide care to this public. Sexual and Gender Minorities Health Services Accessibility Gender Diversity Transphobia Background Recognising sexual and gender diversity as a social marker of difference and an indicator of vulnerability in accessing comprehensive healthcare, public health policies have been developed at the national level to facilitate healthcare access for LGBTQIA+ individuals (lesbians, gays, bisexuals, travestis, and transgender people, queer, intersex, asexual, and other identities) 1,2,3. Despite the implementation of these guidelines, the underreporting of the LGBTQIA+ population due to the lack of official records contributes to the invisibility of these individuals. It is estimated that 1.8% of the Brazilian population identifies as transgender or non−binary, and 14% with a non−heterosexual sexual orientation 4,5. Taking into account the intersection of vulnerabilities enables a deeper understanding of the complex phenomenon of structural violence. Of all those victimised by LGBTQIA + phobia in Brazil in 2023, more than half were trans women and travestis, young, black, and murdered in public spaces 6 . Violence can also manifest subtly through neglect and silencing within healthcare settings. Consequently, the detachment of this population from healthcare networks is reflected in higher rates (compared to cisgender heterosexuals) of psychiatric disorders, substance abuse, and preventable diseases such as cervical and breast cancer 7 . The lack of preparation among medical professionals to welcome, care for, and understand the specificities and experiences of LGBTQIA + patients is evident 8,9 . Alongside this reality, the inclusion of LGBTQIA + health topics in medical school curricula remains sporadic when present at all. The academic landscape compounds the programmatic violence experienced by this community, resulting in healthcare services shaped by empirical knowledge and personal beliefs, which directly impact health indicators 10 . Recognising the multiple agents that contribute to the perpetuation of structural violence faced by the LGBTQIA + population, this study aimed to deeply explore the perceptions and experiences of self-identified LGBTQIA + individuals within healthcare settings. Furthermore, the study seeks to reflect on the implications of these experiences for the promotion of equitable and inclusive healthcare. Methods This is a quantitative cross−sectional observational study conducted from June 2023 to March 2024, originating in a tertiary university hospital located in the northeast of Brazil. An anonymous online form was used, divided into two sections: the first comprised multiple−choice questions to capture sociodemographic profiles, and the second included a semi−structured questionnaire with open−ended questions designed to examine the perceptions and experiences of LGBTQIA+ individuals in the context of healthcare services. The emphasis was placed on analysing the quality of medical care received, evaluating not only technical and humanised aspects of care but also identifying potential discriminatory attitudes, behaviours, and practices that may emerge in healthcare settings. This analysis aims to contribute to the reflection on strategies that promote more inclusive and respectful care for sexual and gender diversity. The instrument was disseminated through social media using a snowball strategy, and a Free and Informed Consent Form was provided. Self−identified LGBTQIA+ individuals residing in Brazil were included in the study. Exclusions were made for individuals under 18 years of age or those not residing in Brazil. The interpretation of the results considered not only the participants' responses but also their sociodemographic particularities. To compare sociodemographic variables with the questionnaire responses, the following tests were used: Fisher's exact test, Pearson's chi−square test, and the Mann−Whitney test. Data were presented as means, standard deviations, medians, counts, and percentages. The study adopted a 5% significance level, and R software version 4.0 was used for the analysis. Microsoft Excel was also utilised to create graphs. This research was approved by the Ethics and Research Committee of the Maternidade Escola Assis Chateaubriand at the Federal University of Ceará under CAAE 69064723.1.0000.5050 and received funding from the Brazilian Association of Medical Education (Call for Proposals No. 05/2022 – Research Assistance in Medical Education)." Results A total of 134 participants were included in the study, of whom 49.2% identified as black, 88% identified as cisgender, and 58.2% considered themselves homosexual in terms of sexual orientation. Regarding education, 67.9% had completed higher education, and 64% earned up to five minimum wages. In terms of healthcare services used, 43.3% relied solely on supplementary healthcare (Table 1). Table 1 Sociodemographic Data of Self-Declared LGBTQIA + Participants (n = 134). Variable N % Age Participants’ age – Mean and range (years) 30,9 16–54 Ethnicity/Race Black 66 49,2 White 64 47,8 Yellow 4 3 Gender Identity Cisgender woman 75 55,9 Cisgender man 43 32 Trans woman / travesti 7 5,2 Non-binary 5 3,7 Trans man 2 1,5 Gender fluid 1 0,7 Sexual Orientation Homosexual 78 58,2 Bisexual 41 30,6 Heterosexual 9 6,9 Asexual 2 1,5 Pansexual 2 1,5 Queer 2 1,5 Education level Higher education completed 91 67,9 Incomplete higher education 41 30,5 Lower education completed 2 1,5 Own Monthly Income Up to 5 minimum wages 80 59,7 Over 5 minimum wages 45 33,5 Did not respond 9 6,7 Health service utilized Supplementary health 58 43,3 Public health system + supplementary health 50 37,3 Public health system 26 19,4 Total 134 100 Source: Research data. In the second section of the study, focusing on the experiences of the LGBTQIA+ population within the healthcare system, it is useful to categorise satisfaction with healthcare received into users of the public health system exclusively and those with access to supplementary healthcare. In both groups, satisfaction was most frequently rated as "neutral"; however, individuals with access to supplementary healthcare reported lower dissatisfaction (11.1%) compared to those relying exclusively on the public system (26.9%). LGBTQIA+ individuals without access to health insurance faced significantly greater difficulties in accessing healthcare services (46.1%) compared to those with private health coverage (7.4%). Similarly, individuals with lower income reported higher levels of difficulty accessing care compared to those with higher income (p < 0.05). When asked in a dichotomous format, 31.3% of participants reported experiencing some form of discrimination related to their sexuality in healthcare settings. When identifying the specific situation in which prejudice occurred, most individuals highlighted gynaecological consultations as the environment where discrimination was most prevalent. Regarding the need for specialised healthcare services tailored to the specific needs of the LGBTQIA+ population, 63.4% of participants agreed, and 85% do not believe that healthcare professionals are adequately prepared to care for the LGBTQIA+ population. Lastly, participants were asked in an open−ended format whether they were aware of any health programmes developed by the Ministry of Health promoting equal social rights for the LGBTQIA+ population, and 52% responded that they were not (Table 2). Table 2 Responses on LGBTQIA+ population perceptions regarding healthcare received (n = 134). Variable N % How would you classify your experience with healthcare services? Very poor 5 3,7 Poor 14 10,4 Average 67 50 Good 44 32,8 Very good 4 3 How do you classify your access to healthcare services? Extremely difficult 4 3 Very difficult 16 11,9 Moderate 50 37,3 Easy 54 40,3 Very easy 10 7,5 Have you ever suffered any form of discrimination related to your sexuality in healthcare services? Yes 42 31,3 No 92 68,6 Do you believe there should be specialized healthcare services available to meet your specific needs? Strongly disagree 9 6,7 Disagree 17 12,7 Neutral 23 17,2 Agree 53 39,6 Strongly agree 32 23,9 Do you know any health program developed by the Ministry of Health that supports social equality rights for the LGBTQIA+ population? Yes 23 17,1 No 25 18,6 Did not respond 86 64,1 Do you believe that health professionals are prepared to care for the LGBTQIA+ population? Yes 20 14,9 No 114 85 Total 134 100 Source: Research data. Despite the existence of health policies developed nationwide, little appears to have progressed in mitigating the violence reported by LGBTQIA+ users of healthcare services, as confirmed by 31.3% of the sample, who reported experiencing some form of prejudice related to their sexuality within the healthcare system. Discussion Dissatisfaction with healthcare was notably higher among those relying solely on the public system (26.9%) compared to individuals with supplementary healthcare (11.1%), reflecting broader challenges in access and equity. These difficulties were particularly pronounced among people without health insurance (46.1%) and those with lower incomes, highlighting the intersection of socioeconomic barriers. Adding to these challenges, 31.3% of participants reported experiencing discrimination related to their sexuality, with gynecological consultations emerging as a frequent setting for such prejudice. These experiences underscore the pressing need for specialized services, as recognized by 63.4% of participants, alongside a shared concern−voiced by 85%−that healthcare professionals lack adequate preparation to meet the unique needs of the LGBTQIA+ population. Regarding the experiences of the LGBTQIA+ population within the health system, transgender and gender diverse (TGD) individuals appeared to have more negative experiences (20%) compared to cisgender participants (13.4%). The lack of awareness and understanding of specific needs related to transgender health, as well as discrimination, were identified as the primary causes of dissatisfaction with healthcare access, as highlighted by Hobster and McLuskey (2020). These issues contribute negatively, compromising comprehensive care and fostering a scenario that marginalises non−cisgender and non−heterosexual experiences rather than promoting inclusive healthcare. There was greater difficulty in accessing health services among LGBTQIA+ individuals with lower incomes and users of the public health system. These findings align with the perception that financial vulnerability in accessing healthcare significantly contributes to negative overall health outcomes, disability, and depression among older LGBTQ individuals 12. Gender diversity also appears to play a role in access to healthcare services, as TGD individuals reported greater difficulty in receiving care (33.3%) compared to cisgender individuals (12.6%). Rigid legislation and insurance policies often prevent TGD individuals from accessing necessary care, such as gender−affirming procedures. There are also reports of issues related to legal name and gender changes, leading to refusals of care, disrespect of chosen names, and discrimination 13. There was a high prevalence of discrimination related to sexuality in healthcare settings, particularly in gynaecological consultations. Notably, Burgart et al. (2021) observed that training related to transgender and non−binary healthcare in the medical residency programme for gynaecology and obstetrics is insufficient, despite medical students' interest in further exploring the topic. The majority of participants defended the presence of specialized health services adapted to the specific needs of the LGBTQIA+ population. In addition, the majority do not believe that health professionals are adequately prepared to care for the LGBTQIA+ population. A study of 9,522 medical students highlighted significant concerns among students when addressing certain aspects of LGBTQIA+ health, particularly with TGD patients 8.A study conducted with 9,522 medical students highlighted significant concerns among students when addressing certain aspects of LGBTQIA+ health, particularly with TGD patients 8. Most of the participants were not aware of public health programmes for LGBTQIA+ population in Brazil. In fact, national data lacks official information on the extent of the LGBTQIA+ population in the country, as the national census excludes variables related to sexual and gender diversity. This hinders more accurate associations between gender identity/orientation and difficulties in accessing healthcare services. Therefore, it is understood that social determinants in the dynamic process of health and illness recognize that social exclusion resulting from discrimination, such as homophobia and transphobia, should be considered in the social determination of suffering and disease 10. As a limitation of the study, the sample may not fully represent the lived experience of the majority of the LGBTQIA+ population in the country, as 67.9% of participants have completed higher education, contrasting with the 19.2% of the brazilian population that, in 2022, had the same level of education, according to the national demographic census for that year 15. Additionally, 80.6% of the study participants have access to supplementary health insurance, and 43.3% state that they do not seek care from the public health system for medical consultations, further diverging from the brazilian population as a whole, particularly the LGBTQIA+ community. There was also incomplete response to questions in the form, particularly the question, “Are you aware of any health programmes developed by the Ministry of Health that advocate for equal social rights for the LGBTQIA+ population?” Conclusions The advancements projected by public health policies do not appear to align with the real experiences of the LGBTQIA+ population in healthcare services in the country. Proportionally, the majority of participants believe that healthcare professionals are not adequately prepared to serve this group. The study highlighted the disparities in access to healthcare faced by LGBTQIA+ individuals in situations of financial vulnerability, emphasizing how the intersection of social markers of difference (such as sexual orientation, gender identity, and economic conditions) creates significant barriers to obtaining adequate care. Other markers, such as race and education, are equally important and should be considered. A closer look should be directed, particularly at individuals with diverse gender identities, who frequently report negative experiences reflecting professional unpreparedness, structural violence, and the marginalisation of non−conforming experiences. It seems imperative to train healthcare professionals in the already established guidelines for LGBTQIA+ care in order to restore, preserve, and promote health within this community. Abbreviations LGBTQIA+: lesbians, gays, bisexuals, travestis, and transgender people, queer, intersex, asexual, and other identities; TGD: Transgender and gender diverse. Declarations Author Contribution L.N.E.S. and R.A.C.P. wrote and revised the main manuscript, D.F.B. conducted the literature review and contributed to the research design, A.M.S. developed the questionnaires used in the study, and J.P.V.L. and L.F.M. were responsible for disseminating the questionnaire to recruit participants. All authors have approved the submitted version and have agreed to be personally accountable for their own contributions, ensuring that any questions related to the accuracy or integrity of any part of the work, even those in which the author was not directly involved, are appropriately investigated, resolved, and documented in the literature. Acknowledgement We gratefully acknowledge the financial support provided by the Brazilian Association of Medical Education (ABEM), which was instrumental in facilitating this study. ABEM played no role in the study design, data collection, analysis, interpretation, or manuscript preparation. Funding Declaration: This study received funding from the Brazilian Association of Medical Education (ABEM). ABEM's financial support was fundamental to the execution of this project, enabling data collection and dissemination of the results. ABEM had no influence on the design of the study, the collection, analysis and interpretation of the data, or the writing of the manuscript. References Brasil. Brasil Sem Homofobia: Programa de combate à violência e à discriminação contra GLTB e promoção da cidadania homossexual. Ministério da Saúde; 2004. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/brasil_sem_homofobia.pdf Brasil. Portaria n. 2.803, de 19 de novembro de 2013. Redefine e amplia o Processo Transexualizador no Sistema Único de Saúde (SUS). Ministério da Saúde. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2803_19_11_2013.html Ministério da Saúde. Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Ministério da Saúde; 2013. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_saude_lesbicas_gays.pdf Spizzirri G, Eufrásio R, Lima MCP, et al. Proportion of people identified as transgender and non-binary gender in Brazil. Scientific Reports. 2021;11(1). DOI:10.1038/s41598-021-81411-4 Statista. LGB+ orientation by country 2023. 2024 jul 5. Disponível em: https://www.statista.com/statistics/1270143/lgbt-identification-worldwide-country Benevides BG. Dossiê: assassinatos e violências contra travestis e transexuais brasileiras em 2023. ANTRA (Associação Nacional de Travestis e Transexuais), 2024;125. Disponível em: https://antrabrasil.org/wp-content/uploads/2024/01/dossieantra2024-web.pdf Ciasca SV, Hercowitz A, Junior AL. Saúde LGBTQIA+: Práticas de cuidado transdisciplinar. Manole; 2021 White W, Brenman S, Paradis E, et al. Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students' Preparedness and Comfort. Teaching and Learning in Medicine. 2015;27(3):254–263. DOI:10.1080/10401334.2015.1044656 Casey LS, Reisner SL, Findling MG, et al. Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research. 2019;54(S2):1454–1466. DOI:10.1111/1475-6773.13229 Ferreira BO, Bonan C. Vários tons de “não”: relatos de profissionais da Atenção Básica na assistência de lésbicas, gays, bissexuais, travestis e transexuais (LGBTT). Interface - Comunicação, Saúde, Educação. 2021;25. DOI:10.1590/interface.200327 Hobster K, McLuskey J. Transgender patients’ experiences of health care. British Journal of Nursing. 2020;29(22):1348–1353. DOI:10.12968/bjon.2020.29.22.1348 Fredriksen-Goldsen KI, Emlet CA, Kim HJ, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. The Gerontologist. 2013;53(4):664–675. DOI:10.1093/geront/gns123 Chong LS, Kerklaan J, Clarke S, et al. Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review. JAMA Pediatrics. 2021;175(11):1159–1173. DOI:10.1001/jamapediatrics.2021.2061 Burgart JM, Walters RW, Shanahan M. Transgender Education Experiences Among Obstetrics and Gynecology Residents: A National Survey. Transgender Health. 2021; DOI:10.1089/trgh.2020.0018 Gomes I, Ferreira I. Em 2022, analfabetismo cai, mas continua mais alto entre idosos, pretos e pardos e no Nordeste. Agência de Notícias IBGE; 2023 jun 7. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/37089-em-2022-analfabetismo-cai-mas-continua-mais-alto-entre-idosos-pretos-e-pardos-e-no-nordeste Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5708264","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":394971560,"identity":"fe9607ec-ba68-4744-914b-5c96454ab37b","order_by":0,"name":"Letícia Nacle Estefan Sobral","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIie3QMQrCMBSA4RcC7VLsGnHwCgEnsXgRl4aCLiqCi6BopFAXwdVJr6A3aAjo0gO49wIdCzqYYichpW4O+SFQknyEVwCT6Q9rqBUDLT4xh+yzgyuJpc5Lgjg6AhCrDilDHDu1iH0QcT7rT92d2KbeQq4tO5QUVt5ASxwJYk+DOUlY2BknkljOLfDhNpxwHSEBSKCY8QeKWpNIETLuxIhLPWmnBdmw8wPtnt1ahOCCSHZRr2BUEr+SOAFVs9zZVc3S3CejZqRmoX7FLK4t0ix/LdnpLkWWL3quq/4YyVaelmjyf7tuMplMpq/e3TVUrSX9Mh4AAAAASUVORK5CYII=","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":true,"prefix":"","firstName":"Letícia","middleName":"Nacle Estefan","lastName":"Sobral","suffix":""},{"id":394971561,"identity":"1a1b0d14-1738-463d-98ba-69cdc4173a32","order_by":1,"name":"João Pedro Venancio Lima","email":"","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":false,"prefix":"","firstName":"João","middleName":"Pedro Venancio","lastName":"Lima","suffix":""},{"id":394971562,"identity":"6fa16eec-0e6e-41e4-bb10-3084709fa6ae","order_by":2,"name":"Amanda Madureira Silva","email":"","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"Madureira","lastName":"Silva","suffix":""},{"id":394971563,"identity":"3fd9395e-00d5-489a-976c-492376a4796f","order_by":3,"name":"Liandra Fernandes Monteiro","email":"","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":false,"prefix":"","firstName":"Liandra","middleName":"Fernandes","lastName":"Monteiro","suffix":""},{"id":394971564,"identity":"61e5e554-3031-4fc2-9a9a-43e93abd7ffc","order_by":4,"name":"Débora Fernandes Britto","email":"","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":false,"prefix":"","firstName":"Débora","middleName":"Fernandes","lastName":"Britto","suffix":""},{"id":394971565,"identity":"c3eec9c5-ef27-4084-a736-c14e9e9a8619","order_by":5,"name":"Raquel Autran Coelho Peixoto","email":"","orcid":"","institution":"Universidade Federal do Ceará","correspondingAuthor":false,"prefix":"","firstName":"Raquel","middleName":"Autran Coelho","lastName":"Peixoto","suffix":""}],"badges":[],"createdAt":"2024-12-24 22:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5708264/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5708264/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72738075,"identity":"74dde69f-c4d2-49f0-b3c4-c3f4214508b5","added_by":"auto","created_at":"2025-01-01 09:01:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":539977,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5708264/v1/0ce36782-9f8f-4d20-a3f8-a054d472acdc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHealthcare for LGBTQIA+ People: What Do Patients Say?\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eRecognising sexual and gender diversity as a social marker of difference and an indicator of vulnerability in accessing comprehensive healthcare, public health policies have been developed at the national level to facilitate healthcare access for LGBTQIA+ individuals (lesbians, gays, bisexuals, travestis, and transgender people, queer, intersex, asexual, and other identities) 1,2,3. Despite the implementation of these guidelines, the underreporting of the LGBTQIA+ population due to the lack of official records contributes to the invisibility of these individuals. It is estimated that 1.8% of the Brazilian population identifies as transgender or non\u0026minus;binary, and 14% with a non\u0026minus;heterosexual sexual orientation 4,5.\u003c/p\u003e \u003cp\u003eTaking into account the intersection of vulnerabilities enables a deeper understanding of the complex phenomenon of structural violence. Of all those victimised by LGBTQIA\u0026thinsp;+\u0026thinsp;phobia in Brazil in 2023, more than half were trans women and travestis, young, black, and murdered in public spaces \u003csup\u003e6\u003c/sup\u003e. Violence can also manifest subtly through neglect and silencing within healthcare settings. Consequently, the detachment of this population from healthcare networks is reflected in higher rates (compared to cisgender heterosexuals) of psychiatric disorders, substance abuse, and preventable diseases such as cervical and breast cancer \u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe lack of preparation among medical professionals to welcome, care for, and understand the specificities and experiences of LGBTQIA\u0026thinsp;+\u0026thinsp;patients is evident \u003csup\u003e8,9\u003c/sup\u003e. Alongside this reality, the inclusion of LGBTQIA\u0026thinsp;+\u0026thinsp;health topics in medical school curricula remains sporadic when present at all. The academic landscape compounds the programmatic violence experienced by this community, resulting in healthcare services shaped by empirical knowledge and personal beliefs, which directly impact health indicators \u003csup\u003e10\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRecognising the multiple agents that contribute to the perpetuation of structural violence faced by the LGBTQIA\u0026thinsp;+\u0026thinsp;population, this study aimed to deeply explore the perceptions and experiences of self-identified LGBTQIA\u0026thinsp;+\u0026thinsp;individuals within healthcare settings. Furthermore, the study seeks to reflect on the implications of these experiences for the promotion of equitable and inclusive healthcare.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis is a quantitative cross\u0026minus;sectional observational study conducted from June 2023 to March 2024, originating in a tertiary university hospital located in the northeast of Brazil.\u003c/p\u003e\n\u003cp\u003eAn anonymous online form was used, divided into two sections: the first comprised multiple\u0026minus;choice questions to capture sociodemographic profiles, and the second included a semi\u0026minus;structured questionnaire with open\u0026minus;ended questions designed to examine the perceptions and experiences of LGBTQIA+ individuals in the context of healthcare services. The emphasis was placed on analysing the quality of medical care received, evaluating not only technical and humanised aspects of care but also identifying potential discriminatory attitudes, behaviours, and practices that may emerge in healthcare settings. This analysis aims to contribute to the reflection on strategies that promote more inclusive and respectful care for sexual and gender diversity. The instrument was disseminated through social media using a snowball strategy, and a Free and Informed Consent Form was provided.\u003c/p\u003e\n\u003cp\u003eSelf\u0026minus;identified LGBTQIA+ individuals residing in Brazil were included in the study. Exclusions were made for individuals under 18 years of age or those not residing in Brazil. The interpretation of the results considered not only the participants\u0026apos; responses but also their sociodemographic particularities. To compare sociodemographic variables with the questionnaire responses, the following tests were used: Fisher\u0026apos;s exact test, Pearson\u0026apos;s chi\u0026minus;square test, and the Mann\u0026minus;Whitney test. Data were presented as means, standard deviations, medians, counts, and percentages. The study adopted a 5% significance level, and R software version 4.0 was used for the analysis. Microsoft Excel was also utilised to create graphs.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This research was approved by the Ethics and Research Committee of the Maternidade Escola Assis Chateaubriand at the Federal University of Cear\u0026aacute; under CAAE 69064723.1.0000.5050 and received funding from the Brazilian Association of Medical Education (Call for Proposals No. 05/2022 \u0026ndash; Research Assistance in Medical Education).\u0026quot;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 134 participants were included in the study, of whom 49.2% identified as black, 88% identified as cisgender, and 58.2% considered themselves homosexual in terms of sexual orientation. Regarding education, 67.9% had completed higher education, and 64% earned up to five minimum wages. In terms of healthcare services used, 43.3% relied solely on supplementary healthcare (Table 1).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic Data of Self-Declared LGBTQIA\u0026thinsp;+\u0026thinsp;Participants (n\u0026thinsp;=\u0026thinsp;134).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParticipants\u0026rsquo; age \u0026ndash; Mean and range (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u0026ndash;54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity/Race\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYellow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCisgender woman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCisgender man\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrans woman / travesti\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrans man\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Orientation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBisexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeterosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePansexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQueer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher education completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIncomplete higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower education completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOwn Monthly Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUp to 5 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOver 5 minimum wages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not respond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth service utilized\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupplementary health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic health system\u0026thinsp;+\u0026thinsp;supplementary health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePublic health system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eSource: Research data.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the second section of the study, focusing on the experiences of the LGBTQIA+ population within the healthcare system, it is useful to categorise satisfaction with healthcare received into users of the public health system exclusively and those with access to supplementary healthcare. In both groups, satisfaction was most frequently rated as \u0026quot;neutral\u0026quot;; however, individuals with access to supplementary healthcare reported lower dissatisfaction (11.1%) compared to those relying exclusively on the public system (26.9%). LGBTQIA+ individuals without access to health insurance faced significantly greater difficulties in accessing healthcare services (46.1%) compared to those with private health coverage (7.4%). Similarly, individuals with lower income reported higher levels of difficulty accessing care compared to those with higher income (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eWhen asked in a dichotomous format, 31.3% of participants reported experiencing some form of discrimination related to their sexuality in healthcare settings. When identifying the specific situation in which prejudice occurred, most individuals highlighted gynaecological consultations as the environment where discrimination was most prevalent.\u003c/p\u003e\n\u003cp\u003eRegarding the need for specialised healthcare services tailored to the specific needs of the LGBTQIA+ population, 63.4% of participants agreed, and 85% do not believe that healthcare professionals are adequately prepared to care for the LGBTQIA+ population.\u003c/p\u003e\n\u003cp\u003eLastly, participants were asked in an open\u0026minus;ended format whether they were aware of any health programmes developed by the Ministry of Health promoting equal social rights for the LGBTQIA+ population, and 52% responded that they were not (Table 2).\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResponses on LGBTQIA+ population perceptions regarding healthcare received (n = 134).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHow would you classify your experience with healthcare services?\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32,8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHow do you classify your access to healthcare services?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtremely difficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery difficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEasy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery easy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever suffered any form of discrimination related to your sexuality in healthcare services?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you believe there should be specialized healthcare services available to meet your specific needs?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you know any health program developed by the Ministry of Health that supports social equality rights for the LGBTQIA+ population?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18,6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDid not respond\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDo you believe that health professionals are prepared to care for the LGBTQIA+ population?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14,9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eSource: Research data.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003eDespite the existence of health policies developed nationwide, little appears to have progressed in mitigating the violence reported by LGBTQIA+ users of healthcare services, as confirmed by 31.3% of the sample, who reported experiencing some form of prejudice related to their sexuality within the healthcare system.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDissatisfaction with healthcare was notably higher among those relying solely on the public system (26.9%) compared to individuals with supplementary healthcare (11.1%), reflecting broader challenges in access and equity. These difficulties were particularly pronounced among people without health insurance (46.1%) and those with lower incomes, highlighting the intersection of socioeconomic barriers. Adding to these challenges, 31.3% of participants reported experiencing discrimination related to their sexuality, with gynecological consultations emerging as a frequent setting for such prejudice. These experiences underscore the pressing need for specialized services, as recognized by 63.4% of participants, alongside a shared concern\u0026minus;voiced by 85%\u0026minus;that healthcare professionals lack adequate preparation to meet the unique needs of the LGBTQIA+ population.\u003c/p\u003e\n\u003cp\u003eRegarding the experiences of the LGBTQIA+ population within the health system, transgender and gender diverse (TGD) individuals appeared to have more negative experiences (20%) compared to cisgender participants (13.4%). The lack of awareness and understanding of specific needs related to transgender health, as well as discrimination, were identified as the primary causes of dissatisfaction with healthcare access, as highlighted by Hobster and McLuskey (2020). These issues contribute negatively, compromising comprehensive care and fostering a scenario that marginalises non\u0026minus;cisgender and non\u0026minus;heterosexual experiences rather than promoting inclusive healthcare.\u003c/p\u003e\n\u003cp\u003eThere was greater difficulty in accessing health services among LGBTQIA+ individuals with lower incomes and users of the public health system. These findings align with the perception that financial vulnerability in accessing healthcare significantly contributes to negative overall health outcomes, disability, and depression among older LGBTQ individuals 12. Gender diversity also appears to play a role in access to healthcare services, as TGD individuals reported greater difficulty in receiving care (33.3%) compared to cisgender individuals (12.6%). Rigid legislation and insurance policies often prevent TGD individuals from accessing necessary care, such as gender\u0026minus;affirming procedures. There are also reports of issues related to legal name and gender changes, leading to refusals of care, disrespect of chosen names, and discrimination 13.\u003c/p\u003e\n\u003cp\u003eThere was a high prevalence of discrimination related to sexuality in healthcare settings, particularly in gynaecological consultations. Notably, Burgart et al. (2021) observed that training related to transgender and non\u0026minus;binary healthcare in the medical residency programme for gynaecology and obstetrics is insufficient, despite medical students\u0026apos; interest in further exploring the topic.\u003c/p\u003e\n\u003cp\u003eThe majority of participants defended the presence of specialized health services adapted to the specific needs of the LGBTQIA+ population. In addition, the majority do not believe that health professionals are adequately prepared to care for the LGBTQIA+ population. A study of 9,522 medical students highlighted significant concerns among students when addressing certain aspects of LGBTQIA+ health, particularly with TGD patients 8.A study conducted with 9,522 medical students highlighted significant concerns among students when addressing certain aspects of LGBTQIA+ health, particularly with TGD patients 8.\u003c/p\u003e\n\u003cp\u003eMost of the participants were not aware of public health programmes for LGBTQIA+ population in Brazil. In fact, national data lacks official information on the extent of the LGBTQIA+ population in the country, as the national census excludes variables related to sexual and gender diversity. This hinders more accurate associations between gender identity/orientation and difficulties in accessing healthcare services. Therefore, it is understood that social determinants in the dynamic process of health and illness recognize that social exclusion resulting from discrimination, such as homophobia and transphobia, should be considered in the social determination of suffering and disease 10.\u003c/p\u003e\n\u003cp\u003eAs a limitation of the study, the sample may not fully represent the lived experience of the majority of the LGBTQIA+ population in the country, as 67.9% of participants have completed higher education, contrasting with the 19.2% of the brazilian population that, in 2022, had the same level of education, according to the national demographic census for that year 15. Additionally, 80.6% of the study participants have access to supplementary health insurance, and 43.3% state that they do not seek care from the public health system for medical consultations, further diverging from the brazilian population as a whole, particularly the LGBTQIA+ community. There was also incomplete response to questions in the form, particularly the question, \u0026ldquo;Are you aware of any health programmes developed by the Ministry of Health that advocate for equal social rights for the LGBTQIA+ population?\u0026rdquo;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe advancements projected by public health policies do not appear to align with the real experiences of the LGBTQIA+ population in healthcare services in the country. Proportionally, the majority of participants believe that healthcare professionals are not adequately prepared to serve this group. The study highlighted the disparities in access to healthcare faced by LGBTQIA+ individuals in situations of financial vulnerability, emphasizing how the intersection of social markers of difference (such as sexual orientation, gender identity, and economic conditions) creates significant barriers to obtaining adequate care. Other markers, such as race and education, are equally important and should be considered.\u003c/p\u003e\n\u003cp\u003eA closer look should be directed, particularly at individuals with diverse gender identities, who frequently report negative experiences reflecting professional unpreparedness, structural violence, and the marginalisation of non\u0026minus;conforming experiences. It seems imperative to train healthcare professionals in the already established guidelines for LGBTQIA+ care in order to restore, preserve, and promote health within this community.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLGBTQIA+: \u0026nbsp;lesbians, gays, bisexuals, travestis, and transgender people, queer, intersex, asexual, and other identities;\u003c/p\u003e\n\u003cp\u003eTGD: Transgender and gender diverse.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.N.E.S. and R.A.C.P. wrote and revised the main manuscript, D.F.B. conducted the literature review and contributed to the research design, A.M.S. developed the questionnaires used in the study, and J.P.V.L. and L.F.M. were responsible for disseminating the questionnaire to recruit participants. All authors have approved the submitted version and have agreed to be personally accountable for their own contributions, ensuring that any questions related to the accuracy or integrity of any part of the work, even those in which the author was not directly involved, are appropriately investigated, resolved, and documented in the literature.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe gratefully acknowledge the financial support provided by the Brazilian Association of Medical Education (ABEM), which was instrumental in facilitating this study. ABEM played no role in the study design, data collection, analysis, interpretation, or manuscript preparation.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003e This study received funding from the Brazilian Association of Medical Education (ABEM). ABEM\u0026apos;s financial support was fundamental to the execution of this project, enabling data collection and dissemination of the results. ABEM had no influence on the design of the study, the collection, analysis and interpretation of the data, or the writing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBrasil. Brasil Sem Homofobia: Programa de combate \u0026agrave; viol\u0026ecirc;ncia e \u0026agrave; discrimina\u0026ccedil;\u0026atilde;o contra GLTB e promo\u0026ccedil;\u0026atilde;o da cidadania homossexual. Minist\u0026eacute;rio da Sa\u0026uacute;de; 2004. Dispon\u0026iacute;vel em: https://bvsms.saude.gov.br/bvs/publicacoes/brasil_sem_homofobia.pdf\u003c/li\u003e\n\u003cli\u003eBrasil. Portaria n. 2.803, de 19 de novembro de 2013. Redefine e amplia o Processo Transexualizador no Sistema \u0026Uacute;nico de Sa\u0026uacute;de (SUS). Minist\u0026eacute;rio da Sa\u0026uacute;de. Dispon\u0026iacute;vel em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2803_19_11_2013.html\u003c/li\u003e\n\u003cli\u003eMinist\u0026eacute;rio da Sa\u0026uacute;de. Pol\u0026iacute;tica Nacional de Sa\u0026uacute;de Integral de L\u0026eacute;sbicas, Gays, Bissexuais, Travestis e Transexuais. Minist\u0026eacute;rio da Sa\u0026uacute;de; 2013. Dispon\u0026iacute;vel em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_saude_lesbicas_gays.pdf\u003c/li\u003e\n\u003cli\u003eSpizzirri G, Eufr\u0026aacute;sio R, Lima MCP, et al. Proportion of people identified as transgender and non-binary gender in Brazil. Scientific Reports. 2021;11(1). DOI:10.1038/s41598-021-81411-4\u003c/li\u003e\n\u003cli\u003eStatista. LGB+ orientation by country 2023. 2024 jul 5. Dispon\u0026iacute;vel em: https://www.statista.com/statistics/1270143/lgbt-identification-worldwide-country\u003c/li\u003e\n\u003cli\u003eBenevides BG. Dossi\u0026ecirc;: assassinatos e viol\u0026ecirc;ncias contra travestis e transexuais brasileiras em 2023. ANTRA (Associa\u0026ccedil;\u0026atilde;o Nacional de Travestis e Transexuais), 2024;125. Dispon\u0026iacute;vel em: https://antrabrasil.org/wp-content/uploads/2024/01/dossieantra2024-web.pdf\u003c/li\u003e\n\u003cli\u003eCiasca SV, Hercowitz A, Junior AL. Sa\u0026uacute;de LGBTQIA+: Pr\u0026aacute;ticas de cuidado transdisciplinar. Manole; 2021\u003c/li\u003e\n\u003cli\u003eWhite W, Brenman S, Paradis E, et al. Lesbian, Gay, Bisexual, and Transgender Patient Care: Medical Students\u0026apos; Preparedness and Comfort. Teaching and Learning in Medicine. 2015;27(3):254\u0026ndash;263. DOI:10.1080/10401334.2015.1044656\u003c/li\u003e\n\u003cli\u003eCasey LS, Reisner SL, Findling MG, et al. Discrimination in the United States: Experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Services Research. 2019;54(S2):1454\u0026ndash;1466. DOI:10.1111/1475-6773.13229\u003c/li\u003e\n\u003cli\u003eFerreira BO, Bonan C. V\u0026aacute;rios tons de \u0026ldquo;n\u0026atilde;o\u0026rdquo;: relatos de profissionais da Aten\u0026ccedil;\u0026atilde;o B\u0026aacute;sica na assist\u0026ecirc;ncia de l\u0026eacute;sbicas, gays, bissexuais, travestis e transexuais (LGBTT). Interface - Comunica\u0026ccedil;\u0026atilde;o, Sa\u0026uacute;de, Educa\u0026ccedil;\u0026atilde;o. 2021;25. DOI:10.1590/interface.200327\u003c/li\u003e\n\u003cli\u003eHobster K, McLuskey J. Transgender patients\u0026rsquo; experiences of health care. British Journal of Nursing. 2020;29(22):1348\u0026ndash;1353. DOI:10.12968/bjon.2020.29.22.1348\u003c/li\u003e\n\u003cli\u003eFredriksen-Goldsen KI, Emlet CA, Kim HJ, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. The Gerontologist. 2013;53(4):664\u0026ndash;675. DOI:10.1093/geront/gns123\u003c/li\u003e\n\u003cli\u003eChong LS, Kerklaan J, Clarke S, et al. Experiences and Perspectives of Transgender Youths in Accessing Health Care: A Systematic Review. JAMA Pediatrics. 2021;175(11):1159\u0026ndash;1173. DOI:10.1001/jamapediatrics.2021.2061\u003c/li\u003e\n\u003cli\u003eBurgart JM, Walters RW, Shanahan M. Transgender Education Experiences Among Obstetrics and Gynecology Residents: A National Survey. Transgender Health. 2021; DOI:10.1089/trgh.2020.0018\u003c/li\u003e\n\u003cli\u003eGomes I, Ferreira I. Em 2022, analfabetismo cai, mas continua mais alto entre idosos, pretos e pardos e no Nordeste. Ag\u0026ecirc;ncia de Not\u0026iacute;cias IBGE; 2023 jun 7. Dispon\u0026iacute;vel em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/37089-em-2022-analfabetismo-cai-mas-continua-mais-alto-entre-idosos-pretos-e-pardos-e-no-nordeste\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sexual and Gender Minorities, Health Services Accessibility, Gender Diversity, Transphobia","lastPublishedDoi":"10.21203/rs.3.rs-5708264/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5708264/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Recognising sexual and gender diversity as a social marker of difference and an indicator of vulnerability in accessing comprehensive healthcare, this research aims to explore the perceptions of self-declared LGBTQIA+ people in relation to health care received in Brazil.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a quantitative cross-sectional observational study carried out using an anonymous online form disseminated through social media using a snowball strategy, aimed at LGBTQIA+ people living in Brazil. The instrument contained a sociodemographic questionnaire and semi-structured questions about the medical care provided and the identification of prejudiced attitudes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 134 people took part, with an average age of 30, the majority black, cisgender and homosexual. The quality of care received was positive for 35.8 per cent of the participants and 47.8 per cent reported easy access to healthcare. There was a greater perception of difficulty in access among people on low incomes when compared to people on high incomes (p \u0026lt; 0.05). In the healthcare environment, 31.3% said they had already suffered discrimination for being LGBTQIA+, with gynaecology being the area most frequently mentioned. 63.4% believe that there should be specific environments to meet their needs and 85% perceive that health professionals are not prepared to deal with LGBTQIA+ people.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003eThere was a high prevalence of discrimination related to their sexuality in the healthcare environment, especially in gynaecological consultations. The majority of LGBTQIA+ participants believe that health professionals are not prepared to provide care to this public.\u003c/p\u003e","manuscriptTitle":"Healthcare for LGBTQIA+ People: What Do Patients Say?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-30 06:13:12","doi":"10.21203/rs.3.rs-5708264/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7386d6a4-f460-431c-a57b-0816d2678dd2","owner":[],"postedDate":"December 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-01T08:53:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-30 06:13:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5708264","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5708264","identity":"rs-5708264","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}