The role of country-level structural stigma on sexual orientation disclosure and discrimination in health care settings among lesbian, gay, and bisexuals across Europe

Abstract

Abstract Background The national climate surrounding sexual minorities (i.e., those self-identifying as lesbian, gay, or bisexual [LGB]) varies greatly worldwide. Recent Cross-European studies have shown that country-level structural stigma is a strong determinant of sexual minority individuals health risk behaviors and mental health. The consequences of the significant country-level variation in structural stigma on sexual minorities’ experiences of health care discrimination and disclosure of sexual orientation to health care providers have not been previously investigated. Methods In 2012, 86 000 sexual minority individuals (aged 18 years and older) from all 28 European Union countries responded to questions concerning discrimination in health care settings and sexual orientation disclosure to health care providers (EU LGBT survey). Structural stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of sexual minority acceptance among citizens of each country. Results Disclosure of sexual orientation to health care providers were much more common in low stigma coutries (e.g., the Netherlands, Sweden, UK) compared to high stigma coutries (e.g., Lithuania, Latvia, Slovakia). Experiences of discrimination in health care settings were more common among LGB indiviudals who were open about their sexual orientaiton and increased by degree of country-level structural stigma. Conclusions Disclosure of sexual orientation and experiences of discrimination in health care settings varies greatly among LGB individuals in Europe largely due to structural stigma surrounding sexual minorities. Main messages These findings highlight the importance of eliminating legislation, policies, and national attitudes that promote the unequal treatment of sexual minorities in currently unsupportive European countries.