Discriminação experienciada pela população LGBTQIA+: impacto no acesso aos serviços odontológicos e autopercepção da saúde bucal

Abstract

The LGBTQIA+ population is a heterogeneous group, which includes sexual and gender minorities, whose life experiences are marked by discriminatory and violent events, including in health services, which can impair the access to these services and lead to unfavorable outcomes. Despite their persistence in oral health services, there is a lack of variety in studies that discuss this topic and its association with this population’s oral health subjective parameters. Thus, the aim of this study was to estimate the association between the discriminatory experiences undergone in daily life and oral health visits by the LGBTQIA+ population and the outcomes related to these people’s oral health services access and oral health self-perception. To achieve it, a cross-sectional study was conducted with a sample of 762 people who live in Brazil, aged over 18 years and self-declared as LGBTQIA+. Data were collected via an online formulary composed of a questionnaire featuring items from validated questionnaires, which included the dependent and independent variables necessary to estimate the association between the discriminatory events and oral health services access and subjective oral health aspects. The data were processed on the SPSS program version 20.0. The Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis H, Chi-square, t-test, ANOVA tests were performed. The binary and multinomial logistic regression analyses were performed to statistically analyze the association between dependent and independent variables. For the multivariate analysis, the multinomial logistic regression analysis was performed to analyse the oral health self-perception outcome, whilst the binary logistic regression analysis was performed for the other outcomes. A 95% confidence interval and a 5% significance level (p<0.05) were adopted for all analyses. Discrimination in dental services (38.5%) was associated with negative self-perceived oral health (OR 4.76; 95% CI: 1.57-14.48) and the impact of oral health on daily activities (OR 1,82; 95% CI: 1.05–3.14), but did not maintain the association in the final logistic regression model for outcomes related to access to dental services. In turn, hesitation in seeking dental care due to a perceived lack of acceptance based on sexual orientation and/or gender identity was associated with seeking care (OR 0.55; 95% CI: 0.33–0.91) and difficulty in accessing dental services (OR 4.35; 95% CI: 1.40–13.54). It is concluded that despite the fact that the experience of discrimination does not demonstrate an association with access to dental services, the apprehension of experiencing discrimination in these services indicates this association. However, the discrimination experienced in dental care settings is associated with subjective oral health outcomes. It is noted that there is a necessity for an intersectoral approach to mitigate the discrimination suffered by this population and the improvement of their care, in addition to the consideration of oral health in policies directed to them.