Abstract
Background
China has the world’s largest lesbian, gay, bisexual, and transgender (LGBT) population. This study assessed the discrimination experienced by LGBT individuals in China in a comprehensive way, covering discrimination perpetrated by family, media, medical services, religious communities, schools, social services, and in the workplace.
Methods
The current study involved a national survey of 31 provinces and autonomous regions. Discrimination was measured both in terms of heterosexual participants’ attitudes towards LGBT individuals, and LGBT participants’ self-perceived discrimination. Pearson correlation analysis was performed to examine the difference between heterosexual participants’ attitudes towards LGBT individuals and LGBT participants’ self-perceived discrimination. Linear regression was used to investigate the association between gross domestic product per capita and discrimination.
Results
Among 29,125 participants, 2066 (7.1%) identified as lesbian, 9491 (32.6%) as gay, 3441 (11.8%) as bisexual, 3195 (11.0%) as transgender, and 10,932 (37.5%) as heterosexual. Heterosexual people were generally friendly towards the LGBT community with a mean score of 21.9 (SD = 2.7, total scale score = 100) and the grand averaged score of self-perceived discrimination by LGBT participants was 49.9 (SD = 2.5). Self-perceived discrimination from family and social services is particularly severe. We created a series of provincial level choropleth maps showing heterosexual participants’ acceptance towards the LGBT community, and self-perceived discrimination reported by members of the LGBT community. We found that a higher level of economic development in provinces was associated with a decrease in discrimination, and we identified that every 100 thousand RMB increase in per capita GDP lead to a 6.4% decrease in discriminatory events perpetrated by heterosexuals.
Conclusions
Chinese LGBT groups consistently experience discrimination in various aspects of their daily lives. The prevalence of this discrimination is associated with the economic development of the province in which it occurs. In order to reduce discrimination, it is important for future studies to discover the underlying reasons for discrimination against LGBT individuals in China.
Peer Review reports
Background
As the country with the largest population, China is also home to the world’s largest lesbian, gay, bisexual and transgender (LGBT) community. In China, the LGBT community remains largely invisible in society, and its members consistently report experiencing barriers in their lives [1, 2]. In the first version of the Chinese Classification of Mental Disorders (CCMD; 1978), homosexuality was classified as sexual disorder [3]. Although the Chinese Society of Psychiatry no longer considers homosexuality a mental disorder as of 2001, the related stigma and discrimination against the LGBT community still remains in Chinese society [2]. Members of the LGBT community face social, cultural, and political discrimination, which may be why they remain a hidden sub-population [4]. Such discrimination marginalizes the LGBT community and can have an impact on their mental health and daily lives. There are approximately forty to seventy million LGBT individuals in China, and it is important to increase their social visibility, advocate for their rights, and reduce discrimination against them [5]. Researchers have paid considerable attention to investigating public discrimination against the LGBT community in a whole range of areas such as public service, schools, and employment [6]. However, there remains no comprehensive survey of discrimination against the LGBT community in China.
Previous studies have illustrated that economic development and modernization could increase tolerant attitudes towards sexual minority groups [7, 8]. However, compared with developed Western countries, modernization and economic development in China is still lacking. Moreover, unlike Western countries, Chinese people’s view of the LGBT community is strongly impacted by the distinctive Chinese cultural context. It is likely that LGBT individuals’ experiences pronounced negative feelings, psychological distress and perceive severe discrimination within the traditional Chinese cultural context [9]. In Chinese culture, there is an emphasis on obeying the ‘rules of nature’, due to the historical influence of Confucianism [10]. People are expected to conform to the gender identities/sexual orientations accepted by the vast majority, which is also a part of the Doctrine of the Mean (‘Zhongyong’), which literally means average and ordinary in Confucianism [11]. Moreover, China is a collectivist culture and therefore Chinese people experience a great amount of influence from their family and society [2]. People in Chinese society emphasize family honor and dignity, and value maintaining ‘face’ (reputation) in social interactions. Being LGBT is still considered a form of shame for one’s family (‘losing face’) [12]. Having an LGBT family member could make the family the subject of vicious gossip, and stigmatize the family name [9, 13]. Parents of LGBT individuals will also be blamed for raising children who will fail to uphold their duty to carry on the family line. The Chinese government enacted a one-child policy in the 1970s in order to control the growing population, and the one-child policy was only recently replaced by a second child policy in the year of 2016 [14, 15]. Due to the influence of the one-child policy, the pressure of continuing the family line is extremely high for those in the one child only cohort. It is important to consider the Chinese context in order to provide a more in-depth understanding of the discrimination experienced by LGBT individuals across cultures.
Although there have been many public policies developed for improving the rights of stigmatized and marginalized LGBT individuals, they still face a great deal of discrimination in various contexts. In Japan, a qualitative study found that the discrimination experienced by the LGBT community was frequently evident in the development of laws and policies, employment, housing, healthcare, donating blood and education [16]. Similar results were identified in Korea. However, a positive change in attitudes toward LGBT people has been observed over the past two decades [17]. In China, it was reported that heterosexual people had an 11.1% rejection rate towards LGBT family members and a 2.1–4.1% rejection rate of social relationships with LGBT individuals [18]. While discrimination against the LGBT community in China has been studied [19], previous research rarely described the different levels of discrimination against the lesbian, gay, bisexual and transgender subgroups separately and comprehensively.
To develop appropriate strategies to reduce discrimination against the LGBT community, it is necessary to investigate the different aspects of discrimination faced by gay, lesbian, bisexual and transgender people in China as well as the geographic variation of discrimination. In the present research, we used a national sample of Chinese LGBT participants to examine the extent of self-perceived discrimination faced by each LGBT subgroup in different aspects of their daily lives, including interactions with family, medical services, religious communities, educational institutions, social services, in the media and in their workplace. Besides the self-perceived discrimination reported by LGBT participants, discriminatory attitudes towards members of the LGBT community were also measured by surveying a group of heterosexual participants. The association between seriousness of discrimination and economic development was additionally investigated.
Method
Sampling procedures
Between August 2015 and October 2015, we conducted a national survey via multiple sites. These sites included 24 community organizations working with sexual and gender minorities, educational institutions, LGBT social networks, and the United Nations Development Program’s social media. Participants were allowed to submit their responses in person, on paper, or online.
Multiple sampling strategies were applied in the current study including snowball, convenience, and respondent-driven sampling, with the majority of participants approached using online questionnaires. These strategies are proven to be sufficient for accessing stigmatized and discriminated populations [13, 20, 21]. We received 31,579 survey responses from all provinces, autonomous and special administrative regions. Of these, 29,125 were valid responses from LGBT and heterosexual individuals and were included in final analyses (which only included respondents from the 31 provinces of the Chinese mainland). More details about inclusion and exclusion criteria are given in the appendix. According to the categorization procedure described in Figure S1, the participants were categorized into five groups: lesbian, gay, bisexual, transgender, and heterosexual participants.
All participants provided informed consent before completing the survey. This study (secondary data analysis) was granted ethical approval by the Ethics Committee at Second Xiangya Hospital, Central South University.
Measures
The questionnaire used in the current study was designed based on previous findings and expert consultation from the Beijing LGBT center [13, 20]. The questionnaire consisted of four parts: 1) Sample characteristics (demographic information); 2) Heterosexual participants’ self-reported acceptance towards members of the LGBT community; 3) LGBT participants’ reports of self-perceived discrimination; 4) Discrimination from public service providers (including educational institutions, public health institutions and the police) towards LGBT individuals. Each part of the survey contained several items. Rejection and discrimination were quantified as scores ranging from 0 to 100, with higher scores representing higher levels of rejection/discrimination. Further details about the measurements can be found in the Appendix.
Data analysis and visualization
Chi-square tests were performed to examine the differences in basic characteristics between participants with different sexual orientations or gender identities. Heterosexual participants’ acceptance towards LGBT individuals was calculated and visualized in six national geographical (choropleth) maps. The grand averaged scores, indicating perceived discrimination against LGBT individuals across the seven settings, as well as general discrimination, were also calculated and visualized in choropleth maps of China.
Subsequently, we compared the results of the current study and those of a previous study. We examined similarities and differences in disclosure of sexual orientation/gender identity, perceived discrimination against LGBT individuals, heterosexual participants’ rejection and discrimination towards LGBT individuals, and heterosexual participants’ rejection towards LGBT individuals in relation to GDP. It should be noted that Tibet had the lowest sample size. The data from Tibet could therefore have severely undermined the correlation pattern. As such, we excluded this data from the correlation analysis.
In a recent study, RY Chua, KG Huang and M Jin [22] examined tolerance toward LGBT individuals among participants from 31 Chinese provinces. Pearson correlation analysis was performed to examine whether the discrimination measured in the current study was consistent with their results. Similar to RY Chua, KG Huang and M Jin [22], we standardized the general rejection scores among all provinces, and we added 3 to all of the provinces’ scores. In RY Chua, KG Huang and M Jin [22] study, the scores denoting tolerance towards LGBT individuals ranged from 0 to 5. To compare with the tolerance scores, we subtracted the general rejection scores from 5 to form tolerance scores, with larger scores representing higher tolerance towards the LGBT community.
Furthermore, we examined whether the heterosexual participants’ rejection (measured by general rejection scores) was consistent with the perceived discrimination reported by the LGBT participants (measured by general discrimination scores). The Pearson correlation between these two aspects was calculated. Furthermore, since data on the LGBT participants’ disclosure and perceived violent events was collected using two items across five scenarios (including family, school, medical service, workplace, and religion), it is worth exploring whether disclosure in certain environments was related to experiencing more violent events. For this purpose, we performed multivariate analyses after adjusting for age and education.
In addition, many studies have showed that higher economic growth is associated with higher social tolerance [8]. Therefore, we performed linear regression analyses to investigate how gross domestic product (GDP) per capita (http://www.stats.gov.cn/tjsj/ndsj/2016/indexch.htm) influences discrimination against members of the LGBT community (measured by general rejection scores).
Results
Basic characteristics of the sample
The sample size across the 31 provinces in mainland China for each group are displayed in Figure S2, and the basic characteristics of the sample of are listed in Table 1. Further details about the sample are provided in the appendix.
Provincial level friendly environments
As in Fig. 1a, across the 31 provinces in mainland China, heterosexual participants showed tolerance towards the LGBT community with a mean general rejection score of 21.9 (SD = 2.7, total scale score = 100). A relatively higher level of rejection was found in the northwestern provinces of China (including Tibet, Qinghai, Shaanxi, and Gansu), and central China (Henan) (Mean = 25.8, SD = 2.6). In contrast, Shanghai, Tianjin, Beijing, Guangdong, Jiangsu, and Sichuan were found to be LGBT friendly, with scores under 20 (mean = 18.5, SD = 1.4). Of the five dimensions of acceptance assessed, heterosexual participants reported a low level of acceptance of having children who identify as LGBT (Mean = 46.4, SD = 5.5). There was a noticeably low overall acceptance rate in the westernmost region of China; Tibet had the lowest acceptance rate, followed by Qinghai, Shanxi, Gansu and Shaanxi (Mean = 55.2, SD = 4.5). In contrast, overall, acceptance of the position of LGBT persons (Mean = 11.3, SD = 1.8), getting close to LGBT persons (Mean = 15.7, SD = 2.6) LGBT persons raising children (Mean = 15.2, SD =2.9) was found to be high. Moderate-high acceptance level of general attitude towards LGBT was identified (Mean = 20.5, SD = 2.9). Furthermore, the distribution of general attitude shown in the map (Fig. 1a) was in line with the distribution of general rejection.
Link #1
Meanwhile the perceived discrimination reported by LGBT participants was also visualized. As shown in Fig. 1b, the grand averaged score of self-perceived discriminations across seven environments was 49.9 (SD = 2.5). Gay men (Mean = 51.4, SD = 1.6) and transgender persons (Mean = 51.4, SD = 2.0) reported the highest rate of self-perceived discrimination, while less severe of discrimination was reported by lesbians (Mean = 47.8, SD =2.3). Consistent with the rejection of LGBT individuals reported by heterosexual people, a higher rate of self-perceived discrimination was more commonly reported by LGBT participants living in the north of China (Qinghai, Gansu, Shanxi, and Hebei), and Henan in central China (mean = 52.5, SD = 0.6).
We mapped perceived discrimination against LGBT persons separately for each of the seven environments. As shown in Fig. 1c, of the seven settings, the highest level of self-perceived discrimination was reported for social services (Mean = 57.1, SD = 5.7), and discrimination was higher in the north of China. LGBT participants also reported relatively higher levels of self-perceived discrimination in religious settings, with a mean score of 53.5, with a noticeably high incidence among lesbians living in Hainan (Mean = 70.6) and Xinjiang (Mean = 69.2), and transgender persons living in Gansu (Mean = 68.1). Self-perceived discrimination was generally lower in medical service settings (mean = 36.7, SD =3.8), with the exception of transgender participants, who reported an elevated rate (mean = 39.6, SD =2.7). In school settings, LGBT participants reported a moderate to high level of discriminatory behaviors by peers or teachers (mean = 52.9, SD =3.9), with a relatively lower level of discrimination found among the lesbian group (mean = 48.9, SD =3.1). LGBT participants reported less attention and biased reporting on their community by Chinese media (mean = 56.3, SD =2.7). In family (mean = 47.5, SD =2.3) and workplace settings (mean = 48.4, SD =3.1), a moderate rate of perceived discrimination was reported by LGBT participants.
The disclosure status of sexual orientation and gender identity of LGBT participants
The disclosure levels of the sexual minority groups are listed in Table 2. Lesbian participants had the highest rate of sexual orientation disclosure to family (70.1%), in school (67.3%) and the workplace (36.0%). In school, transgender individuals and gay men were found to be more likely to hide their gender identity and sexual orientation compared to lesbians and bisexual persons (χ2 = 440.5, df = 3, p < 0.01). Furthermore, gay men were less likely to report their sexual orientation in their workplace (χ2 = 116.0, df = 3, p < 0.01). Bisexual participants reported being more willing to disclose their sexual orientation when receiving medical services (χ2 = 116.0, df = 3, p < 0.01). Interestingly, transgender participants reported a higher disclosure rate when receiving social services (χ2 = 39.0, df = 3, p < 0.01). No statistically significant group differences were found regarding disclosure in religious settings.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08834-y/tables/2
Validation of heterosexuals’ rejection of the LGBT community
Heterosexual participants’ self-reported tolerance towards the LGBT community in the present study showed a correlation with that in RY Chua, KG Huang and M Jin [22] study (r = 0.76, P < 0.001) (see Fig. 2). Furthermore, in the current study, heterosexual participants rejection of the LGBT community was also correlated with LGBT participants’ self-perceived reports of discrimination (r = 0.70, P < 0.001) (see Fig. 3).
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08834-y/figures/2
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08834-y/figures/3
Additional information – https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08834-y
by Yuanyuan Wang, Zhishan Hu, Ke Peng, Joanne Rechdan, Yuan Yang, Lijuan Wu, Ying Xin, Jiahui Lin, Zhizhou Duan, Xuequan Zhu, Yi Feng, Shitao Chen, Jianjun Ou & Runsen Chen
Source – BMC Public Health
