Abstract

The 2022 Demographic Census shed light on the debate concerning the inclusion of variables that would allow one to reach sexual minorities with low or no coverage in official population surveys in Brazil. The agenda is justified, considering that the LGBTI+ population demands statistical visibility and calls for public policies to guarantee their rights. This article analyzes the process of the formulation and inclusion of the sexual orientation and gender identity variables in the IBGE’s official national household surveys. To this end, a mapping of international experiences was carried out, which showed that this investigation was initially applied in health surveys through self-reports and the use of the “2-step” method to identify the trans population. Furthermore, in the light of the existing bibliography, the planning stages, challenges, and future perspectives for investigating the topic are presented. With this, we hope to contribute to an informed debate, given the current invisibility of the LGBTI+ population in official population databases.

Key words:
Population surveys; Sexual minorities; Public policies; LGBTI+; Public statistics

Introduction

Official public statistics constitute the fundamental information base for developing appropriate public policies that, together with legislation and regulations, guide access to benefits and ensure the realization of rights for the population. These statistics also allow us to understand the populations profiles in different territorial areas, recognizing their diversities and heterogeneities, as well as revealing inequities among (and within) population groups that share certain characteristics - physical, social, cultural - capable of determining differentiated trajectories and opportunity sets for each individual or group. From an intersectional perspective, the combination of several of these characteristics generates new and complex social identities that require visibility in order to be considered in the process of developing public policies and guaranteeing rights. .

In this sense, National Statistical Systems play a major role. In more consolidated democracies, social groups usually mobilize themselves to ensure their proper representation in the set of official data produced and, as consequence, publicize their existence and have subsidies to pressure the government and parliament for actions that promote equality and protect individual and collective rights. Historical series of indicators on women (based on the variable sex at birth) and color or race, for example, have guided and still guide the demands of feminist and anti-racist movements, giving rise to policies and laws aimed at equal opportunities and access to health care, education, work, public safety, among others.

It is this path that some social groups, such as the LGBTI+ (lesbian, gay, bisexual, transgender, intersex, and other identities) movement, are seeking to follow at this time in a field that is still under dispute. However, such visibility efforts are not recent. On the 1988 Constituent Assembly, the recently created Brazilian homosexual movement called for their “inclusion in the new constitutional charter of ‘sexual orientation’ and ‘gender identity’ among the various discrimination situations to be fought by public authorities”¹1 Carrara S, Vianna A. Os direitos sexuais e reprodutivos no Brasil a partir da Constituição Cidadã. In: Oliven RG, Ridenti M, Brandão GM, organizadores. A Constituição de 1988 na vida brasileira. São Paulo: Hucitec; 2008.. Since then, several other collective actions in this field have sought to promote measures to recognize rights and protect against violence and discrimination.

The collection of information on gender identity and sexual orientation faces the difficulties inherent in the operationalization of complex concepts in population surveys, especially since the definitions and response categories have not been yet agreed in the bibliography or between social movements that represent each letter of the acronym.

In the theoretical field, it is important to reflect on the perception of sex and gender as independent of each other. Butler shows us, for example, that “when the constructed status of gender is theorized as radically independent of sex, gender itself becomes a free-floating artifice,” bringing as an example for reflection that the consequence of this perception is that “man and masculine might just as easily signify a female body as a male one, and woman and feminine a male body as easily as a female one”²2 Butler J. Problemas de gênero: feminismo e subversão da identidade. Rio de Janeiro: Civilização Brasileira; 2003.. Butler also questions the categories of sex, gender, and gender identity. For the author, the binary notion of masculine/feminine, from which the categories used in population surveys historically derive, “constitutes not only the exclusive framework in which that specificity can be recognized, but in every other way the “specificity” of the feminine is once again fully decontextualized and separated out analytically and politically from the constitution of class, race, ethnicity, and other axes of power relations that both constitute ’identity‘ and make the singular notion of identity a misnomer”²2 Butler J. Problemas de gênero: feminismo e subversão da identidade. Rio de Janeiro: Civilização Brasileira; 2003..

Beyond the conceptual debate, there are technical-methodological issues on the best practices to collect personal and sensitive information in household surveys and the limits inherent to statistical sampling for small population groups. Furthermore, there is no internationally accepted guide or manual for collecting information on gender identities and sexual orientation. However, some countries have sought to advance in this direction and their experiences have served as a reference for the discussions taking place within the scope of official Brazilian statistics.

In Brazil, since the 2007 Population Mid-Decade Census questionnaire, the list of household members that express the relationship of each resident with the household reference person (or head of the household) has the option “same-sex spouse/partner”. Although the results are limited to the marital status of the household reference person, it has become an option for some analysis on the topic. In 2019, the first specific investigation of sexual orientation was experimentally conducted in the National Health Survey (Pesquisa Nacional de Saúde - PNS).

This article seeks therefore to discuss the process of constructing information on sexual orientation and gender identity in Brazil, briefly presenting the advancement of the topic in the international context and in the household surveys carried out by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), pointing out the limits and some potential uses of this information based on previously released information, albeit on an experimental basis.

The process of constructing information on sexual orientation and gender identity in population surveys

In general, the formulating of official public statistics follows a known and shared path among the different countries committed to the United Nations (UN) Fundamental Principles of Official Statistics³3 United Nations (UN). Fundamental Principles of Official Statistics [Internet]. 2013. [cited 2024 fev 11]. Available from: https://unece.org/statistics/FPOS
https://unece.org/statistics/FPOS... . Based on a theoretical-conceptual framework or benchmark agreed upon through thematic conventions and/or specifically constituted Working Groups within the UN system, recommendations are drawn up in order to collect data with similar parameters and methodologies, allowing comparability among countries and consistent historical series. This shared pathway is also an instrument to defend the technical independence of national statistical systems, since information is based on a method recognized and ratified by several experts on the subject, although it may suffer some adaptations to each country’s context and legislation.

There is an important history of conferences, manuals, and studies around the term “gender” in the UN system. However, it is still focused almost exclusively on discussing the situation of women vis-à-vis men. A recent example is the Sustainable Development Goal 5 of the 2030 Agenda, whose statement is “to achieve gender equality and empower all women and girls”, monitored with indicators based exclusively on data disaggregation by sex. In turn, the manual “Integrating a Gender Perspective into Statistics”⁴4 United Nations (UN). Integrating a Gender Perspective into Statistics [Internet]. 2016. [cited 2024 fev 11]. Available from: https://digitallibrary.un.org/record/3905339?v=pdf
https://digitallibrary.un.org/record/390... treats gender statistics as “statistics that adequately reflect differences and inequalities in the situation of women and men in all areas of life”.

In this context, the “pathway” to construct the information on the topic of sexual orientation and gender identity already lacks a framework of agreed upon recommendations that serve as a guide for the collection of information by different countries. A proxy to an international agreement to guarantee the rights of the LGBTI+ population is the Yogyakarta Principles⁵5 Princípios de Yogyakarta. Princípios sobre a aplicação da legislação internacional de direitos humanos em relação à orientação sexual e identidade de gênero. Tradução de Jones de Freitas, 2007., prepared by a group of human rights experts from different countries aiming to apply the Universal Declaration of Human Rights (1948) to the LGBTI+ population. However, these were endorsed by official government representatives of the countries, nor do they address the methodological issues surrounding the collecting information on the topic.

Nonetheless, in recent years, some countries have managed to advance on this investigation, generally via household health surveys. Some Population and Housing Censuses, carried out at the turn of the 2020s, included one or more categories on gender identity and sexual orientation/identity. Among the countries that advanced in this investigation, Australia, the United States, the United Kingdom, Canada, Scotland, and, in Latin America, Argentina, Ecuador, Uruguay, Chile, Colombia, Mexico, and Peru stand out. In Brazil, such investigation is still quite incipient. Some unofficial organizations have already produced research that includes the topic, at least partially, at a national level⁶6 Havaianas, All Out e Datafolha. Pesquisa do Orgulho [Internet]. 2022. [acessado 2024 mar 1]. Disponível em: https://pesquisadoorgulho.com.br/
https://pesquisadoorgulho.com.br... ^,77 Brasil. Ministério da Saúde (MS). Secretaria de Vigilância Saúde. Programa Nacional de DST e AIDS. Pesquisa de Conhecimento Atitudes e Práticas na População Brasileira de 15 a 54 anos, 2004. Brasília: MS; 2005., while others have investigated the topic with a more restricted geographic scope⁸8 Companhia de Planejamento do Distrito Federal (CODEPLAN). Gênero e orientação sexual no DF - um olhar inclusivo: inserção de perguntas sobre identidade de gênero e orientação da PDAD 2021 e em questionário suplementar on-line [Internet]. 2022. [acessado 2024 mar 1]. Disponível em: https://www.codeplan.df.gov.br/wp-content/uploads/2018/03/NT-Genero-e-Orientacao-Sexual-no-DF-um-olhar-inclusivo.pdf
https://www.codeplan.df.gov.br/wp-conten... .

The demand for investigating sexual orientation and gender identity by IBGE gained strength as the 2022 Population and Housing Census (CD2022) approached. In a statement dated 11/18/2021, IBGE reported that in 2018 the Federal Public Defender’s Office, through a Public Civil Action, requested a “question aimed at counting the transsexual population” be included in the CD2022⁹9 Instituto Brasileiro de Geografia e Estatística (IBGE). Nota sobre o questionário do Censo 2022 [Internet]. 2021. [acessado 2024 mar 5]. Disponível em: https://www.ibge.gov.br/novo-portal-destaques/32272-nota-sobre-o-questionario-do-censo-2022.html
https://www.ibge.gov.br/novo-portal-dest... . On the eve of the CD2022 going into the field, after a series of postponements due to the COVID-19 pandemic and resource restrictions, another injunction gained notoriety, issued by the Acre judicial system, which was later joined by the social movements Grupo Arco-Íris (Rainbow Group) and the National LGBTI Alliance, which determined the inclusion of census investigation on gender identity and sexual orientation. The IBGE appealed on both injunctions with technical justifications, warning that adjustments to the schedule to include the variables at that time would lead to (another) postponement of this already problematic Census.

Among the explanations provided, the IBGE argued that “identification issues, which require the person as a respondent, are not compatible with a census operation, which one resident per household responds for other residents”⁹9 Instituto Brasileiro de Geografia e Estatística (IBGE). Nota sobre o questionário do Censo 2022 [Internet]. 2021. [acessado 2024 mar 5]. Disponível em: https://www.ibge.gov.br/novo-portal-destaques/32272-nota-sobre-o-questionario-do-censo-2022.html
https://www.ibge.gov.br/novo-portal-dest... . In other words, it warned that, if the requested questions were included, the sexual orientation and gender identity of residents would, to a large extent, be answered through a proxy informant, other than the person themselves, with potential measurement errors in the information collected.

Secondly, it argued that the terms to be used as response categories did not have a definition or even an agreed upon (and tested) set of all possible gender identities. “Open-ended” questions, without specified categories, require extra coding effort (and resources) a posteriori and, considering the incipient debate on the topic in a way accessible to the whole population, with countless misinformation and taboos that lead to confusion and a lack of knowledge of the terms. In NHS (PNS 2019), for example, the interviewer´s observations highlighted problems with the understanding of “sexual orientation” and its response categories¹⁰10 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde: orientação sexual autoidentificada da população adulta [Internet]. 2022. [acessado 2024 mar 4] Disponível em: https://agenciadenoticias.ibge.gov.br/media/com_mediaibge/arquivos/dc3c7903468565be702f076f9795980a.pdf
https://agenciadenoticias.ibge.gov.br/me... .

The definition of terms and acronyms is also debated in academia and organized civil society. Regina Facchini, in her Master’s research, discussed the use of the term ‘sexual minorities’ because, according to some groups, such as CORSA (Group for Awareness and Emancipation of Sexual Minorities), it was necessary to identify the collective subject on behalf of which they spoke more directly. Therefore, the term was replaced by GLT (gays, lesbians, and transsexuals) and, later, by GLBT (including bisexuals). Facchini also points out that the acronym GLS (with the term ‘sympathizers’) - initially used and widely disseminated for a period - was discarded by the movement because it was considered “an acronym for the market, not for the movement”¹¹11 Facchini R. Sopa de letrinhas? - movimento homossexual e produção de identidades coletivas nos anos 90: um estudo a partir da cidade de São Paulo [dissertação]. Campinas: Universidade Estadual de Campinas; 2022.. Currently, acronyms are used that can accumulate a still undefined number of possibilities (LGBTI+, LGBTQ+, LGBTQIA+, LGBTQIAP+), which makes their operationalization even more difficult.

Finally, it is highly recommended that the inclusion of a new topic or new methodology in official surveys undergo cognitive and field tests to evaluate the wording and the population’s understanding of the questions and proposed response categories, as well as the flow of the questionnaire and the suitability of the selected collection method.

In the end, in response to civil society and respecting the legal agreements made, IBGE created, in June 2022, a Working Group to discuss the topic (GT OSIG - Sexual Orientation and Gender Identity Working Group), especially to advance the limitations of methodological nature and study international experiences on the topic.

International methodologies and experiences: some results and references

The first action by the GT OSIG was to review surveys, questionnaires, reports and the types of household surveys that included the investigation of sexual orientation and gender identity so that these could serve as a reference for the construction of a pilot questionnaire to be tested (Chart 1).

In conceptual terms, the main reference material was the report Measuring Sex, Gender Identity and Sexual Orientation, from the National Academy of Sciences, Engineering and Medicine¹²12 National Academies of Sciences, Engineering, and Medicine. 2022. Measuring Sex, Gender Identity, and Sexual Orientation [Internet]. 2022. [cited 2024 fev 8]. Available from: https://nap.nationalacademies.org/catalog/26424/measuring-sex-gender-identity-and-sexual-orientation
https://nap.nationalacademies.org/catalo... . This report was developed by a committee of experts in sociology, psychology, public health, medicine, survey methodology, and statistics to review current measures and methodological issues on the topic (Chart 2).

The type of investigation proposed by NAS (2022) clearly distinguishes the sex assigned at birth and the current gender, allowing the enumeration of people with transgender experience directly (via identification as such in the gender identity question) or by crossing information about “sex” and “gender” (2-step method), such as trans women who want to report male sex (assigned) at birth and female gender.

To prepare this article, we updated and expanded the reviewed international experiences, which are systematized in Chart 3. Although investigation on sexual orientation and gender identity is being increasingly recognized among international bodies¹³13 United Nations Economic Commission for Europe (UNECE). In-Depth Review of Measuring Gender Identity [Internet]. 2019. [cited 2024 mar 3]. Available from: https://unece.org/sites/default/files/2021-01/In-depth%20review%20of%20Measuring%20Gender%20Identity%20for%20bureau.pdf
https://unece.org/sites/default/files/20... and their signatory countries, the brevity of the lists of countries that collect this information is representative of the experimental state of measurement standards and the implementation of the topic by statistical systems. The Society at a Glance 2019 report, from the Organization for Economic Co-operation and Development (OECD), brought a compilation of these experiences regarding gender identity, to which we added the experiences found by Malaguti et al. (2022). Such investigation has been applied, mainly, in health surveys that carry out interviews with selected respondents, identifying the trans population through the 2-step approach. The last column of Chart 3 compiles some estimates found for the trans population, in general, less than 1% of the population.

The materials produced by NGOs, Associations, and Collectives linked to the LGBTI+¹⁸18 Reis T, Cazal S, organizadores. Manual de comunicação LGBTI+. Curitiba: IBDSEX; 2021.^,1919 Associação Brasileira de Shopping Centers (ABRASCE). Abraçando a diversidade e a inclusão: o papel dos shoppings centers na promoção de espaços mais inclusivos e livres de discriminação [Internet]. 2020. [acessado 2024 mar 4]. Disponível em: https://abrasce.com.br/wp-content/uploads/2024/02/Cartilha_Diversidade_Inclusao_Abrasce.pdf
https://abrasce.com.br/wp-content/upload... movement were also reviewed by the Working Group and were important for adapting terms to the Brazilian context. Added to this list are scientific articles and reports compiled by government and research institutions²⁰20 Instituto Nacional de Estadísticas (INE). Evaluación de Comprensión y Estimación de Preguntas de Sexo al Nacer, Identidad de Género y Orientación Sexual [Internet]. 2019. [acceso 2024 mar 3]. Disponible en: https://www.ine.gob.cl/docs/default-source/genero/gu%C3%ADas-y-documentos/documentos/evaluaci%C3%B3n-de-comprensi%C3%B3n-y-estimaci%C3%B3n-de-preguntas-de-sexo-al-nacer-identidad-de-genero-y-orientacion-sexual-2019.pdf?sfvrsn=78209faf_4
https://www.ine.gob.cl/docs/default-sour...

21 Instituto Nacional de Estadísticas (INE). Estudio de Metodologías para la Medición de Identidad de Género y Orientación Sexual em Chile [Internet]. 2018. [acceso 2023 fev 11]. Disponible en: https://www.movilh.cl/wp-content/uploads/2021/01/INE-Censo-LGBTI-Movilh.pdf
https://www.movilh.cl/wp-content/uploads...

22 Instituto Nacional de Estadísticas (INE). Evaluación de Comprensión y Estimación de Preguntas de Sexo al Nacer, Identidad de Género y Orientación Sexual [Internet]. 2019. [acceso 2024 fev 8]. Disponible en: https://www.ine.gob.cl/docs/default-source/genero/gu%C3%ADas-y-documentos/documentos/evaluaci %C3%B3n-de-comprensi%C3%B3n-y-estimaci%C3%B3n-de-preguntas-de-sexo-al-nacer-identidad-de-genero-y-orientacion-sexual-2019.pdf?sfvrsn=78209faf_4
https://www.ine.gob.cl/docs/default-sour...

23 Instituto Nacional de Estadísticas (INE). Estudio de Metodologías para la Medición de Identidad de Género y Orientación Sexual en Chile [Internet]. 2018. [acceso 2024 mar 4]. Disponible en: https://www.movilh.cl/wp-content/uploads/2021/01/INE-Censo-LGBTI-Movilh.pdf
https://www.movilh.cl/wp-content/uploads...

24 National Center for Education Statistics (NCES). Current Measures of Sexual Orientation and Gender Identity in Federal Surveys [Internet]. 2016. [cited 2024 mar 5]. Available from: https://nces.ed.gov/FCSM/pdf/current_measures_20160812.pdf
https://nces.ed.gov/FCSM/pdf/current_mea...

25 Stats NZ. Statistical standard for gender, sex and variations on sex characteristics [Internet]. 2021. Available from: www.stats.govt.nz
www.stats.govt.nz...

26 United Nations Economic Commission For Europe (UNECE). Measuring Gender Identity [Internet]. 2019. [cited 2024 mar 4]. Available from: https://unece.org/DAM/stats/publications/2019/Issue_5_Gender_Identity.pdf
https://unece.org/DAM/stats/publications... ^-2727 Snyder JA, Tabler J, Gonzales CM. Measuring sexual identity, gender identity, and biological sex in large social surveys: implications for victimization research. Criminal Justice Behavior 2022; 49(9):1376-1395..

After a joint analysis of these materials, the Working Group presented a first proposal for a questionnaire to carry out in a cognitive test (Chart 4), in a controlled environment and with the presence of observers in addition to the interviewers and the interviewee, in order to assess understanding and people’s reactions throughout the interview. In addition, the suitability of the questionnaire was also tested, identifying possible problems before data collection in the field.

The questionnaire was presented in some meetings held with social movements, researchers on the topic, and members of civil society²⁸28 Belandi C. IBGE realiza estudo inicial para levantamento sobre população em situação de rua [Internet]. 2023. [acessado 2024 mar 5]. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/34881-ibge-recebe-sociedade-civil-para-discutir-producao-de-estatisticas-sobre-genero-e-orientacao-sexual
https://agenciadenoticias.ibge.gov.br/ag... . The participants of these first conversation rounds were those who had already officially presented their demands to IBGE to investigate the topic and that ones mappped as the most representative groups for each acronym letter. The invitation was made by the members of the Working Group and by recommendation of the initial guests themselves. Two meetings were held in a face-to-face and hybrid format, in addition to specific meetings with researchers and groups that were unable to attend the first meetings. In total, nine civil society organizations, twelve public bodies, and two researchers were consulted in this initial discussion.

In general, the main criticism was about the lack of investigation of the intersex population and about gender identity categories; the non use of the term “cis/cisgender”; the separate categories for men/women and “trans”; the use of the term ”transvestic” (a specific category of transgender population with common use in Latin American countries) ; and, for sexual orientation, a separation between lesbians and gays to include them in the first option. Such demands were later discussed by the Working Group, which understood that the intersex population should be investigated through a specific question, as recommended by the NAS (2022), at a later stage, and, according to the experiences observed in some countries, at this first stage, the gender categories proposed for evaluation would be maintained.

Following the methodology proposed by the International Labor Organization (ILO)²⁹29 Benes E, Walsh K. ILO LFS pilot studies cognitive interviewing tests: methodology, process and outcomes [Internet]. 2018. [cited 2024 mar 4]. Available from: https://www. ilo. org/wcmsp5/groups/public/---dgreports/---stat/documents/publication/wcms_627874. pdf
https://www. ilo. org/wcmsp5/groups/publ... , the cognitive test was carried out in November 2022 in Rio de Janeiro with a total of 43 people interviewed, in a planned intentional sample (active search in the vicinity of the test site in the central region of Rio de Janeiro) to include both sexual and gender diversity, as well as different socioeconomic categories of the population, especially age, sex, and education. The results showed that, in general, talking about the topic did not bring embarrassment, but some interviewees reported that they would not feel comfortable answering these questions in the presence of other household members. The observation questions focused on the following topics: “Did you understand the term used?”; “Are there other terms not covered by the answers?”; and “Did you feel comfortable talking about your sexual orientation or gender identity and that of other household members for an IBGE survey?”.

Although the questions were easily understood, they required repetition or paraphrasing of terms at times. At other times, the concepts of sex and gender were confusing, and difficulty in separating the concepts of sexual orientation and gender identity was relatively common. However, most interviewees answered the questions confidently after the response categories were read to them. The greatest difficulty was identified concerning the complexity and novelty of the concepts covered rather than the format and composition of the applied questionnaire, with elderly people presenting more difficulties in understanding and answering.

The results also pointed to the need to include the “non-binary” category in the question about gender identity, a term mentioned more than once in the test. It is worth highlighting that, quite frequently, people reported not feeling comfortable answering about the sexual orientation and/or gender identity of another household member and a certain discomfort in the answers related to these categories, even when the person answered for themselves.

After some adjustments (Chart 5), the questions were sent to a field test in preparation for the National Demographic and Health Survey - (Pesquisa Nacional de Demografia e Saúde - PNDS 2023), the next survey to go to the field using “selected respondent” as the collection method. Considering the importance of sex at birth to structure the questionnaire of this survey, mainly focused on women’s reproductive health issues, and considering the need for studies on the impact of a third sex category on population projections, the investigation of the intersex population did not appear in this edition. The fieldwork ended in February 2024, with results expected to be published in 2025.

Answers regarding gender identity were maintained in the format applied in the cognitive test, understanding that reading the categories separately helped in understanding the question. Therefore, following the NAS (2022) proposal, trans people would have the freedom to identify themselves both directly (as a trans woman/man, 1-step method), and by crossing sex and gender information (2-step method). In the wording of the question, the term “prefer to define yourself” was incorporated to make it clear that it is up to the informant to choose the term that better defines their gender identity.

In the end of 2023, two other experimental investigations were in the planning phase, including an investigation of sexual orientation and gender identity: Homeless Population Census (pilot test in December 2023)²⁸28 Belandi C. IBGE realiza estudo inicial para levantamento sobre população em situação de rua [Internet]. 2023. [acessado 2024 mar 5]. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/34881-ibge-recebe-sociedade-civil-para-discutir-producao-de-estatisticas-sobre-genero-e-orientacao-sexual
https://agenciadenoticias.ibge.gov.br/ag... and a module in the National Continuous Household Sample Survey (Pesquisa Nacional por Amostra de Domicílios Contínua - PNADC) planned to collect information on these topics on 2024. Both surveys have the same questionnaire applied in the PNDS, improved with field experiences reported by data collection agents and meetings with civil society. The application via PNADC is an important step to test the response per proxy household member, a collection method used in the Population Census.

The main adjustments were the separation of the categories “Lesbian” and “Gay” and the exclusion of the term “Homosexual”; as well as the inclusion of explanations in parentheses for the response categories of “Lesbian” (a woman who is only attracted to women), “Gay” (a man who is only attracted to men), “Bisexual” (a person who is attracted to more than one gender), and “Heterosexual” (a man who is only attracted to women / a woman who is only attracted to men), given the difficulties in understanding reported by the interviewers.

Research potential from PNS 2019 and PNDS 2023

The inclusion of the module on sexual orientation in the NHS (PNS 2019) allowed for an unprecedented array of possibilities for studies in the area of sexuality³⁰30 Carvalho AA, Barreto RCV. The invisibility of the LGBTQIA+ people in the databases: new possibilities in the 2019 National Health Research? Cien Saude Colet 2021; 26(9):4059 4064.. Although it does not include other groups such as transvestis and transgenders, nor other gender expressions and performances (e.g. non-binary people, queer), the progress towards going beyond the sex variable, which, alone, can lead to the notion of presumed heterosexuality of the respondent, is undeniable.

The investigation was carried out in the Module on Sexual Activity and was answered by people aged 18 years or over, which also included questions related to the frequency of sexual intercourse and the use or not of condoms. In a technical note, the IBGE warns that data regarding sexual orientation and its possible intersections must be analyzed with caution, given the restricted sample size¹⁰10 Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa Nacional de Saúde: orientação sexual autoidentificada da população adulta [Internet]. 2022. [acessado 2024 mar 4] Disponível em: https://agenciadenoticias.ibge.gov.br/media/com_mediaibge/arquivos/dc3c7903468565be702f076f9795980a.pdf
https://agenciadenoticias.ibge.gov.br/me... . Microdata was only released in 2022 as experimental statistics, that is, statistics “that have not reached a complete degree of maturity in terms of harmonization, coverage or methodology, and result from a new statistical operation or new indicators in existing operations” ³¹31 Instituto Brasileiro de Geografia e Estatística (IBGE). Estatísticas experimentais: descrição. [acessado 2024 mar 5]. Disponível em: https://www.ibge.gov.br/estatisticas/investigacoes-experimentais/estatisticas-experimentais.html
https://www.ibge.gov.br/estatisticas/inv... .

It is assumed that the sample of people who declare themselves homosexual/bisexual in the survey (1.9% in the country or 2.92 million people) is underreported due to issues such as a possible lack of knowledge on the part of the declarant of the nomenclatures used; discomfort in revealing one’s sexual orientation to an unknown person; impossibility, in some cases, of privacy at the time of the interview; and the self-declaratory nature excludes people who do not identify as homosexual or bisexual, even if they engage in sexual activity with people of the same sex/gender.

In a brief bibliographical study on the use of PNS statistics to evaluate its research potential, an article was found that focuses on violence against LGB+ people in Brazil³²32 Vasconcelos NM, Alves FTA, Andrade GN, Pinto IV, Soares Filho AM, Pereira CA., Malta DC. Violência contra pessoas LGB+ no Brasil: análise da Pesquisa Nacional de Saúde, 2019. Rev Bras Epidemiol 2023; 26(Supl. 1):e230005., identifying a higher prevalence of violence in men and women who declare themselves homosexual/bisexual. The authors emphasize that there is an intersection of factors that place lesbian women at a greater degree of vulnerability in all of the analyzed subtypes of violence, the highest prevalence having occurred among LGB+ women [(psychological: 40.53%; 95%CI 34.29-47.09); (physical: 15.84%; 95%CI 10.99-22.28); (sexual: 5.50%; 95%CI 3.23-9.20)], while the lowest prevalences were found among heterosexual men [(psychological: 15.33%; 95%CI 14.62-16.08); (physical: 3.71%; 95%CI 3.39-4.06); (sexual: 0.34%; 95%CI 0.25-0.46)]³²32 Vasconcelos NM, Alves FTA, Andrade GN, Pinto IV, Soares Filho AM, Pereira CA., Malta DC. Violência contra pessoas LGB+ no Brasil: análise da Pesquisa Nacional de Saúde, 2019. Rev Bras Epidemiol 2023; 26(Supl. 1):e230005..

From another perspective, Barreto and Carvalho (2023) pointed out the urban character and the importance of the networks that urban space has to interconnect this population and reinforce sociability networks³³33 Barreto RCV, Carvalho AA. Espaço urbano, redes de sociabilidade e políticas de saúde LGBTI+ sob o prisma da Pesquisa Nacional de Saúde - PNS 2019. Rev Lat Am Geogr Genero 2023; 14(1):158 177.. The authors showed, for example, that most capitals exceeded the average for Brazil of self-declared LGB people, that is, there would be a greater concentration of LGB people in areas characterized by centrality in the urban network of their regions³³33 Barreto RCV, Carvalho AA. Espaço urbano, redes de sociabilidade e políticas de saúde LGBTI+ sob o prisma da Pesquisa Nacional de Saúde - PNS 2019. Rev Lat Am Geogr Genero 2023; 14(1):158 177.. This is an important input when thinking about inclusion policies, as well as the design of future nationwide research, rethinking approaches in territories outside capitals and their metropolitan regions.

Although the PNDS 2023 does not yet allow for intersex people to be captured in the results, it will be the first official sample survey carried out in Brazil to map gender identity. Like the PNS 2019, the survey will capture some aspects related to the population’s perception of access to health with a focus on Primary Care offered by the Brazilian Unified Health System (SUS) and, in this sense, it has the potential to generate unprecedented information about the use of health promotion and protection services from the perspective of the population outside the cisheteronormative standard. The relevance of this topic needs to be highlighted, as discrimination based on sexual orientation and gender identity is a social determinant of health, especially in the process of suffering and illness resulting from prejudice and social stigma reserved for lesbian, gay, bisexual, transvesti, and transgender populations³⁴34 Brasil. Ministério da Saúde (MS). Política Nacional de Saúde Integral de Lésbicas, Gays, Bissexuais, Travestis e Transexuais. Brasília: MS; 2013..

Furthermore, as it is part of the IBGE’s Integrated System of Household Surveys (SIPD) (as well as the PNS), it allows for an investigation of socioeconomic and territorial inequalities involving the LGBTI+ group by crossing data with variables related to work, income, education, and place of residence. These areas are closely related to acceptance in social environments associated with its impact on the most varied forms of violence and the wellbeing of this population³⁵35 Rondas LO, Machado, LRS. Inserção profissional de travestis no mundo do trabalho: das estratégias pessoais às políticas de inclusão. Rev Pesqui Pratic Psicossociais 2015; 10(1):191-204.^,3636 Alves CER. Travestis e transexuais na escola: ressonâncias do uso do nome social na rede municipal de educação de Belo Horizonte. In: Anais do 10 Seminário Internacional Fazendo Gênero. Belo Horizonte; 2013..

Final considerations

This article shows that the demand for statistical visibility of sexual minorities in government databases has been growing and becoming the subject of countless debates and legal disputes. This pressure adds to the challenges already faced by national statistical systems in meeting growing demands for information in the context of restricted physical, financial, human, and technological resources.

Promoting constructive dialogue between civil society and government agencies constitutes the basis for advancing the development of data collection methods beyond binary, and, more generally, expanding the debate about sexual diversity in society, seeking a better understanding of the subject by the population. Militancy is a key part of this process, working to raise awareness among the LGBTI+ population regarding the importance of self-declaration in surveys and official records, as well as in the fight for the social environment to be increasingly favorable and welcoming to diversity, allowing LGBTI+ people to feel safe in exposing and expressing publicly their sexual orientation and gender identity.

In parallel, official statistics are guides for decision-making and public policy planning, which are fundamental when it comes to social minorities. Therefore, the inclusion of this investigation, whether in population surveys or administrative records, represents an advance towards the population’s recognition of sexual and gender minorities and their political-social representation in the national context.

References

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