Health Professionals' Experiences of Professional Bias, Harassment, and Discrimination in the Context of Gender Diversity in Southern Brazil: a thematic analysis of focus groups

Background Transgender and gender-diverse individuals face significant barriers in accessing public health services due to stigma. While much research focuses on direct stigma experienced by these populations, less attention has been given to "stigma by association", which affects healthcare professionals providing their care. This study explores the experiences of healthcare professionals working with transgender and gender-diverse populations in southern Brazil, examining how stigma by association impacts their professional trajectories, institutional affiliations, and daily practices. Methods This qualitative study involved two focus groups comprising nine permanent staff members from primary and specialized transgender health services located in a Brazilian metropolitan region in southern Brazil. Participants were recruited through both personal and professional networks. Data collection employed a semi-structured protocol that examined sociopolitical conditions, operational challenges, and individual experiences of stigma by association. The transcripts underwent analysis using Braun and Clarke's reflexive thematic analysis, which utilized Taguette software for coding. Methodological integrity was upheld through participant diversity and researcher reflexivity. Results Four thematic areas were identified: structural/institutional stigma, contingent stigma (identity spoiling due to social proximity), affective costs of stigma, and strategies for managing stigma. The findings underscored that services often originated from personal commitment rather than formal planning, resulting in unstable foundations, inconsistent funding, and workforce-related challenges. Professionals encountered both explicit and subtle forms of discrimination, isolation, and demotivation. Advocacy and social movements played a pivotal role in addressing stigma. At the same time, personal identification with the lesbian, gay, bisexual, transsexual, travesti , and others (LGBT+) community frequently functioned as a protective factor for professionals. Conclusions Healthcare professionals delivering care to transgender and gender-diverse populations in southern Brazil encounter substantial stigma, both structurally and interpersonally. This phenomenon harms their well-being and the sustainability of services. Addressing these challenges necessitates targeted strategies to support professionals, enhance institutional support, and promote equitable healthcare practices for transgender populations. Future research should emphasize intersectional analyses and assess the experiences of both sexual and gender minority and cisgender heterosexual professionals within this domain.