A/HRC/38/43 persons face are linked to experiences of biphobia and bisexual invisibility. 64 Even where health workers do not intend to discriminate, they often lack basic information or training about specific health concerns and appropriate medical and counselling practices. In countries where non-conforming sexual orientation and gender identities are criminalized and health policies are discriminatory, abuses and discriminatory attitudes in health-care institutions are explicitly condoned. Such an environment has a negative impact on access to health-care services and health-related information, and on the quality of the services provided.65 It also affects the ability of States to design adequate policy responses to global and public health concerns. 60. Stigma at the root of violence and discrimination corrodes the social fabric. It affects values of fundamental importance, such as empathy, social inclusion and solidarity. Recent research also provides evidence of its impact on development: it was found, for example, that a 10 per cent increase in the level of homophobia at the country level was associated with a reduction of 1.7 years in men’s life expectancy.66 61. Lesbian, gay, bisexual, trans and gender non-conforming persons may internalize the negative attitudes and values of society, which may have a detrimental impact on their mental health and result in self-harm or violence.67 Studies have shown that the risk for suicide among lesbians and gays may be particularly high for those who experience familial or social abuse and rejection.68 Bullying has been shown to be a contributing factor in many suicides of trans and gender non-conforming persons,69 while recent research suggests that around three in every four young trans persons have experienced anxiety or depression, that four out of five have engaged in self-harm at some stage, and that almost one in two has attempted suicide.70 C. Negation and the resulting data gap 62. Negation is adopting the position that violence and discrimination based on sexual orientation or gender identity do not exist in a particular context or that, in a given social context, there are no lesbian, gay, bisexual, trans or gender non-conforming persons. It enables violence and discrimination, and lies at the root of some of the heinous acts described in the present report. In a context of negation, perpetrators feel motivated and enabled to supress or punish diversity. Invariably, any data gathered will be unreliable, unsystematic and biased; all State measures to address violence and discrimination, be it public policy, access to justice, law reform or administrative actions, will be therefore hindered by this fact. 63. Conversely, a policy of acknowledgement of violence and discrimination based on sexual orientation and gender identity will be accompanied by data and therefore evidence of the extent of the challenges faced: for example, a survey conducted by the European Union in 2012 found that as many as 47 per cent of respondents had been subjected to discrimination or harassment during the previous year. 71 As worrisome as that information is, the Independent Expert commends this and other data-gathering exercises because they 64 65 66 67 68 69 70 71 14 Barker et al., The Bisexuality Report (see footnote 45). WHO, Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people: Recommendations for a public health approach, 2011. Erik Lamontagne et al., “A socioecological measurement of homophobia for all countries and its public health impact”, European Journal of Public Health, March 2018, p. 2. Blondeel et al., “Violence motivated by perception of sexual orientation” (see footnote 11). McManama O’Brien et al., “Suicide and self-injury in gender and sexual minority populations”, (see footnote 10), pp. 181–198; UNDP, Leave no one behind (see footnote 11). UNESCO, Out in the Open (see footnote 58); McManama O’Brien et al., Suicide and self-injury in gender and sexual minority populations (see footnote 10), pp. 181–198. Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D., Lin, A., “Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results”, Telethon Kids Institute, Perth, Australia, 2017. European Union Agency for Fundamental Rights, European Union lesbian, gay, bisexual and transgender survey, 2014, p. 11.