September 30, 2015
In February 2015, a Regional Dialogue on LGBTI Rights and Health in Asia-Pacific was held in Bangkok, Thailand. It brought together more than 200 representatives of governments, development partners, national human rights institutions, lesbian, gay, bisexual, transgender and intersex (LGBTI) people and other civil society members. The report, which is available for download from our website, documents the presentations and discussions made during this conference.
The participants discussed achievements in LGBTI rights in key areas such as health, education, employment and social protection and explored avenues to further strengthen the protection of LGBTI human rights across the region. With regards to health and human rights, priority issues of LGBTI people identified in the report are:
Mental health problems are common among LGBTI people. Negative factors impacting mental health include criminalization, pathologization, corrective counselling, intrusive psychological therapies, and religious and cultural transphobia and homophobia. Many LGBTI people experience social isolation, depression, low self-esteem, addictions, low confidence, self-doubt, self-blame and paranoia. There are high rates of suicide.
Mental health services are often uninformed about LGBTI people’s needs. In some countries, LGBTI groups provide peer support and counselling in safe places, but most countries have few or no services. Mental health services and support for LGBTI people should be integrated into government social services. Decriminalization, legal recognition of gender identity and legal recognition of same-sex relationships would encourage stable relationships that are good for people’s mental and physical health.
Transgender health rights
The health needs of transgender people to access hormone treatment and sex reassignment surgery are poorly addressed in most countries. Transgender people’s health is placed at risk where they are only able to access hormone treatment through unregulated sources such as the Internet.
Intersex health rights
Surgery for intersex people is often not necessary and violates human rights to bodily integrity, physical autonomy and self-determination. Surgery imposed on intersex people can reinforce the stigma, secrecy and shame associated with an intersex status. There are no guidelines on best practice for intersex health. In 2013, the Australian government initiated a Senate Inquiry that made recommendations for guidelines, multidisciplinary teams and resourcing to ensure effective peer support and involvement in the medical pathways offered to intersex people. It is crucial not to pathologize intersex conditions. Provision of information and support to families of intersex people would help to address the high incidence of suicide among intersex people.
Criminalization and stigmatization of people because of their sexual orientation or their gender identity makes it harder to engage people in HIV prevention and treatment. Sodomy is still a criminal offence in many countries, particularly Commonwealth countries. Fiji and Palau have removed the sodomy offence from their laws, but otherwise across the region there is a lack of progress on law reform. Criminalization of sex work means that male and transgender sex workers hesitate to take an HIV test or to carry condoms. Young gay men and transgender people are at very high risk of HIV and therefore require targeted, rights-based interventions.
Health care workers
LGBTI issues are not included in the health care curriculum of workers, so most are unaware of how to address the specific needs of LGBTI people. Inclusion of sexual orientation and gender identity issues in the professional curricula of health care workers is required. Many medical colleges still treat homosexuality as a disease or a form of moral deviance and there is little professional education available to health care workers on transgender and intersex issues.
Download full report (PDF)