Health Care and Human Rights for LGBT People: A Critical Focus for Our Work

Before his untimely death, Jonathan Mann, founder of the UN AIDS program, educated us on the strong link between the concepts of health and human rights. Mann demonstrated how stigma and discrimination are deeply connected to limitations and barriers to sensitive, humane care. In his book Health and Human Rights: A Reader, Mann explains that “Discrimination against ethnic, religious, and racial minorities, as well as on account of gender, political opinion, or immigration status, compromises or threatens the health and well-being and, all too often, the very lives of millions. In its most extreme forms, prejudice or the devaluation of human beings because they are classified as “other” has led to apartheid, ethnic cleansing, and genocide. Discriminatory practices threaten physical and mental health and result in the denial of access to care, inappropriate therapies, or inferior care.”

The same connection can be drawn from the Institute of Medicine’s recent report on the Health of Lesbian, Gay, Bisexual and Transgender People, a publication which represents a landmark step towards LGBT health awareness. Also in Healthy People 2020, the Surgeon General describes how many of the health disparities noted among LGBT people stem directly from stigma and discrimination.

Tyler Clementi is a recent, and tragic example of how prejudice and stigma can hurt LGBT Americans.

A person cannot live a full, healthy life when they are unable to experience real human rights or freely express who they are. Recent examples of bullying are too numerous to cite, the most prominent being Tyler Clementi who jumped to his death from the George Washington bridge after classmates filmed him having sex with another man and posted the video online. And the connection between health and human rights is not limited by national borders. In Senegal in 2008, nine male HIV prevention workers were imprisoned for “acts against nature” prohibited by Senegalese law. Subsequent study showed that this singular event had a chilling effect on HIV prevention activities among Senegalese men who have sex with men (MSM). The majority of service providers suspended HIV prevention work with MSM out of fear for their own safety, and those who continued to provide services noticed a sharp decline in MSM participation. The study concluded that an effective response to the HIV epidemic in Senegal should include active work to decrease enforcement of this law (…or eliminate it!).

In our context, LGBT health education, a core principle is the recognition of how difficult it is to be LGBT and not feel the impact of reports of institutionalized and individual violence and discrimination, even when they take place at a great distance from home. In thinking about what we teach about LGBT health to health care organizations, schools, and other institutions, our work to improve health must start with identifying situations that jeopardize the safety and comfort of the individual to authentically express basic human desire.

It is for this reason that we cannot overstate the importance of recent statements by President Obama, Hillary Clinton, and the United Nations on this topic.

President Obama’s presidential directive International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons directs U.S. agencies to:

  • Combat the criminalization of LGBT status or conduct abroad.
  • Protect vulnerable LGBT refugees and asylum seekers.
  • Leverage foreign assistance to protect human rights and advance nondiscrimination.
  • Ensure swift and meaningful U.S. responses to human rights abuses of LGBT persons abroad.
  • Engage International Organizations in the fight against LGBT discrimination.
  • Report on the U.S. government’s progress

Speaking in Paris, Secretary Clinton unequivocally stated to the international community that, “Like being a woman, like being a racial, religious, tribal, or ethnic minority, being LGBT does not make you less human. And that is why gay rights are human rights, and human rights are gay rights.”

The United Nations just recently issued its first report on LGBT rights from the UN office of the High Commissioner for Human Rights (OHCHR) in Geneva. It outlines “a pattern of human rights violations… that demands a response,” and says governments have too often overlooked violence and discrimination based on sexual orientation and gender identity.

Violence against LGBT persons tends to be especially vicious compared to other bias-motivated crimes. (UN Issues First Report on Human Rights of Gay and Lesbian People)

Homophobic and transphobic violence has been recorded in every region of the world, the report finds, and ranges from murder, kidnappings, assaults and rapes to psychological threats and arbitrary deprivations of liberty. Not only are LGBT people affected by family and community violence, but they are also targets of organized abuse from groups such as religious extremists, paramilitary groups, neo-Nazis, and extreme nationalists. Lesbians and transgender women are at particular risk. “Violence against LGBT persons tends to be especially vicious compared to other bias-motivated crimes,” the report notes, citing data indicating that homophobic hate crimes often include “a high degree of cruelty and brutality.” And violent incidents or acts of discrimination frequently go unreported because victims do not trust police, are afraid of reprisals, or are unwilling to identify themselves as LGBT.

December 6, 2011—Hillary Clinton addresses the UN to deliver the message that, “It should never be a crime to be gay.”

The report—prepared in response to a request from the UN Human Rights Council earlier this year—draws from information included in past UN reporting, official statistics on hate crimes, and reporting by regional organizations and NGOs. In the report, Navi Pillay, the UN High Commissioner for Human Rights, calls on countries to repeal laws that criminalize homosexuality, abolish the death penalty for offences involving consensual sexual relations, and enact comprehensive anti-discrimination laws. It is notable that in 76 countries it remains illegal to engage in same-sex conduct and in at least five countries—Iran, Mauritania, Saudi Arabia, Sudan and Yemen—the death penalty prevails.

Fortunately, there are recent and strong milestones towards progress. Only weeks ago on November 23rd, the Massachusetts legislature enacted a new law to protect transgender people from discrimination. The law, entitled An Act Relative to Gender Identity, will go into effect next July and will prohibit discrimination in several key areas, including employment, housing, and places of public accommodation. Recent studies estimate that there are 33,000 transgender residents living in Massachusetts that will benefit from this law. Click here for a press release.

While laws like this represent concrete steps in the right direction, prevalent instances of violence and discrimination, both international and domestic, still prevent LGBT people from seeking and receiving the health care they need. Negative attitudes have a chilling effect on LGBT people and lead to behavioral and other health disparities. If we are to be successful in our efforts to eliminate LGBT health disparities we must focus on the root causes of stigma and discrimination. This will be an important driver for our work ahead.

Respect for human rights in the context of HIV/AIDS, mental illness, and physical disability leads to markedly better prevention and treatment. Respect for the dignity and privacy of individuals can facilitate more sensitive and humane care. Stigmatization and discrimination thwart medical and public health efforts to help people with disease or disability. (UN Issues First Report on Human Rights of Gay and Lesbian People)

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