PAHO/WHO calls for equitable access to care and respectful treatment for LGBTs in health services

Washington DC, 16 May 2013 (PAHO/OMS) — Prejudice, indifference, hatred, and discrimination all have negative effects on the health of lesbians, gays, bisexuals, and transgender people (LGBTs) in the Americas and hinder their access to health services. On the International Day against Homophobia and Transphobia, the Pan American Health Organization/World Health Organization (PAHO/WHO) is calling for the eradication of these attitudes and practices in schools, workplaces, and in public institutions, especially health services.

Rafael Mazin, PAHO/WHO's senior advisor on HIV, sexually transmitted diseases and hepatitis, notes that expressions of intolerance and hatred affect the well-being of people, families, and communities; cause suffering and stress; and increase other risks, such as of violence. For these reasons alone, homophobia and transphobia need to be addressed as public health problems. 

The International Day against Homophobia and Transphobia has been observed on May 17 each year since in 1990, when WHO eliminated homosexuality from the International Classification of Diseases (ICD). Until then, the health sector and society in general had believed that the sexual orientation of lesbians, gays, and bisexuals was a "disease" or "illness."

The ICD still regards transgender people as "patients" because their identity does not conform to the sex assigned to them at birth. Although experts say that this designation does not mean that they have a psychopathological condition, it has given rise to requests to review the classification. Mazin notes that when transgender people receive support and are treated with respect, consideration, and solidarity, "they are as well-adapted, productive, and as happy as anyone else."

In addition to the impact of intolerance on the emotional and mental health of LGBTs, these people are at greater risk of being injured by physical violence. Gay men and transgender women are frequent victims of crimes of hatred and homicide, crimes that are often reported as "crimes of passion" rather than the expressions of extreme intolerance that they actually are.

Many gay men and lesbians, bisexuals, and transgender people are still being subjected to sexual abuse under the pretext of "curing" their sexual orientation. In a technical position statement published in May 2012, PAHO says that this "conversion" therapy has no medical basis and poses a serious threat to the health and well-being of those who are subjected to it.

Increased risk of contracting HIV among men who have sex with men

HIV infection disproportionately affects homosexual men, bisexuals, and transgender women. Some studies suggest that prevalence of HIV infection among men who have sex with other men may be 10 to 15 times greater than in the general population. A meta-analysis published in the December 2012 issue of The Lancet concluded that the rate can be at least 20 times greater for transgender women.

Although there are no published studies examining the situation in Latin America and the Caribbean, unpublished research suggests that transgender people have fewer educational and social opportunities, which means that they often resort to sex work. Many of them live in extreme poverty.

There is also preliminary evidence that many LGBTs fail to seek needed medical treatment. This situation could be related to low health literacy and lack of knowledge about preventive practices, but Mazin warns that it could also be related to the persistence of homophobia and transphobia in many health services.

"Many gays and transgender women avoid going to the hospital for fear of being insulted or abused," Mazin notes, "and this exclusion contributes to overall deterioration of their health and even premature death." Transgender women have a shorter life expectancy than the rest of the population, according to estimates, and this is at least in part because unequal access to health services.

International agreements exist on the rights of lesbians, gays, bisexuals, and transgender people. In a 2012 resolution (AG/RES, 2721), the Member States of the Organization of American States (OAS) reaffirmed their commitment to the prevention of violence, discrimination, and human rights violations against LGBTs because of their sexual orientation or gender identity.

Considerate and respectful treatment, together with equitable access to health services, can help to protect the lives and the health of these human beings.