The first significant barrier highlighted in many studies was the total lack of services designed to support the health and well-being of LBT+ communities.
In Botswana, for example, there is no public healthcare support for trans communities to medically transition, meaning that only those with the income required to access private healthcare can afford hormone therapy and other care. Of 24 research participants, 20 said they wanted to medically transition, but of these:
‘only three study subjects indicated that they had begun transitioning medically. All three had accessed or acquired hormones from a private health facility… were employed or self-employed… had medical health coverage and had a personal doctor or health care provider they saw regularly.’
In Venezuela, there is a complete lack of public access to hormone treatments for all trans communities. In Brazil, this public healthcare commitment exists in principle, but in practice specialised healthcare units in hospitals and clinics are not consistently available across the country. This leaves trans communities in many cities and regions poorly served.
Additionally, various studies noted that a lack of knowledge and training among healthcare practitioners were serious barriers to proper treatment.
Many studies address how significantly norms, myths and stereotypes can disadvantage LBT+ communities when it comes to healthcare.
In Ecuador, 58 per cent of respondents reported that they were presumed to be heterosexual by healthcare providers, and in Zambia some participants ‘reported being asked by healthcare providers to bring their husbands’ to appointments. In Peru, respondents reported that 61.4 per cent of mental healthcare providers had expressed at least one prejudicial attitude about being LGBTI. The most common prejudice among them was ‘a person turns LGBT because that person suffered sexual violence during their childhood’.
Additionally, the idea that LBT+ people are not a ‘normal’, ‘natural’, ‘moral’, ‘healthy’ and/or ‘reproductive’ part of the societies in which they live plays a significant role in LBT+ people being underserved by healthcare providers. In Zambia, researchers concluded that:
Healthcare providers’ refusal to provide care to LBT patients based on different personal norms and belief systems, and perceptions that non-normative sexual orientations and gender identities are immoral and unnatural […] has fuelled the levels of stigma and discrimination towards the target group and demotivates them from accessing services.
There was evidence of coercive and harmful medical practices being used against LBTI+ communities across the studies. Central to this were so-called ‘conversion therapies’, where medical practitioners, families, wider communities, and religious authorities were shown to work in coordination with one another.
In Peru, a striking proportion of respondents, 34.8 per cent, reported they had participated in ‘conversion’ therapies intended to change their sexual orientation or gender identity. Parents or wider family members were involved in most cases (55.9 per cent), whether on their own or in collaboration with religious authorities.
Numerous studies show a pattern of justifying harm in the name of treatment, and of blaming LBT+ people themselves, and their sexuality, for their health problems. In Chechnya, there were many examples of unnecessary ‘treatment’ of LBQ women in healthcare settings. One example involved the government-linked Boyev’s Clinic in Gorzny, which provides ‘psychiatric treatment to those rendered unfit to the Chechen society’. Alisa was a victim of severe mistreatment who said that her parents, upon finding out that she was queer, took her to the Boyev’s clinic. She was forced to sign papers stating that it was a voluntary hospitalisation and stayed there for at least four weeks, being drugged:
‘I could barely focus; I was in a vegetative state or so. During the times when I was able to think clearly, I begged them to let me go. But all they told me is that it was for my own good, that it would make me healthy.’
The studies also contain specific examples of damaging practices in mainstream healthcare settings. In Jamaica, a patient described visiting a private doctor with blackouts. The doctor asked a series of ‘humiliating’ questions about her sexual practices, in front of her father, in a way which outed her without her consent. The doctor then blamed the respondents’ blackouts on her anal sexual practices and proceeded to undertake a rectal examination ‘absent of sensitivity and dignity’. In Zambia, there was also a prevalence of ‘forced subjection’ to ‘religious practices’ which served as a further barrier to proper LBT+ healthcare.
These examples show a pattern of justifying harm in the name of treatment, and of blaming LBT+ people themselves, and their sexuality, for their health problems.
The research projects undertaken as part of the Out of the Margins project prove that LBT+ people face massive challenges in accessing appropriate, high quality healthcare, and this is fuelled by wider social and economic exclusion. This in turn is likely to result in poorer health, and may also impact on civil and political rights.
Out of the Margins used the UN’s Sustainable Development Goals to guide their research. These include the aim to ensure healthy lives and promote well-being for all, at all ages. This report makes clear exactly how crucial it is that the SDGs are met, and the difference it will make for LBT+ people when they are. For more information, and to read the whole report, click here.