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The U.S. Government and Global LGBT Health: Opportunities and Challenges in the Current Era

In recent years, the U.S. government has paid increasing attention to the health and human rights of lesbian, gay, bisexual and transgender (LGBT) individuals around the world, utilizing both multilateral and bilateral channels, including through a 2011 Presidential Memorandum on “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons” and diplomatic engagement at the United Nations (UN) and World Health Organization (WHO). Most of these efforts have been broadly cast as part of the U.S. government’s human rights policy, rather than through its global health strategies and programs, although they have included health elements. Still, however, many LGBT individuals continue to face stigma, discrimination, and violence, both within and outside of the health sector, which compromise their ability to access needed health services and can adversely affect health status. Moreover, in many countries, the barriers faced by LGBT individuals include discriminatory laws and policies. Indeed, in 81 countries, same sex behavior is criminalized; 7 of those countries impose the death penalty. Many of these countries receive U.S. global health assistance and/or are key strategic partners of the U.S., raising complex questions about how best to address the health needs of LGBT individuals within them. Recent actions to further criminalize same sex behavior and/or restrict the rights of LGBT persons and their supporters by the governments of Nigeria, Uganda, India, and Russia (and worries that other countries may soon follow suit), have heightened concerns about the safety of LGBT individuals as well as those who work to provide them services, raising the stakes in the conversation and introducing a greater sense of urgency. While the U.S. government has begun to respond to some of these recent cases, many questions and challenges remain about how it should chart a course forward, both in the short and long term.

To explore opportunities and challenges facing the U.S. government in this arena, the Kaiser Family Foundation convened two roundtable discussions (in October 2013 and March 2014) of high-level experts working on global LGBT health and rights as well as those working more broadly on global health. Participants included representatives from the U.S. government, multilateral institutions, non-governmental organizations, think tanks, and academia. This issue brief summarizes the main points of discussion raised by roundtable participants, focusing on opportunities, challenges, and potential next steps for the U.S. government to consider in addressing the health needs of LGBT individuals around the world (see Table 1). It also provides an overview of global LGBT health issues, and reviews U.S. government efforts to address global LGBT health to date.

Table 1: Summary of Key Challenges, Opportunities, and Next Steps
Challenges
Participants identified several significant challenges in addressing global LGBT health in the short and long term, including:

  • Lack of a proactive and/or coordinated U.S. strategy.
  • Reaching LGBT individuals with health interventions when they are criminalized by their State.
  • Addressing the immediate needs of those in danger.
  • Limited capacity of LGBT civil society.
  • Addressing claims of Western imperialism.
  • Managing the move toward increased “country ownership” of U.S. global health programs.
  • Ongoing data gaps and research needs.
Opportunities
Participants also recognized a number of opportunities for U.S. engagement, including:

  • More conducive U.S. policy environment for addressing LGBT human rights around the world.
  • Potential to augment a focus on global LGBT health within U.S. global health policy.
  • Increasing coordination between broader human rights, LGBT, and health groups on LGBT health issues.
  • Elevating LGBT voices in-country to help inform the U.S. policy response.
  • Using the Post-2015 framework.
  • Growing evidence base.
Looking Forward: Potential Next Steps
Participants outlined a number of concrete steps that could be taken in the short and long term to address global LGBT health issues, including:

  • Review U.S. health and development portfolios.
  • Develop proactive strategy for moving forward.
  • Consider appointing a U.S. “Special Envoy” or other high-level point person on LGBT issues.
  • Expand efforts to help LGBT individuals facing violence, arrest, and threats due to their sexual orientation or gender identity.
  • Articulate importance of continuing U.S.-funded health services.
  • Bolster PEPFAR’s focus on LGBT health access and safety.
  • Use Global Health Diplomacy.
  • Coordinate with other donor governments and multilateral organizations.
  • Engage the private sector.
  • Engage the faith community.
  • Build LGBT civil society.
  • Support data collection, analysis, and research on global LGBT health.
Introduction