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

LGBT individuals around the world face considerable challenges and barriers to accessing needed health services, and as a result, may experience poorer health outcomes.1,2,3,4,5,6,7,8,9,10 Barriers can range from stigma, discrimination, rejection by families and communities, receipt of substandard care or outright denial of care, to violence, even killings, because of one’s sexual orientation, gender identity, and/or gender expression.11,12,13,14,15,16 Moreover, in many countries, the barriers faced by LGBT individuals include discriminatory laws and policies.17 Indeed, as of April 2014, 81 countries (77 countries and 4 entities/territories18) criminalized19 same sex behavior. Seven of these countries impose the death penalty (2 of which do so in parts of the country).20,21 While such laws are not necessarily enforced in every country, their presence can serve to reinforce stigma and legitimize violence and police brutality.22,23 And, in addition to the direct health consequences of violence towards LGBT people, there is a growing body of evidence documenting the health effects of criminalization laws, discrimination, and stigma.24,25,26,27,28,29,30,31,32,33 These include increased stress and depression, fear to seek care, increased risk behaviors, and greater prevalence of some diseases, perhaps most notably HIV, which continues to have a significant and disproportionate impact on men who have sex with men (MSM) and transgender individuals around the world.34,35,36,37 In addition to the negative effects on the health and health-care seeking behavior of LGBT individuals, such laws can impact health care providers and NGOs as well, as they can become targets or experience discrimination themselves for working with and providing services to LGBT populations.38,39

In recent years, the U.S. government has paid increasing attention to the health and human rights of LGBT individuals around the world, through both multilateral and bilateral channels. Of note, in 2011, President Obama issued a Presidential Memorandum on “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons40 in U.S. diplomatic and foreign assistance efforts, and the U.S. helped lead an effort resulting in the passage of the first-ever UN resolution on sexual orientation and gender identity.41,42

At the same time, many of the countries that criminalize same sex behavior 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 by the governments of Nigeria, Uganda, India, and Russia, have brought new scrutiny to these issues, and have heightened concern about the safety and well-being of LGBT individuals and the organizations that serve or employ them. There are also worries that other countries may soon follow suit.43,44,45,46,47 While the U.S. government has begun to lay the groundwork to enhance a focus on LGBT human rights and health in its foreign assistance programs, many questions and challenges remain about how it should chart a course forward in both the short and long term.

 

Executive Summary U.S. Government Efforts to Address Global LGBT Health to Date