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.