Trust and Inclusion are essential approaches for global health
Today marks the International Day Against Homophobia, Biphobia, and Transphobia (IDAHOBIT) with the theme Together Always. It highlights the importance of equitable and inclusive healthcare services for LGBTQI+ individuals.
LGBTQI+ individuals face considerable challenges in achieving health equity. These challenges result from discrimination, stigma, social marginalization, and even violence. Consequently, LGBTQI+ communities experiences higher rates of suicide than ‘average’ along with depression, anxiety, and other mental health issues. Rates of drug use are higher than in most populations at large, and the transmission of sexually transmitted infections are frequently an indirect result of the stigma, shame and secrecy that prevents people seeking medical treatment and advice. The COVID-19 pandemic exacerbated these factors, with lockdown directives, isolation, increased stress, exposure to harm and violence at home, and forced homelessness through poverty and exclusion from employment or key government or health services. It is also important to consider the intersection between these structural barriers and gender, disability, education, race, religion, and socioeconomic status. The health of LGBTQI+ people with intersectional identities, such as black or refugee, and those with low socioeconomic status, is particularly vulnerable.
We are currently witnessing rollbacks on LGBTQI+ rights in many countries, with Uganda and the US as recent examples. This is concerning and has negative implications for the well-being and health outcomes of LGBTQI+ individuals worldwide. There are still 67 countries where homosexuality is criminalized, with sentences varying from imprisonment to execution. Laws and regulations that criminalize and stigmatize sexual orientation and gender identities are major sources of health-related discrimination and violence. These harms are experienced as manifold personal and structural barriers in everyday health situations.
Achieving equity in health underpins the strategy of the WHO Foundation to help achieve help for all, and addressing the structural factors that prevent this, are core to its mission. More work is needed to include LGBTQI+ communities in national health policies and practices, in order to increase access to integrated health care. In countries where measures against the LGBTQI+ communities are discriminatory, people are more likely to encounter healthcare providers who are neither trained in nor knowledgeable about their specific health needs. This lack of competency can lead to health workers denying care as well as providing inadequate or inappropriate care, further discouraging individuals from seeking services and, at worst, resulting in negative health outcomes.
Most recently, we saw the essential role of trust in demystifying and tackling stigma, racism, and discrimination faced when mpox was highlighted as a public health emergency. Fear, stigma, and discrimination can prevent people from accessing correct information or health care. Harmful narratives were directed against the communities most affected by the disease. The WHO mpox public health guidance was developed using the lessons learned from decades of HIV response, which served to dismantle stigmatizing views.
The mental health of young LGBTQI+ individuals is another priority area that has been long neglected. Young LGBTQI+ people have a higher incidence of mental health issues than their peers as a result of the many issues they face, including victimization, violence (both physical and psychological), stigma, bullying, lack of family acceptance, and discrimination. Mental health conditions can manifest as suicidal ideation and action, drug and alcohol misuse. The need for culturally competent health care workers as they deal with their unique challenges is important as we aim to save lives and ensure the wellbeing of future generations.
Health for All is person-centered
Achieving equity in health underpins the strategy of the WHO Foundation to help achieve health for all. Addressing the structural factors that stand in the way of this, are core to its mission.
A report by the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity sets out how healthcare can be more equitable. Health care is not delivered within a bubble, to ensure equitable access to healthcare, there needs to be progressive changes in laws and policies which allow LGBTQI+ individuals to fully enjoy their human right to health and free expression.
Health services need to be equitable & non-discriminatory, of quality, and person-centered with healthcare staff that are compassionate and non-judgmental. Health services should be shaped and include the voices and needs of the LGBTQI+ community in every aspect of care. Contextualized and evidence-based health interventions must be developed and implemented based on information gathered from the LGBTQI+ community.
It is crucial to advocate for the protection and advancement of LGBTQI+ rights in global health initiatives. Without a connection to the lived experience of those who experience violence and prejudice because of sexual orientation or gender identity, the mantra to “ensure healthy lives for all, leaving no one behind” will remain superficial. We must always look at health interventions from a non-discrimination and intersectional lens. By integrating LGBTQI+ inclusion into global health efforts, we can work towards a more equitable and just healthcare system that meets the diverse needs of all individuals, regardless of sexual orientation or gender identity. Everyone deserves access to quality health services and the opportunity to lead healthy lives free from discrimination and ill health.
By Martina Dhliwayo – Emergencies Officer and Tia Jeewa – DEI Special Adviser.