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Article American Academy of Nursing on Policy| Volume 64, ISSUE 3, P279-280, May 2016

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Lesbian, gay, bisexual, and transgender health disparities are a global concern

        Increasingly, initiatives by civil societies, governmental and nongovernmental agencies, and international partners have highlighted inequities in health care access and health outcomes for lesbian, gay, bisexual, and transgender (LGBT) people throughout the world. The United States Agency for International Development promotes LGBT human rights globally through its LGBT Global Development Partnership and has a vision that “…the basic and universal human rights of LGBT persons are respected and they are able to live with dignity, free from discrimination, persecution, and violence” ().
        The U.S. Department of Health and Human Services acknowledges that LGBT persons across the globe “…face barriers to accessing health care…simply because of their sexual orientation or gender identity” (
        • Daulaire N.
        Perspectives: The importance of LGBT health on a global scale.
        ). Such barriers range from the denial of care to harassment or persecution when seeking care. In some parts of the world, lesbians who have been raped are denied appropriate care—or even vilified—because the rape may be viewed as an acceptable way to “correct” a woman's lesbian or bisexual orientation (
        • Reddy V.
        • Potgieter G.-A.
        • Mkhize N.
        Cloud over the rainbow nation: ‘Corrective rape’ and other hate crimes against black lesbians.
        ). Same-sex sexual behavior is illegal in 76 countries, and in at least 10 countries, it is punishable by death (
        • International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA)
        • Carroll A.
        • Itaborahy P.
        State sponsored homophobia 2015: A world survey of laws: Criminalisation, protection and recognition of same-sex love.
        ). In countries where same-sex behavior is a criminal offense, it is unlikely LGBT persons will reveal their sexual orientation to health care workers (
        Academy of Science of South Africa
        Diversity in human sexuality: Implications for policy in Africa.
        ,
        • Beyrer C.
        Pushback: The current wave of anti-homosexuality laws and impacts on health.
        ). The World Health Organization (WHO) notes that violence, abuse, discrimination, and a sense of isolation are strongly associated with suicidal behavior and that globally suicide rates are elevated among vulnerable groups such as LGBT people ().
        Historically, many of the world's LGBT health initiatives, including health research, have stemmed from efforts to curb the spread of HIV and other sexually transmitted infections (
        • Branstrom R.
        • van der Star A.
        All inclusive public health—What about LGBT populations?.
        ). Broader efforts have generally been met with resistance. For example, the 65th World Health Assembly in 2012 included a panel discussion on “Improving the health and well-being of LGBT persons.” An outcome of that discussion was the placement of the topic on the 2013 WHO Executive Board agenda. The item was removed from the agenda after two member states—Egypt and Nigeria—called for its deletion (
        • Daulaire N.
        Perspectives: The importance of LGBT health on a global scale.
        ). However, the Pan American Health Organization (PAHO; WHO regional office for the Americas) recently passed a resolution addressing disparities in health service access and utilization for LGBT persons (
        Pan American Health Organization (PAHO)
        Resolution CD52.R6 addressing the causes of disparities in health service access and utilization of lesbian, gay, bisexual, and trans (LGBT) persons.
        ).
        In 2011, U.S. President Barack Obama released an official memorandum to executive departments and agencies of the U.S. government that outlined the detrimental effects of LGBT stigmatization, discrimination, and criminalization across the globe and directed that concrete actions be taken to assure the human rights of LGBT persons (
        The White House
        Presidential LGBT memorandum—International initiatives to advance the human rights of lesbian, gay, bisexual, and transgender persons.
        ). Later that year, U.S. Secretary of State, Hillary Clinton, delivered the first ever address on LGBT human rights to the United Nations (

        Capeheart, J. (2011, December 7). Clinton's Geneva accord: ′Gay rights are human rights.' Washington Post, Retrieved from http://www.washingtonpost.com/blogs/post-partisan/post/clintons-geneva-accord-gay-rights-are-human-rights/2011/03/04/gIQAPUipcO_blog.html.

        ). Last year, the International Federation of Health and Human Rights Organizations, an organization of health professionals for human rights, sent a letter to President Museveni of Uganda deploring his signing of the Parliamentary Bill against Homosexuality and noting that “the World Medical Association condemns all forms of stigmatization, criminalization and discrimination of people based on their sexual orientation” (
        International Federation of Health and Human Rights Organizations
        Letter to the President of the Republic of Uganda regarding signing of the anti-homosexuality bill.
        ).
        The American Academy of Nursing supports initiatives by the U.S. government, WHO, the United Nations, and other entities that advance the human rights and health of LGBT persons across the globe by dismantling institutionalized barriers to health care access and services, eliminating stigma and discrimination based on sexual orientation or gender identity, and promoting health outreach to LGBT populations.

        Acknowledgments

        The authors gratefully acknowledge Tonda Hughes, Kevin Mallinson, and Carol Boyd for authoring the policy brief. The authors acknowledge all LGBTQ and Global Health expert panel members who contributed to the review of this policy brief.

        References

          • Academy of Science of South Africa
          Diversity in human sexuality: Implications for policy in Africa.
          2015 (Retrieved from)
          • Beyrer C.
          Pushback: The current wave of anti-homosexuality laws and impacts on health.
          PLoS Medicine. 2014; 11: e1001658
          • Branstrom R.
          • van der Star A.
          All inclusive public health—What about LGBT populations?.
          European Journal of Public Health. 2013; 23 (Retrieved from): 353-354
        1. Capeheart, J. (2011, December 7). Clinton's Geneva accord: ′Gay rights are human rights.' Washington Post, Retrieved from http://www.washingtonpost.com/blogs/post-partisan/post/clintons-geneva-accord-gay-rights-are-human-rights/2011/03/04/gIQAPUipcO_blog.html.

          • Daulaire N.
          Perspectives: The importance of LGBT health on a global scale.
          LGBT Health. 2014; 1: 8-9
          • International Federation of Health and Human Rights Organizations
          Letter to the President of the Republic of Uganda regarding signing of the anti-homosexuality bill.
          2014 (Retrieved from)
          • International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA)
          • Carroll A.
          • Itaborahy P.
          State sponsored homophobia 2015: A world survey of laws: Criminalisation, protection and recognition of same-sex love.
          ILGA, Geneva2015
          • Pan American Health Organization (PAHO)
          Resolution CD52.R6 addressing the causes of disparities in health service access and utilization of lesbian, gay, bisexual, and trans (LGBT) persons.
          in: 52nd Directing Council, 65th Session of the Regional Committee. Author, Washington, D.C.2013
          • Reddy V.
          • Potgieter G.-A.
          • Mkhize N.
          Cloud over the rainbow nation: ‘Corrective rape’ and other hate crimes against black lesbians.
          HSRC Review. 2007; 5: 10-11
          • The White House
          Presidential LGBT memorandum—International initiatives to advance the human rights of lesbian, gay, bisexual, and transgender persons.
          2011 (Retrieved from)
          • USAID
          LGBT global development partnership fact sheet.
          2015 (Retrieved from)
          • World Health Organization (WHO)
          Suicide.
          2014 (Retrieved from)