Ensuring prioritisation of gender and sexual minority health as part of our demands for UHC and LGBT+ rights
Anita Raj is a Tata Chancellor Professor of Medicine and the Director of the Center on Gender Equity and Health at the University of California at San Diego (UCSD), as well as a Professor of Education Studies in the Division of Social Sciences at UCSD. She holds a secondary appointment as a Professor of Medicine at Boston University School of Public Health. Davey Smith is Professor of Medicine and Chief of the Division of Infectious Diseases and Global Public Health and Co-Director of the San Diego Center for AIDS Research at UCSD.
Much of our understanding and addressing of inequalities in health, particularly in low- and middle-income countries, is limited to people who are cis-gender and heterosexual. Health data that do exist on gender and sexual minorities—eg, lesbian, gay, bisexual, transgender, and gender non-binary people (LGBT+)—largely focus on risks for HIV and sexually transmitted diseases. Such focus can negate or hide broader health issues and inequalities these populations face.
Population-based studies from the USA and Sweden document lower health-care coverage and higher unmet social health and medical needs for sexual minorities relative to heterosexuals. While population-based research on gender-minority individuals is unavailable due to smaller numbers, available data document poor physical and mental health, substantial vulnerability to victimisation from interpersonal violence, and a high level of social stigma and discrimination that impedes health-care seeking. In particular, rates of violence against transgender women are very high, with a majority of them having experienced physical or sexual assault from a romantic or sexual partner. Such violence places them at increased risk of mental health concerns and HIV.
These health inequalities start early, with gender and sexual minority adolescents having increased risk of a variety of behavioural health issues, especially violence and suicidality, compared with their cis-gender and heterosexual peers. Tackling these health issues is complicated by the fact that, for both sexual and gender minorities, health providers themselves can often stigmatise their patients and discriminate against them in the provision of health care. Stigma and discrimination from providers builds and reinforces barriers to health care for these groups. Such issues are of even greater concern in the many countries in which same-sex behaviour or being transgender is criminalised—a form of structural violence rooted in social norms regarding male and female behaviour and compromising safety across genders and sexual orientations.
As we in global health and medicine move forwards from our celebration of Pride and continue our efforts towards achievement of UHC, let us remember to prioritise the elimination of health inequalities among sexual and gender minorities globally through both advocacy for policies that prevent ongoing discrimination AND through improvement of efforts to better reach and provide health-care services as part of our demand for LGBT+ rights.