Discrimination Against the LGBTQ+ Community in Healthcare

The LGBTQ+ community is quite large, and it spans so many different races, countries, ages, social classes and religions. This community is one that has only started getting the representation it deserves in recent years and for many years it has been discriminated against. Nowadays, with more attention being brought to the discrimination and stigma this community faces, many countries, businesses and people are starting to change their views and make themselves more inclusive. That said, there are still many elements of life—like healthcare—that aren’t easy to get through for members of the LGBTQ+ community. This is because of the discrimination they face from the people hired to do these jobs.

So, why healthcare? Because healthcare is one of the most important things that is currently being withheld from a lot of members of the community. Many doctors who are still practicing are very uninformed about certain specific needs that members like transgender people have. They also ask inappropriate questions that make patients uncomfortable and they often refuse to treat members of the community altogether. According to Jamison Green, a 70-year-old transgender man, “One of the worst things is just anticipating having to explain yourself.” This discourages many people from going to their doctors for issues because they fear being judged and discriminated against. Dr Mitchell Lunn, a co-director of The PRIDE Study - a comprehensive national health study for LGBTQ+ people - says that they “hear stories very frequently from people going into a provider's office and having an inappropriate encounter,” with their provider. According to a study conducted in 2015 by Lambda Legal, more than 50% of lesbian, gay and bisexual people had been victims of discrimination while looking for healthcare and 70% of transgender persons faced discrimination while seeking healthcare for themselves. The consequences of this can often be life-threatening and very dangerous.

What laws and legal frameworks relating to healthcare are there that aid this community around the world?

Europe

8 member states of the EU–Belgium, Bulgaria, Germany, Spain, Austria, Romania, Slovenia and Slovakia—all have anti-discriminatory legislation that covers discrimination based on sexual orientation when it comes to employment, as well as all other areas described in the Racial Equality Directive. 10 member states of the EU—the Czech Republic, Ireland, Latvia, Lithuania, Luxembourg, Hungary, Netherlands, Finland, Sweden and the UK—have anti-discriminatory legislation that is partially extended to cover discrimination based on sexual orientation in areas other than employment. In Denmark, Estonia, Greece, France, Italy, Cyprus. Malta and Poland, anti-discriminatory legislation only covers discrimination based on sexual orientation in employment, but Estonia, France, Greece and Poland are debating an extension to the legislation.

Despite these legal protection members of the LGBTQ+ community still face discrimination when it comes to healthcare and healthcare providers. They are often refused entry to visit their partners or children in hospitals and are charged higher premiums on insurance. They don’t have access to the social benefits that married couples have and many have been refused rent and struggle to find places to live.

The EU has conducted multiple investigations on the inequalities faced by this community in healthcare. One of them is the Health4LGBTQ pilot project which was financed by the European Parliament and ended in 2018. The program reviewed issues like access to care and developed a practical training package for doctors and professionals. So far it has been piloted in Bulgaria, Lithuania, Italy, the Netherlands, Poland and the UK. On the 14th of February, 2019, a resolution was reached in parliament, to ask the European Commission to make LGBTI rights a priority in 2019-2024.

The USA

In America, protections vary by state but as can be seen in the figure above 54% of the LGBTQ population live in states that specifically include healthcare-related to gender transition as part of their Medicaid coverage. 25% live in states that don’t have explicit policies about transgender care and health coverage from Medicaid coverage. 21% live in states that explicitly exclude transgender health coverage and care from Medicaid coverage.

From the map above, you can see that 38% of the LGBTQ population live in states that give transgender employees access to transgender and transition-related healthcare from their state employee health benefits. 41% live in states that don’t encompass transgender and transition-related healthcare as part of their state employee health benefits. 21% live in states that explicitly omit transition-related healthcare from their state employee benefits.

As is shown in the map above, 57% of the LGBTQ population live in states that forbid transgender exclusions in health insurance. 42% live in states with insurance protections that encompass gender identity and sexual orientation. 13% live in states with insurance protections that cover solely gender identity. 0% live in states with insurance protections that cover only sexual orientation. 45% live in states that don’t carry LGBT inclusive insurance protections.

According to the 2015 U.S. Transgender Survey, 25% of responders had problems with their health insurance because they were transgender. 55% of respondents who looked for coverage relating to transition surgery were denied it and 25% who looked for coverage for hormones were denied. 33% of responders who saw a healthcare provider, noted that they had had negative interactions related to them being transgender with higher rates for transgender persons who were disabled or POC. That includes being verbally harassed, physically or sexually assaulted or the person had to teach the provider about trans healthcare to receive adequate treatment. 23% of the responders did not visit a doctor when they needed to because they were scared of being mistreated because they were transgender.

South America

In Argentina, the law allows people to undergo gender reassignment surgery if they feel the need to and they are also allowed to change their gender on government documents officially, free of charge. In Bolivia, the new Constitution which was ratified in January of 2009 and the Law Against Racism from October of 2010, prohibit discrimination based on sexual orientation and gender identity from individuals as well as public and private institutions. The 2004 Reproductive Rights Law also gives rights to all citizens notwithstanding sexual orientation.

In May 2011, Brazil’s Supreme Court ruled that same-sex unions were legal, and gay couples had the same rights as heterosexual couples which includes health pension. The public health system also gives free sex-change operations with a legal framework from Brazil’s Federal Medicine Council. In Cuba, sex reassignment surgery has been done for free since 2008.

The 1998 constitution of Ecuador banned discrimination based on sexual orientation and the 2008 constitution includes gay rights as well. Transgender people are also allowed to change their gender on their identity cards by request in court. In México, same-sex couples were legally granted access to health benefits from the Institute for Social Security and Services for State Workers in May 2013.

Lastly, in Uruguay, the Civil Union Law from December 2007 allows married same-sex couples rights to health benefits, pension, inheritance and parenting benefits on the condition that the couple has been together for a minimum of 5 years. A law was passed in December 2009 that allows same-sex couples to adopt children legally. Uruguayan citizens are also allowed to change their name and gender on legal documents without having to first undergo surgery, thanks to the Gender Change Law passed in November 2009.

Africa

In Angola, Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe, the constitution recognises transgender peoples right to be free from discrimination. All of these countries mentioned, have signed and ratified the African Charter on Human and People’s Rights. Article 2 of the ACHPR states that “Every individual shall be entitled to the enjoyment of the rights and freedoms recognised and guaranteed in the present Charter without distinction of any kind such as race, ethnic group, colour, sex, language, religion, political or any other opinion, national and social origin, fortune, birth or another status”.

Article 12.1 of the International Covenant on Civil and Political Rights expresses that “The States Parties to the present Covenant recognise the right of everyone to the highest attainable standard of physical and mental health,” yet many members of the LGBTQ+ community still don’t receive adequate healthcare and services.

In most parts of Southern Africa, hormone treatment still is not easily available. In Angola, there is no legal access to gender reassignment surgery or hormone treatment. In Botswana, there is no access to gender reassignment surgery and although it is legal, access to hormone treatments is also limited because most hospital staff have transphobic views. Transgender persons often have to go under invasive tests before they can be allowed to undergo hormone treatment. The National Strategic Framework for HIV and AIDS 2010-2016 includes plans to ensure equal access to healthcare regardless of sexual orientation and even mentions gay men specifically in plans to develop programmes to address HIV.

In Lesotho, members of the LGBTQ+ community are often victims of discrimination from hospital workers. Because gender reassignment surgery and hormone treatments are also unavailable, people have to go to South Africa to get these things done and it is extremely expensive. The Lesothan National HIV and AIDS Strategic Plan 2011/12-2015/16 includes gay men and sex workers but not lesbians and transgender people.

In Malawi, there is no access to gender reassignment surgery and just like a lot of other African countries, member of the LGBTQ+ community face a lot of discrimination from hospital staff. Section 19(1) of The Gender Equality Act of 2012 states that “every person has a right to adequate sexual and reproductive health” and this encompasses the right to access sexual and reproductive services as well as family planning services. It also encompasses the right to protection from STIs, the right to choose how many children and when to bear them and the right to control fertility and choose appropriate methods of contraception. To summarise section 20(1): Health officers must respect the sexual and reproductive rights, respect the dignity and integrity of any person accessing sexual and reproductive health services, and provide family planning services to any person demanding them regardless of marital status or accompaniment by a spouse, all without discrimination. Any person found violating this “commits an offence and is liable to a fine or imprisonment for three years”.

In Namibia, transgender people can apply to change their sex description legally and hormone therapy is available privately but isn’t funded by the state and so it can be very expensive.

In South Africa, the right to health care comes under Section 27 of the Constitution and hormone replacement treatment is available after the age of 18. In Zimbabwe, the right to health care comes under Section 76 of the Constitution and Section 29.1 says that “the State must take all practical measures to ensure the provision of basic, accessible and adequate health services throughout Zimbabwe”.

Why is it so important for countries all over the world to recognise and protect these communities?

Governments must recognise the discrimination that is so deeply rooted in the history this community has because without the representation the community deserves, they won’t ever be treated as equal human beings. Many countries have already introduced policies and legislation to protect members of this community from discrimination yet the prejudice against members is still very prominent. Healthcare is one of the most important aspects of adult life and life in general and so it is only fair that everyone receives the same standard of care regardless of their sexual orientation or gender identity. At the end of the day, we are all humans and we all deserve to be treated impartially.

For the original article and citations please see this link: https://docs.google.com/document/d/1Ie31ctFEKbezyxgS1bxvbqEEGdzB1PSIqVWOBiY7c-E/edit?usp=sharing