A Silent Battle
Overcoming Barriers in LGBT Global Health
Silence = death. At the height of the HIV/AIDS epidemic of the 1980s, this iconic slogan represented a powerful movement that brought countless individuals to unite in solidarity to turn a “gay disease” into a cause worthy of the concern and support of the public. Silence and inaction became increasingly less tolerable, and health officials and the public alike understood that complacency meant a sure death sentence for many.
One of the great triumphs of the AIDS movement was the emergence of LGBT health as a focus area in which to address the various health concerns that disproportionately face this demographic. Lesbian, gay, bisexual, and transgender individuals worldwide are more vulnerable to sexually transmitted diseases, mental illness, drug abuse, violence, and homelessness. Because of stigma and intolerance, many LGBT patients will also experience discrimination and access issues when seeking health care. These disparities are often amplified in a great number of developing nations, where homosexuality is at times criminalized or even punishable by death.
While health authorities in some countries have made strides towards embracing a focus on LGBT health, countless nations have demonstrated opposition or silence towards these movements for complex religious, cultural, and political reasons. Nations with domestic LGBT health movements have struggled to expand these initiatives abroad. For a field that has long prided itself on its inclusion and advocacy, why is global health so far behind in confronting the silence and inactivity that continues to hold back progress for LGBT health worldwide?
Governmental Inaction
When the United Nations established the Sustainable Development Goals in 2015, many were shocked to see no mention of LGBT inequalities as a threat to international health and development. This reflects an ongoing battle for intergovernmental organizations like the UN and the WHO to acknowledge the human rights of LGBT people worldwide. While many countries in these assemblies do attempt to advocate for LGBT issues, the diplomatic structure of many international congresses makes it possible for dissenting nation states to easily block progress.
Most recently, when planning a high-level meeting to address the HIV/AIDS epidemic, 11 gay and transgender nongovernmental organizations were blacklisted from the global conference by Russia, Cameroon, Tanzania, and 57 Islamic nations. These banned groups represented a diverse group of regions from Russia to Jamaica that are devoted to addressing the health concerns of LGBT patients. Governmental opposition like this critically inhibits dialogue and action, leaving LGBT populations more vulnerable than ever as LGBT health remains largely undiscussed and lacking meaningful advocacy.
Barriers to LGBT health also exist at the national level. Within individual governments, anti-LGBT legislation creates further hurdles to improving health conditions worldwide, despite the Universal Declaration on Human Rights’ affirmation that discrimination based on gender or sexual identity is a breach of human rights. Many nations criminalize homosexuality, making it difficult to promote LGBT health initiatives as disclosing sexual identity may further jeopardize individual health. Other countries, while not criminalizing homosexuality, are at times in denial of the discrimination that LGBT individuals face in their population, creating a culture of silence and complacency. Considering these political barriers, how can those willing to support change act to address LGBT global health?
Aid and Empowerment
Many allies still question whether LGBT rights are even compatible with the developing world. Accordingly, much focus still remains on solely progressing LGBT rights in Western nations while other parts of the world are at times moving in the opposite direction on the issue, creating a “gay divide” of aid for LGBT health issues. A huge incongruity exists when some countries have normalized same-sex marriage while others subject LBGT individuals to corrective rape and death sentences. The de-prioritization of LGBT health in the developing world is the result of a lack of visibility of both LGBT issues abroad and the ongoing work being done by LGBT organizations in developing nations.
With national and local advocacy groups already doing some of the brave work of meeting the health needs of LGBT populations, responsibility lies on Western governments to engage with these groups and continue to pressure other governments to do the same. There are a variety of ways in which this can be done. Western LGBT support groups can broaden their mission to provide funding and aid to groups abroad. Donor governments can place pressure on beneficiary nations with homophobic laws to push for a change in legislation. Allied individuals can speak up and create a productive dialogue to end the silence around LGBT health in the developing world.
When discussing the need to address health disparities that target the LGBT community in Malawi, Global Health Corps fellow Chad Noble-Tabiolo explained that “these are not concepts that are philosophies of ‘the West,’ but moral ideologies that all [ought to] share.” Promoting LGBT global health will be a difficult task given how differing cultural norms create barriers for progress on the issue. Regardless, there is hope for this generation to lend our voices to ensure that advancing LGBT health abroad is no longer a silent battle, but another victory for international health.
