Health for All, Means All

By Mandeep Dhaliwal, Director of HIV, Health and Development, United Nations Development Programme

Negative rhetoric against LGBTI people and crackdowns on civil society are shaping an environment of fear and repression in countries around the world, driving individuals underground and away from health systems and services. At the same time, many countries are taking steps to achieve universal health coverage — the idea that everyone, everywhere should have access to a set of essential health services without experiencing financial hardship.

LGBTI rights and universal health coverage have long been viewed as distinct issues, but the reality is that the two go hand in hand. Around the world, repressive laws and policies that impede the rights of LGBTI individuals are having devastating consequences for their health. Countries cannot achieve “health for all” as long as LGBTI individuals continue to encounter stigma, discrimination, violence and criminalization that deters them from accessing health services.

LGBTI individuals face unique and significant health challenges, making it especially important for them to have a trusted and quality source of health care. Men who have sex with men are 24 times more likely to acquire HIV than the rest of the population, and transgender women are 49 more times more likely.

The problem is not limited to HIV. LGBTI individuals are also especially vulnerable to mental health disorders and substance abuse due to the stigma, discrimination and social exclusion they face on a regular basis. In all regions of the world, studies have found that transgender people, men who have sex with men, and other LGBTI individuals suffer from depression at significantly higher rates than the rest of the population. Youth often bear the greatest burden — in some countries, more than half of young LGBTI people report self-harm.

Despite their health needs, LGBTI individuals are often unable to access HIV and other health services because of punitive laws and policies. A recent report published by the Global Commission on HIV and the Law highlighted the extent to which bad laws and policies, including those that criminalize homosexuality, are fueling the global HIV epidemic. In countries where being homosexual is a crime, LGBTI people are less likely to seek out health services due to fear of prosecution. And with governments around the world taking steps to crack down on LGBTI civil society groups, service providers outside the formal health system are often unable to step in and offer the essential health services that LGBTI individuals need and deserve.

Even where homosexuality is not criminalised, LGBTI individuals often face difficulties in accessing health services because of fear of discrimination, high costs and lack of social support. Access to sexual and reproductive health (SRH) services — including commodities for safer sex like condoms and lubricants — remains especially limited. For example, repressive global policies are impede access to sexual and reproductive care services for LGBTI people.

In the era of the Sustainable Development Goals, we simply cannot neglect LGBTI people in the global health and development efforts any longer. A new discussion paper by the United Nations Development Programme, published this week, highlights the extent to which LGBTI individuals are being left behind in sustainable development efforts and outlines suggested areas for policy and programme action, including steps to improve their access to health and social services.

As countries around the world celebrate their commitments to scaling up universal health coverage this week, it is important to remember that “health for all” means health for all, including sexual and gender minorities. We simply cannot afford to leave LGBTI people behind.

* LGBTI stands for lesbian, gay, bisexual, transgender and intersex.