Will the UN ‘leave no one behind’ and improve LGBTI health and well-being?

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A new report illustrates how the UN Sustainable Development Goals can ensure healthy lives and promote well-being for all, including LGBTIQ people, writes Dr Felicity Daly.

WHILE AUSTRALIA has an established tradition of researching the health and well-being of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people, elsewhere in the world such research is often inadequate and incomplete.

A new report published by OutRight Action International, the Global Forum on MSM and HIV with input from the Australian Research Centre in Sex, Health & Society, highlights the available data suggesting that LGBTI people’s health is consistently poorer than the general population. 

Agenda 2030 for LGBTI Health and Well-Being, has been written in advance of the High Level Political Forum on Sustainable Development which convenes from 10-19 July 2017 at the United Nations in New York. At this meeting, UN member states will review progress on implementation of the Sustainable Development Goals — a plan of action for ‘people, planet and prosperity’.

The aspiration of the SDGs to ‘leave no one behind’ can be utilised to improve the health and wellbeing of LGBTI. UN officials, former Secretary General Ban Ki-Moon and the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity Professor Vitit Muntarbhorn, have made it clear that the SDGs are inclusive of all people regardless of their sexual orientation, gender identity and expression, and sex characteristics.

LGBTI people have a right to health the same as all other people and LGBTI health concerns should be included in the implementation of the health goal — SDG 3. Thus Agenda 2030 for LGBTI Health and Well-Being reviews data from low- and middle-income countries, which shows that compared with the general population gay, bisexual men and other men who have sex with men are 19 times more likely to be living with HIV, and transgender women are 49 times more likely to be living with HIV.

The report notes that the health concerns of lesbian and bisexual women, trans and intersex people have all too often been overlooked. Additionally, data is presented that demonstrates that LGBTI people also experience: poor mental health, higher prevalence of alcohol and substance abuse, lack of access to sexual and reproductive health services, and inadequate funding for inclusive and effective health interventions. 

The common drivers behind these health disparities are violence, criminalisation, social exclusion and discrimination, including widespread discrimination LGBTI people experience in health care settings. Ironically, this means that very often LGBTI people are rendered invisible in efforts to collect health data, which do not include questions about sexual orientation, gender identity and expression and sex characteristics.

The lack of data poses problems in effectively targeting health services to help those in most need. While Australia has effectively used research to inform HIV prevention and care for gay and bisexual men, and other affected populations, this has not been the case in most countries. Missing health data makes it harder for LGBTI people to advocate for resources they need and becomes an excuse for governments hostile to LGBTI populations to ignore the health needs of LGBTI people.

Moreover, data about LGBTI health overwhelmingly represents research conducted in high income countries where there has been social and legal progress for some sexual and gender minorities. For example, a systematic review of general population studies conducted in Australia, Europe and North America found that, compared with heterosexual people, lesbian, gay, and bisexual people are at higher risk for mental disorders, including depression and anxiety, suicidal ideation and deliberate self-harm. Data gaps are starkest in countries where discrimination based on sexual orientation, gender identity or gender expression and sex characteristics is entrenched in law.

There are no specific indicators in the SDG framework that measure the health specifically for LGBTI people. Nevertheless, states can voluntarily report on progress and we urge them to do so in order to live up to the commitment to ‘leave no one behind’. Agenda 2030 for LGBTI Health and Well-Being details the type of data UN member states should collect to effectively monitor implementation of the targets of SDG 3 in a way that improves the health and well-being of LGBTI people. We want to ensure member states ask the right questions in order to understand and monitor health and well-being among LGBTI people. We urge that they also focus on ending stigma and discrimination which has a major detrimental impact on health and well-being and also poses barriers to accessing health care services that LGBTI people need.

We stress that all member states must repeal the laws, policies and practices that criminalise same sex behaviour and limit the ability of people to express, and have legally recognised, their gender identity and legally prohibit non-consensual medical procedures, including intersex genital mutilation, forced sterilisations as requirements for gender recognition, as well as forced anal examinations. 

LGBTI people are well aware of the health disparities taking hold and stealing lives in their communities, but insufficient evidence makes it harder to make a convincing case. Australia has shown that conducting research with LGBTI people can improve the health and well-being of the community and we hope others countries will follow that lead.

Download the full 'Agenda 2030 for LGBTI Health and Well-Being' report HERE. Download the fact sheets for the report HERE.

Dr Felicity Daly is the Global Research Coordinator for OutRight Action International.

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