RESUMO
INTRODUCTION: Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices. METHODS: We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations. RESULTS: A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP. CONCLUSIONS: Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essential.
Assuntos
Infecções por HIV , Humanos , Masculino , Infecções por HIV/psicologia , Infecções por HIV/epidemiologia , Feminino , Minorias Sexuais e de Gênero/legislação & jurisprudência , Minorias Sexuais e de Gênero/psicologia , Pessoas Transgênero/psicologia , Pessoas Transgênero/legislação & jurisprudência , Ásia Central/epidemiologia , Comportamento Sexual , Direitos Humanos/legislação & jurisprudência , Estigma Social , Tadjiquistão/epidemiologia , Identidade de Gênero , Adulto , Armênia/epidemiologia , Ucrânia/epidemiologia , Quirguistão/epidemiologia , Uzbequistão/epidemiologia , Cazaquistão/epidemiologia , Europa Oriental/epidemiologiaRESUMO
BACKGROUND: Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW. PURPOSE: To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set. METHODS: Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women). RESULTS: Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women. CONCLUSIONS: Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.
Previous studies have found that sexual minority women (SMW) are more likely to report adverse infant outcomes, particularly for women who do not live in states with anti-discrimination policies against lesiban, gay, bisexual, transgnder, or queer (LGBTQ) populations. This is the first to examine sexual orientation disparities in prenatal care use using a nationally representative, prospective data set. Additionally, we examined whether prenatal care use varied by the number of state-level policies that protect against discrimination based on sexual orientation. Our results show high rates of prenatal care use in the first trimester across all sexual orientations, however, in states with states with two or more policies that prevent discrimination by sexual orientation, sexual minority women were more likely to access prenatal care in the first trimester than heterosexual women. These findings suggest that more inclusive state-level environments promote healthcare-seeking behaviors during pregnancy for sexual minority women.
Assuntos
Primeiro Trimestre da Gravidez , Cuidado Pré-Natal , Minorias Sexuais e de Gênero , Humanos , Feminino , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Cuidado Pré-Natal/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Estudos Prospectivos , Adulto Jovem , Adolescente , Estudos Longitudinais , Comportamento Sexual/estatística & dados numéricosRESUMO
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
Assuntos
Disparidades em Assistência à Saúde , Minorias Sexuais e de Gênero , Humanos , Minorias Sexuais e de Gênero/legislação & jurisprudência , Estados Unidos , Masculino , Feminino , Relações Médico-Paciente , Acessibilidade aos Serviços de Saúde , Sociedades Médicas , Disparidades nos Níveis de Saúde , Discriminação Social/legislação & jurisprudênciaRESUMO
This Viewpoint explores Centers for Medicare & Medicaid Services guidance on the collection of sexual orientation and gender identity data and how these data could be used to advance health equity for LGBTQI+ people.
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Equidade em Saúde , Medicaid , Minorias Sexuais e de Gênero , Feminino , Humanos , Coleta de Dados , Equidade em Saúde/legislação & jurisprudência , Equidade em Saúde/estatística & dados numéricos , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Minorias Sexuais e de Gênero/legislação & jurisprudência , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estados UnidosRESUMO
A deluge of state "anti-equity" legislative bills seek to reverse prevailing trends in diversity, equity, and inclusion; withdraw protections of LGBTQ+ communities; and deny access to gender-based care for trans minors and adults. While the political and constitutional fate of these acts is undetermined, profound impacts on patients and their providers are already affecting the delivery of health care and public health services.
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Saúde Pública , Humanos , Estados Unidos , Saúde Pública/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Atenção à Saúde/legislação & jurisprudência , Equidade em Saúde/legislação & jurisprudência , Masculino , Feminino , Pessoas Transgênero/legislação & jurisprudênciaRESUMO
Industry-funded religious liberty legal groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers' growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system's delegated structure to transform social policy and bureaucratic agencies more generally.
Assuntos
Direitos Civis , Política de Saúde , Humanos , Direitos Civis/legislação & jurisprudência , Estados Unidos , Política de Saúde/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Governo Estadual , LiberdadeRESUMO
This Viewpoint summarizes existing federal regulations aimed at protecting research data, describes the challenges of enforcing these regulations, and discusses how evolving privacy technologies could be used to reduce health disparities and advance health equity among pregnant and LGBTQ+ research participants.
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Confidencialidade , Regulamentação Governamental , Gravidez , Sujeitos da Pesquisa , Pesquisa , Minorias Sexuais e de Gênero , Feminino , Humanos , Confidencialidade/legislação & jurisprudência , Anonimização de Dados/legislação & jurisprudência , Governo Federal , Consentimento Livre e Esclarecido/legislação & jurisprudência , Informações Pessoalmente Identificáveis/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Recusa de Participação/legislação & jurisprudência , Pesquisa/legislação & jurisprudência , Sujeitos da Pesquisa/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Estados UnidosRESUMO
This Viewpoint examines the importance of the Supreme Court decision in 303 Creative and its possible effects on legislation safeguarding nondiscriminatory health care.
Assuntos
Atenção à Saúde , Minorias Sexuais e de Gênero , Discriminação Social , Decisões da Suprema Corte , Feminino , Humanos , Gravidez , Aborto Induzido/legislação & jurisprudência , Atenção à Saúde/legislação & jurisprudência , Instalações de Saúde/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Estados Unidos , Discriminação Social/legislação & jurisprudência , Discriminação Social/prevenção & controleRESUMO
This Viewpoint explains the "legal limbo" physicians may find themselves in, straddling state laws banning gender-affirming care and federal nondiscrimination law, both of which remain unclear due to ongoing legal challenges in the courts.
Assuntos
Equidade de Gênero , Assistência ao Paciente , Médicos , Minorias Sexuais e de Gênero , Humanos , Médicos/legislação & jurisprudência , Estados Unidos , Equidade de Gênero/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudênciaRESUMO
Importance: Gender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies. Objective: To investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents. Design, Setting, and Participants: Population epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019. Exposures: California's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013. Main Outcomes and Measures: Receipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure. Results: A total of 25â¯252 patients (California: n = 17â¯934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001). Conclusions and Relevance: Implementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.
Assuntos
Identidade de Gênero , Seguro Saúde , Cirurgia de Readequação Sexual , Minorias Sexuais e de Gênero , Adulto , Feminino , Humanos , Masculino , California/epidemiologia , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/estatística & dados numéricos , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Cirurgia de Readequação Sexual/economia , Cirurgia de Readequação Sexual/legislação & jurisprudência , Cirurgia de Readequação Sexual/estatística & dados numéricos , Estados Unidos/epidemiologia , Washington/epidemiologia , Arizona/epidemiologia , Adulto Jovem , Pessoa de Meia-Idade , Minorias Sexuais e de Gênero/legislação & jurisprudência , Minorias Sexuais e de Gênero/estatística & dados numéricosRESUMO
This Viewpoint discusses a pending US Supreme Court case to determine the extent to which people who identify as LGBTQ+ are protected under state antidiscrimination laws in the commercial marketplace.
Assuntos
Equidade em Saúde , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Minorias Sexuais e de Gênero , Humanos , Equidade em Saúde/legislação & jurisprudência , Minorias Sexuais e de Gênero/legislação & jurisprudência , Decisões da Suprema Corte , Estados Unidos , Disparidades em Assistência à Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/legislação & jurisprudênciaRESUMO
This Viewpoint outlines how the revival of now defunct state-level antisodomy laws would harm the health care of LGBTQ individuals should the US Supreme Court reverse itself and urges medical professionals and their societies to advocate for the immediate abolition of antisodomy laws.
Assuntos
Crime , Comportamento Sexual , Minorias Sexuais e de Gênero , Decisões da Suprema Corte , Humanos , Minorias Sexuais e de Gênero/legislação & jurisprudência , Estados Unidos , Crime/legislação & jurisprudênciaAssuntos
Identidade de Gênero , Acessibilidade aos Serviços de Saúde , Assistência ao Paciente , Minorias Sexuais e de Gênero , Pessoas Transgênero , Humanos , Pessoas Transgênero/legislação & jurisprudência , Assistência ao Paciente/normas , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/normas , Minorias Sexuais e de Gênero/legislação & jurisprudênciaRESUMO
Nesta tese indagamos acerca do lugar da psicologia no debate público sobre diversidade sexual no Brasil da atualidade. Através da análise de publicações, fontes documentais públicas e entrevistas, exploramos diversos modos em que o saber e autoridade da profissão de psicólogo são invocados para sustentar posicionamentos públicos sobre a questão homossexual no país. Nesse âmbito, destacamos a Resolução nº 1/99 do Conselho Federal de Psicologia (CFP), que estabelece normas de atuação para os psicólogos em relação à questão da orientação sexual. Há mais de vinte anos essa normativa é um marco na conquista dos direitos LGBTQIA+ no país. Para essa discussão, reconstruímos os debates que precederam as condições institucionais e o contexto de elaboração da Resolução. Os efeitos da mesma extrapolam o âmbito da regulação profissional da psicologia. A seguir, abordamos as trajetórias de figuras com diferentes perfis de atuação que ganharam notoriedade por atacar publicamente a Resolução, suscitando, desta maneira, polêmicas em torno da mesma. Em seguida, exploramos as frequentes contestações à Resolução CFP nº 1/99 que se deram na arena legislativa e o deslocamento dessas ofensivas para a arena da justiça e para a disputa pela condução dos Conselhos de Psicologia em 2019. A compreensão destes processos como cenas de uma controvérsia pública busca jogar luz sobre a disputa entre diferentes visões da diversidade sexual e de gênero, que transitam pela ciência, religião e política. Acreditamos que esta investigação contribua para expandir a compreensão da evolução, dos efeitos e dos desafios que se colocam à expansão de abordagens afirmativas da diversidade sexual e de gênero no campo da Psicologia.
In this thesis, we inquire about the place of psychology in the public debate on sexual diversity in Brazil today. Through the analysis of publications, public documentary sources, and interviews, we explore different ways in which the knowledge and authority of Psychology as a profession are invoked to support public positions on homosexuality as an issue in the country. In this context, we highlight Resolution 1/99 of the Federal Council of Psychology (CFP), that establishes standards of action for psychologists in relation to the issue of sexual orientation. For over decades, this regulation has been a milestone in the achievement of LGBTQIA+ rights in the country. For this discussion, we reconstructed the debates that preceded the institutional conditions and the context in which the Resolution was drafted. Its effects go beyond the regulation of professional psychology. Next, we address the trajectories of figures with different profiles of action who gained notoriety for publicly attacking the Resolution, thus raising controversies around it. Then, we explore the frequent challenges to Resolution CFP 1/99, that took place in the legislative arena, and the migration of these offensives to the arena of justice, and to the dispute for the presidence of the Psychology Councils in 2019. An understanding of these processes as scenes of a public controversy sheds light on the dispute between different visions of sexual and gender diversity, which transit through science, religion and politics.. This investigation expand the understanding of the evolution, effects and challenges facing the expansion of affirmative approaches to sexual and gender diversity in the field of Psychology.