Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries.

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.

Assessing Impacts of "Anti-Equity" Legislation on Health Care and Public Health Services.

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.

Church Against State: How Industry Groups Lead the Religious Liberty Assault on Civil Rights, Healthcare Policy, and the Administrative State.

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.

Protecting Privacy of Pregnant and LGBTQ+ Research Participants.

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.

The Supreme Court's 303 Creative Decision and the Threat to LGBTQ+ Health Care.

This Viewpoint examines the importance of the Supreme Court decision in 303 Creative and its possible effects on legislation safeguarding nondiscriminatory health care.

Legal Penalties for Physicians Providing Gender-Affirming Care.

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.

Association Between California's State Insurance Gender Nondiscrimination Act and Utilization of Gender-Affirming Surgery.

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 25 252 patients (California: n = 17 934 [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.

Antidiscrimination Laws as Essential Tools for Achieving LGBTQ+ Health Equity.

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.

Implications of Dobbs for the (Re)Criminalization of Intimacy Among LGBTQ Individuals.

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.

A psicologia e a questão da diversidade sexual no Brasil: a Resolução CFP nº 1/99 / Psychology and the issue of sexual diversity in Brazil: Resolution CFP nº 1/99

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.

LGBTQ state policies: A lever for reducing SGM youth substance use and bullying.

PURPOSE: Sexual and gender minority youth (SGMY) are more likely than their cisgender and heterosexual peers to use substances and to be bullied, yet it is unknown whether the absence/presence of youth- and LGBTQ-specific equity laws drive these disparities. The purpose of this study was to extend previous research focused on adult- and LGBTQ-specific structural factors (e.g., same-sex marriage laws) to determine whether the youths' structural environment (i.e., state-level LGBTQ youth-focused equity laws) was associated with bullying and recent alcohol use, binge drinking, and cigarette use among SGMY. PROCEDURES: We utilized data from the LGBTQ National Teen Survey, collected in 2017 (N = 8,841 sexual and gender minority youth). Linear regression analyses examined the association between bullying and substance use and between state-level LGBTQ youth-focused equity laws (individually and as a composite variable) and bullying and substance use. FINDINGS: SGMY living in states with LGBTQ equity laws were less likely to experience bullying. Findings regarding the relation between LGBTQ equity laws and substance use were mixed, such that LGBTQ equity laws were associated with a higher likelihood of binge drinking and alcohol use, and a lower likelihood of cigarette use. CONCLUSIONS: Findings highlight the role of state-level equity laws in reducing bullying and substance use disparities for SGMY. Yet, given the finding that equity laws were associated with a higher likelihood of binge drinking, it is important to continue to explore how the structural environment shapes SGMY health.

Erasing violence: lesbian women asylum applicants in the United States.

Despite growing recognition of sexual orientation- and gender identity-based violence, scholars continue to identify barriers for lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals seeking asylum protection. Lesbian women asylum applicants, in particular, encounter a system that is unsure how to classify their cases and that generally questions the credibility of women's experiences. In this way, lesbian women applicants are among the most vulnerable populations of asylum claimants, particularly in the U.S. context. In this research note, I examine U.S. appellate level Circuit Court cases initiated by lesbian women asylum applicants. I expand existing literature to include an examination of how the violence faced by lesbian women is interpreted and ultimately erased as Circuit Courts grapple with legal interpretations of persecution. Specifically, I find three mechanisms of erasure: ruling that the violence experienced was unextreme, finding that the applicants' accounts of violence were unsubstantiated, or arguing that the violence experienced was unrelated to the applicants' sexual orientation. When placed in historical context, these patterns are troubling. Unlike previous decades that have witnessed overt homophobia, racism, and ethnocentrism in the immigration system, these cases indicate a more subtle form of exclusion-finding technicalities in case law and formal legal definitions as grounds for denial.