The recently concluded 7th Asia Pacific Conference on Reproductive and Sexual Health and Rights (7th APCRSHR) in Manila saw some interesting discussions on protecting and advancing Sexual Orientation And Gender Identity (SOGI) rights and improving their access to Sexual and Reproductive Health (SRH) services. While LGBTI (Lesbian, Gay, Bisexual, Transgender and Intersex) people form a sizeable population in Asia, their general and unique health needs are largely ignored or at the best seen through the HIV lens. Facing rejection and discrimination, even within the family and community, they are subject to violence in various forms – physical, psychological, sexual, economic and social. And yet they generally do not report cases out of fear of exposure, ignorance of the law, and due to self- stigma.
While Dr Sharful Islam Khan, Scientist Centre for HIV and AIDS in Bangladesh, and Project Director, The Global Fund RCC felt that HIV interventions must be integrated with the public health systems for sustainability, sensitiveness and inclusiveness. Dede Oetomo, founder of GAYa NUSANTARA, Indonesia, and Regional Chair of Asia Pacific Coalition on Male sexual health (APCOM), blamed rise of conservative religion, governments and societies led by older people, who often forget what it is to be young and are resistant to change.
Speaking to Citizen News Service (CNS), Dr Khan said, “We have to stop treating the LGBTI as the vector of disease transmission. This population is already isolated from the mainstream because of their sexual orientation and the current interventions are further excluding them. If we focus just on HIV, mainstream inclusion is never going to happen. We have to put them in the normal framework of health and wellbeing, and not just for HIV/AIDS. They are to be treated like normal human beings for their inclusion in mainstream society. We have to work with mainstream healthcare professionals to change their attitudes. Instead we are spending money to treat LGBTI in standalone and donor dependant drop-in-centres. For inclusion and sustainability, they should be treated in the same hospitals as for the common public. Government and private health setups must be able to respond to all the healthcare needs of LGBTI, and not just HIV. It is imperative to bring about effective changes in the medical education curricula to sensitize doctors/healthcare professionals about gender and sexuality of diverse groups, and about normalization of all diverse groups. Right now all our concentration in this group is to halt the march of HIV. I am not against that, but if we ignore equally important issues and continue with just HIV, then at some point of time, when donor funding stops, they will all be back to their earlier situation due to our folly of missing out on an all- inclusive healthcare policy.”
Jeross Romano Aguilar, Chairperson, Youth Steering Committee, Family Planning Organization of the Philippines (FPOP) and organizing committee member of 7th APCRSHR, told CNS about the need to have a comprehensive approach and talk to the youth, irrespective of their gender orientations, about Sexual and Reproductive Health and Rights issues and empower them all at the same time with proper information and proper education. He said that, “We do not have to go separate segments of LGBTIs separately. But it is especially important that we do not overlook anyone. Very often when we try to empower people those that are least empowered are often ignored. While developing policies we need to consider people who are most marginalised.”
Shaleen Rakesh, Director Technical Support at India HIV/AIDS Alliance, is worried that many MSM and transgender persons in India get married due to societal and family pressures. So it is important for SRH services in the country to reach out to them to address their and their female partners’ specific concerns.
Sharing his thoughts with CNS Dede conceded that, “As the socially excluded transgender women are very visible by way of outward appearance and mannerisms, they tend to be in dangerous places at dangerous times. This makes them more vulnerable to violence and discrimination. But MSMs who are not effeminate can hide behind their manly appearance and it may seem on the surface that they do not have any problems. But one finds them very burdened and afraid of the fact that somebody (especially their family) might find out about their gay status. With more and more young people in Asia understanding their sexual orientation much earlier in life, family rejection can prove disastrous for them. Unlike the West, for us Asians, family is very important—both emotionally and economically. For an increasing number of school boys and girls in Asia life becomes unbearable because of their different sexual inclinations. If they are lucky they find a wise older person who guides them through this difficult phase of your life. Else it could be a disaster. They are bullied by their friends, and at times also by their homophobic teachers, who should actually be protecting them. Most of them are not tough enough to fight back. We need to train teachers to innovate and to realize that they have to protect their pupils with different sexuality and not perpetrate injustice.”
APCOM Board Chair Dede Oetomo added, “Sociologically young people are changing. They want not only to be hand held, but also to be themselves. Unfortunately, programmes for their betterment are working in pockets. Condoms are not being promoted properly and innovatively—they are promoted for family planning but not for safe sex. This alienates people. It takes years to lobby with the government, but we have no time to wait. Let us not act like ostriches by burying our heads in the sand. We will have to do guerrilla warfare. Planned Parenthood clinics will have to be made more youth friendly. Sex education will have to be introduced early on and we should not wait for them to have sex before they can become aware. I once complimented a 17 years old boy at a youth centre for being a lucky generation which has all the information. His reply was thought provoking: But sir we do not know what is right and what is wrong. We need guidance, we need to talk to elders who will not judge us but help us.”