An inclusive rights-based foreign policy for health

Abstract

30 years ago the disease now known as AIDS transfixed suffering and death on gay communities. The spread of AIDS transformed an entire generation, forging powerful connections between gay activists and their health professionals.1 AIDS activists reached beyond the picket lines to set up entirely new drug approval processes at the US Food and Drug Administration (FDA). At the same time, AIDS physicians adopted the cause of advocacy in ways hitherto unthinkable. Although the synergy between human rights and health continues to this day, these partial gains reveal an unfinished project. We define inclusive rights as civil, social, and health rights independent of sexual orientation or gender.2 Yet violence and discrimination against lesbian, gay, bisexual, and transgender (LGBT) individuals remain the norm in many regions.3 In 2012, 78 nations worldwide had laws discriminating against LGBT individuals.2 This harsh environment discourages LGBT individuals from seeking health services, disclosing sexual behaviours, reporting sexual violence, and, ultimately, from receiving antiretroviral therapy for those HIV-infected LGBT in need of treatment.4 In 2011, in recognition of the importance of an inclusive rights-based foreign policy, US President Barack Obama issued a memorandum that raised LGBT rights to the status of a foreign policy priority. Obama declared: “The struggle to end discrimination against LGBT persons is a global challenge, and one that is central to the United States commitment to promoting human rights. I am deeply concerned by the violence and discrimination targeting LGBT persons around the world whether it is passing laws that criminalize LGBT status, beating citizens simply for joining peaceful LGBT pride celebrations, or killing men, women, and children for their perceived sexual orientation. That is why I declared before heads of state gathered at the United Nations, ‘no country should deny people their rights because of who they love, which is why we must stand up for the rights of gays and lesbians everywhere.’”5 An inclusive rights-based foreign policy can improve the health and wellbeing of LGBT communities by several mechanisms. First, worldwide support for LGBT individuals’ human rights nurtures an environment that is conducive to stable, healthy same-sex partnerships. An analysis based on WHO data showed that after European nations introduced same-sex partnership laws, syphilis rates decreased by 43%.6 Second, an inclusive rights-based foreign policy decreases barriers for HIV-infected LGBT individuals to receive antiretroviral therapy. Finally, an inclusive foreign policy prioritises the safety of LGBT individuals. LGBT individuals have been murdered in many countries because of sexual orientation or gender identity. This inclusive foreign policy agenda has also elicited criticism, especially from local leaders. Religious practices that condemn homosexuality, entrenched heterosexual family norms, and widespread public disapproval in many regions7 challenge the expansion of an inclusive foreign policy in different parts of the world. Potential exists for conflict between religious groups and organisations supporting inclusive policies; however, faith leaders have also become powerful advocates for HIV prevention.7 This advocacy could be extended explicitly to include LGBT rights. Working in partnership with local religious organisations and other multisectoral partners will be crucial to the success of comprehensive initiatives in HIV control. Another common criticism against an inclusive foreign policy is the belief that paternalistic global forces misunderstand local cultures; yet the persistence and momentum of LGBT community-based organisations in the harshest environments cannot be ignored. Homosexuality is not a political ideology; rather, it is woven into the fabric of humanity. The UN Human Rights Council has unequivocally stated that LGBT rights are human rights.8 An inclusive foreign policy is gaining traction and could generate considerable health benefits. Although an inclusive foreign policy has advanced most rapidly in high-income nations where discrimination and violence are less common, 29 US states9 and 12 European countries2 still have laws that discriminate against homosexual individuals. Advancement of LGBT rights is about embracing health and wellness for all, irrespective of sexual orientation or gender.