Traditionally, the entry points to examining discrimination against those with non-normative sexual or gender identities has been through HIV prevention work and human rights activism. However, recent research has begun to examine the impact of social, economic and political barriers and how they shape these marginalised groups experiences of a double-bind of prejudice and exclusion; such as struggles in accessing education, healthcare, employment discrimination, housing and the greater role migration plays in their lives, particularly amongst sex workers and trans people. Alongside this, international efforts to reduce poverty often amongst development actors have normative conceptions of sexuality coded into poverty alleviation policies, in ways that further compound and exclude those individuals marginalised as a consequence of their sexuality or gender identity.
We can also see that in those countries with discriminatory laws, policies, institutions and public opinion against sexual and gender minorities, it is even harder to make the case for interventions. The lack of an evidence base to illustrate the effects of this marginalisation also ensures that the case for economic benefit, often found as an important outcome of tackling this discrimination is harder to make in national and international contexts. Although recent qualitative studies produced by the Institute of Development Studies (IDS) and the World Bank have examined the ‘cost of homophobia’ in India, which are having an impact on global debates. Anecdotal evidence indicates that extreme poverty amongst these communities is even starker in rural contexts, hence the levels of migration to urban centres where surveillance from family and peers is reduced, but to date there hasn’t been a critical mass of research in this area.
The vast majority of research on sexuality and health has only examined sexual and reproductive health or HIV/AIDS prevention, however there is a large body of evidence that illustrates how the experience of such services are heavily gendered. There remain huge blockages in ensuring that women can access appropriate advice and support independently, whilst dominant constructions of masculinity often prevent men from engaging constructively in good health behaviours and lead to a higher mortality rate. Furthermore the provision of health services for sexual and gender minorities remain a cause of concern with the inability for many to be able to honestly disclose their identity for fear of dismissal or hostility from health professionals.
Although there has been some positive political shifts in around the understanding of gendered and sexual identities, such as a greater use of multi-sectoral rights-based approaches to sexual health promotion and prevention, there is still a long way to go, for example, the World Health Organisation still classifies transgender as a mental illness. In relation to people with disabilities, the ability of individuals to exercise their rights to sexual expression can be rendered invisible and
Some useful resources on this issue include: