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      Sexual and gender minorities rights in Latin America and the Caribbean: a multi-country evaluation

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          Abstract

          Background

          Although the extent of legal inequities experienced by sexual and gender minorities (SGM) has declined during recent decades, this population still enjoys fewer legal protections and benefits than the non-gender-variant, heterosexual population. Herein we analyze the current scenario of SGM rights in Latin America and the Caribbean (LAC).

          Methods

          Policy documents and governmental strategies addressing SGM rights were analyzed within a timeline framework by three major LAC sub-regions: the Caribbean, Mesoamerica and South America.

          Results

          Our search identified 88 eligible documents addressing the following categories: (1) legal protections towards same-sex couples (decriminalization of same-sex acts among consenting adults, legal recognition of same-sex unions, same-sex marriage, adoption by same-sex couples), and (2) anti-discrimination laws (SGM allowed to serve openly in the military and anti-discrimination laws related to sexual orientation, gender identity and/or expression). The majority of Caribbean countries prohibit same-sex acts between consenting adults, while in Mesoamerica same-sex couples do not have equal marriage rights and are not allowed to adopt as a couple. In the Caribbean and Mesoamerica transgender people lack proper legal protection. Legislation to protect SGM rights in South America is the most inclusive and progressive in LAC. Several countries recognize same-sex marriage and the right of transgender people to legally change their name and gender. The majority of South American countries have some kind of anti-discrimination law, but no effective mechanisms to enforce these laws. In spite of those progresses, the LAC region registers the highest rate of violence and hate crimes against SGM in the world.

          Conclusion

          In the Caribbean and Mesoamerica the overall discriminatory legislation exacerbates violence against SGM within a social and cultural context of strong sexist, gender stereotypes and widespread violence. This scenario is driving hundreds of SGM to leave their home countries. In spite of progressive legislations, several South American countries are currently controlled either by highly conservative leaders (e.g. Brazil and Chile) or by repressive dictators (Venezuela). The near future of the LAC region is unknown, but if such trends continue, severe human rights problems, including setbacks in SGM legal protections, are likely.

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          Most cited references33

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          A population-based study of sexual orientation identity and gender differences in adult health.

          We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature. We aggregated data from the 2001-2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N = 67,359) to examine patterns in self-reported health by sexual orientation identity and gender, using multivariable logistic regression. Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease. Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk. Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease. Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women. Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.
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            Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination.

            José Cruz (2014)
            Transgender and gender nonconforming people face stigma and discrimination from a wide variety of sources and through numerous social realms. Stigma and discrimination originating from biomedicine and health care provision may impact this group's access to primary care. Such stigma and discrimination may originate not only from direct events and past negative experiences, but also through medicine's role in providing treatments of transitioning, the development of formal diagnoses to provide access to such treatments, and the medical language used to describe this diverse group. This paper examines the postponement of primary curative care among this marginalized group of people by drawing from the National Transgender Discrimination Survey, one of the largest available datasets for this underserved group. This paper also proposes an innovate categorization system to account for differences in self-conceptualization and identity, which has been of considerable concern for transgender and gender nonconforming communities but remains underexplored in social and health research. Results suggest that experience, identity, state of transition, and disclosure of transgender or gender nonconforming status are associated with postponement due to discrimination. Other findings suggest that postponement associated with primary place of seeking care and health insurance has ties to both discrimination and affordability. These findings highlight the importance of combating stigma and discrimination generated from within or experienced at sites of biomedicine or health care provision in improving access to care for this group of people. Improving access to care for all gender variant people requires a critical evaluation of existing research practices and health care provision to ensure that care is tailored as needed to each person's perspective in relation to larger social processes. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review

              Background The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. Method A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population’s access to health services and original articles with full text available online. Results The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. Conclusions The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.
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                Author and article information

                Contributors
                Monica.Malta@camh.ca
                Journal
                BMC Int Health Hum Rights
                BMC Int Health Hum Rights
                BMC International Health and Human Rights
                BioMed Central (London )
                1472-698X
                6 November 2019
                6 November 2019
                2019
                : 19
                : 31
                Affiliations
                [1 ]ISNI 0000 0001 2157 2938, GRID grid.17063.33, Faculty of Medicine, Department of Psychiatry, , University of Toronto, Toronto, ; 33 Russell Street / Room RS 2035, Toronto, Ontario M5S 2S1 Canada
                [2 ]ISNI 0000 0000 8793 5925, GRID grid.155956.b, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, ; Toronto, ON Canada
                [3 ]ISNI 0000 0001 0723 0931, GRID grid.418068.3, Department of Social Science, , National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), ; Rio de Janeiro, Brazil
                [4 ]ISNI 0000 0004 1936 9481, GRID grid.423243.0, Department of International Law, Organization of American States (OAS), ; Washington, DC USA
                [5 ]ISNI 0000 0001 0723 0931, GRID grid.418068.3, Department of Epidemiology and Quantitative Methods in Health, , Sergio Arouca National School of Public Health (DEMQS-ENSP), FIOCRUZ, ; Rio de Janeiro, Brazil
                [6 ]ISNI 0000 0004 4647 9280, GRID grid.452549.b, Rio de Janeiro Federal Institute of Education, Science and Technology, ; Belford Roxo, RJ Brazil
                [7 ]UN Women Brazil, Civil Society Advisory Group, Brasilia, DF Brazil
                [8 ]Felipa de Sousa Women’s Group, Rio de Janeiro, RJ Brazil
                [9 ]Brazilian National Association of Transgender and Travesties (ANTRA), Salvador, BA Brazil
                [10 ]ISNI 0000 0001 0723 0931, GRID grid.418068.3, Department of Social Science, , Sergio Arouca National School of Public Health (DCS-ENSP), FIOCRUZ, ; Rio de Janeiro, Brazil
                [11 ]ISNI 0000 0004 1936 7961, GRID grid.26009.3d, Center for Health Policy and Inequalities Research, , Duke Global Health Institute, Duke University, ; Durham, NC USA
                Article
                217
                10.1186/s12914-019-0217-3
                6836409
                31694637
                8acbeb64-3356-486d-860d-f40a6dd8eed4
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 August 2018
                : 16 October 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                Health & Social care

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