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Peru Chooses Bigotry in Medical Services

Government Should Scrap Decree that Pathologizes LGBT Identities

Organizations march to demand investigations and justice in cases of transphobic violence in Lima, Peru, on February 22, 2023. © 2023 Guillermo Gutierrez Carrascal/SOPA Images/LightRocket via Getty Images

Peru’s government published a presidential decree on May 10 classifying trans identities as mental health conditions in the country’s Essential Health Insurance Plan, which lists insurable health conditions for insurance policies. The decree, signed by President Dina Boluarte, the minister of health, and the minister of the economy, also refers to “ego-dystonic sexual orientation” as a mental health condition.

A Ministry of Health official said the policy change was meant to facilitate coverage for “transsexual people and people with gender identity disorders,” particularly in private clinics. However, the decree is profoundly regressive.

It employs obsolete classifications related to gender identity and sexual orientation that the World Health Organization (WHO) replaced in the most recent International Classification of Diseases, published in 2019. The decree also further calcifies prejudices against lesbian, gay, bisexual, and transgender (LGBT) people in Peru which have led to violence and discrimination against this population.

The Ministry of Health has since affirmed it does not view LGBT identities as “illnesses,” but the decree remains in place despite heavy criticism from Peruvian human rights organizations and activists, including PROMSEXMás Igualdad Perú, and Gahela Cari.

Officially pathologizing LGBT people in Peru may seriously undermine efforts to improve rights protections based on sexual orientation and gender identity. Peru currently does not allow same-sex couples to marry or enter into civil unions, does not have a procedure for trans people to change their documents to reflect their gender identity, and does not have civil laws prohibiting discrimination against LGBT people. The decree could also give legitimacy to “conversion practices” and exacerbate mental health issues that LGBT communities face in Peru.

The United Nations Committee on the Rights of the Child, a group of UN human rights experts, the Inter-American Commission on Human Rights, the African Commission on Human and Peoples’ Rights, and the Commissioner for Human Rights of the Council of Europe have urged governments worldwide to reform medical classifications because pathologization is “one of the root causes behind the human rights violations that [LGBT people] face.”

The Peruvian government should discard this biased and unscientific decree and aim to implement the WHO’s updated classification of diseases with respect to sexual orientation and gender identity. It should also consult with Peru’s LGBT organizations about how best to ensure their communities’ rights to physical and mental health through rights-respecting and proportionate public policies.

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