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PLHIVs ask PhilHealth to reconsider HIV response

Pinoys living with HIV are complaining about the varying services offered by different treatment hubs, even if they all pay the same amount to PhilHealth. PhilHealth is now asking PLHIVs to make an issue of this so it can “get back to the hospital and we will penalize them. Sisingilin namin sa kanila ng doble ‘yung ginastos ng pasyente. We really go after hospitals, including or especially government hospitals that don’t extend the mandated services of the PhilHealth institution,” says Risa Hontiveros of PhilHealth.

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This is a continuing story on the disparities in the services received by PLHIVs in different hubs in the Philippines, even if they are required to pay the same amount by PhilHealth.

PhilHealth on San Lazaro1

Living with HIV for eight years now, Paolo’s* CD4 count was going down. And so his attending physician told him to have his viral load counted. This test, Paolo said, “costs P6,000!”

PhilHealth on San Lazaro2For Paolo, the costs of the viral load testing is not the problem per se; instead, it is the inconsistency of the services offered by the treatment hubs. At least in his treatment hub (i.e. San Lazaro Hospital), part of the treatment, care and support (TCS) that he receives is getting his ARV supplies every three months, and paying two other visits for his CD4 test to ascertain if his ARVs are working for him. The viral load counting is not included in the services offered, thus the need for him to cough up approximately P6,000.

There are other treatment hubs in the Philippines that provide other TCS services to PLHIVs enrolled in their systems. For instance, RITM-ARG in Alabang requires PLHIVs enrolled in its system to get their viral load counted, as well as CBC, Creatinine, TB skin test or PPD, and X-ray at least once a year, during their “anniversary” (that is, when they were enrolled into the system).  These tests are provided for free as part of PhilHealth’s Outpatient HIV/AIDS Treatment (OHAT) Package.

Paolo, like most PLHIVs who are taking ARV medications, is also a PhilHealth member. And his treatment hub requires him to completely pay, and then submit to them the necessary PhilHealth documents before they could serve him.

“Even if I’m an old PhilHealth member and I’m able to avail free CD4 count tests and my ARV medications, I was still asked to pay that amount [for the viral load test],” Paolo said.

CONFUSING DISPARITY

In an interview with Outrage Magazine, newly appointed PhilHealth director Risa Hontiveros said that particularly for a government hospital, not providing the complete tests could constitute a violation.

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Under PhilHealth’s Circular No. 19, s-2010 or the Outpatient HIV/AIDS Treatment Package, “covered items under the benefits are drugs and medicines, laboratory examinations, and professional fees of providers.”  The circular adds that “all treatment hubs in accredited facilities are required to follow the guidelines set by the DOH.”

PhilHealth on San Lazaro3Meanwhile, under the revised OHAT Package, Circular No. 11-2015 released last June, PhilHealth once again stressed that “there shall be no separate accreditation for HIV/AIDS Treatment Hubs as OHAT Package providers, as long as they are PhilHealth accredited health care institutions.”

Similar to the first circular, the newer circular emphasized that “covered items under this benefit are drugs and medicines, laboratory examinations based on the specific treatment guideline, including CD4 level determination test, viral load (if warranted) and test for monitoring ARV drugs toxicity and professional fees of providers.”

The revised guidelines also stated that the OHAT package can already be accessed in all 22 DOH-designated HIV/AIDS treatment hubs in the country.

Some PLHIVs enrolled in San Lazaro Hospital, and who were interviewed for this article claimed that they already asked about the “missing” services that other hubs are offering. They were, however, only told to discuss the issue with the PhilHealth coordinator/s assigned at the treatment hub. Some followed the advise; but the services continue not to be offered.

The disparities in the services received by PLHIVs do not only happen in treatment hubs in Metro Manila.

In Davao City, a PLHIV – who also works with the Mindanao AIDS Advocates Association Inc. – similarly said that viral load count is not offered to PLHIVs, even if they, too, pay the same PhilHealth amount. To his knowledge, only those who enrolled after April 2014 get free viral load count; though only once, upon enrollment.

He admitted that there is a feeling of “lugi (not getting what you paid for)” for not being given the viral load count, particularly since they know it can be offered since “gi-offer na man sa Manila (it is already being offered in Manila).”  But as far as they know, “walang (there is no) VL machine in Davao, so it can’t be offered here because of this”.

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Meanwhile, in Cagayan de Oro City, a PLHIV, who is a volunteer at the Northern Mindanao Advocates Society (NorMA), said that viral load count is also not given to those enrolled in the treatment hub there.  Again, they are required to pay the same PhilHealth amount, since “pareha ra man ginabayran sa PLHIVs (all PLHIVs pay the same rate),” he said.

The NorMA volunteer added that there was even a time when “nahudtan ug reagent (the hub run out of CD4 reagent), so even the CD4 count was delayed.”  Nonetheless, at least as far as CD4 count is concerned, “naayo na gamay karon (it has bettered now)”, but as far as viral load count is concerned, “nganga (we wait for nothing).”

Because of the inconsistencies in the services offered by treatment hubs, there are PLHIVs who “shop around” – that is, they look for hubs with “the most number of services offered,” he said.  “Pero maayo ra kung tanan ka-afford mubalhin ug (But it’s not as if everyone can afford to move to another) hub. For those who can’t, suffer jud (you really suffer).”

For Hontiveros, situations like this “cannot be tolerated, it has to be corrected. The point of generating demand through an institution like PhilHealth creates the obligation to make the supply side available and accessible to the members or patients. So we have to correct that.”

RAISE THE ISSUE

Outrage Magazine coordinated with the office of Dr. Rosario Jessica Tactacan-Abrenica, HACT head of the HIV/AIDS Pavilion of San Lazaro Hospital, to get the facility’s position on the issue; but was forwarded to the office of Dr. Winston Go, Medical Center Chief II of San Lazaro Hospital. No response has been received from the latter’s office as of press time (The response/s of Dr. Go will be included in a follow-up article on this issue, along with the positions of other people also involved in HIV-related work in the Philippines – Ed).

But in San Lazaro Hospital, one PhilHealth coordinator who asked not to be named stated that “sa RITM lang libre ‘yun. Dito kasi, matagal na namin naayos ‘yung mga PhilHealth papers ng mga pasyente at na-submit na namin sa admin ng San Lazaro. Siguro natagalan lang (the viral load count is only free in RITM. Here, we’ve long prepared the documents of the PLHIVs and submitted these to the administrators of San Lazaro Hospital. Perhaps the inclusion of viral load count is just taking longer).”

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For PLHIVs dissatisfied with the services rendered by their treatment hubs; or even if they have concerns, Hontiveros said that “members can write us (about the situation). They can also send proof of having been made to pay for a benefit package that is supposedly covered by the policy.”

This way, PhilHealth can “get back to the hospital and we will penalize them. Sisingilin namin sa kanila ng doble ‘yung ginastos ng pasyente (We will make them pay double what the patients paid). We really go after hospitals, including or especially government hospitals that don’t extend the mandated services of the PhilHealth institution,” Hontiveros said.

For Paolo, this is a welcome development. He just hopes “it doesn’t take forever”.

PhilHealth may be reached at (+63 2) 441 7444 or (+63 2) 441 7442, or email actioncenter@philhealth.gov.ph.

Outrage Magazine is one with the PLHIV community in demanding for a uniform implementation of TCS services, particularly as mandated by PhilHealth. 

Article amended on August 14, 5:30PM to include the interviews from Mindanao AIDS Advocates Association Inc. and Northern Mindanao Advocates Society (NorMA).

*NAME CHANGED TO PROTECT THE PRIVACY OF THE INTERVIEWEE

Living life a day at a time – and writing about it, is what Patrick King believes in. A media man, he does not only write (for print) and produce (for a credible show of a local giant network), but – on occasion – goes behind the camera for pride-worthy shots (hey, he helped make Bahaghari Center’s "I dare to care about equality" campaign happen!). He is the senior associate editor of OutrageMag, with his column, "Suspension of Disbelief", covering anything and everything. Whoever said business and pleasure couldn’t mix (that is, partying and working) has yet to meet Patrick King, that’s for sure! Patrick.King.Pascual@outragemag.com

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Phl votes for LGBTQIA rights at UN Human Rights Council

The UNHRC adopted a resolution to renew the mandate of the Independent Expert focusing on the protection against violence and discrimination on the basis of sexual orientation and gender identity.

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ALL PHOTOS TAKEN DURING METRO MANILA PRIDE PARADE 2019

The United Nations Human Rights Council (UNHRC) adopted a resolution to renew the mandate of the Independent Expert focusing on the protection against violence and discrimination on the basis of sexual orientation and gender identity (SOGI).

The resolution was adopted by a vote of 27 in favor, with 12 voting against and seven abstentions.

Now this is worth highlighting: The Philippines voted in favor of the resolution.

The Philippines’ UN voting history vis-à-vis LGBTQIA people has been inconsistent. In 2016, when the UNHRC adopted the resolution on “protection against violence and discrimination based on SOGI (which created the post for the Independent Expert), the Philippines abstained from voting for the resolution. It was then under the presidency of Benign Aquino III.

Also to date, the country still does not have a national anti-discrimination policy protecting the human rights of LGBTQIA Filipinos, even if various versions of the anti-discrimination bill (ADB) have been filed in the Upper and Lower Houses of Congress for 20 years now. In 2017, during the last – 17th – Congress, it passed the House of Representatives; but its counterpart version in the Senate failed to gain traction.

Created in 2016, the UN Independent Expert on SOGI has been supported by a growing number of States from all over the world. This new resolution to create and renew the mandate was presented by a Core Group of seven Latin American countries – Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico and Uruguay.

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The UN Independent Expert on SOGI is tasked with assessing implementation of existing international human rights law, by talking to States, and working collaboratively with other UN and regional mechanisms to address violence and discrimination. Through the work of this mandate since 2016, the impact of criminalization of same-sex relations and lack of legal gender recognition, the importance of data-collection specific to SOGI communities, and examples of good practices to prevent discrimination have been highlighted globally, with visits to Argentina, Georgia, Mozambique and Ukraine.

As a top-to-bottom approach, however, the immediate impact of the UN Independent Expert on SOGI on grassroots LGBTQIA activism remains a sore issue for those critical of its.

The renewal process of the mandate had to overcome 10 hostile amendments, but the core of the resolution in affirming the universal nature of international human rights law stands firm.

RESULTS OF THE VOTE

Voting in favor of the resolution

Argentina, Australia, Austria, Bahamas, Brazil, Bulgaria, Chile, Croatia, Cuba, Czech Republic, Denmark, Fiji, Iceland, Italy, Japan, Mexico, Nepal, Peru, Philippines, Rwanda, Slovakia, South Africa, Spain, Tunisia, Ukraine, UK, Uruguay

Voting against the resolution

Afghanistan, Bahrain, Bangladesh, China, Egypt, Eritrea, Iraq, Nigeria, Pakistan, Qatar, Saudi Arabia, Somalia

Abstaining on the resolution

Angola, Burkina Faso, Democratic Republic of Congo, Hungary, India, Senegal, Togo

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SOGIE Equality Bill filed anew in 18th Congress

In the Lower House, Lumad leader-turned-Bayan Muna Rep. Eufemia Cullamat has refiled the SOGIE Equality Bill as House Bill 258. Meanwhile, in the Upper House, Akbayan Sen. Risa Hontiveros refiled the bill as Senate Bill 159, one of her priority measures.

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ALL PHOTOS TAKEN DURING METRO MANILA PRIDE PARADE 2019

We continue to #ResistTogether.

Versions of the Sexual Orientation, Gender Identity and Gender Expression (SOGIE) Equality Bill have been re-filed in the Lower and Upper Houses of Congress.

In the Lower House, Lumad leader-turned-Bayan Muna Rep. Eufemia Cullamat has refiled the SOGIE Equality Bill as House Bill 258. Co-authors are Bayan Muna Reps. Karlos Ysagani Zarate and Ferdinand Gaite.

Meanwhile, in the Upper House, Akbayan Sen. Risa Hontiveros refiled the bill as Senate Bill 159, one of her priority measures.

The explanatory note of HB 258 talks about intersectionality, stating that “LGBT (people) often find it difficult to exercise their rights as persons, laborers, professionals, and ordinary citizens.”

For instance, “LGBT students are denied admission or expelled from school due to their sexual orientation or gender identity. Companies block the promotion and stymie the career advancement of gay or lesbian employees due to the deeply embedded notion that homosexuality denotes weakness. Laws such as the current anti-vagrancy law are also abused by the law enforcement agencies to harass gay men.”

Incidentally, the latter – i.e. anti-vagrancy law – was repealed in March 2012 (via Republic Act 10158), but members of the LGBTQIA community (particularly gay and bisexual men) often still fall prey victim to harassment by law enforcers.

“It is therefore imperative to define and penalize practices that discriminate against LGBT (people),” continued the explanatory note of HB 258.

Hontiveros, for her part, said the time has come for the enactment of the SOGIE Bill; even vowing that the incoming Congress will be a “massive victory against hate and discrimination.”

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“If the Senate’s 17th Congress was a big win for women and health, the 18th Congress will be a massive victory against hate and discrimination. The SOGIE Equality Bill will pass. It is a measure whose time has come,” Hontiveros said.

In 2017, the House of Representatives actually passed the SOGIE Equality Bill. The Senate’s version, however, did not gain the final approval of the 17th Congress.

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Over 50,000 parade for Pride in Metro Manila

The Pride-goers gathered not just to show force and then party, but also to highlight the need to create safe spaces for LGBTQIA Filipinos.

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Growing rainbow number.

Over 50,000 people gathered in Marikina City to attend the annual LGBTQIA Pride parade in a largely disorganized event affected by sporadic downpours and marred by event planning/execution issues. The Pride-goers gathered not just to show force and then party, but also to highlight the need to create safe spaces for LGBTQIA Filipinos.

While confusion continued to exist even during Pride day about what revelers were supposed to #ResistTogether – this year’s catchy theme – there was at least a call to recognize the sector (particularly with the number) by passing the anti-discrimination bill (ADB) that has been pending in Congress for two decades now.

And despite the numbers fascination, the total number of attendees is still undetermined even with the mandatory/forced registration of all participants (else not be allowed entry into the premises), with the information desk “told to say it’s 52,000” while a host inconsistently bragged figures reaching 70,000. All the same, this year’s number easily eclipsed last year’s estimated 25,000 revelers.

Notably, this year’s gathering attempted to “return” the format to the older Pride parades in Metro Manila by allowing various groups/organizations to speak onstage, as opposed to only those affiliated with the political party/leaning of the organizing Metro Manila Pride.

According to Regie Pasion, who helms LGBTbus, the Marikina-based LGBTQIA organization that helped in organizing this year’s Pride (and the gatherings in 2017 and 2018), “at it’s core, Pride remains a protest” and “will remain so until LGBTQIA human rights are recognized”.

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Locally, for Marikina, while the ADB continues to languish, the city’s mayor Marcy R. Teodoro signed the local anti-discrimination ordinance (ADO), passed ahead of the Pride parade. In signing, Teodoroo said that the ADO will “nagbibigay sa lahat ng pantay at parehong karapatan sa trabaho, edukasyon, tirahan, at mga serbisyo ng pamahalaan (give everyone equal right to access education, work, accommodation and government services).”

The same ADO was passed after Marikina hosted the Pride parade for three years; pushed exclusively by the local LGBTQIA community.

Coming from Lucena City to attend the 2019 Pride parade, Aaron Moises Bonette of QZN Pride and Bahaghari QZN said that the challenge remains “for us to utilize this same number to take the same streets to fight for our actual rights (and not just to parade),” he said.

Last year’s Pride parade, for instance, may have gathered over 20,000 revelers, but when it came to rally for the ADB, the organizers were not able to attract 50 participants.

“Don’t get me wrong: Reaching this big number is admirable. But Pride shouldn’t start and end in June. It should be done every day (hopefully by as many, or even by more) people until we are treated as equals. Otherwise, this thing we call ‘pride’ is but an ideal,” Bonette ended.

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Now illegal to discriminate against LGBTQIA people in Marikina

Marikina City joins the list of local government units (LGUs) that now has an anti-discrimination policy that eyes to protect the human rights of its LGBTQIA constituents. Offenders may be penalized from P1,000 (first offense) to P2,000/P5,000 (second and third-time offenders), along with imprisonment of up to 15 days.

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The rainbow cometh.

Marikina City has joined the list of local government units (LGUs) that now has an anti-discrimination policy that eyes to protect the human rights of its LGBTQIA constituents.

The host of Metro Manila Pride parade since 2017, the city was also – for a while – under scrutiny for claiming to be pro-LGBTQIA but with (seemingly) limited LGBTQIA-related efforts topped by the once-a-year parade held in June.

But the ordinance introduced by councilors Paul Dayao, Mario de Leon, Manuel Sarmiento and Zifred Ancheta eyes to make it a policy of the city to hold non-discrimination of LGBTQIA people (at least there).

Discriminatory acts included in the ADO include: employment- and school-related discrimination; refusal to provide goods/services/accommodation because of a person’s SOGIE; and by subjecting (verbally or by writing) people to ridicule because of their SOGIE.

Offenders may be penalized from P1,000 (first offense) to P2,000/P5,000 (second and third-time offenders), along with imprisonment of up to 15 days.

The ordinance introduced by councilors Paul Dayao, Mario de Leon, Manuel Sarmiento and Zifred Ancheta eyes to make it a policy of the city to hold non-discrimination of LGBTQIA people (at least there).

Surprisingly, while the ADO is creating an Anti-discrimination Mediation and Conciliation Board to deal with ADO-related violations, no LGBTQIA organization/party will be among the board members.

The ADO is awaiting the signature of Marikina Mayor Marcy R. Teodoro, though this is already expected. In 2018, Teodoro told Outrage Magazine that hosting Pride is a way to show the city’s support to Metro Manila’s LGBTQI community, particularly since his office in particular supports this community’s push for a nationally enacted anti-discrimination policy. In the end, Teodoro said, “we want to be known as an inclusive community. We can only do that by recognizing everybody as all equal to each other.”

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Sexuality continues to change and develop well into adulthood – study

Substantial changes in attractions, partners, and sexual identity are common from late adolescence to the early 20s, and from the early 20s to the late 20s, indicating that sexual orientation development continues long past adolescence into adulthood. The results also show distinct development pathways for men and women, with female sexuality being more fluid over time.

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Photo by Sharon McCutcheon from Unsplash.com

Traditional labels of ‘gay’, ‘bisexual’ and ‘straight’ do not capture the full range of human sexuality, and whether a person is attracted to the same, or opposite sex can change over time.

This is according to a study, published in the Journal of Sex Research, which analyzed surveys from around 12,000 students, and found that substantial changes in attractions, partners, and sexual identity are common from late adolescence to the early 20s, and from the early 20s to the late 20s, indicating that sexual orientation development continues long past adolescence into adulthood. The results also show distinct development pathways for men and women, with female sexuality being more fluid over time.

“Sexual orientation involves many aspects of life, such as who we feel attracted to, who we have sex with, and how we self-identify,” said Christine Kaestle, a professor of developmental health at Virginia Tech. “Until recently, researchers have tended to focus on just one of these aspects, or dimensions, to measure and categorize people. However, that may oversimplify the situation. For example, someone may self-identify as heterosexual while also reporting relationships with same-sex partners.”

In order to take all of the dimensions of sexuality into account over time, Kaestle used data from the National Longitudinal Study of Adolescent to Adult Health, which tracked American students from the ages of 16-18 into their late twenties and early thirties. At regular points in time, participants were questioned about what gender/s they were attracted to, the gender of their partners, and whether they identified as ‘straight’, ‘gay’ or ‘bisexual’.

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The results showed that some people’s sexual orientation experiences vary over time, and the traditional three categories of ‘straight’, ‘bisexual’ and ‘gay’ are insufficient to describe the diverse patterns of attraction, partners, and identity over time. The results indicated that such developmental patterns are better described in nine categories – differing for both men and women.

For young men these patterns have been categorized as:

    null
  • ‘straight’ (87%),
  • ‘mostly straight or bi'(3.8%),
  • ’emerging gay’ (2.4%)
  • minimal sexual expression’ (6.5%).

Young women on the other hand were better described by five categories:

    null
  • ‘straight’ (73.8%),
  • ‘mostly straight discontinuous’ (10.1%),
  • ’emerging bi’ (7.5%),
  • ’emerging lesbian’ (1.5%)
  • ‘minimal sexual expression’ (7%).

Straight people made up the largest group and showed the least change in sexual preferences over time. Interestingly, men were more likely than women to be straight – almost nine out of 10 men, compared to less than three-quarters of women.

Men and women in the middle of the sexuality spectrum, as well as those in the ’emerging’ gay and lesbian groups showed the most changes over time.

For example, 67% of women in the ‘mostly straight discontinuous’ group were attracted to both sexes in their early 20s. However, this number dropped to almost zero by their late 20s, by which time the women reported only being attracted to the opposite sex.

Overall, women showed greater fluidity in sexual preference over time. They were more likely (one in six) to be located in the middle of the sexuality continuum and to be bisexual.

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Fewer than one in 25 men fell in the middle of the spectrum; they were more likely to be at either end of the spectrum, as either ‘straight’ or ’emerging gay’. Relatively few women were classed as ’emerging lesbian’.

“In the emerging groups, those who have sex in their teens mostly start with other-sex partners and many report other-sex attractions during their teens,” Kaestle said of her findings. “Then they gradually develop and progress through adjacent categories on the continuum through the early 20s to ultimately reach the point in the late 20s when almost all Emerging Bi females report both-sex attractions, almost all Emerging Gay males report male-only attractions, and almost all Emerging Lesbian females report female-only attractions.”

Kaestle said that the study demonstrates young adulthood is still a very dynamic time for sexual orientation development.

“The early 20s are a time of increased independence and often include greater access to more liberal environments that can make the exploration, questioning, or acknowledging of same-sex attractions more acceptable and comfortable at that age. At the same time – as more people pair up in longer term committed relationships as young adulthood progresses – this could lead to fewer identities and attractions being expressed that do not match the sex of the long-term partner, leading to a kind of bi-invisibility,” said Kaestle.

For Kaestle, “we will always struggle with imposing categories onto sexual orientation. Because sexual orientation involves a set of various life experiences over time, categories will always feel artificial and static.”

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Importantly, although the study found nine categories of sexual orientation development, limitations in the statistical methods used mean that more categories could exist.

The names of the categories are also in no way meant to replace or contradict any person’s current self-labelled identity. Rather, Kaestle hopes that these findings will help researchers in the future to better understand how a range of sexual orientation experiences and patterns over time can shape sexual minorities’ experience of distinct health disadvantages, and the effects of discrimination.

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Transgender people are not mentally ill, says WHO

The new classification is not expected to affect the healthcare provision to respond to the needs of transgender people, but – all the same – it’s expected to improve social acceptance among transgender people while still making important health resources available.

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Photo by Cecilie Johnsen from Unsplash.com

The World Health Organization (WHO) has decreed that transgender people are not mentally ill, with the WHO’s legislative body voting to move the term used to describe transgender people – “gender incongruence” – to the panel’s sexual health chapter from its mental disorders chapter.

The new standard of classification appears in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11); but will go into effect on January 1, 2022.

The WHO uses “gender incongruence” to describe people whose gender identity is different from the gender they were assigned at birth.

The new classification is not expected to affect the healthcare provision to respond to the needs of transgender people, but – all the same – it’s expected to improve social acceptance among transgender people while still making important health resources available, according to the United Nations health agency last year when it announced the intended change.

Dr. Jack Drescher, a member of the ICD-11 working group, wrote: “There is substantial evidence that the stigma associated with the intersection of transgender status and mental disorders contributes to precarious legal status [and] human rights violations”.

It is worth noting that the WHO still classifies intersex traits as “disorders of sex development”.

This is not the first time the ICD changed a classification related to sexuality. In 1990, the WHO declared that “sexual orientation alone is not to be regarded as a disorder.”

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