Reaching out to LGBTQI+ communities in Honduras

What are the main barriers to care for LGBTQI+ patients in Honduras?

Stigma and discrimination are the main barriers people encounter when trying to access different services, including access to information. People are reluctant to approach health [providers] for fear of being judged, stigmatized, or denied services, which has indeed happened.  

In health care services, at the national level and as a state policy, there isn't a gender identity law, for example. So all medical forms and records are handled with the name that appears on [patient’s] national ID document, which is very strict in requiring that the name assigned at birth appear. But for trans patients, often that name isn't the name with which they identify because they may have chosen another name that better aligns with their gender identity. 

In other words, from the moment I enter, they can't call me by my name — they call me by the name that appears on my national ID. If I'm a trans woman, they'll always list the male gender. If I'm a trans man, they'll list the female gender, not the gender with which I identify. And that's where the differentiation of services begins.  

How do these experiences affect the health needs of LGBTQI+ communities?

People in the LGBTQI+ community often don't find health services welcoming because they aren't adapted to their specific needs ... Many needs are not met in the medical sector. 

For example, some tests that are necessary for people who may engage in sexual relationships other than heterosexual are not covered. And that's why these barriers prevent people from accessing services. Because ultimately, [they think], ‘I'll be revictimized, I'll feel judged, and I won't receive the specific service I'm looking for.’

How does the team help make patients feel safe in MSF's clinic?

All the staff are highly trained to approach diverse communities. They ask questions like, "What's your preferred pronoun?" or, "What name would you like us to call you?"  

Within the clinic and other facilities, there are many signs and small symbols that create a friendly and open space. We, as staff members, sometimes wear small [LGBTQI+ friendly] badges. Sometimes in just seeing the badge, they understand that you're an organization open to the LGBTQI+ community, and above all, that you're raising awareness.

Also, our forms are designed to accommodate people's chosen names — we don't strictly adhere to national regulations that require including information from their identity documents, such as name and gender. Instead, we're more flexible and give people the opportunity to present themselves as they see themselves and how they feel, and we treat them accordingly. In other words, they are treated as they request to be treated. This is how the clinic's services best adapt to people's needs. 

Why is community outreach a vital part of our work in San Pedro Sula?  

The importance of outreach visits for the community lies in the fact that they differ from activities carried out by other entities, such as government agencies, which tend to be more closed off. What we do on these visits is provide friendly, personalized experiences. The community gets to know us and recognizes the MSF staff who conduct these outreach visits.  

Above all, it fosters a greater sense of belonging and connection with the community, because on these visits we not only provide educational sessions, but also offer psychosocial support. We tell people, "We are here with you, we can help you. Trust us, and come to our services because they are for you." 

How does the community receive these outreach visits?

About a year ago, while I was out on outreach, we came across a young woman at one of the checkpoints who looked visibly unwell. Her demeanor was somewhat scattered, and she seemed very conflicted. So, as usual, we went to deliver the kit [kits containing sexual and reproductive health items are distributed during these visits].

I approached her and started talking about how she was feeling. She was in a very bad way and told me she had been in a women's prison for a while, and that she had been diagnosed with a mental health issue there — a pretty serious mental health condition, anxiety. She'd been receiving treatment there, but when she got out of prison, they just stopped giving her treatment. She'd already been out of treatment for months.

I told her about our clinic's services, that she could access them and that she could come to us and trust that we could support her in some way. In the end, she didn't come. But I kept approaching her every time we went out on our rounds to remind her that the services were available and that she could access them when she was ready. It was a process of working around her for about three or four months.

Finally, after one round, I managed to convince her, and she was like, "Okay, I'll go the next day." I knew she came.  

Now, when I see her on the street, I see that she's visibly much better. I see that she's starting to take control of her life. She's much happier, and whenever she sees us on our rounds, she says something like, "Thank you for insisting and insisting, until I finally went; I went because you all managed to convince me I could do it.”

How does the team stay motivated when you face these challenges?

Mainly it's about having the resilience to keep insisting and insisting that people visit the clinic. Sometimes, the person isn't used to it or it's their first time with MSF. It can be a little demotivating to go out on a round, promote the services, and see people who need the services we've identified, but haven’t recognized it within themselves. ... It's about learning to deal with that, but also seeing the other side — that these are very personal decisions. It's up to the person to seek their own change as well.  

We don't have to force anyone to seek the services. But we also have to learn how to approach people, look for different strategies, and find a friendly and fun way to connect with them ... to get them to come to the clinic out of their own free will, because they recognize that seeking health care is necessary.

What does LGBTQI+ inclusion in health care look like to you?

Well, as a health promotion team, our main vision is to make information accessible, user-friendly, and above all, understandable to all communities. We also want this information to generate a change in the people we reach — a change in perspective, a paradigm shift — so they can understand or conclude that the pursuit of health is necessary, personal, and essential for well-being, not only physically but also mentally.  

Our vision for the future is to ensure that all these people are fully aware of the need to address mental and physical health conditions, and that regular checkups are necessary. We want them to make a conscious and voluntary decision to access the services available in their communities and actively seek them out. 

About the MSF clinic in San Pedro Sula

Since 2021, the MSF clinic in San Pedro Sula has provided comprehensive medical and mental health care for people from vulnerable and marginalized communities such as LGBTQI+ people, sex workers, and survivors of sexual violence. Sexual and reproductive health services include testing for sexually transmitted diseases, preventive vaccination, contraceptives, and pre- and post-exposure prophylaxis (PrEP and PEP) for protection against HIV. The clinic also has an in-house laboratory offering rapid testing as well as an emergency hotline for patients in crisis.