Stigma and criminalization

Being LGBTQI+ is criminalized in 71 countries around the world, including 34 of the 75-plus countries where MSF works. While criminalization can deter people from seeking care out of fear of being reported, even those living in non-criminalized countries can face cultural and religious stigmas that can have the same effect. For example, in countries like Rwanda, Egypt, Ukraine, and Greece, same-sex relationships are legal, but LGBTQI+ people are still subjected to arbitrary arrests, physical violence, sexual violence, and other hate crimes, including murder.

Discrimination by health care providers

Sometimes, people face discrimination from health care providers themselves. Those who hold negative views about LGBTQI+ people may verbally or physically harass patients, provide inappropriate care, minimize their health needs, or refuse care outright. It may also lead to dangerous breaches of confidentiality. As a result of these factors, many LGBTQI+ patients may avoid seeking care unless it’s absolutely necessary or until their health conditions have deteriorated drastically — by then, it may be too late.

Josefa, a transgender woman receiving care from MSF in Mozambique, shares a similar experience: “Even at the hospital I feel that people are looking at me because of the way that I dress. But I don’t care anymore … now that I get health care from MSF, it is a lot easier.”

Negative experiences with health care providers can have a lasting impact on patients’ decisions to seek care in the future, making them avoid or delay accessing care. As such, diseases and other health concerns may be neglected, contributing to significant health disparities faced by LGBTQI+ people. 

Knowledge gaps

One of the most frequently reported barriers to health care access for LGBTQI+ patients is a lack of knowledge among health providers about their specific needs. As a result, many may receive inappropriate or insufficient care, or resort to unsafe or black market treatment.

Barriers to accessing health care can have a real impact on LGBTQI+ patients’ well-being. The consequences can be life-threatening, heightening the risk of some diseases and often leading to mental health issues like depression due to the isolation and marginalization many experience. 

LGBTQI+ health disparities

• Late presentation of treatable diseases  
• Mental health disorders including depression, anxiety, post-traumatic stress disorder (PTSD), and a heightened risk of suicide  
• Increased risk of physical injury resulting from targeted violence  
• Increased risk of cervical and breast cancer
• Higher rates of heart disease
• Sexually transmitted infections (STIs), sexually transmitted diseases (STDs), and HIV/AIDS
• Sexual and gender-based violence
• Complications from unmonitored, self-medicated hormone replacement therapies due to lack of access to safe and affordable gender-affirming care

LGBTQI+ people in conflict and migration settings

Displaced people are often among the most vulnerable in many of the contexts where MSF works, particularly those who identify as LGBTQI+. People forced to flee their homes often lack access to services specific to LGBTQI+ health. Mental and social support services for LGBTQI+ people are sorely lacking in humanitarian settings, and for those caught in conflict zones, the barriers to accessing health care become even more acute.

In host countries, LGBTQI+ refugees and asylum seekers may be unable to access public health care due to a lack of proper immigration paperwork. This can be compounded by cultural and/or linguistic barriers that many face on their search for safety.

“When you come to a new country that is not your culture, not your language, and you need to show your body at the hospital, they don't understand exactly,” says Yuli. “I know that the Greek medical system is very good. But the problem is the gender. We are trans, and mostly we are Black.”

MSF works with LGBTQI+ communities in various contexts and regions around the world. 

Inclusive care in Honduras

In San Pedro Sula, Honduras, MSF opened a clinic 2021 to improve access to health care for the LGBTQI+ community and other vulnerable groups, such as sex workers and survivors of sexual violence. With the values of inclusivity and respect at its core, the program offers comprehensive medical and mental health care in a space free of stigma and discrimination, where all patients are treated with dignity and respect and get the care they need. The project also includes outreach teams that visit communities to help people overcome any mistrust or misinformation impacting their access to care.

Peer support in Kenya

In Mombasa, Kenya, MSF runs a peer-led project helping young people who are marginalized or excluded from health care — called “key populations”* — get the advice and care they need. The MSF team has created safe spaces where they can access care without fear, offering confidential sessions and peer-led health promotion activities that link patients to public health services.

* "Key populations" are defined by the Joint United Nations Program on HIV and AIDS (UNAIDS) as men who have sex with men, transgender people and those with diverse gender identities or expressions, people who use drugs, and sex workers. These identities and experiences often intersect, which further increases vulnerability.

No one should be denied access to medical and mental health care simply because of who they are or whom they love. MSF is committed to ensuring that every individual, regardless of identity, has access to the care they need. Making care more inclusive isn’t just the right thing to do — it saves lives.  

There are a number of ways health care providers can address the health needs and access barriers that LGBTQI+ patients face. These include providing services tailored to their particular health and protection needs; training health care workers and promoting cultural competence; creating programs, practices, and policies that address barriers to care, particularly for people who are transgender, displaced, or youth; and ensuring representation of LGBTQI+ voices in gathering community feedback without compromising personal safety. 

“Thanks to the multiple trainings, activities, and awareness-raising initiatives targeting health professionals, trans women can go to the hospital, feel accepted, and receive treatment without feeling discriminated [against],” says Suzy, a transgender woman and MSF patient in Mozambique. “I love who I am. I love my Identity, and my family loves me the way I am. I am very proud of this.”

MSF’s LGBTQI+ Inclusion project

In August 2022, MSF launched the LGBTQI+ Inclusion project, which aims to transform how LGBTQI+ patients are welcomed and treated in our health projects. The project is the first of its kind at MSF, and entails taking concrete steps to promote inclusion, such as:

• conducting a baseline survey of current projects to learn of innovative practices across MSF and assess barriers to health care;
• creating interactive maps of local LGBTQI+ organizations for support;
• researching best practices and providing resources to boost cultural competency among MSF staff; and
• raising awareness of the need for unbiased and quality health care for LGBTQI+ people.

As part of the LGBTQI+ Inclusion project, we published a report gathering findings from interviews with 15 local LGBTQI+ NGOs operating in MSF project areas around the world. 

• Introduction to LGBTQI+ Inclusive Care

• Best Practices to Create a Welcoming Environment for LGBTQI+ People

• GLAAD Media Reference Guide