M. Yasin Yıldırım
While the obstacles to LGBTI+’s right to access health cause serious health problems, the education curriculums of universities are a significant source of discrimination, phobia, and lack of information that LGBTI+s face during their access to health.
LGBTI+s living in Turkey are exposed to discrimination and hate crimes in many areas. Unfortunately, these are not limited to daily verbal or physical hate crimes of various segments of society. The state, obliged to provide equal rights and services to every citizen, reproduces LGBTI+ phobia daily through its officials, institutions, and enforcement.
This LGBTI+phobia, produced by the state, is so great that it almost established its new election policies based on this phobia. Moreover, it exploits the religious values of especially the conservative part of society and organizes them around the hatred of LGBTI+. The LGBTI+s, who have never been treated as equal citizens in Turkey, become even more vulnerable to discrimination and hate crimes in social areas such as homes, workplaces, universities, and public institutions such as hospitals, police stations, and courthouses as a result of the state’s targeting. Subsequently, LGBTI+s do not have equal access to rights that every citizen should benefit from, such as the right to health, housing, education, freedom, and security.
Violations prevent access to the right to health
While the freedom aspect of the right to health, which is one of the fundamental rights of an individual, includes the control of one’s own health and body, including the freedoms of sex and reproduction and not being subject to torture and non-consensual medical interventions; the human rights dimension includes having a health system that allows people to benefit equally from the highest attainable standard of health. The right to health, guaranteed by many national and international conventions, declarations, and legislation, means much more than being healthy, as it includes the individual’s rights and policymakers’ and service providers’ obligations.
The LGBTI+s, who are not protected by any legislation in Turkey, cannot access safe and adequate health services due to discrimination, phobia, stigma, and hate crimes. In addition, multiple discriminations and violations, such as healthcare professionals’ insufficient knowledge about the unique needs of LGBTI+ people in the field of health, associating health problems with LGBTI+ identities, disclosure of LGBTI+ identity without the consent of the person, concerns about privacy and confidentiality, affecting their working status and job applications if their identities are shared with social security institutions creates obstacles to subjects’ access to health care.
Although some LGBTI+s risk all kinds of discrimination they may encounter and apply to health institutions for treatment, examination, and various medical interventions, they are exposed to many violations due to healthcare professionals’ discriminatory attitudes, stigmatizing speeches, humiliating attitudes and failure to respect the personal space and privacy of those applying for healthcare services. Thereby, many LGBTI+, especially trans+s, prefer not to go to health institutions even if they suffer serious health problems.
The LGBTI+’s lack of access to health, delaying their check-ups, and postponing their treatment causes more severe health problems by making early diagnosis of diseases difficult. In addition, as violations against LGBTI+s reduce trust in healthcare providers, many individuals are forced to hide personal and medical information that may need to be shared for their treatment. As a matter of fact, the LGBTI+s, currently deprived of their right to secure employment, are forced to turn to private healthcare providers to avoid the discrimination they frequently face in public institutions. While this means an extra financial burden for the individuals, it does not guarantee they will be protected against discrimination.
“I tried to treat myself by researching on the internet”
S.K. a trans woman who works as a sex worker in Turkey describes her access to health experience as follows:
“Since I am a trans woman, even simple daily errands like grocery shopping make me very insecure. I have not been to the hospital for years because of the many discriminations I have experienced in the past and the hate speech I have endured. About six months ago, inflamed sores started to appear on my body due to infection. The growing scars covered almost my entire body. In this process, I tried to treat myself with the research I did on the internet for months. Finally, with the help of another trans friend, a health worker, I got through the long and painful illness.”
Ilgaz, a university student who started the gender-affirmation process a few months ago, has the following to say about the process:
“I can talk about the access of trans people to their health rights in Ankara. It has been a challenging experience for me both to reach the health services I need to start my gender-affirmation process and to learn where to start. Unfortunately, there was no resource I could refer to on this matter. Therefore, the time I spent figuring out where to apply delayed my process more than I wanted. Furthermore, the number of psychiatrists working in the field of gender is limited to only one or two people in Ankara. As a result, getting an appointment with these people is almost impossible. The fact that it is a state mandate to go to these doctors to complete the gender affirmation process puts most trans people, myself included, in a challenging situation. Even when we barely make an appointment with these doctors, they do not provide therapeutic support for our social and family problems. The process is more like the execution of a procedure. Finally, access to hormones is very difficult in this city. Some hormones are sold at exorbitant prices that no one can access; moreover, they are unavailable in most pharmacies. For many trans people, access to hormones is a matter of survival; this situation drives people to death and misery.”
The LGBTI+ health has no room in the curriculum
The education curriculums in medical and other health departments of universities are a significant source of discrimination, phobia, and lack of information that LGBTI+s face during their access to health. No faculty course content has a specific area regarding LGBTI+ health. As a result, students graduate and start providing health services without learning basic concepts such as sexual orientation, gender identity, and gender.
While the current guides worldwide recognize intersex people and their bodies as a diversity in the gender spectrum, they are still classified under the name of “gender development disorders” in the course content in Turkey. It is taught that the genitals of intersex people can be “corrected” with surgical interventions called “normalization surgeries,” disregarding their body autonomy.
Gender affirmation processes do not find their place anywhere in the curriculum. Instead, the entire gynecology specialization is treated as if only cis women have a vulva and vagina, and trans bodies are ignored. Furthermore, regarding the viruses such as HIV, HPV, and Hepatitis and the diseases they cause, LGBTI+s are not addressed with the social and historical aspects of these diseases and are instantly stigmatized. According to current studies and guidelines on mental health, although it is known that LGBTI+s experience mental and physical health problems such as stress, anxiety, eating disorders, and depression more commonly and at a higher rate than the rest of society, LGBTI+s are not mentioned as a key population in these subjects in psychiatry courses and internships.
LGBTI+s, who are tried to be crushed by all these hate crimes, violations, and discriminations, come together through their organizations, associations, and professional chambers, survive with solidarity, and become stronger every day by scaling up their fight.