More than a year after the World Health Organization (WHO) declared COVID-19 a global pandemic, the virus continues to ravage the Asia-Pacific with catastrophic human, social, economic, and developmental costs. Many lesbian, gay, bisexual, trans, intersex, gender-diverse, and queer (LGBTIQ+) persons experienced increased vulnerability on top of systemic human rights violations and social inequity many currently shoulder as the pandemic places more stress on health systems and social safety nets.
Confronted with these vulnerabilities, governments continue to minimize the health and wellness of gay men and other men who have sex with men (MSM) and transgender people. Violence and stigma against LGBTIQ+ persons, often reinforced by the criminalization of same-sex relations, create barriers to essential health services, including HIV and other sexual and reproductive health services.[i],[ii] According to UNAIDS, gay men and other MSM and transgender people accounted for more than half of the total new HIV infections in the region in 2019, at 44 percent and 7 percent, respectively.[iii]
In many countries, LGBTIQ+ persons have fewer economic opportunities as they are often overly dependent on the informal economy to survive.[iv],[v] Additionally, politicians and religious leaders are increasingly using homophobia and transphobia as a tool to rally political support and power. [vi],[vii] More disturbingly is the constant threat of gender-based violence, especially for lesbian and bisexual women and trans people from their communities and families;[viii] and the discrimination, bullying, and violence LGBTIQ+ youth face from their peers and adults in schools as well as online .[ix]
Furthermore, many governments continue to view homosexuality as an ‘illness’ and can be ‘treated’ and ‘cured’ through, often forced, if not outright state-sanctioned, conversion therapy and corrective rape. Lawmakers in countries like Brunei, Indonesia, and Malaysia continue to push legislation that would force LGBTIQ+ persons to undergo government-sanctioned, religiously-based rehabilitation treatments. Other draft legislation in these countries aims to increase criminal penalties against same-sex relations through the country’s Syariah Courts system. For example, Malaysia and Aceh Province of Indonesia have introduced dehumanising punishments, including social media-friendly public flogging for gay and lesbian sex.
Intertwining these experiences and realities has an impact on mental health based on continuous and long-term exposure to the trauma LGBTIQ+ persons and their communities face – all of which have now been amplified and exacerbated by the COVID-19 pandemic.
As defined by the WHO, health is a “state of complete physical, mental and social well-being and not merely the absence of disease of infirmity.”[x] Despite being an essential and integral component of overall health, government health bodies have largely neglected mental health. Furthermore, it continues to go unnoticed due to the stigma, taboo, and discrimination surrounding the issue.
In the region, mental health research, programmes, and interventions that focus on and consider the well-being of LGBTIQ+ persons are scarce and often treated as a peripheral issue. A significant portion of the mental health needs of LGBTIQ+ persons goes unidentified and unmet. What is known, however, is the high rates of suicide in the region within the LGBTIQ+ community and, except for the limited peer support services, the mostly nonexistent LGBTIQ+ mental health services in most countries.[xi]
Despite the limited research and documentation from the region on the impact of economic shocks and natural disasters on vulnerable populations, a consistent theme that emerges each time is an increased psychological vulnerability and risk experienced by vulnerable and marginalized populations, including LGBTIQ+ persons.[xii]’[xiii]
The COVID-19 pandemic is no exception. A regional survey carried out by the United Nations Interagency Task Team (IATT) on young key populations found that 40% of those self-identified as LGBTIQ+ individuals have faced gender-based violence during the pandemic.[xiv] Another survey conducted by Sustained Health Initiatives of the Philippines (SHIP) showed more than 60% of individuals at risk of HIV, including MSM and transgender people reporting a decrease in testing; and that more than half have either decreased or stopped taking their HIV preventive medications. Experts believe this figure to be comparable throughout our region due to the heavy burden the pandemic has placed on the already weakened health systems and the severity of quarantine measures.
In Hong Kong, research on the mental health impact of COVID-19 on LGBTIQ+ persons found that depressive and anxiety symptoms, including a sense of social isolation and loneliness, were more pronounced in LGBTIQ+ persons during the COVID-19 pandemic and could be explained by stressors unique to their gender identity and sexual orientation. General COVID-19-related stressors such as physical and social distancing, economic insecurity, family relations, visa/travel restrictions affect transnational couples, disruption in daily routine, and access to health services were exacerbated in LGBTIQ+ persons and differ across the various LGBTIQ+ subgroups by age and income.[xv]
In an absurd and somewhat paradoxical nature of disasters, the pandemic has provided a path and a window of opportunity for us to normalize conversations and shape the narrative about mental health in our region. The collapse of health and social protection systems in countries like India and Nepal speaks not only to the horror of this pandemic but the painful and long-term impact of collective trauma that awaits us in years to come. COVID-19 has magnified the inextricable links between vulnerability, stigma, gender inequity, social exclusion, mental health, and overall well-being.
Efforts to address the gaps in mental health care for LGBTIQ+ persons must consider the layered and complex interactions and dynamics between the biological, psychological, and social factors and go beyond the health sector. Programmes, interventions, research, and policies supporting LGBTIQ+ mental health care must move outside of the narrow biomedical approach and be an integral part of health and wellbeing. Above all else, mental health care must be grounded in human rights principles of human dignity, equality, autonomy, and inclusion and based on the lived experiences and realities of LGBTIQ+ persons and communities.
Sixteen years after the global community first observed IDAHOBIT Day to raise awareness of LGBTIQ+ rights and dignity, we are still seeing unprecedented levels of physical and sexual assault, hatred, stigma, and discrimination against LGBTIQ+ people. Today, 69 countries continue to criminalize same-sex relations, and worldwide transgender people face high levels of violence. Under the pretext of the pandemic and public health measures, we are witnesses the backsliding on LGBTIQ+ rights and well-being. We need to do better. Our response must change. We must leverage greater social awareness about the vulnerabilities and inequalities engendered by the COVID-19 pandemic to tackle the structural and systemic inequalities that have long inhibited growth and acceptance and confront the violence, stigma, and discrimination LGBTIQ+ people continue to shoulder.
[i] Beyrer, C., Sullivan, P. S., Sanchez, J., Dowdy, D., Altman, D., Trapence, G., Collins, C., Katabira, E., Kazatchkine, M., Sidibe, M., & Mayer, K., H. (2012). A call to action for comprehensive HIV services for men who have sex with men. Lancet (London, England), 380(9839), 424-438. doi:10.1016/S0140-6736(12)61022-8.
[ii] UNAIDS (2020). UNAIDS Executive Director Report: Opening of the 47th meeting of the UNAIDS Programme Coordinating Board. 15 December 2020, Geneva, Switzerland.
[iii] UNAIDS (2021), UNAIDS: Asia and the Pacific Data 2020.
[iv] UNDP, ILO (2018), LGBTI People and Employment: Discrimination Based on Sexual Orientation, Gender Identity and Expression, and Sex Characteristics in China, the Philippines and Thailand.
[v] Winter, S., Davis-McCabe, C., Russell, C., Wilde, D., Chu, T.TH., Suparak, P. and Wong, J. (2018). Denied Work: An audit of employment discrimination on the basis of gender identity in Asia. Bangkok: Asia Pacific Transgender Network and United Nations Development Programme.
[vi] Yulius, H. (2017). Behind Political Homophobia: Global LGBT Rights and the Rise of Anti-LGBT in Indonesia. Published on: https://th.boell.org/en/2017/06/16/behind-political-homophobia-global-lgbt-rights-and-rise-anti-lgbt-indonesia
[vii] International Lesbian, Gay, Bisexual, Trans and Intersex Association (2016), The Personal and the Political: Attitudes to LGBTI People Around the World.
[viii] Asia Pacific Transgender Network (2020). Regional Mapping Report on Trans Health, Rights and Development in Asia.
[ix] UNESCO (2015). From Insult to Inclusion: Asia-Pacific report on school bullying, violence and discrimination on the basis of sexual orientation and gender identity.
[x] World Health Organization: Promoting Mental Health. Concepts, Emerging Evidence, Practice Geneva: World Health Organization 2004.
[xi] UNDP (2015). Report of the Regional Dialogue on LGBTI Human Rights and Health in Asia-Pacific. 26-27 February 2015, Bangkok, Thailand.
[xii] APCASO, Global Fund Advocates Network Asia-Pacific (2020). Asia-Pacific Rapid Assessment on Key and Emerging Issues of HIV, TB, and Malaria Affected Communities and Civil Society During the COVID-19 Pandemic. Thailand: APCASO.
[xiii] OutRight Action International (2020). Vulnerability Amplified: The Impact of the COVID-19 Pandemic on LGBTIQ People. (Geneva)
[xiv] Interagency Task Team on Young Key Populations (2020). Preliminary Findings: Rapid Survey on the Needs of Young Key Populations and Young People Living with HIV in Asia and the Pacific in the Context of COVID-19.
[xv] Suen, Y.T., Chan, R.CH., & Wong, E.M.Y. (2020). Effects of general and sexual minority-specific COVID-19 related stressors on the mental health of lesbian, gay, and bisexual people in Hong Kong. Psychiatry Research, October; 292:113365
Edmund Settle, Executive Coach, Social Entrepreneur
* APCASO is an Asia-Pacific civil society network of community-based and non-governmental organisations on health, human rights, and social justice, focusing on advocacy and community capacity development. Visit our website to learn more about our work on mental health, COVID-19, and communities most need.
The views expressed in this article are not necessarily those of Heinrich Böll Stiftung