New Peruvian regulation on health care for transgender people generates negative reactions

The bulletin appeared without much fanfare in an official Peruvian government newspaper that publishes new laws and regulations. Peruvian health officials say they had no idea what response it would trigger.

They say they wanted to expand access to privately insured mental health care for transgender Peruvians. So the government decree included language classifying transgender identity as a “mental health issue.”

But when news of the regulation leaked, it sparked outrage among LGBTQ people and their advocates in the country.

Many critics said the rule was another blow in a country where gay marriage and civil unions are illegal; transgender identity is not legally recognized; there is no legislation that recognizes hate crimes; and trans-Peruvian people say they face widespread discrimination and violence.

“What they are doing is labeling an entire community as sick,” said Cristian González Cabrera, who researches LGBTQ rights in Latin America for Human Rights Watch.

But health officials said the anger and backlash were the result of a miscommunication and that they did not intend to offend trans people.

This month, the Peruvian government added seven diagnosis codes from the World Health Organization’s medical classification system to a list of conditions in Peru that must be covered by public and private insurance.

But the law used language from an outdated version of the WHO classification system that included “transsexualism” and “gender identity disorder” as “mental and behavioral disorders.”

A new version of the WHO system, which came into force in 2022, replaced those terms with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” in a chapter titled “Conditions related to sexual health”.

The change, according to the WHO, was intended to reflect “current knowledge that trans and gender diverse identities are not conditions of poor mental health, and that classifying them as such can cause enormous stigma.”

Peruvian health officials said in an interview that they were aware of the WHO changes but were only now beginning the process of adopting and incorporating a new standard due to bureaucratic obstacles.

“It’s a path we’ve already started to travel,” said Henry Horna, communications director for Peru’s Health Ministry, although officials did not say how long the process would take. So, for now, the current classification is maintained.

Given the commotion, the ministry clarified in a statement that “gender and sexual diversity are not diseases” and that it rejects discrimination.

Dr. Carlos Alvarado, the ministry’s health insurance director, said the regulation was intended to make it easier for insurers to bill for treatment related to transgender identity.

“Honestly, we didn’t expect the reaction,” he said.

“The problem obviously arose from a misunderstanding of the meaning of the rule,” Horna said. “The rules are written in legal language, in cold language, in technical language.”

But Leyla Huerta, a trans activist, said access to private insurance is irrelevant for most trans Peruvians due to the discriminatory hiring practices of many private sector employers.

He said any benefits to the trans community were outweighed by the stigmatization of the language used in government regulation.

Classifying transgender people as mentally ill, activists and experts say, could open the door to promotion by some conservative groups of the widely discredited practice of conversion therapy, aimed at changing a person’s gender identity or sexual orientation. person.

But health officials took note of previous government guidelines that stated transgender identity was not a mental illness and discouraged conversion therapy.

The current controversy is just one of many fights to expand gay and transgender rights and health care in Latin America, a region with high levels of violence against LGBTQ people.

Still, even in that environment, Peru stands out because its legal system grants almost no rights to gay and transgender people, González said.

Same-sex marriage has been legal for years in other South American countries, such as Brazil, Colombia, Chile, Argentina and Ecuador. “Peru is far behind its South American neighbors,” González said.

The head of the Peruvian government’s human rights office, during his testimony last year before the country’s Congress, referred to homosexuality as “deformities that must be corrected.”

And last year, a trans woman who worked as a prostitute was kidnapped and shot 30 times on the streets of Lima, a murder that was captured on video. So far one person has been arrested, but no trial has yet taken place.

The Peruvian government does not collect data on acts of bias or violence against transgender people.

But a study published in 2021 by a Peruvian human rights group, Más Igualdad, found that among a sample of 323 LGBTQ Peruvians, 83 percent said they had experienced some type of verbal or physical abuse and 75 percent said they had been object of discrimination.

Más Igualdad president Alexandra Hernández, a psychologist, said she believed some Health Ministry officials had good intentions in issuing this rule, but did not consult with LGBTQ mental health experts.

“They say it was beneficial for us,” said Gianna Camacho García, a trans activist and journalist. “In reality, it was a minimal benefit compared to how much we have to lose in other areas or aspects of life by calling ourselves mentally ill.”

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