“Today, in France, we still cannot live and love freely just as we are,” said Joël Deumier, president of the association SOS Homophobie. In its annual report published May 10, 2017, the organization stated it received 1,575 testimonies of anti-LGBT acts in 2016, an increase of nearly 20% compared with the previous year. It’s possible that the increase in reported incidents reflects a greater willingness of victims to speak out. Still, SOS Homophobie believes that many victims of anti-LGBT acts do not dare come forward.

Demonstration in support of same-sex marriage in Paris, 16 December 2012.

© 2012 Olivier Hoffschir

In 2016, SOS Homophobie received 26 reports from people who said they had a homophobic, biphobic, or transphobic encounter with justice or law enforcement officials. By this is meant that an officer refused to characterize an assault as homophobic in a complaint or to even file a complaint, or that a law enforcement officer himself discriminated against LGBT people.

While these incidents remain thankfully limited, they are no less unacceptable. France should take measures to determine how widespread these attitudes are among public officials, and to prevent subversion of their duties because of this attitude.

SOS Homophobie’s report also shows a correlation between debates over equal rights and the increase of anti-LGBT acts. The organization recorded a spike in reported incidents in 2013, the year France legalized same-sex marriage. In 2016, France adopted a law waiving the requirement for transgender people to provide proof of medical treatment to amend their legal gender. That same year saw a 76% spike in reported transphobic incidents.

While a majority of the French population is in favor of allowing same-sex couples to get married and adopt children, opponents of LGBT rights are a “vocal minority,” and are especially active on social media, where prosecution for homophobic statements remains difficult to carry out.

Several candidates for the 2017 presidential election expressed their intention to “rewrite the Taubira law” on same-sex marriage and adoption. One candidate even received the support of Sens commun, an organization openly opposed to the rights of LGBT people. When political figures take stands that are hostile to equal rights, they may “rekindle hate.”

It is high time to end discrimination against LGBT people and the French authorities have a key responsibility and role to turn this into reality.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

This week Poland’s parliament has the chance to improve the lives of transgender people by passing a law that simplifies the legal gender recognition procedure.

Recognition before the law in your preferred gender is a vital aspect of ensuring respect for the human rights of transgender people. For example, it allows transgender people to access services on an equal footing with their peers.

Transgender activists march in the 2015 Warsaw Pride holding a banner that reads "YES to Gender Accordance Act.”

© 2015 Trans-Fuzja

Momentum on this matter is building. Earlier this year, the Parliamentary Assembly of the Council of Europe issued a resolution noting “the emergence of a right to gender identity”, while raising concerns that “transgender people face widespread discrimination in Europe.”

Members of Poland’s parliament will consider the country’s Act on Gender Recognition this Friday. Parliament already passed the draft legislation over the summer, although the president vetoed it last week.

The act proposes some important advances.

First, it defines gender identity as a “settled and intense experience of one’s own gender,” which may or may not correspond with one's sex assigned at birth.

Second, it eliminates the requirement for physical interventions before gender can be legally recognized, and instead makes the process a court procedure.

Third, it spells out the various documents on which applicants are legally entitled to change their gender – including education certificates, work qualifications, and health records – and allows the possibility for young transgender people, once they reach age 16, to change their name.

Access to documents in your preferred gender and name is a key element in ensuring respect for an individual’s right to personal and private life, and also allows transgender people better access to healthcare, education, and employment.

In a recent survey, 78 percent of Polish transgender people said quicker and easier legal gender recognition procedures would allow them to live more comfortably.

There’s no doubt President Andrzej Duda’s recent veto of the act was a setback. But if parliament does vote in majority support of the legislation, Poland will take a huge step forward and transform the lives of many.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Graeme Reid is an expert on LGBT rights. He has conducted research, taught and published extensively on gender, sexuality, LGBT issues, and HIV/AIDS. He is author of How to be a Real Gay: Gay Identities in Small-Town South Africa (University of KwaZulu-Natal Press, 2013). Before joining Human Rights Watch in 2011, Reid was the founding director of the Gay and Lesbian Archives of South Africa, a researcher at the Wits Institute for Social and Economic Research and a lecturer in Lesbian, Gay, Bisexual, and Transgender Studies at Yale University, where he continues to teach as a visiting lecturer. An anthropologist by training, Reid received a master’s from the University of the Witwatersrand, Johannesburg, and a PhD from the University of Amsterdam.

Posted: January 1, 1970, 12:00 am

People protest U.S. President Donald Trump's announcement that he plans to reinstate a ban on transgender individuals from serving in any capacity in the U.S. military, in Times Square, in New York City, New York, U.S., July 26, 2017.

© 2017 Reuters

The Trump administration has proposed a rule that would allow insurers and health care providers to discriminate against transgender patients, making it even more difficult for transgender people to find accessible, inclusive healthcare in the United States.

The Department of Health and Human Services (HHS) should reject the proposed rule, which would narrow how the department defines sex discrimination.

During the Obama administration, HHS clarified that discrimination based on gender identity, sex stereotypes, pregnancy, and termination of pregnancy are forms of sex discrimination, and are prohibited under the Affordable Care Act. That meant insurers couldn’t refuse to insure someone, raise their rates, or deny them coverage for certain forms of health care simply because they’re transgender, and providers couldn’t turn away or mistreat transgender patients.

A federal judge in Texas put some of these protections on hold in 2016 in response to a court challenge, and the Trump administration has declined to defend them in court. It now plans to claw them back altogether – at the expense of LGBT and pregnant patients.

Human Rights Watch has documented the difficulties transgender people in the US face when seeking health care providers who offer the services they need without discriminating or making them feel unwelcome. People described struggling to obtain insurance for basic health care needs, traveling hours to find welcoming providers, and being mocked or humiliated by medical personnel or refused service outright. The proposed rule would make it even harder to change this harmful status quo.

Without federal protections, individuals have to look to states for protection – and the landscape is bleak. Only 14 states and the District of Columbia expressly prohibit private insurers from discriminating on the basis of gender identity, while only 20 states and the District of Columbia ban them from offering plans that categorically deny coverage for transition-related care. The impact of the federal rollback will be swiftly felt in places such as Iowa, where lawmakers recently overrode a court decision prohibiting health care discrimination by expressly excluding transition-related care from the state’s Medicaid policy.

Eliminating existing protections would put transgender people and pregnant people at risk. The Trump administration should keep these vital safeguards in place, instead of bending over backwards to stop the federal government from fighting discrimination.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Secretary Alex Azar

Department of Health and Human Services

Hubert H. Humphrey Building, Room 509F

200 Independence Avenue SW

Washington, DC 20201


Re: RIN 0945-AA11, “Nondiscrimination in Health and Health Education Programs or Activities”

Dear Secretary Azar:

Human Rights Watch is an independent organization working to investigate, expose, and address human rights violations around the globe. We write to oppose the proposed rule on Nondiscrimination in Health and Health Education Programs or Activities, and to urge the Department of Health and Human Services to instead renew its efforts to eradicate discrimination on the basis of sex – including discrimination against transgender people – in healthcare settings.

In July 2018, Human Rights Watch published the report “You Don’t Want Second Best”: Anti-LGBT Discrimination in US Health Care.[1] The report documents the difficulties that lesbian, gay, bisexual, and transgender (LGBT) people encounter in accessing healthcare services in the United States. In November 2018, Human Rights Watch published the report "Living at Risk”: Transgender Women, HIV, and Human Rights in South Florida.[2] Based on our research, we believe the proposed rule would exacerbate discrimination against transgender people in medical settings and would negatively affect their health and rights.[3] The proposed rule would narrow the Department’s definition of discrimination based on sex; among other changes, it would exclude discrimination based on gender identity as a form of sex discrimination. In doing so, it would leave transgender people vulnerable to discrimination and refusals of service by insurers and healthcare providers, jeopardizing their health and rights.  

  1. The Proposed Rule Does Not Sufficiently Protect Patients

In the Final Rule issued in 2016, the Department of Health and Human Services observed that transgender individuals experience stark health disparities and often are unable to obtain insurance coverage, are not protected under covered entities’ nondiscrimination policies, are harassed in healthcare settings, are refused care, and delay or forego needed healthcare because of concerns about mistreatment.[4] The Department determined at the time that the Final Rule would help ameliorate these concerns and would benefit the health and well-being of women, transgender people, and the wider society.[5] It specifically found that “[b]y prohibiting discrimination on the basis of sex, Section 1557 [of the Affordable Care Act] would result in more women and transgender individuals obtaining coverage and accessing health services.”[6]

A substantial body of research indicates that these conditions persist. Moreover, the potential benefits of the existing regulations have not yet been realized, as they have been enjoined by a federal court and the Administration has not enforced them or established alternative means of protecting transgender people from discrimination in healthcare. The Administration’s decision to roll back the Final Rule does not address the weighty concerns that initially motivated rulemaking in this area, and leaves transgender individuals vulnerable to discrimination, mistreatment, and refusals of care by insurers and providers alike.

The failure to protect patients is exacerbated by other recent law and policy changes that weaken protections and permit insurers and providers to discriminate. Last year, Human Rights Watch expressed opposition to the Proposed Rule on Protecting Statutory Conscience Rights in Health Care; Delegations of Authority.[7] The Department ultimately adopted a version of this rule, expanding exemptions for religious and moral objectors and jeopardizing the ability of women and LGBT people to obtain the healthcare services they need. The Department’s approach to nondiscrimination protections jeopardizes transgender health on two fronts; it substantially expands “exemptions” to nondiscrimination provisions by arguing these are necessary to preserve the rights of religious and moral objectors, while simultaneously rejecting or repealing the underlying nondiscrimination protections themselves.[8] The cumulative result of these regulatory changes is more pervasive discrimination and significantly reduced access to care. The changes facilitate discrimination against groups who already face persistent mistreatment and bias in healthcare settings.

  1. LGBT People, Especially Transgender People, Already Face Stark Health Disparities and Barriers to Accessing Care; Federal Protection is Necessary

When LGBT people experience health problems, they may encounter a variety of barriers to obtaining the care they need. A nationally representative survey in 2017 found that 25 percent of transgender respondents were uninsured, compared to only 8 percent of cisgender respondents.[9] Transgender people also face high rates of discrimination and mistreatment in medical settings. The same survey found that 21 percent of transgender respondents had been subject to harsh or abusive language by healthcare providers in the year preceding the survey.[10] Over the same period, 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their gender identity or sexual orientation.[11] Similarly, a survey of almost 28,000 transgender people in 2015 found that 33 percent of respondents had experienced a negative interaction with a healthcare provider because of their gender identity in the year preceding the survey.[12]

When LGBT people experience discrimination or refusals from healthcare providers, this can prevent them from obtaining the care they need. One survey found that 41% of LGBT people outside of major metropolitan areas felt it would be “very difficult” or “not possible” to find an alternative provider if they were refused care at a hospital.[13]

The discrimination and mistreatment that transgender people experience throughout healthcare settings make expansive nondiscrimination protections important. In interviews, patients and advocates noted that they not only encountered discrimination from medical providers, but from administrative staff. Jeynce Poindexter, a victims advocate at the LGBT organization Equality Michigan, observed in an interview with Human Rights Watch: “The initial interaction in the emergency room, where you have to give your ID, info, insurance, that’s mainly where the complaints come from… There’s lots of misgendering, harmful terminology, intentional disrespect.”[14] Connie L., a 31-year-old transgender woman in Miami, recalled: “This woman shouted for ‘Kevin’ to come to the desk. I shrunk in my seat, hoping she would see the note on the chart about my gender change. But she just kept yelling for Kevin. I finally had to get up and cross the room in a walk of shame. Will I ever go back there? No way.”[15]

Other Human Rights Watch interviewees faced humiliation or discrimination from providers themselves. In 2018, Renae T., a transgender woman in Memphis, Tennessee, told Human Rights Watch about an incident where a nurse was treating her for cardiomyopathy (a heart condition), left the room, and audibly told another nurse to come look at the patient’s breasts.[16] Judith N., a transgender woman in East Tennessee, described a pre-employment medical examination in which a doctor abruptly ended the appointment without giving her the exam as soon as he saw that she had shaved her legs.[17] Karen W., a transgender woman in Biloxi, Mississippi, recounted that she had been admitted and then ignored when seeking care at the emergency room at a local hospital.[18]

In some instances, transgender people are refused care outright because of their gender identity. Jessica Shea, a clinical social worker in Memphis, described how a religiously affiliated psychiatric practice turned away a transgender child:

They accepted the person at first, but when they found out it was a trans client, the doctor said we don’t see trans clients here. They got in the door, but then got turned away. It often takes months to get an appointment here, and the family felt they had invested a lot of time to get in, and was then turned away. It was the doctor there.... Once he found out the child was a trans child he said they would not be able to accommodate them for the psych evaluation. The family was told they don’t provide services to trans clients.[19]

Other services that were offered to the general public were similarly withheld from transgender individuals. One interviewee in Memphis recounted the story of a transgender woman who “had a yeast infection, and five to six doctor’s offices told her we don’t treat trans patients. But a prescription for Diflucan isn’t gendered! Unless you’re talking about HRT or surgery, health care isn’t different for trans people. It’s a body that needs care.”[20]

Such discriminatory incidents can deter people from returning for further medical care. As Carla B., the mother of a transgender teenager, told Human Rights Watch in 2017: “I said these are [my son’s] name and his pronouns and he was sitting there, and the doctor uses his birth name and pronouns.... After the doctor left, [my son] cried for a solid ten minutes, and said I don’t want to come back here ever again.”[21]

Discrimination in health care can compound the isolation and discrimination in society that also contribute to health disparities. Researchers have found that the added stressors that members of marginalized groups experience – called minority stress – can adversely affect both physical and mental health.[22] Levels of minority stress are influenced by the environment in which people live. Research shows that, in parts of the country with greater social and legal equality, LGBT people have better health outcomes and smaller disparities in comparison with their cisgender, heterosexual counterparts.[23]

Conversely, laws targeting LGBT people can contribute to stress. One recent study found that the passage of state-level religious refusal laws, for example, was associated with a 46 percent increase in the number of LGBT residents of the state reporting mental distress.[24]

Consistent with these findings, research has established that transgender people are at heightened risk of physical and mental health conditions.[25] Existing data from the United States indicates that transgender people are more likely to be overweight, be depressed, report cognitive difficulties, and forego treatment for health problems than their cisgender counterparts.[26] In the United States, the National HIV/AIDS Strategy designates transgender women as a “high-risk” and “key” population as a recent meta analysis found 14 percent of transgender women are HIV positive, with higher prevalence rates among transgender women of color.[27] This is grossly disproportionate to the overall prevalence of HIV in the US, which is under one percent.[28]

Despite these clear patterns regarding transgender health needs and challenges securing access to care, state-level nondiscrimination laws and policies are limited, leaving many transgender people in the US without sufficient protection.[29] Public insurance also varies considerably from state to state. While Medicaid expressly covers transition-related care in 19 states and the District of Columbia, it is silent on the issue in 24 states, and excludes transition-related care in seven states.[30] Rolling back federal protections would leave people especially vulnerable in states that lack comprehensive protections against gender identity discrimination in health care. In 2018, for example, the Iowa Supreme Court ruled that excluding transition-related care from public insurance violated the Iowa Civil Rights Act; in 2019, the legislature amended the Iowa Civil Rights Act to expressly permit such discrimination.[31] Federal protection is necessary to meaningfully prevent discrimination in healthcare for transgender people throughout the United States.

  1. The Proposed Rule Would Exacerbate Documented Barriers to Accessing Health Care

Through interviews, Human Rights Watch has identified some of the many barriers that transgender people encounter when seeking healthcare services. The proposed rule would exacerbate each of these concerns. 

First, as described above, transgender people face widespread discrimination, even when accessing routine health services. Existing nondiscrimination protections at the federal level ensure that individuals who need care receive that care, regardless of their gender identity or expression. The proposed rule would permit discrimination by providers, allowing them to decide whether to provide care based not on the patient’s healthcare needs, but on their identity or expression. A foreseeable consequence is that some providers will feel emboldened to discriminate, and transgender individuals will be less certain that they will receive or can insist on fair treatment in the absence of clear protections.

Second, transgender people are often unable to obtain healthcare to meet specific needs related to their gender identity, and the current rule helps mitigate this situation by improving insurance coverage and ensuring that services available to cisgender patients are also available to transgender patients. Transgender people who medically transition, for example, may seek access to hormone replacement therapy (HRT) or gender-affirming surgeries as part of their transition.[32] Transgender women may have a greater need for HIV-related health care, including preventive care such as pre-exposure prophylaxis (PrEP), a daily pill that significantly lowers the risk of HIV infection. Some transgender people who decide to have children may seek out fertility specialists or utilize assisted reproductive technologies as part of the process. A change to the existing federal rule could jeopardize access to these services when a patient is transgender.

In interviews with Human Rights Watch, many LGBT individuals and service providers said there were few, if any, LGBT-friendly healthcare providers in their area – rendering a federal obligation to provide care even more important. As the head of one community center in rural Michigan said, “I do not know of any trans-affirming healthcare providers in the area. And I’ve talked to many trans people in the area.”[33] Interviewees told us that as a result of the lack of providers in rural areas, transgender individuals would drive two hours from Tennessee to attend a weekend support group for gender-expansive youth in Birmingham, Alabama;[34] would travel two hours from Mississippi to meet with a trans-affirming doctor in Memphis, Tennessee;[35] and would drive from East Tennessee to North Carolina for regular hormone injections.[36]

The lack of providers was especially acute in rural areas, but certain services were difficult to find in metropolitan areas as well. As one mother of a transgender child noted:

In Knoxville, we have a lot of hospitals, a lot of doctor’s offices, but even with all of that, finding hormone therapy is very difficult. So difficult. Gynecologists don’t do hormones, GPs don’t do hormones, you have to see an endocrinologist. And that can be cost prohibitive, or maybe you don’t find one you like.... It’s hard to find medical care for trans people even in a city around here—and that’s just for hormones. Finding a GP where you can go in the office that you’re comfortable in, where the doctor is good, the office is good—that’s hard for anyone, even if you’re not trans. But having them treat you like a normal human being when you’re trans is even more difficult. If you’re in a rural area, you’re up a creek.[37]

While some of the scarce services were related to gender-affirming treatment, others were general medical services available to cisgender people that providers denied to transgender people. Interviewees noted that breast surgeries that were available to cisgender individuals, for example, were not similarly available to transgender individuals.[38] One sexual and reproductive health services provider estimated that in Memphis, Tennessee, with a population of 650,000, only four medical practices provide hormone replacement therapy – in contrast with menopausal hormone therapy for cisgender women, which she described as virtually identical to HRT and much more widely available.[39]

When protections are piecemeal, transgender patients may not know whether services are available to them. One doctor in a rural state noted that her hospital had extensive services for transgender youth, but was not allowed to market or advertise those services because administrators were concerned about repercussions from the state legislature.[40] The mother of a transgender child who had struggled to find a pediatric endocrinologist said, “The ones in this area, they’ve told us they’re not certain about displaying something saying they’re LGBT-friendly, out of fear of how people would react.”[41] Judith N., a transgender woman in East Tennessee, said “I spent years looking for access to therapy and hormones and I just couldn’t find it.”[42] When a limited number of providers were known to the community to be competent and welcoming, they could be overwhelmed with demand.[43] Having federal protections in place can help establish a presumption that healthcare services are offered without discrimination.

By permitting insurers and providers to limit coverage and services without repercussion, the proposed rule would adversely affect those who cannot afford or access alternative options. When providers are limited, other forms of disadvantage and marginalization can make access practically impossible, particularly where lengthy travel or out-of-pocket expenses are required. Data from the 2015 U.S. Transgender Survey indicated that 15 percent of transgender respondents were unemployed and 29 percent were living in poverty.[44] Of those who had held or applied for a job in the previous year, 27 percent reported experiencing employment discrimination because of their gender identity or expression.[45] Without employment, individuals may have a more difficult time maintaining insurance and affording health care. In the same survey, a third of the transgender respondents indicated that they had foregone medical care they needed in the past year because of concerns about cost.[46] When accessible options are few and far between, a provider’s hostility or unwillingness to see a transgender patient is not only an indignity and inconvenience, but may prevent the patient from obtaining treatment at all.

The proposed rule would exacerbate these barriers. Individuals would not only need to find accessible, affordable services in their areas, but would need to ensure that their insurers would cover those services and that their providers would deliver those services without discriminating based on gender identity. A foreseeable outcome is that many transgender individuals will simply be unable to obtain the care they need. Without adequate healthcare, workers are less able to contribute to the economy, tenants are less able to maintain stable housing, and parents are less able to care for their children.

Third, LGBT people, and especially transgender people, may be reluctant to seek out the care they need when they anticipate discrimination or have been subject to discrimination in healthcare settings in the past. Data suggest that discrimination deters many LGBT people from seeking care. In a nationally representative survey, eight percent of LGBT respondents had delayed or foregone medical care because of concerns of discrimination in healthcare settings—and those who had previously experienced discrimination were six times more likely to avoid going to a doctor’s office than those who had not experienced discrimination.[47] In a National Center for Transgender Equality survey, twenty-three percent of respondents did not seek care they needed because of concern about mistreatment based on gender identity.[48]

Clara B., the mother of a transgender teenager in Knoxville, told Human Rights Watch: “The dentist is a good example—[my son] hasn’t gone back in two years. They’re very religious people and [my son] said, ‘I don’t know how they feel about me and I don’t want to go.’ We’ve yet to agree on finding another dentist.”[49] Judith N., a transgender woman in East Tennessee, described how she had foregone medical care, attributing her decisions to “the combination of not having money anymore and the [low-quality] insurance that goes with it, and then worrying about how I’ll be treated.”[50]

As these examples suggest, many transgender people are already reluctant to seek out care because of how they are treated, and delay or forego that care as a result. The proposed rule would take the position that such discrimination is permissible, further deterring transgender people from seeking care.

  1. Rights at Stake

The Right to Health

Under international law, everyone has the right “to the enjoyment of the highest attainable standard of physical and mental health” without discrimination on the basis of sex, age, or other prohibited grounds.[51] The right to health is also inextricably linked to provisions on the right to life and the right to non-discrimination that are included in the International Covenant on Civil and Political Rights (ICCPR), which the US has ratified.[52]

The Committee on Economic, Social and Cultural Rights, the United Nations body charged with interpreting and monitoring the implementation of the International Covenant on Economic, Social, and Cultural Rights (ICESCR), has identified four essential components to the right to health: availability, accessibility, acceptability and quality.[53] In General Comment 22, the Committee further affirmed that “[n]on-discrimination, in the context of the right to sexual and reproductive health, also encompasses the right of all persons, including LGBTI persons, to be fully respected for their sexual orientation, gender identity and intersex status.”[54] Even though the US is not a party to the ICESCR, the Committee’s interpretation represents a useful and authoritative guide to the steps governments should take to realize and protect the right to health and other human rights. The proposed rule will reduce the availability and accessibility of healthcare services, particularly for transgender people, in communities across the US.

When states enact laws allowing healthcare providers to discriminate, they undermine the right to health. Individuals may be denied services outright; have difficulty finding services of comparable quality, accessibility, or affordability; or avoid seeking services for fear of being turned away.

The Committee on Economic, Social and Cultural Rights has noted that the right to health is threatened both by direct discrimination and by indirect discrimination, in which laws appear neutral on their face but disproportionately harm a minority group in practice.[55] To promote the right to health, the Committee has thus urged states to “adopt measures, which should include legislation, to ensure that individuals and entities in the private sphere do not discriminate on prohibited grounds.”[56]

The Right to Non-Discrimination

Non-discrimination is a central principle of international human rights law.[57] As a party to the ICCPR, the US is obligated to guarantee effective protection against discrimination in the enjoyment of rights, including discrimination based on sex, sexual orientation, and gender identity.[58] Existing protections, if implemented fully, would be a positive step toward fulfilling this obligation. Adopting the proposed rule would eliminate a clear nondiscrimination protection without any alternative proposal to ensure transgender people are able to access healthcare on equal terms with others.

  1. Conclusion

Human Rights Watch has documented a range of barriers that transgender people face when seeking healthcare services in the United States. These findings are consistent with research by academic experts and nongovernmental organizations, as well as government data, including the findings cited by the Department when it issued the Final Rule protecting transgender individuals from discrimination in 2016. We believe that withdrawing explicit protection for transgender people will exacerbate existing health disparities and fail to uphold US commitments under international human rights law. For these reasons, Human Rights Watch urges the Department to reject the proposed rule and support inclusive nondiscrimination protections.


Ryan Thoreson

Researcher, LGBT Rights Program

Human Rights Watch


[1] Human Rights Watch, “You Don’t Want Second Best”: Anti-LGBT Discrimination in US Health Care (2018), https://www.hrw.org/sites/default/files/report_pdf/us_lgbt0718_web.pdf.

[2] Human Rights Watch, “Living at Risk”: Transgender Women, HIV, and Human Rights in South Florida (2018), https://www.hrw.org/report/2018/11/20/living-risk/transgender-women-hiv-and-human-rights-south-florida.

[3] While this Comment primarily examines how the rollback of the rule would jeopardize the rights of transgender people, the rollback would also adversely affect LGB and pregnant people who are protected under existing regulations.

[4] “Nondiscrimination in Health Programs and Activities; Final Rule,” 45 CFR 92, Federal Register Vol. 81, No. 96, May 18, 2016, https://www.gpo.gov/fdsys/pkg/FR-2016-05-18/pdf/2016-11458.pdf.

[5] Ibid. at 31461.

[6] Ibid. at 31460.

[7] Human Rights Watch, “Human Rights Watch Letter to US Secretary of Health and Human Services Alex Azar,” March 27, 2018, https://www.hrw.org/news/2018/03/27/human-rights-watch-letter-us-secretary-health-and-human-services-alex-azar.

[8] See Human Rights Watch, “All We Want is Equality”: Religious Exemptions and Discrimination against LGBT People in the United States (2018), https://www.hrw.org/sites/default/files/report_pdf/lgbt0218_web_1.pdf.

[9] Kellan Baker & Laura E. Durso, “Why Repealing the Affordable Care Act is Bad Medicine for LGBT Communities,” Center for American Progress, March 22, 2017, https://www.americanprogress.org/issues/lgbt/news/2017/03/22/428970/repe... affordable-care-act-bad-medicine-lgbt-communities (accessed August 11, 2019).

[10] Shabab Ahmed Mirza & Caitlin Rooney, “Discrimination Prevents LGBTQ People from Accessing Health Care,” Center for American Progress, January 18, 2018, https://www.americanprogress.org/issues/lgbt/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing- health-care (accessed August 11, 2019).

[11] Ibid.

[12] Sandy James et al., Executive Summary of the Report of the 2015 U.S. Transgender Survey, National Center for Transgender Equality (2016), https://transequality.org/sites/default/files/docs/usts/USTS-Executive-S... (accessed August 11, 2019).

[13] Shabab Ahmed Mirza & Caitlin Rooney, “Discrimination Prevents LGBTQ People from Accessing Health Care,” Center for American Progress, January 18, 2018, https://www.americanprogress.org/issues/lgbt/news/2018/01/18/445130/disc... health-care (accessed August 11, 2019).

[14] Human Rights Watch interview with Jeynce Poindexter, Equality Michigan, Detroit, MI, January 16, 2018.

[15] Human Rights Watch interview with Connie L., Miami, Florida, February 6, 2018.

[16] Human Rights Watch interview with Renae T., Memphis, TN, January 12, 2018.

[17] Human Rights Watch interview with Judith N. (pseudonym), Johnson City, TN, December 10, 2017.

[18] Human Rights Watch telephone interview with Karen W. (pseudonym), Biloxi, MS, October 4, 2017.

[19] Human Rights Watch interview with Jessica Shea, Memphis, TN, January 11, 2018.

[20] Human Rights Watch interview with Holly Calvasina, Choices, Memphis, TN, January 10, 2018.

[21] Human Rights Watch interview with Carla B. (pseudonym), Knoxville, TN, December 9, 2017.

[22] Brief of Ilan H. Meyer, PhD., and Other Social Scientists and Legal Scholars Who Study the LGB Population as Amici Curiae Supporting Respondents, Masterpiece Cakeshop v. Colorado Civil Rights Commission, No. 16-111 (U.S. 2017), p. 23-24.

[23] Ibid.

[24] Mary Elizabeth Dallas, “‘Religious Refusal Laws May Take Mental Health Toll on LGBT Americans,” US News & World Report, May 23, 2018, https://health.usnews.com/health-care/articles/2018-05-23/religious-refu... (accessed August 11, 2019).

[25] See Centers for Disease Control and Prevention, “About LGBT Health,” March 24, 2017, https://www.cdc.gov/lgbthealth/about.htm (accessed August 11, 2019).

[26] Carl G. Streed, Ellen McCarthy & Jennifer S. Haas, “Association Between Gender Minority Status and Self-Reported Physical and Mental Health in the United States,” JAMA Internal Medicine, Vol. 177, No. 8 (2017), 1210-1212.

[27] US Centers for Disease Control, “HIV Among Transgender People,” https://www.cdc.gov/hiv/group/gender/transgender/index.html (accessed August 11, 2019);“HIV among Transgender People Fact Sheet,” https://www.cdc.gov/hiv/pdf/group/gender/transgender/cdc-hiv-transgender... (accessed August 11, 2019); US Office of National HIV/AIDS Strategy, “National HIV/AIDS Strategy for the United States, Updated to 2020,” https://files.hiv.gov/s3fs-public/nhas-update.pdf (accessed August 11, 2019).

[28] Avert, “HIV and AIDS in the United States of America,” https://www.avert.org/professionals/hiv-around-world/western-central-eur... (accessed August 11, 2019).

[29] Movement Advancement Project, “Healthcare Laws and Policies,” http://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies (accessed August 6, 2019).

[30] Ibid.

[31] Michael Ollove, “Iowa, Other States Diverge on Transgender Healthcare,” The Gazette, July 17, 2019, https://www.thegazette.com/subject/news/nation-and-world/iowa-other-states-diverge-on-transgender-health-care-aidan-zingler-gender-dysphoria-reassignment-surgery-20190717 (accessed August 6, 2019).

[32] Human Rights Watch, “Living at Risk”: Transgender Women, HIV, and Human Rights in South Florida (2018), https://www.hrw.org/report/2018/11/20/living-risk/transgender-women-hiv-and-human-rights-south-florida.

[33] Human Rights Watch interview with Mary Jo Schnell, OutCenter, Benton Harbor, MI, January 17, 2018.

[34] Human Rights Watch telephone interview with Paula R. (pseudonym), September 7, 2017.

[35] Human Rights Watch interview with Gail Stratton, Oxford, MS, January 13, 2017.

[36] Human Rights Watch interview with Judith N. (pseudonym), Johnson City, TN, December 10, 2017.

[37] Human Rights Watch telephone interview with Sarah H. (pseudonym), Knoxville, TN, October 20, 2017.

[38] Human Rights Watch interview with Holly Calvasina, Choices, Memphis, TN, January 10, 2018; Human Rights Watch interview with Kayla Gore, OutMemphis, Memphis, TN, January 10, 2018; Human Rights Watch interview with Renae T., Memphis, TN, January 12, 2018.

[39] Human Rights Watch interview with Holly Calvasina, Choices, Memphis, TN, January 10, 2018.

[40] Human Rights Watch telephone interview with Paula R. (pseudonym), September 7, 2017.

[41] Human Rights Watch interview with Carla B. (pseudonym), Knoxville, TN, December 9, 2017.

[42] Human Rights Watch interview with Judith N. (pseudonym), Johnson City, TN, December 10, 2017.

[43] Human Rights Watch interview with Sam P. (pseudonym), Johnson City, TN, December 10, 2017; Human Rights Watch interview with Renae T., Memphis, TN, January 12, 2018.

[44] Sandy James et al., Executive Summary of the Report of the 2015 U.S. Transgender Survey, National Center for Transgender Equality (2016), p. 3, https://transequality.org/sites/default/files/docs/usts/USTS-Executive-S... (accessed August 11, 2019). Comparable rates for the general population of the United States were 5 percent and 12 percent, respectively. Ibid.

[45] Ibid.

[46] Sandy James et al., The Report of the 2015 U.S. Transgender Survey, National Center for Transgender Equality (2016), p. 98, https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report... (accessed August 11, 2019).

[47] Shabab Ahmed Mirza & Caitlin Rooney, “Discrimination Prevents LGBTQ People from Accessing Health Care,” Center for American Progress, January 18, 2018, https://www.americanprogress.org/issues/lgbt/news/2018/01/18/445130/disc... health-care (accessed August 11, 2019).

[48] Sandy James et al., Executive Summary of the Report of the 2015 U.S. Transgender Survey, National Center for Transgender Equality (2016), https://transequality.org/sites/default/files/docs/usts/USTS-Executive-S... (accessed August 11, 2019).

[49] Human Rights Watch interview with Carla B. (pseudonym), Knoxville, TN, December 9, 2017.

[50] Human Rights Watch interview with Judith N. (pseudonym), Johnson City, TN, December 10, 2017.

[51] Committee on Economic, Social and Cultural Rights (CESCR), “Substantive Issues Arising in the Implementation of the International Covenant on Economic, Social and Cultural Rights,” General Comment No. 14, The Right to the Highest Attainable Standard of Health, E/C.12/2000/4 (2000), para. 12.

[52] International Covenant on Civil and Political Rights (ICCPR), adopted December 16, 1966, G.A. Res. 2200A (XXI), 21 U.N. GAOR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, entered into force March 23, 1976, ratified by the United States on June 8, 1992, art. 10.

[53] Committee on Economic, Social and Cultural Rights (CESCR), “Substantive Issues Arising in the Implementation of the International Covenant on Economic, Social and Cultural Rights,” General Comment No. 14, The Right to the Highest Attainable Standard of Health, E/C.12/2000/4 (2000), para. 12.

[54] UN Committee on Economic, Social and Cultural Rights, “General Comment No. 22 (2016) on the Right to Sexual and Reproductive Health,” UN Doc. E/C.12/GC/22, May 2, 2016, para. 23. The “I” in “LGBTI” stands for “intersex.”

[55] UN Committee on Economic, Social and Cultural Rights, General Comment No. 20: “Non-Discrimination in Economic, Social and Cultural Rights”, U.N. Doc. E/C.12/GC/20, July 2, 2009, para. 10.

[56] Ibid., para. 11.

[57] International protections for the right to non-discrimination include: ICCPR, arts. 2, 4, 26; ICESCR art.2(2); Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), adopted December 18, 1979, G.A. res. 34/180, 34 U.N. GAOR Supp. (No. 46) at 193, U.N. Doc. A/34/46, entered into force September 3, 1981, art. 2; International Convention on the Elimination of All Forms of Racial Discrimination (ICERD), adopted December 21, 1965, G.A. Res. 2106 (XX), annex, 20 U.N. GAOR Supp. (No. 14) at 47, U.N. Doc. A/6014 (1966), 660 U.N.T.S. 195, entered into force January 4, 1969, ratified by the United States on October 21, 1994, art. 5; International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (Migrant Workers Convention), adopted December 18, 1990, G.A. Res. 45/158, annex, 45 U.N. GAOR Supp. (No. 49A) at 262, U.N. Doc. A/45/49 (1990), entered into force July 1, 2003, art. 1(1), art. 7.

[58] ICCPR, art. 26. The Human Rights Committee frequently expresses concern about discrimination based on gender identity in its concluding observations on state compliance with the ICCPR. See UN Human Rights Committee, Concluding Observations: Azerbaijan, U.N. Doc CCPR/C/AZE/CO/4 (November 16, 2016), paras. 8-9; UN Human Rights Committee, Concluding Observations: Burkina Faso, U.N. Doc CCPR/C/BFA/CO/1 (October 17, 2016), paras. 13-14; UN Human Rights Committee, Concluding Observations: Colombia, U.N. Doc CCPR/C/COL/CO/7 (November 17, 2016), paras. 16-17; UN Human Rights Committee, Concluding Observations: Costa Rica, U.N. Doc CCPR/C/CRI/CO/6 (April 21, 2016), paras. 11-12; UN Human Rights Committee, Concluding Observations: Denmark, U.N. Doc CCPR/C/DNK/CO/6 (August 15, 2016), paras. 13-14; UN Human Rights Committee, Concluding Observations: Ecuador, U.N. Doc CCPR/C/ECU/CO/6 (August 11, 2016), paras. 11-12; UN Human Rights Committee, Concluding Observations: Ghana, U.N. Doc CCPR/C/GHA/CO/1 (August 9, 2016), paras. 43-44; UN Human Rights Committee, Concluding Observations: Jamaica, U.N. Doc CCPR/C/JAM/CO/4 (November 22, 2016), paras. 15-16; UN Human Rights Committee, Concluding Observations: Kazakhstan, U.N. Doc CCPR/C/KAZ/CO/2 (August 9, 2016), paras. 9-10; UN Human Rights Committee, Concluding Observations: Kuwait, U.N. Doc CCPR/C/KWT/CO/3 (August 11, 2016), paras. 12-13; UN Human Rights Committee, Concluding Observations: Morocco, U.N. Doc CCPR/C/MAR/CO/6 (December 1, 2016), paras. 11-12; UN Human Rights Committee, Concluding Observations: Slovakia, U.N. Doc CCPR/C/SVK/CO/4 (November 22, 2016), paras. 14-15; UN Human Rights Committee, Concluding Observations: South Africa, U.N. Doc CCPR/C/ZAF/CO/1 (April 27, 2016), paras. 20-21.

Posted: January 1, 1970, 12:00 am

The conservative Polish Gazeta Polska magazine is including "LGBT-free zone" stickers inside its weekly edition amid rising tensions between LGBT activists and a conservative Christian movement supported by the country's right-wing ruling party.

© 2019 Jaap Arriens/Sipa USA via AP Images

A court in Poland has ruled that a newspaper must stop including hateful “LGBT-Free Zone” stickers in its publications. The Warsaw District Court ordered Gazeta Polska, a government-aligned newspaper, to halt distribution of the stickers immediately, pending the outcome of a rights activist’s case.

The judgment is a welcome relief in the face of increasingly hostile rhetoric in Poland as a spate of “LGBT Free Zones” have been marked in towns across the country. In response, Twitter erupted with the trending hashtag #jestemLGBT (#IamLGBT), showing an outpouring of popular opposition to these vicious tactics.

Much of the vitriol in recent months has been driven by Poland’s ruling Law and Justice Party, which has a history of scapegoating lesbian, gay, bisexual, and transgender (LGBT) people, and sexual and reproductive health activists, under the rubric of “gender ideology.” Senior party members have misrepresented efforts to advance gender equality and end discrimination as attacks on “traditional” family values, and used such arguments to undermine women’s and LGBT rights groups

Rather than defending equality for everyone in the country, the government has used state resources to promote an agenda that undermines it. For example, to advise it on recent sex education curriculum changes, the government appointed a Catholic theology professor who has claimed that contraception can cause “hedonism, sex addiction and a tendency to be unfaithful.” New curriculum guidelines reinforce discriminatory attitudes against LGBT people and gender stereotypes.

Despite the government’s efforts to curb judicial independence, courts in Poland have been an important backstop against insidious “LGBT ideology” claims. In 2018, the Supreme Court ruled that an employee of a print shop could not refuse to print a banner for an LGBT organization because he did not want, in his eyes, to “promote” the rights of LGBT people.

But state action is needed to counter incitements to discrimination. Gazeta Polksa isn’t backing down. In fact they already revised the now-banned “LGBT-Free Zone” decal to read “LGBT Ideology-Free Zone” and continue to distribute the new version.

It seems those who wish to gratuitously discriminate against LGBT people for their own political gain are not giving up. Polish authorities have an obligation under the country’s constitution, human rights law, and EU law to ensure equality for everyone in society. If they fail to do so, European Union institutions should act.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

A group of Lebanese activists chant slogans as they hold Arabic placards that read: "Freedom of expression," right, and "With Mashrou' Leila against the suppression of freedoms. 

© 2019 Bilal Hussein/AP Photo
(Beirut) – The Byblos International Festival Committee has cancelled the indie band Mashrou Leila’s August 9, 2019 concert, Human Rights Watch said today. The committee cited security considerations and said it wanted to avoid “bloodshed,” following a week of pressure and threats from some individuals and some Christian groups.

The Interior Ministry neither responded to the escalating violent threats against Mashrou’ Leila, nor publicly guaranteed the safety of the festival and the concert-goers. Instead, on July 24, the public prosecution referred two band members for interrogation, which lasted six hours. State Security officers forced them to pledge to censor content on their social media accounts, in violation of their right to free speech.

“The cancellation of Mashrou Leila’s concert reflects the government’s increased reliance on overbroad and abusive laws to stifle and censor activists, journalists, and artists,” said Lama Fakih, acting Middle East director at Human Rights Watch. “The government’s decision to take action against Mashrou’ Leila while ignoring serious threats against the band shows that it is using insult and incitement laws selectively to censor divergent opinions.”

Mashrou’ Leila is a Lebanese band that has that gained worldwide acclaim for tackling pressing social issues in the Arab world and speaking out against oppression, corruption, and homophobia.

Mashrou’ Leila has played in Lebanon multiple times, including at the Byblos Festival in 2010 and 2016, performing songs that some individuals and religious groups now claim are offensive to Christianity. The controversy is the latest in an escalating campaign of repression against peaceful speech in Lebanon.

On July 22, a lawyer filed a complaint with the public prosecution calling on the government to prosecute Mashrou’ Leila for insulting religious rituals and inciting sectarian tensions, citing Articles 317, 474, and 475 of the Penal Code. The same day, the Maronite Catholic Eparchy of Byblos issued a statement claiming the band’s songs “offend religious and human values and insult Christian beliefs.” They demanded that the Byblos Festival cancel the show. The campaign proliferated on social media, and many internet users threatened the band with violence if the concert went ahead.

Although the Mount Lebanon prosecutor, Judge Ghada Aoun, released the band members without charge following their July 24 interrogation, State Security forced them to pledge to remove the “offensive” content from their social media accounts, issue a public apology, and remove songs deemed to be offensive to Christianity from their concert set list.

Such pledges violate the band members’ right to free speech, given that Lebanese lawyers agree that they are unconstitutional and have no legal basis. The United Nations Human Rights Committee has found that blasphemy or “defamation of religion” laws violate freedom of expression.

Several hours after the concert was cancelled, the band released a statement expressing regret that any of its songs offended anyone’s beliefs. They assured the public that: “our songs do not insult any sacred religious symbols or beliefs, and that insulting people’s feelings was primarily the result of campaigns of fabrication, defamation, and false accusations of which we were the first victims, and it is unfair to hold us responsible for them. Our respect for others’ beliefs is as firm as our respect for the right to be different.”

On July 30, 11 rights groups, led by Lebanese human rights organization The Legal Agenda, submitted a complaint to the acting cassation prosecutor. They expressed concern about the widespread threats on social media, including incitement to violence, death threats, and calls to ban the concert by force and asked the prosecutor to investigate. They said that such remarks threaten civil peace and prevent the band members from exercising their constitutionally-guaranteed rights to free artistic expression and free speech.

Rights groups, including Human Rights Watch, have noted an exponential increase in the use of criminal defamation and incitement laws to arrest, interrogate, and prosecute people who are exercising their right to free speech. Journalists and activists have told Human Rights Watch that the current climate of prosecutions for peaceful speech has had a chilling effect. Some said they have started self-censoring for fear of being called in for interrogation.

Lebanon’s constitution guarantees freedom of expression “within the limits established by law.” Article 19 of the International Covenant on Civil and Political Rights (ICCPR), which Lebanon ratified in 1972, provides that “everyone shall have the right to freedom of expression.” But Lebanon’s penal code includes several provisions that criminalize peaceful speech. Articles 474 and 475 criminalize insulting religious rituals and denigrating or distorting religious and sacred symbols, respectively. Both are punishable by six months to three years in prison. Article 317 criminalizes “inciting sectarian tensions,” punishable by one to three years, even if the speech is not likely to, or even intended to, incite violence.

Authorities should drop criminal charges for peaceful speech and parliament should urgently repeal laws that criminalize it, Human Rights Watch said.

Laws that are so vague that individuals do not know what expression may violate it create an unacceptable chill on free speech because citizens may avoid discussing any subject that they fear might subject them to prosecution. Vague provisions not only do not give sufficient notice to citizens, but also leave the law subject to abuse by authorities who may use them to silence dissent.

Instead of ensuring that all the necessary security precautions were taken to guarantee the safety of the concert, the Lebanese authorities chose to infringe on Mashrou’ Leila’s right to free speech, Human Rights Watch said.

“This incident demonstrates how criminal defamation, incitement, and insult laws in Lebanon are exploited by powerful groups and how they fail to protect marginalized voices and those who have divergent opinions,” Fakih said. “Lebanon is joining the ranks of abusive governments in the region that trample on free speech rights, pushing out the talent and debate that has made this country what it is.”

Posted: January 1, 1970, 12:00 am

The world famous Lebanese band, Mashrou’ Leila, has become the latest victim of Lebanon’s criminal defamation and insult laws, encapsulating the alarming crackdown on free speech in a country once proud to embrace diversity.

Mashrou’ Leila is slated to perform at Lebanon’s Byblos Festival on August 9. But this week a lawyer filed a complaint with the public prosecution calling on the state to prosecute the band on archaic and vague laws that criminalize insulting religious rituals and inciting sectarian tensions. Each of the “crimes” Mashrou’ Leila is accused of carries a maximum prison term of three years.

Posted: January 1, 1970, 12:00 am

© AFP/Getty Images

А same-sex Russian couple with two kids, aged 12 and 14, fled the country this summer after being targeted by authorities citing Russia’s notorious “gay propaganda” law. Their story is a particularly disturbing example of the state doing deep damage to children and families in the name of “child protection” and “traditional values.”

The parents, who have been together for 11 years and registered their marriage in Denmark, adopted the boys nine and seven years ago respectively. Only one of the two men was registered as the adoptive father because in Russia same-sex couples cannot apply for adoption. The family lived in Moscow until their life started unraveling on June 18 this year after the younger boy was hospitalized with suspected appendicitis. When a doctor asked him about his “mom,” the child said he had “two dads.”

The men said on same day the hospital sent a letter to Russia’s chief investigative agency and the Prosecutor General’s Office alleging child abuse linked to the parents’ “non-traditional sexual orientation.” The next day, an investigator invited the adoptive father for a “conversation” about their family life. The couple then left the country with the children, fearing social services might take the boys away.

Moscow's social protection department said they had not received any complaints against the men and case workers from the state guardianship office gave the family a positive evaluation. But on July 17, the case workers for the family were charged with inadequate performance of duties, a criminal offense punishable by up to three months in prison. In the spirit of the “gay propaganda” ban, the investigators stated that the social workers had failed to take action despite knowing that the adoptive father “promoted non-traditional relationships, thus shaping distorted ideas about family values in children’s minds and harming their health, moral and spiritual development.”

On July 19, police in Moscow searched the family’s apartment in their absence and police in Magnitogorsk searched the apartment of relatives.

Maxim Olenichev, legal advisor of the "Coming Out" LGBT group, told Human Rights Watch that it’s not clear which charges, if any, the authorities were planning to bring against the couple. But one thing is clear: the criminal charges against the social workers are meant as a warning to other officials that gay people should be viewed as unfit for parenthood.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Participants hold placards during a protest demanding an end to what they say is discrimination and violence against the transgender community, in Bengaluru, India October 21, 2016.

© 2016 Reuters
(New York) – A proposed law to protect the rights of transgender people in India falls short of the country’s human rights obligations, Human Rights Watch said. The Transgender Persons (Protection of Rights) Bill, 2019, introduced in parliament on July 19, 2019, is unclear on a transgender person’s right to self-identify, which India’s Supreme Court recognized in a landmark judgment in 2014.

The Transgender Persons Bill lays out a broad and inclusive definition of “transgender persons” and a clear distinction between identity-based recognition rights and the medical procedures some transgender people might want. However, even though the bill says that a transgender person “shall have a right to self-perceived gender identity,” its language could be interpreted to mean transgender people are required to have certain surgeries before legally changing their gender.

“The Transgender Persons Bill should be a remarkable achievement for a long-persecuted community, but the current draft fails on the fundamental right to self-identify,” said Meenakshi Ganguly, South Asia director at Human Rights Watch. “It’s crucial that the law be in line with the Supreme Court’s historic ruling on transgender rights.”

In recent years in India, considerable progress has been made to protect the rights of transgender people, Human Rights Watch said. In 2014, the Supreme Court in NALSA v. India ruled that transgender people should be recognized as a third gender and enjoy all fundamental rights, while also being entitled to specific benefits in education and employment. In 2018, in a historic decision upholding privacy and nondiscrimination of LGBT persons, the Supreme Court struck down the colonial-era sodomy law that criminalized consensual same-sex relations.

However, the government’s proposed law to protect the rights of transgender people would not provide full protection and recognition, Human Rights Watch said.

The bill appears to mandate a two-step process for legal gender recognition. First, it requires a trans person to apply for a “transgender certificate.” This can be done on the basis of a person’s self-declared identity. Then, a certificate holder can apply for a “change in gender certificate,” which signals to authorities to change their legal gender to male or female. This second step appears to require surgery and then documentation by a medical authority confirming it.

The bill empowers the district magistrate to judge the “correctness” of the application and decide whether to issue the change in gender certificate but does not give guidelines on how this decision should be made. The bill is also silent on whether a trans person who holds a male or female gender certificate will have access to government welfare schemes and programs meant for transgender people.

Besides seemingly violating the Supreme Court ruling, these provisions are also contrary to international standards for legal gender recognition. International standards and best practices – including those of multiple United Nations agencies, the World Medical Association, and the World Professional Association for Transgender Health – call for separation of legal and medical processes of gender reassignment for transgender people. This includes the removal of evaluations of applicants for legal gender recognition by panels of psychologists, physicians, or other experts. Self-declared identity should form the basis for access to all social security measures, benefits, and entitlements.

The UN Office of the High Commissioner for Human Rights in 2015 recommended that states begin immediately “[i]ssuing legal identity documents, upon request, that reflect preferred gender, eliminating abusive preconditions, such as sterilization, forced treatment and divorce.” A 2015 report published by the World Health Organization and the Asia-Pacific Transgender Network recommended that governments “[t]ake all necessary legislative, administrative, and other measures to fully recognize each person’s self-defined gender identity, with no medical requirements or discrimination on any grounds.”

The mention of intersex persons in the Indian bill is an important inclusion, but the bill should be renamed the Rights of Transgender and Intersex Persons Bill and include explicit protections for intersex people in line with India’s international human rights obligations.

“Intersex” refers to the estimated 1.7 percent of the global population born with bodily traits that do not fit conventional expectations of female or male. Their sex characteristics – such as chromosomes, gonads, or genitals – differ from social expectations. Historically, many intersex people – often in infancy – are forced to undergo irreversible surgical procedures to make their bodies conform to gender norms.

The bill should require the informed consent of intersex individuals before non-emergency surgical procedures are conducted and prohibit medically unnecessary procedures on children. Intersex persons should be issued legal identity documents that reflect their preferred gender and the government should ensure that intersex persons and organizations are consulted with regard to laws and policies that have an impact on their rights.

In addition, the bill should be revised to emphasize training teachers to help them adopt inclusive teaching methods to ensure these children are not harassed or discriminated against by staff or other children.

“Transgender people in India should be able to live with dignity and nondiscrimination, and have equal access to education, employment, and health services.” Ganguly said. “To enact a law that meets international standards, it’s critical that parliament fully bring transgender people into the conversation.”

Posted: January 1, 1970, 12:00 am

Russian blogger, Zhenya Svetski, stands with a sign reading “I am not ‘gay propaganda’” in Moscow, December 2018. 

© 2018 Dmitry Belyakov for Human Rights Watch
The European Court of Human Rights ruled this week that the Russian government must pay 42,500 euros in damages to three lesbian, gay, bisexual, and transgender (LGBT) rights groups for having refused their registration in recent years.

From 2006 to 2011, Rainbow House, the Movement for Marriage Equality, and the Sochi Pride House attempted to register their respective organizations with Russian authorities. The government denied their applications, claiming the organizations “will destroy the moral values of society” or “undermine [Russia’s] sovereignty and territorial integrity…by decreasing its population.”

Most perniciously, in denying Movement for Marriage Equality’s registration, the government construed LGBT rights activities as “gay propaganda,” and said the organization’s work amounted to “extremist activities.”

Formally called the law “aimed at protecting children from information promoting the denial of traditional family values,” the “gay propaganda” law – a classic example of political homophobia – bans the “promotion of nontraditional sexual relations to minors,” a reference universally understood to mean a ban on providing children with access to information about LGBT people’s lives. The ban includes, but is not limited to, information provided via the press, television, radio, and the Internet.

As it was debated and passed in 2013, the law contributed to an intensification of stigma, harassment, and violence against LGBT people in Russia. The law has been used to shut down online information and mental health referral services for children, and to discourage support groups and mental health professionals from addressing LGBT issues with children. It has further entrenched antipathy toward LGBT people.

The law has rightly been condemned by the European Court of Human Rights, the UN Committee on the Rights of the Child, the Organization for Security and Co-operation in Europe, and the Council of Europe.

The European court’s new judgement, which found Russia responsible for discrimination and violation of freedom of association, is a cautionary reminder to the Russian government that the baseless and vitriolic gay propaganda law should be repealed.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am
© 2012 Human Rights Watch

Human Rights Watch has joined with 61 organizations calling for the passage of a bill to decriminalize sex work in Washington, DC.

Last week, the groups sent a letter to the Council of the District of Columbia urging passage of the Community Safety and Health Amendment Act 2019, which would repeal statutes that criminalize adults consensually engaging in sexual exchange, while upholding existing laws prohibiting sex trafficking. The signatories represented a wide range of organizations working in racial and gender justice, LGBT rights, health, and civil liberties.

For sex workers in the US capital, who have long been subjected to police harassment (including police extortion of sex), arrests, discrimination, and violence, the bill is a beacon of hope. Human Rights Watch has interviewed sex workers in Washington, other US cities, and in countries ranging from Tanzania to South Africa to China about the impact criminalization has on their lives. We consistently found that criminalization makes sex workers less safe, driving them underground and creating conditions for appalling levels of violence, including rape and murder – a sad reality for sex workers in and around the District of Columbia. People of color, trans people, and members of other marginalized groups who sell sex are particularly at risk, as DC’s Sex Worker Advocates Coalition has argued. Many sex workers fear reporting crimes to the police; when they do, they face humiliation and even arrest. As Human Rights Watch has shown, use of condoms as evidence of sex work, including in Washington, is a deterrent to safer sex practice that undermines protection from HIV, sexually transmitted infections, and pregnancy.

Laws against sex work run afoul of international human rights law, including privacy rights. Sex work, distinct from trafficking, is about having a choice and not being treated as a voiceless victim. Arguments that sex work should be banned to “protect” sex workers disregard their agency. What sex workers need is not condescension and invasion into their private lives, but support in achieving decent working conditions.

As New York State and other jurisdictions also look to decriminalizing sex work, DC’s councilmembers should act immediately to schedule a hearing on the Community Safety and Health Amendment Act. As the letter to the DC Council sets forth, “The time for justice for people who trade sex in DC is now.”

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

July 2, 2019

The Council of the District of Columbia
1350 Pennsylvania Avenue, NW
Washington, DC 20004

Re: Support B23-0318, the “Community Safety and Health Amendment Act of 2019”

Dear Chairman Phil Mendelson, Councilmember Charles Allen, Councilmember Anita Bonds, Councilmember Mary M. Cheh, Councilmember Jack Evans, Councilmember Vincent C. Gray, Councilmember David Grosso, Councilmember Kenyan McDuffie Councilmember Brianne Nadeau, Councilmember Elissa Silverman, Councilmember Brandon Todd, Councilmember Robert White, Jr., and Councilmember Trayon White, Sr.:

We, the undersigned organizations, urge you to support B23-0318, the “Community Safety and Health Amendment Act of 2019.”

This bill would increase public health and safety in the District by removing criminal penalties associated with sex exchange. Specifically, the bill repeals statutes that criminalize adults consensually engaging in sexual exchange, upholds existing laws prohibiting sex trafficking including of people under 18, and establishes a task force to evaluate the impact of decriminalization and the need for additional steps to improve community safety.

This approach is not new, and it has proven results. Sex work has been decriminalized in New Zealand since 2003,[1] and this approach is gaining momentum in the United States as the Community Safety and Health Amendment Act moves forward in DC and similar legislation is introduced in New York.[2]

  1. Criminalization of Sex Work is Ineffective and Harmful

Criminalization of sex work has a greater negative impact on communities already facing discrimination, including communities of color, gender nonconforming and nonbinary people, members of the LGBTQ+ community, people with disabilities, immigrants, and people with criminal convictions.  Many sex workers in Washington, DC are Black and brown trans and cis women, gender nonconforming and nonbinary people, and members of the LGBTQ+ community.

Nationally, around 20 percent of trans people have engaged in sex work in their life, and this number increases to nearly 40 percent for Black trans people.[3] Many turn to sex work to survive after experiencing discrimination or abuse and being denied access to employment, housing, and healthcare.

Criminalization increases violence against sex workers, especially survival sex workers, by exposing them to police harassment and brutality and by creating additional obstacles to safe and stable housing, employment, and healthcare due to arrest and incarceration.

Street-based sex workers engaged in survival sex work often bear the brunt of criminalization. Research shows that over 80 percent of street-based sex workers experience violence in the course of their work.[4] In DC, among the surveyed sex workers who had been approached by police, nearly 40 percent were verbally abused, and one in five said that an officer asked them for sex.[5]  Criminalizing sex work perpetuates stigma against people who face already high rates of violence, subjecting them to harassment, dehumanizing comments, and risk of experiencing violence.

“I’ve been picked up by a police officer before, and I’ve been told that either you give me [sex] or you’re going to jail,” says Louraca, a Black trans sex worker organizing for sex work decriminalization in DC. This experience is common in the District and sex workers rarely feel safe enough to report these harms. In November 2018, two trans sex workers reported that police officers in Prince George’s County and DC were using the threat of arrest to coerce them into having sex with the officers, requesting anonymity for their safety.[6] In DC, when incidents were actually reported to law enforcement, 75 percent of sex workers reported being dissatisfied with police response.[7]

Criminal penalties for consensual sexual exchange often harm the most vulnerable while fostering violence and exploitation. While criminalizing sex work is often touted as a means to prevent trafficking, it can actually increase vulnerability to trafficking for the sex workers who are criminalized, due to fear of arrest, discrimination, and loss of income, particularly with the recent loss of internet platforms through SESTA/FOSTA.[8] Criminalization of sex work also impedes trafficking enforcement because witnesses are less likely to report evidence of coercion or trafficking to authorities if they fear arrest.[9]

As Police Chief Peter Newsham has said, “we can’t arrest our way out of prostitution.”[10] Our response to poverty and lack of traditional employment must be based in supportive services and housing. The District will not solve anything by criminalizing people for doing what they need to survive.

  1. Removing Criminal Penalties Will Help Improve Public Health and Safety

Removing criminal penalties for engaging in sexual exchange reduces public violence and protects sex workers. Criminalization of sex work only leads to a cycle of violence, poverty, and incarceration. Sex workers tell us this, and the research shows us this, as well. 

A meta-review published in PLOS Medicine in December 2018 analyzed 134 studies about sex work from 1990 to 2018 across the world, and found that the policing of sex work is associated with increased risk of violence and increased risk of HIV and other STIs for sex workers.[11] They recommended pursuing legal reforms to remove criminalization and investing in social services for and by sex workers.[12]

  1. Reduces Vulnerability to Exploitation and Violence

People in the sex trade are safest when their work is not criminalized, because they are able to screen clients, to negotiate safer sex practices, and to report incidents of client and police violence.[13] A study in nearby Baltimore demonstrated an association between sex work criminalization and client-perpetrated violence.[14] After criminal penalties were removed in New Zealand, sex workers reported that they were more likely to report a bad incident to the police and 61.9 percent of street-based sex workers reported they were more able to refuse a client.[15]

While most sex workers are not coerced or trafficked, sex workers are in the best position to identify who is being coerced or trafficked, and removing criminal penalties allows them to be full partners in efforts against exploitation.[16] In fact, in 2019, Mexico City passed legislation to decriminalize sexual exchange as part of their effort to combat human trafficking.[17]

  1. Promotes Public Health

Addressing sexual exchange as a public health matter improves the connection to services, increases the ability to negotiate safer sex practices, including condom use, and reduces the transmission of infectious diseases, including HIV and other STIs.[18]  After decriminalization in New Zealand, sex workers reported increased ability to negotiate safer sex with clients.[19]

The criminalization of sex work is a worldwide problem, necessitating comprehensive solutions. Around the world, criminal laws on sex work prevent sex workers from accessing health and legal systems that should serve them. Criminalization of sex work has a profound and costly impact on the sexual and reproductive health and rights of sex workers, especially Black and brown sex workers. Female sex workers, in particular, bear a disproportionate burden of HIV[20] and also experience significant unmet needs related to family planning, safe pregnancy, safe abortion, and gender-based violence.

Criminalization serves as a key barrier to essential health services due to fear that seeking health care could lead to negative legal consequences. The World Health Organization’s guidelines on HIV prevention for key populations points to criminalization of sex work as a key “barrier to effective HIV services,” and recommends that countries “work toward decriminalization of sex work and elimination of the unjust application of non-criminal laws and regulations against sex workers.”[21] Global models suggest that decriminalizing sex work could lead to a 33 to 46 percent reduction in incidences of HIV acquisition among sex workers over the next 10 years.[22]

*          *          *          *          *         

The time for justice for people who trade sex in DC is now. The lives of sex workers and sex trafficking survivors depend on urgent action. Supporting sex workers benefits the safety of our entire community. Sex workers deserve to survive and to thrive.

The undersigned recognize that removing criminal penalties is only one tool to help promote the safety, health, and well-being of sex workers. Housing and employment discrimination, racial profiling and police harassment, poverty and homelessness, are just a few issues that also impact the lives of sex workers.


350 DC
Advocates for Youth
Allen Chapel AME Church
Black and Pink, Inc.
Black Lives Matter DC
Black Youth Project 100
Blacks in Law Enforcement of America
Casa Ruby
Center for Health and Gender Equity (CHANGE)
Collective Action for Safe Spaces
DC Anti Violence Project
DC Area Transmasculine Society
DC Dyke March
DC For Democracy
DC for Reasonable Development
Defending Rights & Dissent
Free Speech Coalition
Harm Reduction Coalition
Human Rights Watch
In Our Own Voice: National Black Women's Reproductive Justice Agenda
Institute of the Black World 21st Century
International Indigenous Youth Council, DC
Jewish Voice for Peace
La ColectiVA
Lambda Legal
March for Racial Justice
Maryland Trans*Unity
Montgomery County Civil Rights Coalition
Movement Voter Project
National Asian Pacific American Women's Forum (NAPAWF)
National Cannabis Festival
National Center for Lesbian Rights
National Center for Transgender Equality
National Coalition for LGBT Health
National Lawyers Guild, D.C. Chapter
National Survivor Network
Nelwat Ishkamewe
No Justice No Pride
Occupation Free DC (OFDC)
Positive Women's Network-USA
Reframe Health and Justice
Restaurant Opportunities Center DC
Sexuality Information and Education Council of the United States (SIECUS)
St. James Infirmary
The Center for Constitutional Rights
The DC Center for the LGBT Community
The Future Is Feminist
The Sex Workers Project at the Urban Justice Center
The W.I.R.E
Tits and Sass
Trans United
Trans-Latinx DMV
URGE: Unite for Reproductive & Gender Equity
Washington Lawyers’ Committee for Civil Rights and Urban Affairs
Whitman-Walker Health
Woodhull Freedom Foundation


[1] Prostitution Reform Act 2003, New Zealand (2003), http://www.legislation.govt.nz/act/public/2003/0028/latest/DLM197821.html.

[2] Decrim NY, Legislators Intro First Statewide Bill to Decriminalize Sex Work, Decrim NY (June 10, 2019), https://www.decrimny.org/post/for-immediate-release-decrim-ny-legislator.... Other sex worker-led coalitions and organizations have been organizing for decriminalization in other parts of the country, too, including, for example, the national Sex Workers Outreach Project-USA, BAY-SWAN in California, COYOTE-RI in Rhode Island, CUSP in Alaska, and Harm Reduction Hawaii.

[3] James, S. E et al., 2015 US Transgender Survey, Nat’l Center for Transgender Equality (2016), https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-... Erin Fitzgerald et al, Meaningful Work: Transgender Experiences in the Sex Trade, Nat’l Center for Transgender Equality (Dec. 2015), https://www.transequality.org/sites/default/files/Meaningful%20Work-Full....

[4] Revolving Door: An Analysis of Street-Based Prostitution in New York City, Urban Justice Center Sex Workers Project (2003)​, http://sexworkersproject.org/downloads/RevolvingDoor.pdf.

[5] Move Along: Policing Sex Work in Washington, D.C., Different Avenues (2008), https://dctranscoalition.files.wordpress.com/2010/05/movealongreport.pdf.

[6] Marina Marraco, Transgender Prostitutes Who Accused Cops in Sex Scandal Meet with US Prosecutors, Fox 5 DC (Nov 20 2018), http://www.fox5dc.com/news/transgender-prostitutes-who-accused-cops-in-s....

[7] Move Along: Policing Sex Work in Washington, D.C., Different Avenues (2008), https://dctranscoalition.files.wordpress.com/2010/05/movealongreport.pdf.

[8]Scott Cunningham, Gregory DeAngelo, Greg Tripp, Craiglist Reduced Violence Against Women, http://scunning.com/craigslist110.pdf; Rose Conlon, Sex workers say anti-trafficking law fuels inequality, https://www.marketplace.org/2019/04/30/sex-workers-fosta-sesta-trafficki...

[9] Erin Albright & Kate D'Adamo, Decreasing Human Trafficking through Sex Work Decriminalization, 19 AMA J. Ethics 122 (2017), https://journalofethics.ama-assn.org/article/decreasing-human-traffickin...

[10] MPD Chief Peter Newsham, 2012 City Council hearing on Prostitution Free Zones.

[11] Lucy Platt et al., Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies, 15 PLOS Med. (Dec. 11, 2018), https://doi.org/10.1371/journal.pmed.1002680.

[12] Id.

[13] Id.; Gilian Abel et al, The Impact of the Prostitution Reform Act on Health and Safety Practices of Sex Workers (Nov. 2007), https://www.otago.ac.nz/christchurch/otago018607.pdf.

[14] Katherine Footer et al., Police-Related Correlates of Client-Perpetrated Violence Among Female Sex Workers in Baltimore City, Maryland, 109 Am. J. Pub. Health 289 (Feb. 2019), https://doi.org/10.2105/AJPH.2018.304809.

[15] Gilian Abel et al, The Impact of the Prostitution Reform Act On Health and Safety Practices of Sex Workers 15, 116 (Nov. 2007), https://www.otago.ac.nz/christchurch/otago018607.pdf.

[16] Erin Albright & Kate D'Adamo, Decreasing Human Trafficking through Sex Work Decriminalization, 19 AMA J. Ethics 122 (2017), https://journalofethics.ama-assn.org/article/decreasing-human-traffickin... Sex Work is Not Sexual Exploitation, Global Network of Sex Work Projects (2019), https://www.nswp.org/sites/nswp.org/files/briefing_note_sex_work_is_not_....

[17] Christine Murray, Mexico City to Decriminalize Sex Work, Eyes Steps to Cut Trafficking, Reuters (June 2, 2019), https://www.reuters.com/article/us-mexico-sexwork-trafficking/mexico-cit....

[18] Lucy Platt et al., Associations between sex work laws and sex workers’ health: A systematic review and meta-analysis of quantitative and qualitative studies, 15 PLOS Med. (Dec. 11, 2018), https://doi.org/10.1371/journal.pmed.1002680; Cunningham, S. & Shah, M., Decriminalizing Indoor Prostitution: Implications for Sexual Violence and Public Health, NBER Paper No. 20281 (July 2014), https://www.nber.org/papers/w20281?utm_campaign=ntw&utm_medium=email&utm....

[19] Gilian Abel et al, The Impact of the Prostitution Reform Act On Health and Safety Practices of Sex Workers 13 (Nov. 2007), https://www.otago.ac.nz/christchurch/otago018607.pdf.

[20] See generally Shannon K. et al., Global epidemiology of HIV among female sex workers: influence of structural determinants, 385 The Lancet 55-71 (2015), https://www.ncbi.nlm.nih.gov/pubmed/25059947.

[21] Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations, World Health Organization 86 (2016), http://apps.who.int/iris/bitstream/handle/10665/246200/9789241511124-eng....

[22] C. Beyrer et al, An action agenda for HIV and sex workers, 385 The Lancet 287 (2015), https://www.ncbi.nlm.nih.gov/pubmed/25059950; HIV/AIDS: Sex Work, World Health Organization, http://www.who.int/hiv/topics/sex_work/about/en/.

Posted: January 1, 1970, 12:00 am

A giant rainbow flag is displayed during Hong Kong's annual pride parade on November 25, 2017.

© 2017 Aaron Tam/AFP/Getty Images
Nearly 120 years after Hong Kong made sodomy punishable by a possible life sentence, a recent court ruling marks a further step toward completely decriminalizing same-sex relations.

In 2007, Hong Kong scrapped its British-era sodomy law. But, for over a decade, several remaining provisions in its Crime Ordinance continued to single out male same-sex relations, either through disproportionate sentencing or by specifically criminalizing sexual acts between men. In 2017, an activist, Yeung Chu Wing, brought a lawsuit challenging the constitutionality of seven discriminatory provisions.

On May 30, the Hong Kong High Court struck down the four offenses that applied specifically to sexual relations between men and eliminated the discriminatory aspects of three other provisions. With this ruling, the court consolidated the decriminalization process by eliminating residual discriminatory provisions in the criminal code.

The efforts form a part of the global trend toward abolishing discriminatory colonial-era laws that criminalize same-sex relations. In 2018, courts in India and Trinidad and Tobago both ruled that laws that criminalized same-sex relations are unconstitutional. This year, Botswana decriminalized same-sex conduct, but there was a setback in Kenya, where the court upheld similar discriminatory laws.

Hong Kong’s justice secretary did not contest the four scrapped provisions. But she asked the High Court to retain the remaining three provisions by making them non-discriminatory.

The four uncontested provisions criminalized “procuring others” to engage in anal intercourse, “gross indecency” with or by a boy under the age of 16, “gross indecency” between men otherwise in private, as well as “procuring gross indecency” between men. All four were struck down as unconstitutional by the High Court. By doing so, the court was mindful that sexual offenses against minors are covered by other provisions that are gender-neutral and non-discriminatory.

The court explained in detail why the four provisions were unconstitutional. Judge Thomas Au eloquently grounded his analysis in the fundamental principle of equality, invoking article 25 of the Hong Kong Basic Law and article 22 of the Hong Kong Bill of Rights. He reasoned that these four provisions punished sexual intercourse between men, while there are no comparable offenses between women or between a man and a woman. The court held that the differential treatment targeting sex between men is discriminatory in nature and violates equal protections.

The remaining three provisions were challenged because they imposed either differential sentencing or age of consent provisions that disproportionately punished sexual relations between men.

For example, one of the provisions punished “gross indecency with the mentally incapacitated” only when it is between men. In dealing with this provision, the court held that all terms “a man” must be read as “a person” for purposes of this provision. Through such remedial interpretation techniques, the court rendered the three provisions gender-neutral or equalized the age of consent, making them compliant with the constitution.

Hong Kong’s Court of Final Appeal struck down the city’s sodomy law in the 2007 case Secretary for Justice v. Yau Yuk Lung, reasoning that the law only criminalized sexual intercourse between men and was therefore unconstitutional. Following the same principle in applying the doctrine of non-discrimination, this current ruling extends equal protection by scrapping or by judicially interpreting the remaining discriminatory provisions in the Crime Ordinance — thus completing the decriminalization process in Hong Kong.

The criminalization of same-sex relations contradicts the fundamental principles of equality and nondiscrimination under international law. Repealing laws that punish consensual same-sex relations from statute books is an essential step toward eliminating discrimination on the basis of gender identity and sexual orientation.

The recent moves toward decriminalization demonstrate the significant role that the judiciary can play in safeguarding the rights of minorities, especially in communities with repressive and unjust laws. Despite residing in their different jurisdictions with different societal and cultural norms, a growing number of courts are in agreement that human dignity, autonomy, and equality must be afforded to all.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Lesbian, gay, bisexual, and transgender people living in the Middle East and North Africa share their responses to myths and stereotypes about LGBT people in the region on a new video and special feature released today by the Arab Foundation for Freedoms and Equality (AFE) and Human Rights Watch. Although these myths can be harmful, activists who spoke to AFE and Human Rights Watch for this video face them every day with grace, determination, and humor. In the video, they debunk these myths and share their experiences with other LGBT people in the region, letting them know they are not alone.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am