Last week, a transgender woman was brutally attacked by eight men. This incident came at the heels of an inundation of overwhelmingly negative and violent public opinion by Malaysians concerning the LGBT community, so much so that a group of transgender persons lodged a police report citing abusive comments and death threats towards LGBT people by social media pages and individual comments.
This sentiment was stoked by the almost daily news cycle that highlighted the views of politicians, religious leaders and other notable people on this issue. While many of these opinions decried the violence and discrimination, they often included the false idea that being LGBT is a social ill that can and must be corrected.
However, stigma and discrimination of any kind cannot be separated from violence, as perpetrators of violence use even the slightest alignment with their views as justification for their violent actions.
The government also made matter worse by actively targeting the LGBT community by ordering an art exhibition in Penang to remove the portraits of two activists holding the Malaysian flag, and raiding a club known to be visited by gay men.
Such targeted stigma, discrimination and criminalisation inevitably lead to the further marginalisation of an already marginalised community, which is a disaster for public health. This will only make the LGBT community, and by extension the Malaysian people, more vulnerable to other health risks and costs associated with this hostile environment.
The impact of stigma and discrimination on the prevalence of HIV/AIDS and other sexually transmitted infections among marginalised populations is well documented.
Community outreach personnel are the cornerstone of HIV prevention, but they can only increase awareness of HIV/AIDS and distribute items like condoms and lubricants to key affected populations that they are able to access.
The increased stigma and discrimination and raids on established places where LGBT people tend to congregate discourages people from frequenting them to avoid being arrested, shamed, harassed or humiliated. This results in them being out of reach of community outreach personnel.
Worse, it encourages the proliferation of private, underground groups or activities like chem sex that lead to a higher risk of unsafe behaviours. This will likely cause the already rising trend in HIV/AIDS and STI transmissions to further increase.
Malaysia will find it an increasingly uphill task to fulfil the Sustainable Development Goals which seeks to end new transmissions of communicable diseases like HIV by 2030.
People have been led to believe that the only public health concerns related to those who are LGBT are venereal. However, as stigma and discrimination continue to increase, mental health morbidities among LGBT people are also likely to increase.
According to the Office of Disease Prevention and Health Promotion of the US Department of Health and Human Services, “discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse and suicide.” The further marginalisation and targeted discrimination also isolates them, removing coping mechanisms like community support and safe spaces.
Mental health morbidities are further compounded by the intensifying of efforts towards promoting and conducting conversion therapies focusing on LGBT persons, particularly Muslim trans women and gay men through the federal religious department’s Mukhayyam programmes.
Multiple international authorities in healthcare like the American Psychological Association and the World Health Organisation have denounced conversion therapy as pseudoscience and warn of the multiple long-term health risks associated with such practices, such as self-harming and suicidal behaviour, depression, social withdrawal, decreased self-esteem, etc.
Conversion therapy is also considered a form of torture in the 2013 report of the United Nations’ Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment.
Increased stigma and discrimination towards LGBT persons also have a larger impact on general health and health-seeking behaviour. Many, especially transgender people, already avoid the public healthcare system due to previous experiences of discrimination.
As they become even more marginalised, they might avoid seeking treatment out of fear of being harassed, humiliated and even detained.
As such, people might be less driven to present themselves for preventative measures and for testing for fear of being labelled and stigmatised as “sexual deviants.” This avoidance of healthcare services makes it hard for the government to achieve public health goals.
The government must ask itself whether it should succumb to populist views by allowing the unchecked stigma and discrimination of LGBT people which results in increased public health risks; or if it should put the public health as a priority by addressing the misinformation and misconceptions using human rights and international health standards.
The answer may yet determine the state of Malaysian public health and international standing.
As published in the Malay Mail.