LGBTIQ+ refugees

Lesbian, gay, bisexual, transgender and intersex (LGBTIQ+) persons have existed in all cultures and societies throughout history. Sexual orientation and gender identity are inherent human characteristics. The human rights of LGBTIQ+ persons have been affirmed by the 2007 Yogyakarta Principles and the Yogyakarta Principles plus 10. In many parts of the world, individuals are subject to serious human rights abuses because of their real or perceived sexual orientation, gender identity, gender expression and sex characteristics (SOGIESC), particularly when these do not conform to dominant social and cultural norms. As of 2019, there were 70 countries that criminalise consensual same-sex sexual acts and the death penalty a possibility in 11 of these countries.

Severe persecution and discrimination from both State and non-State actors force LGBTIQ+ persons – including minors and elderly individuals – to flee their countries of origin or places of habitual residence in search of a safe environment in which they can fully exercise their rights. Many LGBTIQ+ persons who choose to seek asylum may face similar or higher risks of homo- and transphobic violence from both nationals of the host country as well as from other displaced people. These risks are exacerbated by xenophobic hostility, their irregular migration status, socioeconomic marginalization, isolation from traditional support networks and acute emotional stress. Resettlement in a third country is sometimes the only viable durable solution for LGBTIQ+ refugees at heightened risk. In order to enable resettled LGBTIQ+ refugees to the fullest potential, an inclusive response to reception and integration is required.

LGBTIQ+ refugees may be marginalized even in the resettlement country due to homophobia and transphobia from diaspora, refugee communities, or receiving communities. Some continue to face discrimination based on other factors such as nationality, religion, ethnicity, gender, age. Meeting the specific needs of LGBTIQ+ persons must take into account the full range of compounding forms of discrimination that they face. Reception and integration programs that are inclusive of LGBTIQ+, and age, gender and diversity result in better integration outcomes.

LGBTIQ+ inclusive integration programming

LGBTIQ+ persons are not a homogenous group. Support services need to be sensitive to the diverse needs, priorities and capacities of LGBTIQ+ people and how these differ when sexual orientation, gender identity and expression and/or sex characteristics intersect with other diversity elements such as age, gender, disability, race, and religion. This understanding will ensure that LGBTIQ+ refugees receive holistic support. LGBTIQ+ refugees may have specific needs (such as exemplified in the health section) that cannot be met by reception and integration agencies. Therefore, it is important for reception and integration agencies to maintain partnerships and an active referral system with local LGBTIQ+ organisations. It is important to bear in mind that LGBTIQ+ refugees come from different cultural, ethnic, language and religious backgrounds, may have disabilities (including acquired in the process of asylum), may belong to indigenous groups, are of different ages and/or socio-economic background.

It is essential that orientation information provided to resettled refugees includes references to human rights and anti-discrimination legislation and reflects the diversity of families. It is a good practice to include LGBTIQ+ inclusive language. All reception and integration staff responsible for orientation should be trained on SOGIESC. Inclusion of information on LGBTIQ+ persons in orientation guides should be the norm and made available to all refugees. 

Legal services

The need for free and specialist legal services does not cease upon obtaining a refugee status. For LGBTIQ+ refugees this includes obtaining legal counselling and guidance on the ability to change their names and gender markers in documents. Other necessary legal services include access to protections from discrimination (for example tenancy or employment law) or family law.

The challenge in placement is to ensure that there is an appropriate match between the needs of resettled refugees and the resources and needs of the receiving community. If LGBTIQ+ refugees are resettled to rural locations far from LGBTIQ+ resources and networks, they may experience isolation and have difficulties integrating. There is often a lack of specialized services to support LGBTIQ+ refugees. Even in situations where LGBTIQ+ local organizations exist, they may lack understanding of the displacement experience of LGBTIQ+ refugees. This could impact on the type of support they can provide to LGBTIQ+ refugees. Transgender and intersex refugees often need medical treatment that is not available in all locations. Selecting an appropriate resettlement location will improve integration outcomes and reduce secondary movement.

LGBTIQ+ refugees may prefer to live separately from their communities of origin. In some cases, LGBTIQ+ refugees have not come out to their families, thus links with communities of origin may create risks of outing.  It is important to provide safe, secure and affordable housing to LGBTIQ+ refugees. LGBTIQ+ refugees should preferably be housed in private dwellings to avoid any potential discrimination or violence from other tenants. It is important that LGBTIQ+ refugees do not feel the need to hide their sexual orientation and/or gender identity in their housing arrangements. Safety is a paramount consideration in placement. 

Case management that is responsive to the needs of LGBTIQ+ refugees is crucial for positive integration outcomes. It is essential that all staff within reception and integration agencies, including interpreters, are trained on fundamentals of SOGIESC. The following should form part of the training:

• A caseworker needs to be aware, respectful and understand that being LGBTIQ+ is an inherent human characteristic and not a life-style choice;
• A caseworker needs to provide information on available services and support networks for LGBTIQ+ refugees;
• Once a LGBTIQ+ refugee comes out to a caseworker, it is vital that this information is not shared with other staff or organizations without consent.
• Caseworkers and reception and integration agencies can take active and considerate steps to ensure that LGBTIQ+ refugees feel safe and supported from the outset. This is particularly important as LGBTIQ+ refugees may be coming from contexts where they have had to hide their sexual orientation, gender identity or intersex status. Even once resettled, LGBTIQ+ persons may never disclose their SOGIESC. It is important that integration caseworkers first build trust with an LGBTIQ+ refugee and respect confidentiality. 

Some LGBTIQ+ refugees may require medical care, including mental health and psychosocial support (MHPSS). LGBTIQ+ refugees may have acute health needs that arise from their pre-arrival experiences of SOGIESC-based persecution, sexual and gender-based violence, violence by family members or an intimate partner. Consideration should also be given where LGBTIQ+ refugees may have had to resort to sex work in order to survive in homophobic and transphobic social, political, and cultural environments.

Health care

LGBTIQ+ may not have received appropriate health care prior to their resettlement due to homophobia, transphobia, high costs or isolation that exacerbated chronic conditions. Children with intersex traits may have been subjected to surgeries, hormonal treatments and other procedures in an attempt to forcibly change their appearance to align with societal expectations about male and female bodies. Health care professionals must have access to ongoing professional development and training on SOGIESC. 

Sexual and reproductive health

For lesbian, bisexual and queer women there is generally a lack of information available on sexual and reproductive health. “[B]ecause mainstream reproductive rights discourse and policies are usually framed as heteronormative, many lesbian, bisexual and queer women avoid gynecological check-ups.” This creates adverse health consequences. It is thus essential, that all LGBTIQ+ women have access to free and LGBTIQ+ inclusive sexual and reproductive health information, comprehensive sexual and reproductive healthcare including cervical and breast cancer screenings, contraceptive services,  prevention, screening and treatment of HIV and other sexually transmitted infection (STI) and access to infertility treatment where relevant and feasible. 

Many LGBTIQ+ women may have been subjected to sexual violence, forced marriages and Female Genital Mutilation (FGM). Both integration and LGBTIQ+ services need to be equipped to provide relevant counselling and health support to address these experiences and resulting adverse health conditions.

Men have specific and substantial sexual and reproductive health needs, which include the need for access to condoms, prevention and treatment of HIV and other STIs, sexual dysfunction, infertility and male cancers. Gay, bisexual and queer men may also be subject to sexual violence, but due to stigma attached they rarely disclose these experiences. Appropriate responses and referrals must also be in place. Intersex people who have undergone medical treatment designed to “make bodies as typically male or female” should be given access to free counselling and peer support, as well as hormonal substitutes when relevant and feasible. 

Trans health care
Trans people’s needs remain almost invisible in studies on reproductive health. Good practice in trans health services should be community-led and co-designed with the trans community. Trans-inclusive sexual health means affirming people’s identities without bias. This includes understanding that trans men require preventive health screenings including breast and cervical cancer screenings and trans women require prostate cancer screening. Access to gender affirmation is an important consideration for sexual health as it is associated with lower psychological distress.

Other aspects of trans inclusive health care includes access to hormones and gender affirming surgeries. In many contexts there are requirements for trans people to see psychiatrists or clinical psychologists in order to get access to gender affirming surgeries. Access to trained and specialist endocrinologists is also a requirement. It is important that trans refugees have access to such services. 

Mental health and psychosocial wellbeing

Family rejection, isolation, lifelong homophobia and transphobia can contribute to negative mental health outcomes. LGBTIQ+ refugees may also struggle from internalized homophobia, transphobia and shame. These experiences are often compounded by conflict and persecution, resulting in higher risks for mental health conditions such as depression, post-traumatic stress disorder, and suicidal ideations and behaviour. Explicit measures must be taken to improve accessibility and acceptability of mental health and psychosocial support (MHPSS) services for LGBTIQ+ refugees and to ensure such that services are trauma-informed and LGBTIQ+ inclusive and have culturally competent staff.  

Education 

Identify schools that have anti-bullying policies and are welcoming for LGBTIQ+ children and youth. Encourage schools to allow students to use the restroom that aligns with their self-identified gender. Encourage schools to include language specifically prohibiting harassment based on sex development and/or differences in puberty, sexual orientation, nonconformity to gender norms, gender identity and gender expression in the school's anti-bullying policy or code of conduct. Offer to train teachers, staff and school leadership about the specific needs of LGBTIQ+ students. Identify areas where bullying of LGBTIQ+ students might be more likely to occur and encourage teachers and staff to monitor them more closely.

Language learning 

This section focuses on providing language assistance to LGBTIQ+ refugees both in the context of reception and early integration support and in their later interactions with programs and services in the receiving community. Like other refugees, LGBTIQ+ refugees must have access to language training from the outset. It is important that LGBTIQ+ inclusive language is used in language training materials. Language teachers must also be equipped to prevent and address homophobia, transphobia and bullying in the classroom. 

Employment is crucial for all refugees to ensure their financial security. LGBTIQ+ refugees may face some additional challenges and it may take them longer to enter into the workforce. It is also important to acknowledge and address challenges with employment that trans people experience, in particular when their names or gender markers in documents do not match their self-identification. LGBTIQ+ individuals may experience discrimination in access to and maintenance of employment.  Their SOGIESC may be exposed in the workplace with resulting harassment, demotion or dismissal. For transgender individuals in particular, deprivation of employment, often combined with lack of housing and family support, may frequently force them into sex work, subjecting them to a variety of physical dangers and health risks.

In assisting with employment, LGBTIQ+ refugees should be referred to workplaces that are safe and inclusive. Reception and integration agencies also need to ensure that LGBTIQ+ refugees are aware of existing anti-discrimination legislation in relation to work and of available complaints mechanisms in cases of bullying and discrimination. 

It is important for the voice of LGBTIQ+ refugees to be heard and to secure their participation in refugee community forums and relevant consultations. Below are some general considerations for States and reception and integration service providers to ensure meaningful participation of LGBTIQ+ refugees: 

• Consult and involve LGBTIQ+ refugees in decision-making, programming and leadership, giving them the means to voice their opinions and participate fully in the process.
• When designing outreach programs, consider targeted identification and outreach measures to ensure LGBTIQ+ refugees are able to participate meaningfully.
• When developing information and communication materials and tools (digital and non-digital), ensure that it is also targeted to LGBTIQ+ refugees. 
• When setting up communication channels, ensure two-way communication with LGBTI+ persons is in place using their preferred modalities.
• Ensure that interventions respect the safety, dignity and rights of LGBTIQ+ refugees. 

The language used to describe sexual orientation, gender identity, gender expression and sex characteristics varies greatly across the world. Depending on factors like language, age, gender, education and cultural references, it may vary within regions, countries and communities. The majority of these terms are of Western origin and the terms lesbian, gay, bisexual, transgender and queer represent concepts of personal identity that are not universal. People may use other terms or no terms at all and it is critical to respect the autonomy of individuals in defining their own identities. 

• Agender A person who is agender does not identify with any gender.
   
• Bisexual An adjective that describes people who have the capacity for romantic, emotional and/or physical attraction to people of the same gender as their own, as well to people of a different gender from their own.
   
• Coming out A process of self-acceptance. People may acknowledge their identity first to themselves and then share it with others.
   
• Gay An adjective traditionally used to describe men whose enduring romantic, emotional and/or physical attraction is to other men. The term is also used to describe women who are attracted to other women.
   
• Gender Confirmation/Affirming Treatment Gender confirmation or gender affirming treatment refers to various medical interventions that may be one part of transition. Not all transgender people choose or can afford medical interventions such as hormone therapy or surgery.
   
• Gender identity Refers to each person’s deeply felt internal and individual experience of gender, which may or may not correspond with the sex they were assigned at birth or the gender attributed to them by society.
   
• Hate crime Acts of violence or hostility directed at people because of who they are or who someone thinks they are.
   
• Heteronormativity A viewpoint that expresses heterosexuality as a given instead of being one of many diverse possibilities and presents heterosexuality as the default sexual orientation.
   
• Homophobia Includes prejudice, discrimination, harassment, and acts of violence brought on by fear and hatred. It occurs on personal, institutional, and societal levels.
   
• Intersectionality A theoretical framework that allows recognising how power and discrimination intersect and how different groups of people experience them differently. It means understanding that gender identity, race, sexual orientation, religion, ethnicity, age, disability, socio-economic status and others do not exist in isolation from each other but rather are intertwined and influence how we experience the social world and how it perceives us.
   
• Intersex An umbrella term describing a wide range of natural bodily variations related to sex characteristics (including genitals, gonads, reproductive organs and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex traits are a natural part of human bodily diversity.
   
• Lesbian A woman whose enduring romantic, emotional and/or physical attraction is to other women.
   
• LGBTIQ+  An acronym for lesbian, gay, bisexual, transgender, intersex and queer. LGBTIQ+ is a more inclusive and preferred term. The plus sign represents people with diverse sexual orientations, gender identities, gender expressions and/or sex characteristics who identify using other terms. It is an evolving term.
   
• Non-binary A person who is non-binary is someone whose gender identity falls outside the male-female binary.
   
• Outing The intentional disclosure of a person’s sexual orientation, gender identity or intersex characteristics without the person’s consent.
   
• Queer Traditionally a negative term, queer has been reclaimed by LGBTIQ+ people to describe themselves. It is considered inclusive of a wide range of sexual orientations, gender identities and gender expressions.
   
• Sex The classification of a person as having female, male and/or intersex sex characteristics. A person’s sex is a combination of bodily characteristics, including chromosomes, reproductive organs and secondary sex characteristics.
   
• Sexuality or sexual orientation Each person’s capacity for emotional and/or physical feelings for, or attraction to, other people.
   
• SOGIESC  An acronym for sexual orientation, gender identity, gender expression and sex characteristics.
   
• Trans/transgender The terms trans and transgender are used by some people whose gender identity and, in some cases, gender expression, differs from what is typically associated with the sex they were assigned at birth. Trans is independent of sexual orientation.
   
• Transitioning The process of changing one’s external gender presentation to be more in line with one’s gender identity. Transition typically occurs over a long period of time.
   
• Transphobia Intentional hostile and/or violent acts, behaviours and beliefs directed against people who are perceived to be or are trans.