Part I Experiences of being lesbian, gay, bisexual, transgender and intersex in the Asia Pacific This manual uses: • lesbian, gay and bisexual to describe diverse sexual orientations • transgender to describe diverse gender identities • intersex to describe people born with diverse intersex traits and sex characteristics. This manual follows the lead of recent human rights reports in making specific use of the terms ‘sex characteristics’ and ‘intersex people’. Maintaining a distinct focus on the marginalised voices of people with intersex traits is important. It signals that specific intersex concerns are not best understood within a framework focused on sexual orientation and gender identity. For example, some human rights concerns are shared with girls and women, such as in relation to female genital mutilation and cutting, or relate to prenatal screening, sterilisation or other issues that many people with disabilities experience too.57 1.6. DEFINING DIVERSE SEXUAL ORIENTATION, GENDER IDENTITY AND SEX CHARACTERISTICS AS ILLNESSES Some of the prejudice against lesbian, gay, bisexual, transgender and intersex people arises because their sexual orientation, gender identity, gender expression or intersex status is considered a mental or physical illness. These types of beliefs are called pathologisation. They can fuel prejudice and discrimination. Pathologising beliefs have been used to justify reparative or curative or conversion therapies that attempt to change a person’s sexual orientation or gender identity. These therapies have been condemned as unethical by numerous health bodies.58 In 2011, the Psychological Association of the Philippines spoke out in support of ‘global initiatives to remove the stigma of mental illness’ associated with being transgender or identifying as lesbian, gay or bisexual.59 Pathologisation of intersex variations has provided the medical rationale for medically unnecessary genital surgeries and hormone treatment, undertaken on infants or children before they are able to give informed consent.60 These practices raise significant human rights concerns.61 1.6.1. Being lesbian, gay or bisexual is not an illness Homosexuality was officially included in the first classifications of mental disorders. These were the World Health Organization’s International Classification of Diseases 6th edition (ICD-6) in 1948 and the Diagnostic and Statistical Manual of Mental Disorders 1st edition (DSM-1) of the American Psychiatric Association in 1952. Over the last half century, both classification systems have gradually removed diagnoses that defined homosexuality as a mental disorder. This reflects the lack of empirical evidence supporting the pathologisation and medicalisation of variations in sexual orientation. It is also consistent with human rights standards. ICD-10, published in 1992, explicitly states that ‘sexual orientation by itself is not to be considered a disorder’. An American Psychiatric Association position statement in 1998 opposed any psychiatric treatment based on the assumption that either homosexuality is a medical disorder or that patients should change their sexual orientation, including through ‘reparative’ or ‘conversion therapies’.62 57 Commissioner for Human Rights of the Council of Europe, 2015. 58 S.D. Cochran, J. Drescher, E. Kismödi, A. Giami, C. García-Moreno, E. Atalla, A. Marais, E.M. Vieira and G.M. Reed, ‘Proposed declassification of disease categories related to sexual orientation in the International Statistical Classification of Diseases and Related Health Problems (ICD-11)’, Bulletin of the WHO, Vol. 92 No. 9, September 2014, pp. 621-691;E. Coleman. et al, 2011. 59 UNDP, Being LGBT in Asia: the Philippines Country Report, 2014. 60 Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, 30 July 2015, A/70/213, para. 84. 61 See Chapter 4. 62 E. Coleman, W. Bockting, M. Botzer, P. Cohen-Kettenis, G. DeCuypere, J. Feldman, and K. Zucker, Standards of care for the health of transsexual, transgender, and gender nonconforming people, 2011. Chapter 1: Understanding sexual orientation, gender identity and sex characteristics | 21