FAQ on Health and Sexual Diversity An Introduction to Key Concepts FAQ on Health and Sexual Diversity An Introduction to Key Concepts What do the terms sexual orientation, gender identity, gender expression, sexual health, sexual behaviour, and sexuality mean? ● Sexual orientation refers to a person’s While these terms are increasing in familiarity physical, romantic, and/or emotional in some countries, in a number of cultures attraction towards other people. Sexual other terms may be used to describe people orientation is distinct from gender who form same-sex relationships and those identity. Sexual orientation is comprised of who exhibit non-binary gender identities.* three elements: sexual attraction, sexual In some of these countries ‘third gender’ is behaviour, and sexual identity (1). Sexual recognized both in law and cultural traditions, orientation is most often defned in terms and may have legal protection due to cultural, of heterosexuality to identify those who are traditional, or religious signifcance. attracted to individuals of a different sex from ● Gender expression, unlike gender themselves, and homosexuality to identify identity which is an internal experience and those who are attracted to individuals of the understanding of one’s gender, refers to same sex as themselves. the way in which an individual outwardly ● Gender identity is understood to refer presents their gender. These expressions to each person’s deeply felt internal and of gender are typically through the way individual experience of gender, which may one chooses to dress, speak, or generally or may not correspond with the sex assigned conduct themselves socially. Our perceptions at birth, including the personal sense of the of gender typically align with the socially body (which may involve, if freely chosen, constructed binary of masculine and feminine modifcation of bodily appearance or function forms of expression. The way an individual by medical, surgical or other means) and expresses their gender is not always indicative other expressions of gender, including dress, of their gender identity. speech, and mannerisms. Gender identity ● Sexual health is a state of physical, exists on a spectrum. This means that an emotional, mental and social well-being individual’s gender identity is not necessarily in relation to sexuality; it is not merely confned to an identity that is completely male the absence of disease, dysfunction or or completely female. When an individual’s infrmity. Sexual health requires a positive gender identity differs from their assigned and respectful approach to the possibility sex, they are commonly considered to be of having pleasurable and safe sexual transgender, gender fuid, and/or gender experiences, free of coercion, discrimination queer. Whereas when an individual’s gender and violence. For sexual health to be attained identity aligns with their assigned sex, and maintained, the sexual rights of all they are commonly considered cisgender. persons, at all ages and in all contexts must be respected, protected and fulflled (2). * Specifc Indigenous terms include Hijra (India), meti (Nepal), skesana (South Africa), motsoalle (Lesotho), kuchu (Uganda), waria (Indonesia), kawein (Malaysia), travesti (Brazil, Argentina), muxé (Mexico), fa’afafne (Samoa), fakaleiti (Tonga), hamjensgara (Iran) and TwoSpirit (North American Indigenous). 1 ● Sexual behaviour is used to describe ● Sexuality is a central aspect of being the way in which an individual sexually human throughout life that encompasses engages with others. Sexual behaviour is sex, gender identities and roles, sexual not always determined by an individual’s orientation, eroticism, pleasure, intimacy sexual orientation. For instance, an individual and reproduction. Sexuality is infuenced by can be identifed as a man who has sex with the intersection of biological, psychological, other men (MSM) regardless of whether or social, economic, political, cultural, legal, not they have sex with women or have a historical, religious, and spiritual factors (4). personal or social gay or bisexual identity. This concept is useful because it also includes men who self-identify as heterosexual but have sex with other men and would not otherwise be reached through public health interventions (3). The term MSM is also useful in identifying male sex workers whose clients include other men. 2 FAQ on Health and Sexual Diversity An Introduction to Key Concepts What do the terms lesbian, gay, bisexual, transgender, cisgender, queer, and intersex mean? ● Lesbian women and gay men are attracted ● Queer is an umbrella term which is commonly to individuals of the same sex and/or used to defne lesbian, gay, bi, Trans, and gender identity as themselves (3). Lesbian other people and institutions on the margins women and gay men were once commonly of mainstream culture. Historically, the term grouped as homosexual, but this term is has been used to denigrate sexual and gender no longer used as it has a history in the minorities, but more recently it has been wrongful pathologization of people with reclaimed by these groups and is increasingly non-heterosexual orientations as a mental used as an expression of pride and to reject health disorder. narrow reductive labels. Queer can be a ● Bisexual people may be attracted to convenient, inclusive term when referring to individuals of the same or different sex and/ issues and experiences affecting the many or gender identity. groups subsumed under this umbrella. Because it is still used to demean lesbian, ● Transgender (sometimes shortened to gay, bisexual, and transgender people, those “trans”) is an umbrella term used to describe who do not identify as queer are urged to people with a wide range of identities use the term with caution, or not at all. —including transsexual people, people who identify as third gender, and others whose ● Intersex people are born with physical appearance and characteristics are perceived or biological sex characteristics (including as gender atypical and whose sense of their sexual anatomy, reproductive organs and/ own gender is different to the sex that they or chromosomal patterns) that do not ft were assigned at birth. Trans women identify the traditional defnitions of male or female. as women but were assigned as males when These characteristics may be apparent at they were born. Trans men identify as men birth or emerge later in life, often at puberty. but were assigned female when they were Intersex people may be subjected to gender born. Some transgender people seek surgery assignment interventions at birth or in early or take hormones to bring their body into life with the consent of parents though this alignment with their gender identity; others practice is largely contested by intersex do not. persons and has been the subject of a number of recommendations by human rights experts ● Cisgender means having a gender identity and bodies (5, 6). that matches one’s assigned sex. 3 What do the terms heteronormativity, homophobia and transphobia mean? ● Heteronormativity is the assumption However, some use the more inclusive that everyone is heterosexual, and that term, heterosexism, to describe all forms of heterosexuality is “the norm”. Among both discrimination against people who encompass individuals and institutions, this can lead lesbian, gay, or bisexual sexual orientations. to invisibility and stigmatization of other ● Transphobia is the negative devaluing sexualities and gender identities. Often and discriminatory treatment of individuals included in this concept is a level of gender who do not conform in presentation and normativity and gender roles, the assumption or identity to conventional conceptions of that individuals should identify as men and gender and/or those who do not identify women, and be masculine men and feminine with, or express their assigned sex. women. ● Transphobia and homophobia are ● Homophobia is the term often used closely linked and interdependent. As with to describe discrimination on the basis of any form of discrimination, transphobia sexual orientation or gender identity and can be personal or systemic, intentional or may include verbal and physical abuse. unintentional. What specifc protections exist for LGBTI populations? The International Covenant on Economic, Social Declaration of Human Rights and other treaties and Cultural rights indicates that health is a and have obligations under international law to fundamental human right indispensable to the protect the human rights of all persons (8-12). exercise of other human rights. Every human They have a duty to review and reform national being is entitled to the enjoyment of the highest legislation and policies in line with international attainable standard of health conducive to living human rights standards and their treaty a life in dignity, regardless of their race, colour, obligations, with the support of UN entities sex, language, religion, political or other opinion, if necessary. Furthermore, putting in place national or social origin, property, birth, physical supportive legislative and regulatory frameworks or mental disability, health status (including HIV/ and removing unnecessary restrictions from AIDS), sexual orientation* and civil, political, policies and regulations is likely to contribute social or other status (7). signifcantly to improved access to services. Member States have committed to upholding the fundamental values enshrined in the Universal * Although sexual orientation is not specifcally