Articles about LGBTI+

Bhutan has made meaningful strides toward LGBTI+ inclusion in recent years. The introduction of the National Gender Equality Policy in 2020 laid down an important foundation by recognizing the need to “address gender issues” faced by women and gender-diverse communities. The decriminalization of homosexuality in 2021 further enabled LGBTI+ individuals in the country to build community and advocate for their rights. While legal protections remain limited, growing grassroots efforts and shifting public attitudes are steadily laying the foundation for a more inclusive future.   At the forefront of this progress stands Respect Educate Nurture and Empower Women (RENEW), Bhutan’s pioneering civil society organization committed to protecting the sexual and reproductive rights of women, girls and other vulnerable groups, with a focus on providing comprehensive support services to the survivors of sexual and gender-based violence (SGBV). Since its inception, RENEW, IPPF’s Associate Member in Bhutan, has played a pivotal role in advocating for legal reforms, comprehensive sexuality education (CSE), and inclusive health services in the country. In collaboration with Bhutan’s two LGBTI+ networks, national partners, and international allies, RENEW worked to advance the decriminalization of homosexuality in the country.   The Rainbow Help Desk: A Milestone for LGBTI+ Inclusion in Bhutan  While Bhutan’s legal reforms signal progress, the LGBTI+ community still lacks access to inclusive, stigma-free sexual and reproductive health (SRH) services. Members of the men who have sex with men (MSM) and the transgender communities find it hard to avail affordable hormonal therapy and gender-affirmative cosmetic services in the country. Most procure cheap medicines from across the borders without proper medical prescriptions. To address this lack of dedicated and tailored services to the LGBTI+ community, RENEW launched the Rainbow Help Desk in December 2024, in collaboration with Pride Bhutan and Queer Voices of Bhutan, at its head office in Thimphu. The Rainbow Help Desk is the first-of-its-kind help desk dedicated to providing stigma-free, comprehensive sexual and reproductive health support to the LGBTI+ community, including SGBV support services.

  You can write to us for feedback and queries at [email protected]  

Monkeypox Q&A 1. What is monkeypox? Monkeypox is a viral zoonotic disease first discovered in 1958 and typically occurs in tropical areas in central and west Africa. In May 2022, multiple cases of monkeypox were identified in non-endemic countries, and the number of cases and countries where infection has spread has continued to increase to over 16,000 cases over the past 2 months. This is the first time many monkeypox cases have been reported concurrently in non-endemic and endemic countries in different geographical areas. Previously, almost all monkeypox cases in people outside of Africa were linked to international travel to countries where the disease commonly occurs or through imported animals. Most cases so far have been identified through sexual health and other services at primary healthcare facilities, and have involved mainly, but not exclusively, men who have sex with men. Studies are underway to understand the epidemiology of the current spread of disease. Despite being named “monkeypox,” the source of the disease remains unknown. African rodents and non-human primates (like monkeys) are the animals most likely to harbor the virus and infect people. 2. What are the symptoms? The incubation period is between 6-13 days, with a range of 5-21 days. Initially, infection is followed by 0-5 days of fever, intense headache, lymphadenopathy, back pain, myalgia and fatigue. The skin lesions appear 1-3 days after the fever. The rash affects almost all infected people, beginning on the face (95%) and then spreading to other parts of the body, most commonly the palms of the hands and soles of the feet. It also may develop on mucosal membranes and genitalia. The rash begins from macules and progresses to papules, then to vesicles and pustules which dry up and fall off. The lesions may be itchy or painful, and in some cases cause scarring. The infection is self-limited and symptoms generally last 14-21 days. 3. How is it transmitted? The transmission can be spread from human to human via: - Direct contact with the infected areas: rash, scabs or body fluid. This also include the contact during physical intimacy. Respiratory secretions, usually requires prolonged face-to-face contact such as kissing. - Contaminated via infected items such as clothing, bedclothes - Infected pregnant mother to their fetus via placenta It may also be contracted through an animal host, generally through scratching or biting or by preparing or eating meat or using products from an infected animal, in endemic countries. 4. How dangerous is it? Most cases of the virus are mild, sometimes resembling an illness like chickenpox, and resolve without treatment within a few weeks. The risk of transmitting disease is much greater for the infected person than developing severe disease or dying. The case fatality ratio of monkeypox has ranged from 0 to 11 % in the general population and has been higher among children. Recently, the case fatality ratio has been around 3–6%. Severe cases occur most commonly among children and those with underlying immune deficiencies. 5. How can it be prevented? Avoiding close, skin-to-skin contact with people who have a rash that looks like monkeypox. - Avoid handling bedding, towels or clothing or sharing utensils or cups with a person with monkeypox. - Follow normal infection-prevention protocols and behaviors, such as washing hands often with soap and water. Health care providers should use personal protective equipment when monkeypox is suspected. - People with monkeypox should isolate at home for the duration of symptoms of illness and refrain from close physical contact, including sexual activity - Avoid unprotected contact with wild animals, especially those sick or dead, in countries where it is endemic. Additionally, cook well all foods containing animal meat or parts. Vaccination may be available for those who have been exposed to monkeypox through close contact or sexual contact, within 2 weeks of exposure. Prior vaccination against smallpox (which is in the same virus family) is 85% effective in preventing development of disease; however, only persons older than 40 or so may benefit from prior vaccination given that routine smallpox vaccination ceased around 1980 when it was declared eradicated. A newer vaccine based on modified attenuated vaccina virus was approved for the prevention of monkeypox in 2019. This is a two-dose vaccine currently with limited availability. 6. What is the treatment? Clinical care for monkeypox should have a goal to alleviate symptoms, manage complications, and prevent long-term sequelae. Most infected people can manage their symptoms at home without specialized or hospital care. Severe cases or complications arising from the disease, such as pneumonitis or superimposed bacterial infections and sepsis require medical treatment. Patients should be offered fluids and food to maintain nutritional status. Secondary bacterial infections should be treated as needed or indicated. An antiviral agent known as tecovirimat that was developed for smallpox was licensed by the European Medicines Agency (EMA) for monkeypox in 2022 based on data in animal and human studies. It is not yet widely available. 7. How is monkeypox diagnosed? The clinical differential diagnosis that must be considered includes other rash illnesses, such as chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish monkeypox from chickenpox or smallpox. If monkeypox is suspected, health workers should collect an appropriate sample; polymerase chain reaction (PCR) Assays is the preferred laboratory test as it is most accurate and sensitive. Optimal sampling is from skin lesions: the roof or fluid from vesicles or pustules, or from dry crusts. Specimens should be packaged and shipped to appropriate laboratories in accordance with national and international requirements. 8. Are gay men at greater risk? Although many of the cases have been seen in gay and bisexual men, anyone who comes into close contact with someone who has monkeypox could be infected with the virus. All patients regardless of their history or characteristics who need diagnosis and treatment should receive stigma-free care and/or referrals free of discrimination. For any questions, please contact Nathalie Kapp, [email protected].  

What are the challenges for South Asian LGBTQI+ communities and how does one navigate those?  South Asian societies are very relational. Familial relationships substantially define the lives of people in South Asian communities. Maintaining honour is considered a crucial aspect of being able to live in the broader community. Family reactions in the process of “coming out of the closet” of LGBTQI+ people are often violent, with physical harassment and even eviction from the home. So, our movement to end discrimination against the LGBTQI+ community requires working with allies like families and social institutions like religious bodies, educational institutes, and workplaces. Without sensitizing them, it is impossible to achieve equal rights that exemplify living with dignity. What are the different treatments provided in our clinics? In India, our  Clinic in Pune city offers queer affirmative counseling, gender identity-related counseling, laser reduction services, NCD Screening, skill development, and HIV/SRHR services. Clinics in Bangalore, Panchkula, Hyderabad, and Dharwad also offer some of these services. We are working on opening Nepal’s first gender affirmative clinic in Kathmandu in the coming months. Besides queer affirmative counseling, gender identity-related counseling, laser reduction services at subsidized costs, NCD Screening, skill development, and HIV/SRHR services, it will also offer free hormone therapy and free consultations with queer-friendly health care professionals such as endocrinologists, psychiatrists, dermatologists, cosmetologists, and gynaecologists. What gender affirming care (care and support that helps one accept one’s gender) services are IPPF SARO Member Associations offering now? Our Member Association, the Family Planning Association of India, has Gender Affirming clinics that offer gender-affirming services. The Family Planning Association of Nepal will be opening a new trans-friendly clinic this year, which will support trans persons or any non-binary person in their journey towards affirming what gender they are. In Nepal, we are also supporting the movement for marriage equality.  Family Planning Association of Bangladesh has two trans-friendly clinics providing hormone therapy, laser therapy, and peer counselling services. Other than this, through advocacy-related projects, we are fighting for the rights of transgender persons in Bangladesh and working with young people from the transgender community to build capacities.  IPPF has a mission to be inclusive through our services or within the organization. Gender-affirming care services are part of our commitment to ensuring all people are free to choose their sexuality and well-being.  What are examples of appropriate language in gender affirming care? It is essential to respect the self-identity of the queer individual. For example, when taking details of the person visiting the clinic, check how they would like to be addressed. It is equally important to explain why you are asking for specific information about how they identify themselves. Understand that people must be called by their expressed names and pronouns.    Tell us about the type of training you are hosting for IPPF SARO Member Associations?  When it comes to diversity and inclusion, many groups form part of the mix—women, LGBTQ, people living with HIV, and people with disabilities are some of them. We have undertaken some Value Clarification, and Attitude Transformation (VCAT) workshops on ‘Gender’ with the governance boards of our Member Associations in Afghanistan, Bangladesh, India, and Nepal.  Apart from these, we have done VCAT modules on ‘Diverse Sexual Orientation, Gender Identity/Expression and Sex Characteristics (SOGIESC)’ trainings with Member Associations working on projects with LGBTQI+ communities. These include Family Planning of India, Family Planning of Nepal, and RENEW Bhutan.  These workshops are a great mix of theory, participatory learning, and experience sharing. The modules allow us to create a safe environment to uncover unconscious biases and work at rationalizing them for transformation in people’s attitudes and behaviour toward diverse groups. We have held several sessions and discussions with our internal staff too.  SONAL GIANI, Senior Technical Advisor, Diversity & Inclusion at IPPF SARO is an LGBTQ activist and filmmaker. She has been featured on The Better India list of ‘8 Inspiring Indian LGBT Individuals’, ‘Rainbow list of 20 LGBT Role Models’ by Cosmopolitan. She is known for her pioneering work in lesbian and bisexual women’s issues as well as LGBTQ youth work. She co-founded one of India’s largest LGBTQ youth initiatives “Yaariyan”, and ‘Umang, an LGBT initiative in Mumbai. She has worked on human rights issues and crisis handling of the queer community for about 8 years previously when she was an Advocacy Manager at The Humsafar Trust. This includes Section 377 related violations.