Healthcare will not be accessible to all until gender, sexuality and disability are included

Authors: Felicia Mburu, the director of the Article 48 Initiative, is a disability rights activist based in Nairobi, Kenya. Gulnar Feerasta, the Senior Director of Programs at the LGBT Community Center of Greater Cleveland, is passionate about promoting empowerment, resiliency, and leadership throughout marginalized communities. They are both Atlantic Fellows for Health Equity based at George Washington University in Washington, D.C.

Article 3 of the United Nations’ Sustainable Development Goals promotes good health and wellbeing for all at all ages — an admirable and desirable outcome, but health and health equity are determined by structural determinants that shape the distribution of power and resources. There are often people left out of “for all.”

These acts of discrimination are institutionalized in systems and decision-making processes that exclude underrepresented groups at the intersection of gender, sexuality and disability. In order to realize the right to health for these groups, we have to identify and eliminate inequities in accessing health information and services.

Traditionally, persons with disabilities have not been viewed as sexual beings. This bias has made it difficult to have any conversation on disability and sexuality, especially with women and girls with disabilities. The result of this is denial of their identity and access to related health-care services and information.

The closest society has attempted to have this conversation is in the context of sexual and reproductive health rights. Several studies have found that persons with disabilities have lower levels of access to quality services than persons without disabilities, including lower access to sexual education and knowledge of sexual and reproductive health and rights. Young people with disabilities, for example, generally show lower levels of knowledge concerning HIV transmission and prevention. Women and girls with disabilities also report that their needs and expectations are not met by antenatal and gynecological services.

Materials meant to create awareness of reproductive health are often created without consideration for persons with disabilities. For example, sexual l reproductive health materials are not readily available in large print, simple language, braille or with images. Persons with visual and hearing disabilities are often left out, hampering their access to information.  For instance, condom packaging is only friendly to non-disabled persons; a person with visual disabilities may not know how to use it properly, exposing them to improper use and subsequent risks.

There’s the further risk under criminal law where consensual sex between adults with disabilities is deemed as defilement. This forms an attitudinal barrier deterring persons with disabilities from seeking healthcare services or information for fear of having their partners arrested.

In February 2023, the Supreme Court of Kenya gave a ruling on the right of association for members of the queer community. Unfortunately, this ruling was met with backlash, misinformation and disinformation leading to acts of violence against the queer community in Kenya. Particular misinformation was that the Supreme Court had legalized same sex relations, which in Kenya is still criminalized.  The acts of violence included denial of healthcare or health information on the basis of one’s sexual or gender identity or expression. This is against Article 27 of the Constitution which stresses on non-discrimination of all persons and Article 4 which provides for adherence of governing

Misinformation on sexuality, gender and disability creates attitudinal and legal barriers in accessing health including outright denial of gender and disability affirming care and an absence of emergency care due to lack of medical skills by or legal repercussions to medical professionals.

There are also financial constraints as the health care services at this intersection of gender, sexuality and disability are deemed as non-essential or illegal thus most health insurance companies will not pay. Disability naturally comes with financial burdens that most insurers will not cover, including disability-specific sexual reproductive healthcare. Within the Queer community, similar treatment with regards to sexual reproductive health is equally not covered nor provided by insurers or medical practitioners. Finance therefore becomes a huge barrier to accessible  health.

We see stigma and discrimination engrained in the law, such as criminalization of LGBTI sexual relations and criminalization of consensual sex between persons with disabilities which makes members of the queer communities and persons with dibabilities unlikely to seek healthcare services even in emergencies.

Queer communities and persons with disabilities face daily mental stressors – discrimination, substance abuse, homelessness, violence including sexual violence and denial by families – and there are no mental health policies to provide interventions to the queer community nor disabled community.

We recognize the barriers we face as healthcare advocates and providers, but it’s time we start dismantling those barriers.

Here are some ways to do so:

• Training medical practitioners to be comfortable with service provision to persons with disabilities and  queer persons.
• Medical training should have a strong focus on general health care to persons with disabilities. Disability and health is rarely taught in medical schools or taught as a specialization, which leads  to lack of skills to provide required services.
• Carrying out research projects with learning institutions and partnering with them like the documentation of stories on the impact of COVID-19 on women and girls with multiple disabling conditions which was a collaboration between Women Pro Bono Initiative in Uganda and Article 48 Initiative in Kenya. 
• Educating patients at the intersection of disability and sexuality on how to navigate the medical system. There is very little information on accessible, non-discriminatory health care services to persons with disabilities nor queer persons and those at their intersection.
• Creating safe spaces for youth at the intersection of disability and sexuality within learning institutions, which address questions of sexuality in marginalized groups e.g. mental health therapy, art therapy, coping skills workshops, curriculum centered on queer sexuality and reproductive health.
• Starting intergenerational conversations between the younger generation and older generation on acceptance and inclusion of all marginalized persons.
• Setting up a call center where people who face discrimination at the intersection of disability and sexuality  can reach out for help.
• Setting up financial support or pathways to finances to allow persons at the intersection of disability and sexuality affordable health services.

By working together, creating advocacy networks and empowering persons at the intersection of queer and disabled people, change will be slow but it is possible. Health is a fundamental right and no one should be denied.