Sexual health human rights and the law

40 | Sexual health, human rights and the law
positive reforms in line with international human
rights protections, as, for example, in Ethiopia,
which reformed its 1957 Penal Code in 2005 to
remove the exculpation of an alleged rapist in light
of a subsequent marriage to a victim (430).
5.2.4. Violence based on real or perceived sexual
behaviour or expression
Violence committed against persons because
of their real or perceived sexual behaviour or
expression has been recorded in all regions of the
world (121). Among these sexual behaviours or
forms of sexual expression are: having same-sex
sexual partner(s), having extramarital sex, engaging
in sex work, perceived effeminate behaviour by men,
sexual contact with those viewed as being social
inferiors or members of enemy groups, behaviour
deemed to dishonour the kin group, and sexual
disobedience. These behaviours are perceived as
being nonconformist, transgressing societal or moral
codes or norms, and violence is used to punish
people for such conduct. The violent punishment
may be physical or psychological, and the effects
include: injury, reduced ability to access treatment
for these injuries, humiliation, disempowerment and
increased disease burden (121).
Violence based on sexual orientation or gender
identity. There is increasing documentation of
targeted violence against people who have (or are
suspected to have) same-sex sexual relationships,
and against transgender people. The extent of such
violence is currently impossible to estimate as few
states have systems in place for monitoring, recording
and reporting these incidents. Even where systems
exist, incidents may go unreported or are misreported
because victims distrust the police, are afraid of
reprisals or threats to privacy, or are stigmatized (121).
Homophobic and transphobic violence can take
many forms, including harassment and bullying
in schools, so-called street violence and other
spontaneous attacks in public settings (121).
Homophobic and transphobic violence can involve
a high degree of cruelty and brutality, including
beatings, murder, torture, rape and other types of
sexual assault (73, 121, 178, 201, 431, 432). Violent
acts may be committed by family members and
friends, peers at school, health-care providers,
co-workers, the police or others (98, 121, 175, 201,
202, 207, 229, 433, 434).
Severe violence and torture occurring in healthcare
settings has been documented, including
denial of medical treatment, use of verbal abuse
and public humiliation, and a variety of forced
procedures such as psychiatric evaluation and
sterilization. Other types of violence perpetrated by
health personnel and other state officials include
forcible anal examination for the prosecution of
suspected homosexual activities, invasive virginity
examination, hormone therapy, and so-called sex
normalizing surgery and reparative therapy. These
procedures are rarely medically necessary, can cause
serious injury, scarring, loss of sexual sensation, pain,
incontinence and lifelong depression, and have also
been criticized as being unscientific, potentially
harmful and contributing to stigma (178).
Lesbian, gay and transgender people may be subject
to aggravated violence and abuse by inmates and
prison guards when they are in detention or under
state care (121, 228, 229, 232, 435). Incidents have
been reported in which individuals were subjected
to victimization by police and prison guards, and
authorities failed to take reasonable measures to
prevent violence against detainees perceived as
being lesbian, gay or transgender (121).
Criminalization of same-sex sexual behaviour
and non-gender-conforming behaviour, and
discriminatory laws and regulations, can create
and intensify stigma, discrimination and violence,
all of which have direct effects on lesbian, gay,
transgender, gender variant and intersex people’s
health far beyond immediate injury. Criminal laws,
public decency regulations and policing surveillance
systems have all been used to harass, arrest, torture,
rape and abuse people perceived as belonging to
these groups (121, 435–437).
International and regional human rights bodies
increasingly call for the respect and protection
of lesbian, gay, transgender, gender variant and
intersex people’s human rights, including respect
for their rights to life, liberty and security of person,
to be free from torture or inhuman and degrading