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Letter from the Chair in Sexual Health

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Coleman-Chair-BP-7.jpgFirst of all, I have to say that I am grieving the loss of one our pioneering faculty members - Mary Briggs who you will read about in this newsletter. She was an amazing woman and I was fortunate enough to receive some training from here when I was an intern at PHS some 36 years ago!

I am writing this from Mexico where I have started a 6-month sabbatical. The purpose of this sabbatical is to study gender variance which is widespread throughout the world but cultures place different values upon gender identities and cross-gender behavior. In most parts of the world, gender variant identifies and behavioral expressions of those identities are highly stigmatized - although the struggle for acceptance is growing around the world. However, there are cultures where variations in gender identities are much more tolerated, embedded into the normative and historical societal structure of gender, and sometimes a revered phenomenon.

I have started my work here in Mexico in a small indigenous community in Juchitan, Oaxaca. Fifteen years ago, I began my work on this subject, and I have been back to Juchitan many times. From here I will be going to French Polynesia, Thailand, and Burma. These societies (or parts thereof) have a unique and less stigmatized view of gender variance and cross-gender behavior. I will also be visiting Micronesia (Marshall Islands) and Melanesia (Fiji) which have interesting phenomenon but not as positive a situation - but are useful as contrast. I have been studying these societies for many years in my spare time, and I am back to revisit and finalize my observations and conclusions. I am accompanied by Mariette Pathy Allen who will be accenting the data with a photographic study.

I am just concluding my field research with the muxes of Juchitan. Juchitan is a small indigenous community (Zapotec) in the state of Oaxaca, Mexico. I have been able to observe the changes and evolution of the culture and the individual lives of many of the muxes. In Juchitan, muxes are a broad spectrum of gender non-conforming males - which would span our western constructs of gay, cross-dresser, transgender, and transsexual. The vast majority of them have sex with other men - and they are mostly distinctively sexually attracted to 'straight men' or 'bisexual men' known as mayates. Some muxes are heterosexually married and have children - their status as muxe is well recognized by the wife and society. A muxe is identified as such from an early age - and because of the relatively small community is known by everyone as muxe. Most parents in Juchitan would simply understand this as a fate of nature as the Zapotec people are fairly agnostic.

While it is not something that is necessarily desired and many fathers have negative reactions to their son's cross-gender behavior, most muxes become recognized as an asset to the family. Muxes take on a social role of caretakers of the parents and family members (they do this from a very young age). They are traditionally bound to live with the family and living in long-term relationship with another person is not really acceptable (except it seems for the ones who marry a woman and raise their own family). There have been some recent stories of two muxes living together - which is a very new and rare phenomenon.

The muxes are a very interesting phenomenon - and one which you cannot find even in other parts of the state of Oaxaca - never mind Mexico. They have long held a unique status within society, recognized and respected because of their role within the family, and they often inherit family fortune. I would say that they gain acceptance through hard work and good deeds - but at least that option is afforded them. As such, many hold positions of respect and power. The muxes organized themselves as a "gay rights organization in the 1970s - becoming Mexico's earliest gay rights organization. They now wield considerable political power.

It is hard to generalize about muxes - as this is a phenomenon quite complex and dynamically changing. There has been a blending of modern constructs of "gay" and "trans." They defy fitting into either construct and may best be understood in the western constructs of "queer."

The situation in Juchitan is extremely unique and exists as a stark contrast to other indigenous communities or other rural areas in Mexico. Muxes defy simple definition as it is a unique gender role within society which is expressed in a variety of ways - which are, to varying degrees, accepted. Many hold on to the traditional cultural belief that there is a place for sexual and gender diversity in a community.

It is an illustration of a community where sexual and gender diversity can coexist and that diversity can be celebrated. It is not paradise as our binary way of thinking of gender and sexual orientation continues to cause pressure to conform or create prejudice for those that don't fit the binary. And the struggle to maintain the traditions and create even more acceptance continues. But, it is an interesting challenge to other societies to think about how everyone can contribute to society capitalizing on their uniqueness and differentness. And, all can be enriched by those who do not conform to gender expectations. I do believe that celebration of sexual and gender diversity is essential to everyone's sexual health.

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Iantaffi-&-Spencer-BP.jpgThe theme of the 2013 Minnesota Transgender Health Coalition's Trans Health and Wellness Conference was "A Bridge to Access: Providers and Community Together."

The conference held October 12 - 13, 2013, featured keynote speakers Jamison Green, PhD, president-elect for the World Professional Association for Transgender Health; Victoria Kolakowski, the first openly transgender person to be elected as a trial court judge in the United States; and Andrea Jenkins, writer and multimedia visual and performance artist.

Alex Iantaffi, PhD, presented two workshops "Addressing internalized and systemic transphobia when working therapeutically with trans* and gender non-conforming youth and their families," and with Lauren Beach, JD, he presented, "Exploring the intersections between bisexual and transgender identities and organizing."

Katie Spencer, PhD, joined Carrie Link, MD, from Smiley's Family Medicine Clinic at an exhibit table to share with conference attendees transgender-specific care options through the University of Minnesota clinics.

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Free download of gender education materials

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Transformations-BP.jpgYou can now download the play script for Trans/formation: Addressing Gender Issues in School, resources, and an educational supplement designed by Katie Spencer, PhD, and Dianne Berg, PhD.

Spencer said, "We hope that these materials will be a practical tool to help school administrators, teachers, student groups, and parents to begin an open and honest dialogue about gender. Schools could customize these materials to launch a semester-long awareness campaign or to conduct an afternoon assembly. Ideally the play will spark an ongoing conversation."

PHS joined Exposed Brick Theatre to create the play which is based on the stories, experiences, and perspectives of transgender and gender non-conforming youth. The aims of the project are to validate transgender and gender non-conforming youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender and gender non-conforming youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.

The educational supplement offers ideas for using the script in a classroom setting including ideas for casting and directing, preparation of the school and audience, rehearsal process and cast support, and questions for an audience discussion. Additional Spencer and Berg offer secondary resource links to gender terminology, a book list, and research on the experiences of transgender students.

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"Trans/formation" premiere a success

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Transformation-BP.jpgPHS joined Exposed Brick Theatre to create the new play based on the stories, experiences, and perspectives of transgender and gender non-conforming youth. Nearly 180 people attended the premiere performance of Trans/formation: Addressing Gender Issues in School at the Pillsbury House Theatre. After the production, the audience enjoyed a lively discussion with the cast, writers, and director about the themes of the play and their experience working on the project.

The aims of the project are to validate transgender and gender non-conforming youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender and gender non-conforming youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.

The performance on May 4, 2012, was the first step in a larger process. The next steps will be for the playwrights Anton Jones, Suzy Messerole, and Aamera Siddiqui to make final edits to the script and for PHS psychologists Katie Spencer, PhD, and Dianne Berg, PhD, to finalize the educational materials on the themes of the play. The play script and educational materials will then be made available for high school groups to download and perform at their schools, amplifying the impact of this project.

PHS and Exposed Brick would like to thank Stacey Mills and Sam Heins for their donation that made this project possible. We would also like to thank all of the people that helped to create this piece including the youth we interviewed, the advisory board whose thoughtful and creative feedback lifted the play to a whole new level, the youth who read the early drafts and whose honest feedback led us in the right direction. The youth performers are outstanding and their commitment to the piece has been amazing.

PHOTO: credit David Hannigan

 

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Transgender Youth Theatre Project

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Gender-play-BP.jpgPHS has joined Exposed Brick Theatre to create a new play Trans/formation: Addressing Gender Issues in School based on the stories, experiences, and perspectives of transgender and gender non-conforming youth.  Dianne Berg, PhD, and Katie Spencer, PhD, are working with playwrights Anton Jones, Suzy Messerole, Aamera Siddiqui, and a community advisory group to develop the production and educational materials.  The aims of the project are to validate transgender youth experiences through performance, to educate peers, parents, families, friends, and educators about the experiences of transgender youth, and to encourage dialogues around gender issues, advocacy, and ally support for adolescents.
"In working with trans youth, it is integral to reach them in the settings they are in daily, it is not enough to intervene in the therapy office, but you also have to reach out to the classroom, to families, and to the community," said Spencer.  "This is a big step for PHS to put funding behind a community educative initiative like this, and I can tell you, from the community work I have been doing, people are really responding to it and they see it as a positive thing!"

The play production will be premiered on May 4, 2012, at the Pillsbury House Theatre in Minneapolis.  The play will also be performed at a Twin Cities high school.  Ultimately the play script and educational materials will be available for high school groups to download and perform at their schools. 

Messerole said that one of the individuals interviewed for the play shared that during his junior year of high school the gay straight alliance at his school brought in a speaker who was transgender.  The student shared with Messerole that it was the first time he had ever seen another transgender person and it was a very powerful experience.  Messerole added, "We all need to know that we are not alone, we all need to know that there are others who have similar stories. One of the most powerful things about theatre is its ability to hold up a mirror and see one's self reflected on stage. It's very validating to see someone one stage who 'gets you' in a way that is complex and nuanced."

Exposed Brick has worked extensively with area schools, creating over 30 Stand In It with Me performances since 2006.  Stand In It With Me performances are custom created for each school, based on interviews with students and teachers.  The performances fuel dialogue on issues of racism, gender discrimination, sexual orientation, classism, immigration, and more.

PHS and Exposed Brick are grateful to Stacey Mills and Sam Heins for their donation that made this project possible.  We would also like to thank all of the people that helped to create this piece including the youth we interviewed, the advisory board whose thoughtful and creative feedback lifted the play to a whole new level, the youth who read the early drafts and whose honest feedback led us in the right direction.  The youth performers are outstanding and their commitment to the piece has been amazing.

Community Advisory Board Members
Claire Avitable, director, 20% Theater Company
Katie Burgess, director, Trans Youth Support Network
Andrea Jenkins, trans activist, performer, poet
Moe Lionel, performer, Naked Stages Performer
Anthony Neumann, performer, director, Naked Eye
Ethan Turcotte, arts administrator, Kulture Klub Collaborative

Trans/formation: Addressing Gender Issues in School
By Anton Jones, Suzy Messerole, and Aamera Siddiqui

Friday, May 4, 2012 at 7 PM
Pillsbury House Theatre, 3501 Chicago Avenue South, Minneapolis, MN 55407

Parking: Free parking is available in the Pillsbury House lot next to Full Cycle, just south of 35th on the east side of the street.  Free street parking is also available on 35th and all other surrounding neighborhood streets.

Free and open to the public.  To reserve a seat, please RSVP to Jenae Batt at jenae@umn.edu or 612-625-1331.

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PAHO-22-BP.jpgEli Coleman, PhD, and Walter Bockting, PhD, joined a meeting convened by the Pan American Health Organization / World Health Organization (PAHO / WHO) from December 19 to 21, 2011.  PAHO gathered representatives of the health sector, academia, and civil society organizations to discuss a series of recommendations for health services on how to address the needs and demands of transgender people in the region of the Americas.

The conclusions of this meeting will become part of a reference document addressing the main problems affecting access to and utilization of health services for and by transgender people. In addition, a plan for the development of a comprehensive strategy for health care provision for this population throughout the region will be designed. Both documents will subsequently form the basis for sub-regional consultations to be held in 2012.

The participants of the meeting, which was held at the headquarters of PAHO/WHO in Washington D.C., decided to adopt the term "trans" to refer to a population whose members are characterized by a variety of gender identities and expressions that differ from their sex assigned at birth. This population faces a number of problems in accessing health services in the countries of the region, many of which are a result of stigma, a lack of appropriate medical protocols and a lack of information on how to deal with certain social situations.

"Trans people have traditionally been stigmatized, marginalized, abused, discriminated against, and even subject to physical and emotional violence. These and other expressions of transphobia have to be considered factors that negatively impact health," said Dr. Gina Tambini, Area Manager of Family and Community Health. "In order for the health sector to be able to adequately respond to the needs of trans persons, we must create and implement policies of non-discrimination, rely on qualified personnel, and ensure that there are environments of respect and quality of care. The presence and active participation of trans persons was a fundamental and indispensable contribution to the success of the meeting.

Trans people as a group have greater vulnerability and exposure to such health problems as HIV, syphilis, gonorrhea, hepatitis, and genital herpes, which create special demands on health services. But in addition, health care providers need to be sensitive to issues of gender identity related to this group.

"The needs, problems, and demands of trans people cannot be defined externally, but must be expressed by them themselves," said Dr. Tambini.

At the PAHO meeting, participants discussed terminology, definitions, and descriptions of this population, as well as epidemiological profiles and health initiatives that have been carried out in the Americas. In addition to reviewing and discussing the content of the reference document, the meeting was intended to promote a multisectoral and multidisciplinary vision on the provision of services, including prevention.

PAHO was established in 1902 and is the world's oldest public health organization. PAHO works with all countries in the Americas to improve the health and quality of life of people of the Americas and serves as the Regional Office for the Americas of WHO.

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Standards-of-Care-BP.jpgThe World Professional Association for Transgender Health (WPATH) released a newly-revised edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), on September 25, 2011, at the WPATH conference in Atlanta. This is the seventh version of the SOC.  The original SOC were published in 1979.  Previous revisions occurred in 1980, 1981, 1990, 1998 and 2001.

The SOC is considered the standard document of reference on caring for the transsexual, transgender, and gender nonconforming population. The newly-revised SOC will help health professionals better understand how they can offer the most effective care to these individuals.  The SOC focuses on primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services and hormonal and surgical treatment.

"The latest 2011 revisions to the SOC realize that transgender, transsexual, and gender nonconforming people have unique health care needs to promote their overall health and well-being, and that those needs extend beyond hormonal treatment and surgical intervention," said SOC Committee Chair, Eli Coleman, PhD, Professor and Director at Program in Human Sexuality, University of Minnesota. 

"The previous versions of the SOC were always perceived to be about the things that a trans person must do to satisfy clinicians, this version is much more clear about every aspect of what clinicians ought to do in order to properly serve their clients. That is a truly radical reversal . . . one that serves both parties very well," said Christine Burns, SOC International Advisory Committee Member.

More than any other version, 2011 revisions also recognize that gender nonconformity in and of itself is not a disorder and that many people live comfortable lives without having to seek therapy or medical interventions for gender confusion or unhappiness.

This version provides more detailed clinical guidelines to address the health care needs of children, adolescents, and adults with gender dysphoria who need assistance with psychological, hormonal, or surgical care. 

In addition to clearly articulating the collaborative relationship needed between transsexual, transgender, and gender nonconforming individuals and health care providers, the new, 2011 revisions provide for new ways of thinking about cultural relativity and culture competence. 

The document includes a call to advocacy for professionals to promote public policies and legal reforms that promote tolerance and equity for gender and sexual diversity.  This document recognizes that well-being is not obtained through quality health care alone but a social climate that eliminates of prejudice, discrimination, and stigma and promotes a positive and tolerant society that embraces sexual and gender diversity.

WPATH, formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity disorders.  As an international multidisciplinary professional Association the mission of WPATH is to promote evidence based care, education, research, advocacy, public policy and respect in transgender health.

The World Professional Association for Transgender Health. (2011). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version.  Retrieved from http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf

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med-class-crop-2.jpgA study conducted at the Stanford School of Medicine confirms that a majority of American medical schools are lacking LGBT-related health curriculum in the classroom and in clinical training. The study findings were published on September 7, 2011, in the Journal of the American Medical Association.

The Stanford research team surveyed deans of medical schools in Canada and the United States.  Of the complete responses the group received (132 = 75%) they found that of the entire medical school curricula the median reported time dedicated to LGBT-related content was 5 hours.  Some schools reported dedicating no time to LGBT-related content in the classroom or the clinic.

At this time, most schools (128) teach student that when taking a patient's sexual history students should ask the question, "Do you have sex with men, women, or both?"  However, on a list of 16 LGBT-specific topics,* only 11 schools reported covering all 16 topics in their curricula.  The topics covered most frequently by schools are sexual orientation, HIV, and gender identity, and the topics covered least often by schools are genital reconstruction surgery, body image, and transitioning.

*LGBT specific curricula topics:  barriers to Care, body image, chronic disease risk, coming out, DSD/intersex, gender identity, HIV, LGBT, adolescents, mental health issues, safer sex, sexual orientation, SRS, STI, substance use, transitioning, unhealthy, and relationships/IPV

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., . . . Lunn, M. R. (2011). Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education. JAMA, 306(9), 971-977. doi: 10.1001/jama.2011.1255

Photo: PHS faculty teaching the human sexuality course at University of Minnesota Medical School

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Bockting-in-Salzburg-BP.jpgWalter Bockting, PhD, participated in International Partnership for Advancing Transgender Health seminar in Salzburg, Austria, on October 2 - 8, 2011.

The meeting launched a multi-year partnership with international organizations including TIG (lead organization) and Labrys (supporting partner) in Kyrgyzstan, RED TRANS in Peru, Gender DynamiX in South Africa, and The Open Society Public Health Program and the Center of Excellence for Transgender Health at the University of California.

The group aims to establish and implement culturally appropriate guidelines on transgender health care. Ultimately, groups plan to cultivate trained networks of medical care providers who can offer high quality transgender health care and who will participate in the dissemination of best practices regionally.

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FEMESS-BP.jpgOctober 20 - 22, 2011, Eli Coleman, PhD, and Joycelyn Elders, MD, presented at the VIII Congreso Nacional de Educación Sexual y Sexología organized by the Federación Mexicana de Educación Sexual y Sexología, A.C. (FEMESS) in Chiapas, Mexico.

More than 800 individuals attended the conference, including 150 people form the academic sector and health organization and 54 civil servants from the Ambulatory Centers of Prevention and Attention in AIDS and STI (Centros Ambulatorios de Prevención y Atención en SIDA e ITS or CAPACITS).

In a post-conference statement made by FEMESS, the organization thanked the government and university of the state of Chiapas for supporting the conference.  The organization also commended the government for its commitment to reach the United Nations Millennium Development Goals.  The organization also reiterated its support of the 2008 Inter-ministerial Declaration which was adopted by all health and education ministries in Latin American and the Caribbean which advocated for comprehensive sexuality education starting in pre-school to stem the tide of the HIV pandemic.  

FEMESS restated its goal to depathologize transsexualism as a mental disorder.  The organization reaffirms the need for gender expression to be recognized as a fundamental human right of free expression.  Further the group called on mental health professionals to support this position and join in the goal.

Videos from the conference:

Eli Coleman & Youth's Sexual Health in the 21st Century: Get involved!

Joycelyn Elders & Youth's Sexual Health in the 21st Century: Education, Empowerment & Resources

Photo: Joycelyn Elders, MD, Eli Coleman, PhD, with FEMESS conference organizers

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Researcher Jae Sevelius, PhD, visits PHS

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SEVELIUS-BP.jpgAugust 1 - 5, 2011, Jae Sevelius, PhD, visited PHS to meet with one of her project advisors, Walter Bockting, PhD, and to learn about our transgender research and transgender health clinic.

Bockting is working with Sevelius on her NIH/NIMH-funded K-Award project to assess HIV risk behaviors and protective factors among transgender women of color to develop a culturally specific HIV prevention intervention for this high-risk, underserved population. 

The current focus of her K research is examining how the need for gender affirmation (a psychosocial dimension that refers to transgender women's desire for validation and support of their gender identity and expression) interacts with access to gender affirmation (their access to this type of validation and support) to promote or protect against risky health behaviors.  Sevelius is in year 3 of a 5-year grant.

Sevelius presented her research project to PHS faculty and staff.  She said, "I am passionate about promoting health and wellness within transgender communities. That certainly includes addressing health disparities, such as the egregious rates of HIV among transgender women of color, but also includes bringing resources to trans communities to support overall sexual health, mental health, holistic well-being, and spirituality."

She added, "One of the most rewarding aspects of my work so far has been witnessing the direct impact of the sexual health promotion intervention that I am developing for transgender women of color." Sevelius and two research assistants, Danielle Castro and Angel Ventura, conducted a pilot study of the intervention this year.  Sevelius said that she was, "astounded by the intensity of the positive response we got from participants. It is a peer-led intervention so I was just an observer, but there were many moments that I was brought to tears by what I witnessed during the course of these small-group sessions. The participants shared so much of themselves, supported one another through difficult disclosures, and struggled together to find connection and love through the traumas they have faced and continue to face in an ongoing way, even in a place that is as reputedly liberal as San Francisco. The participants were so grateful for the opportunity to come together in that way and learn from each other and the wonderful facilitators."

Sevelius is an advocate for systematic change for the wellness of the transgender community. She is hopeful that an increased visibility for the community will lead to an increased commitment to address the severe inequities and systemic transphobia that are pervasive. Sevelius said, "Unfortunately, I think we still have a long way to go here in the US in that we still do not collect trans-inclusive data that provides us with the essential big picture perspective that would allow us to really frame the issues accurately.  Health care providers are not adequately educated about the needs of trans people, and violence and discrimination are absolutely rampant. We need to start by acknowledging the existence of trans people on a national level by capturing their unique circumstances and needs in a systematic way."

Sevelius is an Assistant Professor with the Center for AIDS Prevention Studies (CAPS) in the Department of Medicine at the University of California San Francisco, and Co-Principal Investigator of the Center of Excellence for Transgender Health, which promotes increased access to culturally competent health care for transgender people through research, training, and advocacy. With funding from the California HIV/AIDS Research Program, building on work of the Transitions Project and in collaboration with API Wellness' TRANS:THRIVE program, Sevelius is also working to adapt and evaluate the evidence-based HIV prevention intervention SISTA (Sisters Informing Sisters about Topics on AIDS) for transgender women of color.  Another CHRP-funded project of Sevelius' is a qualitative investigation of the barriers to HIV treatment engagement and adherence among transgender women living with HIV. 

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UN-General-Assembly-BP.jpgOn June 17, 2011, the United Nations Human Rights Council declared that all human beings should be protected by universal human rights regardless of sexual orientation and gender identity. The declaration stated, "Expressing grave concern at acts of violence and discrimination, in all regions of the world, committed against individuals because of their sexual orientation and gender identity."

The resolution went on to request a global study to document discriminatory laws and practices and acts of violence based on sexual orientation and gender identity. The Human Rights Council will then convene a panel to discuss the study findings and advance a constructive, informed, and transparent dialogue on the issue.

In a press statement, Secretary of State Hillary Clinton said, "All over the world, people face human rights abuses and violations because of their sexual orientation or gender identity, including torture, rape, criminal sanctions, and killing. Today's landmark resolution affirms that human rights are universal. People cannot be excluded from protection simply because of their sexual orientation or gender identity. The United States will continue to stand up for human rights wherever there is inequality and we will seek more commitments from countries to join this important resolution."

The declaration was presented by South African and adopted with the support of 23 countries, 19 countries opposed, 3 countries abstained, and 1 country was absent for the vote.

PHOTO: United Nations General Assembly, UN Photo/Rick Bajornas

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About this Archive

This page is an archive of recent entries in the Gender Identity category.

Gay is the previous category.

HIV/AIDS is the next category.

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