The Court of Justice of the European Union held a significant hearing today concerning legal gender recognition for trans people in Hungary

Today, the Court of Justice of the European Union (CJEU) heard the case Deldits (C-247/23), which involves a trans refugee in Hungary who has been denied legal gender recognition (LGR) since 2021. Represented by Háttér Society and the Hungarian Helsinki Committee, the complainant, who was granted refugee status Hungary in 2014, has sought judicial review under Article 16 of the EU’s General Data Protection Regulation (GDPR).

This case raises crucial questions for the CJEU: whether GDPR mandates the rectification of personal data, including gender marker, upon request; what evidence is necessary to support such requests; and whether medical or surgical interventions must be proven.

In addition to the European Commission and advocacy groups, the governments of Hungary, France, Spain and the Netherlands participated in today’s hearing, highlighting its broader implications for LGR in Hungary.

The Budapest-Capital Regional Court’s referral to the CJEU marks a pivotal moment in the ongoing battle for trans rights in Hungary. Despite the 2018 Constitutional Court decision and the 2020 European Court of Human Rights judgement affirming these rights, the Hungarian legislature has yet to implement necessary changes. LGR for both refugees and Hungarian citizens has been banned since 2020.

According to Katrin Hugendubel, Advocacy Director at ILGA-Europe: In its final judgment, the CJEU will have the opportunity to address the discrimination faced by trans EU citizens when a gender marker that does not correspond to their gender identity is recorded in the national registrars. The case is of the utmost importance to protect the rights of trans citizens in Hungary and across the EU, notably in the context of the Hungarian ban on legal gender recognition.

The opinion of the Advocate General is expected on 12 September 2024. The CJEU’s decision is anticipated later in the autumn, and it holds significant potential to influence the legal framework for trans rights within Hungary and the broader EU.

ILGA-Europe, alongside Transgender Europe (TGEU), are providing support to Háttér Society in this case.

Read the press release by Háttér Society here.

People are affected by cancer no matter what their identity is, but barriers in access to screening, prevention, and treatment puts LGBTI people at increased risk of developing fatal cancers. Keep reading to learn what can be done, so that no one is left behind in the fight against cancer.

Cancer is the second most common cause of death in Europe. With more than 3.7 million new cases every year, cancer prevention and screening programmes are crucial, yet LGBTI people are left lagging behind when it comes to this.

“The cancer community has recognised that the LGBTIQ+ community has historically been marginalised within the healthcare system, which translated into some discrimination, exclusion and unequal treatment in cancer care,” says Mike Morrissey, CEO of the European Cancer Organisation with whom we have been working together.

“This can often be caused by a lack of awareness of the specific needs of the community, policy guidelines that need updating to address the needs of marginalised communities, and the lack of inclusive language in both health documentation and medical check-ups, to name a few examples,” Morrissey adds.

Moving away from gendered language

Trans, intersex, non-binary and third gender people exist in Europe, but are left out when screening, prevention and treatment use binary categories to determine risk factors and eligibility. To put it more plainly, when your body doesn’t fit the binary boxes of ‘female’ or male’, this means that you may not receive the cancer care that your body needs.

Access to health services should be dictated by a person’s body parts and what their organs require to stay healthy. For example, when stating ‘women require mammograms’, we are leaving out those who are not women but are at the same risk of developing breast cancer. Moving away from gendered language in cancer prevention plans and instead referring to specific body parts, will ensure than trans, intersex, non-binary and third gender people can access to the screenings and treatment their bodies need.

Increased risk and lack of prevention for LGBTI people

Some studies suggest higher cancer rates for LGBTI people. While research into the reasons behind this greater prevalence is still too limited, we know that LGBTI people access routine healthcare less frequently than others. Some of the reasons are:

Fear of discrimination

Have you ever worried about talking about your sexual orientation, your sexual experiences, your gender identity, or your sex characteristics to your doctor because you are unsure if you will be treated the same way after you have shared this information? You are not alone. Fear of being discriminated against often prevents LGBTI people from sharing relevant information that could affect their health.

Limitations in access

Many LGBTI people encounter barriers in access to employment or education. These barriers prevent them from accessing healthcare too, and can prevent them having adequate health insurance coverage.

Negative experiences with healthcare providers

It is difficult to reach out to someone when you anticipate an uncomfortable time with them. Fear of having a negative experience with a healthcare provider can lead some LGBTI people to delay or avoid medical care, especially routine care such as screenings for early detection. Missing routine cancer screenings can lead to cancer being diagnosed at a later stage, when can be harder to treat.

Misinformation about cancer risks

Trans and intersex people in particular have historically been exposed to significant human rights violations in healthcare settings. For example, many trans and intersex people report non-consented or coerced gonadectomies wherein the “risk of cancer” was used as a motivator to encourage them or their parents to “consent” to the surgery. This brings further distrust of healthcare providers when it comes to discussions of cancer risks and treatments.

This is why any EU or national plans against cancer must ensure that LGBTI people will receive the screenings and treatments they need, when they need them, and with equal coverage under insurance schemes. As Mike Morrissey states, “the European Cancer Organisation could not achieve its mission to improve outcomes and quality of care for all cancer patients, if one specific marginalised community is not included in the advancements of the cancer community at large. It is therefore of utmost importance for us to bring together the cancer community and guide the effort in fighting for equity for all citizens and cancer patients regardless of their background.”

You can check out our latest feedback to the European Commission and more submissions to the EU Cancer Plan and the Cancer Screening Recommendation.

Over 18,000 cases of monkeypox have been confirmed in the EU since the start of the outbreak in the region in May. Humanitarian organisations, governments and institutions must join forces and put equity at the centre of their thinking so treatments and prevention measures are available for all.

By the end of August, 18,072 confirmed cases of monkeypox have been reported from 29 EU/EEA countries, according to the ECDC, and 46 cases have been reported in the Western Balkans and Turkey. The first cases were registered in early May. Globally, over 48,000 cases have been confirmed since January 2022, according to WHO.

Who can get infected and how?

Monkeypox is transmitted by skin-to-skin contact of any kind, contact with contaminated clothing and fabrics, and by aerosol droplets; the current European and North American outbreak appears to be closely, though not exclusively, linked to sexual practices as well. There are right now specific outbreaks among men who have sex with men (MSM): over 95% of the reported cases in the world are linked to this practice.

Even so, anyone can contract the virus if they engage in risky practices with people who are potentially infected and sexual contact among men is not the only mode of transmission. The risk of infection comes from practices, not identities. This is important to keep in mind, not only to stay away from stigmatisation of gay and bisexual men communities but also to contain the spread, as we learnt from HIV/AIDS epidemic.

Are there vaccines and treatments?

The European Commission has secured 163,000 doses of vaccines to respond to the progression of the spread of this virus in the EU. Spain, Germany, Belgium, Sweden, Ireland and Italy are among the countries who have already received vaccines.

However, vaccines on their own are no silver bullet, says the WHO:

• 85% is the protection estimated from vaccines, according to the limited data available. Additionally, there is one single manufacturer authorised globally, which will probably mean shortages in supply.
• There are great disparities in distribution in the EU. In July, the European Commission announced an order for over 163,000 doses for all the EU, while countries like France had already purchased 250,000. Spain, with over 6,400 cases is the country with the highest number of cases in the EU, has had to this date only 17,000 doses available. These are examples of disparities in the distribution of vaccines in the EU, but as we learnt in 2020, a virus doesn’t know about borders.
• There are no vaccines at all in Africa. Still, the death-per-case rate in Central and Western Africa is 1 in every 21 cases, which is more than 100 times more than in the global north, less than 1 in every 2,500 cases.

What can institutions and governments do?

• Global public health is a global responsibility where equity is key. Vaccines and treatments must be made available in poor countries as well as in richer ones – this is the only way to ensure that outbreaks like this do not happen and that the virus does not become endemic. Therefore, the vaccine supply must be coordinated among countries and institutions such as the European Commission and the WHO.
• Vaccines are a preventative measure, not a reactionary one. Early diagnosis, contact tracing and exposure limitation measures must come along in order to ensure that the limited supply of vaccines has the largest possible impact.
• At a national level, ministries of health need to coordinate closely with LGBTI and HIV-related organisations to develop communications and outreach materials, as well as with groups organising events where transmission is likely so that they can communities with their communities effectively. In order to this, these groups and civil society must be granted sufficient resources.  
• As with the HIV/AIDS epidemic, LGBTI civil society are taking up public health responsibilities to ensure that LGBTI people are effectively protected and served; however, this means diversion of resources from some of the core work of these organisations. Public health institutions must work in equitable, non-discriminatory ways to ensure services of the most vulnerable.

AS the decision by the United States Supreme Court overturning Roe v. Wade, thereby dismantling the US constitutional right to abortion, ILGA-europe joins the center for reproductive rights, alongside many other organisations calling on european decision makers to remove impediments in access to abortion care.

The decision by the United States Supreme Court in Dobbs vs. Jackson Women’s Health Organisation overturns Roe v. Wade, thereby dismantling the US constitutional right to abortion. The decision will have a profound and devastating impact.

As local and global women’s rights, human rights and sexual and reproductive health and rights organisations working in Europe, we express our profound solidarity with the millions of people in the United States whose right to essential reproductive health care has been taken away by this decision and with all of those who have sought
to protect and uphold this right.

On 7 April, in the midst of an ongoing global pandemic, we celebrated World Health Day with the motto: “Building a fairer, healthier world”. But to make this a reality the voices and needs of the most marginalised, including LGBTI people, must be front and centre. Here is how ILGA-Europe and the Nobody Left Outside initiative are working together to build on this vision.

The COVID-19 crisis has made it clear that nobody is safe until everybody is safe. Health and access to healthcare is one of the seven areas where COVID-19 has hugely impacted LGBTI people, organisations and communities in Europe and Central Asia. Although the corona virus does not discriminate, already marginalised groups have been hit harder by the pandemic and yet remain among the least protected. These vulnerable communities include LGBTI people as well as people experiencing homelessness, undocumented migrants, sex workers, people who use drugs and prisoners.

The Nobody Left Outside (NLO) initiative, with the participation of ILGA-Europe, is a collective of organisations representing some of the most marginalised communities in Europe, for whom access to healthcare is not straightforward. It aims to improve healthcare access for these people and calls on policy makers in the EU, at local and international levels, to take the following critical actions:

1. Establish a knowledge platform

Marginalised groups have specific and intricate healthcare needs. However, specific expertise, research and interventions are limited and scattered across Europe. The European Commission should support the establishment of an EU-level knowledge platform to compile and share research and best practices in healthcare access for marginalised, under-served groups. This should be led by academics active in the field, in close collaboration with civil society networks and organisations.

2. Train health and social care providers

Health and social care providers often lack suitable education to deal with the complex challenges faced by marginalised communities. The European Commission should support healthcare training and capacity building via the European Social Fund+. These programmes should include suitable training to educate and enable all staff providing services for marginalised communities and peer training. They should include training to avoid stigma and discrimination, and aim to reinforce collaboration between healthcare staff and community workers. An inspiring example is Health4LGBTI, an EU funded pilot project aiming at reducing health inequalities experienced by LGBTI people.

3. Implement the NLO Service Design Checklist

The NLO Service Design Checklist helps to design and deliver health and support services that are accessible to underserved and marginalised people. The European Commission should support a pilot programme to evaluate its implementation. You can download the NLO Service Design Checklist here.

4. Support Joint Action

International collaboration between academia, advocacy organisations and healthcare providers is key to driving improvements. EU Joint Actions aim to develop tools, methods and approaches and to build capacity through collaboration. Therefore, the European Commission should support a Joint Action to improve access to health and support services among marginalised and under-served communities, which should include the implementation of guidelines for monitoring and evaluation.

5. Support funding for research into access to cancer services

Some cancers are more common in marginalised groups or have worse outcomes due to delays in diagnosis and access to care. The Horizon Europe research programme mission on cancer should support funding for research to help improve access to cancer screening and care services among people in marginalised underserved communities.

6. Make health core to all policies

Healthcare should not be taken in isolation, but in connection to lifestyle, living conditions and other socio-economic determinants. The European Commission should further prioritise a coordinated approach and consider the impacts of health policies beyond the health sector, such as the Digital Single Market.

Health4LGBTI is an EU funded pilot project aiming at reducing health inequalities experienced by LGBTI people. It has been implemented between March 2016 and March 2018.

ILGA-Europe was part of the Consortium that under a service contract with the European Commission has explored the health needs and challenges faced by LGBTI people and analysed the key barriers faced by health professionals when providing care for LGBTI people.

General information about the project

The aims of the Health4LGBTI pilot project are to raise awareness of the specific health inequalities and barriers experienced by LGBTI people and to increase understanding of how best to reduce them; focusing on overlapping inequalities stemming from discrimination and unfair treatment on other grounds. The project also aims to provide European health professionals with relevant tools to allow them to develop the right skills and knowledge to overcome these barriers.

The other Consortium partners include AOUI-Verona (Italy, project coordinator),  University of Brighton (UK), the National Institute of Public Health – National Institute of Hygiene (Poland) and EuroHealthNet.

For more information, visit the European Commission’s website page about the project.

Project activities

The project explored some of the particular health needs and challenges faced by LGBTI people and analysed the key barriers faced by health professionals when providing care. A variety of activities took place including:

• A state-of-the-art study of the health inequalities experienced by LGBTI people and the barriers faced by health professionals in providing healthcare for LGBTI people;
• 12 focus group studies (2 focus groups in each of the 6 participating EU Member States: Poland, Italy, UK, Belgium, Bulgaria, and Lithuania) to map the barriers faced both by LGBTI people and health professionals;
• The development of a modular training course aimed at increasing the knowledge, attitudes, and skills of healthcare professionals when providing care for LGBTI people;
• The piloting of the training course in the same Member States where the focus groups were conducted, in order to fine-tune and finalise the modules;
• A final European conference, which was part of the dissemination efforts to raise awareness of the topic and of the training course in particular.

Key findings

Although situations vary across Member States, the state-of-the-art study and focus group studies confirmed the existence of health inequalities, barriers, and discrimination LGBTI people experience that have an impact on their health outcomes. Key findings included:

1. Root causes likely to contribute to the health inequalities of LGBTI people are:

• prevailing cultural and social norms that assume people are non-LGBTI by default;
• minority stress associated with an individual’s LGBTI identity;
• victimisation;
• discrimination (individual and institutional), and;
• stigma.

2. LGBTI people face significant mental and physical health inequalities and are at higher risk of poor mental health compared to the general population, including higher incidence of suicidal thoughts, substance misuse, anxiety, and deliberate self-harm.

3. LGBTI people face barriers when accessing healthcare, the most significant ones are:

• prejudicial attitudes and discriminatory behaviour of healthcare staff compounded by their use of heteronormative language and documentation;
• fear surrounding the disclosure of their gender identity, sexual orientation, or sex characteristics;
• lack of consistency and continuity in the care provided to LGBTI people;
• lack of knowledge and recognition of the specific health needs of LGBTI people;
• implicit and explicit LGBTI-phobia where LGBTI people report being denied access to health services due to their sexual orientation, gender identity, or sex characteristics.

4. Many health professionals lack knowledge and cultural competence around the lives and healthcare needs of LGBTI people. Medical literature regarding the health of LGBTI people needs to be updated and health professionals’ assumptions should be questioned such as assuming that people are non-LGBTI by default; that being LGBTI is not relevant for healthcare providers; and beliefs that LGBTI people do not experience significant discrimination.

5. All groups within LGBTI communities (and particularly bisexual, trans, and intersex people) encounter their own specific barriers, and healthcare professionals’ knowledge of these groups is limited.

6. Although scarce, examples of promising practice meeting the needs of LGBTI people do exist. The state-of-the-art study revealed significant gaps in research. For example, there is very limited research to understand the general health profile of trans and intersex people, their experiences, as well as their physical and mental health needs. Similarly, further research adopting an intersectional perspective on health inequalities experienced by LGBTI people is required.

Training course

Findings from the state-of-the-art study and focus group studies were used to develop a dedicated training course for healthcare professionals aiming to increase their skills, knowledge and competences when providing care for LGBTI people. The course, comprising four training modules, is aimed at all health professionals regardless of their specialisation or experience of working with LGBTI people, and can include administrative staff (or similar) working in health settings.

The training modules were piloted in the same countries as the focus group studies, and fine-tuned based on feedback. The training is formulated in such a way as to facilitate replication on a large scale in many different European countries.

The training package can be downloaded here.

Training medical professionals on LGBTI inclusive practices works!

Published in December 2019, this paper describes the training methods and impacts of the #Health4LGBTI research project to develop training materials for healthcare providers. Results indicate that training participants increased their understanding, sensitivity, and empathy with LGBTI people seeking healthcare across all sites for the training.

Read here the paper.

The rights of trans people in prison

(Application No. 63378/13), 10 June 2015 

Find Court’s communication here.

Communicated case: 

Submission: 

• The case concerns a transgender prisoner, whose health was jeopardised by the prison authorities’ refusal to provide necessary medical treatment, including the continuation of hormone replacement therapy. The applicant complained about the absence of necessary medical treatment, the lack of an effective remedy and the conditions of her detention as a result of the authorities having disclosed the information about her gender reassignment surgery.
• ILGA-Europe together with TGEU, Coming Out and the European Professional Association for Transgender Health provided information on medical and legal standards for gender reassignment treatment, highlighting where such treatment is medically necessary, the consequences of interrupting hormone replacement therapy, and best practice in the provision of gender reassignment treatment in prisons. They also highlighted transgender persons’ vulnerability to abuse in prisons, and provided wider context of discriminatory attitudes towards transgender persons in Russia.