III. Right to health of key populations and groups
27. The lack of essential services in deprived neighbourhoods and in rural and remote areas of the country disproportionally affects groups in situations of poverty and peasant and indigenous communities. Certain key populations and specific groups face serious challenges in realizing their right to health, including women and girls, children and adolescents, lesbian, gay, bisexual and transgender persons, persons with disabilities and people living with HIV/AIDS.
C. Lesbian, gay, bisexual and transgender persons
74. The Special Rapporteur was pleased to note that the situation and rights of lesbian, gay, bisexual and transgender persons have become more visible in Paraguay over the past few years. The National Plan on Sexual and Reproductive Health includes non- discrimination on the basis of sexual orientation and gender identity.
75. However, lesbian, gay, bisexual and transgender persons face significant barriers in the full enjoyment of their right to physical and mental health. The barriers are connected to deeply entrenched discriminatory attitudes in society at large, which generate stigma, violence and abuse, including in the health system.
76. The Special Rapporteur received testimonies and evidence that lesbian, gay, bisexual and transgender persons face extreme forms [of] violence on the basis of their sexual orientation and gender identity and expression. The violent deaths of at least 34 transgender persons between 1989 and 2013 are evidence of that.24 During his visit, the Senate held a debate about the situation of transgender persons, and he met with a number of high- ranking government officials who were aware of the specificities and challenges faced by that group.
77. The situation of lesbian, gay, bisexual and transgender persons living outside the main urban areas, some of whom met with the Special Rapporteur, is of particular concern as they are isolated from the main support networks, live and work in very difficult environments and face violence from the community.
78. Lesbian, gay, bisexual and transgender persons face discrimination and rejection from health-care personnel and a lack of comprehensive health services tailored to their needs, particularly when it comes to access to treatment and services for HIV/AIDS. Moreover, confidentiality is not always guaranteed in the provision of health services.
79. Information gathered during his visit allowed the Special Rapporteur to conclude that many lesbian, gay, bisexual and transgender persons do not use health services for fear of stigma and rejection, which can drive many health issues underground with negative consequences for the health of the persons concerned and that of society at large.
D. People living with HIV/AIDS
80. There are approximately 17,000 persons living with HIV in Paraguay,25 which represents about 0.25 per cent of the total population. On average, there are three new cases of infection every day. Most of the cases are concentrated in Asunción and the Central department, and the most affected groups are men who have sex with men, and sex workers.
85. Persons living with HIV/AIDS in Paraguay suffer from various forms of public and private discrimination, including arbitrary limitations on access to health services.{{27}} That is exacerbated by the fact that there are no specific programmes or protocols targeting key populations, such as children and adolescents, lesbian, gay, bisexual and transgender persons, indigenous peoples, persons in detention and persons with disabilities.
IV. Conclusions and recommendations
129. However, during his visit, the Special Rapporteur observed serious challenges to the realization of the right to health connected to the implementation of the existing normative and policy framework, and the prevalence of inequalities, discrimination and violence against key populations, particularly women and girls, children and adolescents, lesbian, gay, bisexual and transgender persons, persons with disabilities and people living with HIV/AIDS.
131. The Special Rapporteur recommends that the State:
(h) Ensure that barriers to girls’ and women’s sexual and reproductive rights are removed, including by providing sexual and reproductive health information, services and goods, in particular comprehensive, age-sensitive and inclusive sex education in schools;
(l) Prohibit violence and any discrimination on the basis of sexual orientation and gender identity and expression in all services, including health, education, employment and access to public services; and prosecute perpetrators of violence against lesbian, gay, bisexual and transgender persons, protect victims, and ensure access to justice and remedies;
Link to full text of the report: report-srhealth-paraguay-2016-eng
[[27]]27. Fundación Vencer, Perspectiva comunitaria sobre estigma y discriminación en personas que viven con VIH y sida en Paraguay (Asunción, 2010). [[27]]
