Adopted IFSW General Meeting 2014 Melbourne

Sexual Orientation and Gender
Expression
1 Rationale
1.1 People whose sexual identity, sexual orientation or gender expression differs from thenorm are vulnerable to oppression and marginalization to differing degrees in all nationsof the world. In some situations they face or have faced legal sanctions up to andincluding capital punishment for identifying or behaving as non-heterosexual. Even when
not considered illegal, same-sex attraction or sexual activity (even among consenting
adults) or appearance or behavior that differs from the gender norm of a society is often
stigmatized as a result of institutionalized homophobia or heterosexism. The latter half ofthe twentieth century has seen the emergence of a worldwide “liberation” movement
seeking to eradicate systemic and cultural barriers to equal rights and to promote social
inclusion for lesbian, gay, bisexual, transgender and intersex (LGBTI) people. Social
workers support this effort at empowerment in each national and cultural context inwhich they work.
1.2 Social workers must commit themselves to enhancing the well-being of people whose
sexual identity, sexual orientation, or gender expression may differ from the norm as an
essential aspect of the profession’s ethical and practice commitment to human rights.
This special commitment to people of all ages who are or who are perceived to be gay,lesbian, bisexual, transgender, intersex, queer, or gender-nonconforming is necessary
because, while how they are identified and treated differs across nations and cultures,
they often do not have equal access to the tangible and intangible benefits of being full
members of human society.
1.3 Social workers are involved in many professional activities that are critical to thewell-being of gay, lesbian, bisexual, transgender, queer, and/or gender-nonconforming
people. Specific efforts include the delivery of health and mental health care services andpublic health programs over the life course; prevention and intervention efforts
addressing both vulnerability to interpersonal violence and a range of other healthdisparities, such as vulnerability to HIV infection and to suicide; combatting
marginalization and discrimination in educational, employment, and criminal justicesettings; supporting family formation and functioning in ways that validate couple,
parenting and other family relationships; and activities to provide basic civil rights
protections and to ensure full participation in political, economic, and community
decision making. Thus, it is essential that the International Federation of Social Workers(IFSW) state clearly its position on issues of relevance to all people whose sexual
identity, sexual orientation or gender expression may differ from the norm.

Adopted IFSW General Meeting 2014 Melbourne

2 Issues1
2.1 CRIMINALIZATION. In early 2014, 76 nations still had laws that criminalize
people on the basis of sexual identity or sexual orientation, laws that are currently seen as
a legacy of colonization (UNHCHR, 2011). These laws include “sodomy laws” thatcriminalize sexual and intimate activity between two people of the same gender, which
would include, for example, men who have sex with men (MSMs) who do not identify as
gay or bisexual. Penalties under such laws vary but in some cases even include execution.
According to the UNHCHR, “adult consensual sexual activity in private is covered by theconcept of ‘privacy’ under the International Covenant on Civil and Political Rights”(2011, p. 14). While the overall trend is for nations to rescind such laws, the continuing
existence of this state-sponsored violence against LGBT people and others tends tosanction individual acts of violence against those who are or who are perceived to be
LGBT, MSMs or women who have sex with women (WSWs). It is essential that all
nations act to decriminalize LBGT people and acts.
2.2 PATHOLOGY. Although motivated to combat a view of LGB people as morally
defective, in the global north in the early 20th century sex researchers begancharacterizing same-sex behaviors and attractions as pathology, specifically as forms of
psychiatric illness. This characterization of LGB people as psychiatrically ill in turnushered in an era of involuntary and voluntary “treatments” for these disorders that were
often punitive and almost always ineffective. LGBT people living with these diagnostic
rules “on the books” may have considered themselves “sick” by definition and werevulnerable to unwanted or involuntary mental health treatment. Beginning in the 1970s,
activists who understood LBGT people to be representing normal variation in human
functioning were able to effect in the change psychiatric systems of diagnosis thatdeclared them disordered. In many national contexts, however, there are still mental
health professionals who promote treatments to change an unwanted LGBT identity
despite the fact that a scientific consensus has emerged that such treatments are at best
ineffective and at worst can have long-lasting negative effects (NASW, 2000; APA,
2009). Recent medical and scientific studies as well as court decisions based on them
have strongly emphasized an understanding that the diversity of gender identity andgender expression reflects variations in natural individual and social expressions ofgender identity. Worldwide we can see efforts to depathologize gender non-conformity
on medical, therapeutic, judicial and social levels. Efforts to remove gender nonconformity from all formal disease classification systems and to call a halt to continuing
ineffective and harmful medical or mental health efforts to change such identities or
expressions of gender must continue.
2.3 SIN. Religions and religious organizations vary greatly in their views of LGBT
people. Fundamentalist religious belief systems of many kinds regard gender nonconformity and non-normative sexual acts and sexual identities as sinful. To those withinthose faith communities who come to consider themselves LGBT people, internal conflict1

In this section of the report, terminology varies to reflect the specific policies or studies being referenced(e.g., LGB, LGBT, LGBTQ, LGBTI).

Adopted IFSW General Meeting 2014 Melbourne
and social/spiritual rejection can result. The freedom to pursue the religious beliefs andspiritual practices of one’s choice cannot extend to the point that this pursuit infringes on
the basic human rights and human dignity of any person or group of people. Cultural
struggles over how to allow freedom of religion while preventing the degradation or
marginalization of LGBT people continue in many national contexts.
2.4 CULTURE. There is great variation in how different cultural groups do and do notincorporate LBGT and/or gender-nonconforming people into their societies. Therefore
efforts at enhancing social inclusion and reducing oppression, stigmatization andmarginalization will vary according to cultural context and social system. Even whendominant social norms and beliefs may be homonegative, there are often other social andcultural values that can be invoked to support efforts at destigmatization and inclusion.
Enhancing the visibility of LGBT people is important since positive social interactions
often lead to more accepting attitudes and behavior.
LGBT and other gender-nonconforming people often form social groups, organizations
and institutions with others like themselves. These “subcultures” and non-governmentalorganizations can provide safety, essential services, self-help, social support, and a basefor political activism. A society that is inclusive of LGBT people must also support thosegroups and institutions that are formed by, embrace and empower LBGT people.
2.5. INTERSECTIONALITY. People themselves have multiple identities that intersect
in ways that makes their experiences unique. In the global north, it has been argued thatbeing a man who violates gender norms is more socially stigmatized than being a woman
who does so, while being both a woman and a WSW can confer a “doubly oppressed”
status. It has also been found that LGBT people of color are often marginalized even
within LBGTQ organizations and institutions. As with other dimensions of diversity,
attention to the great variation within and among LBGTQ people in different national,
cultural, and generational contexts must be recognized and celebrated.

3 Background
3.1 The international community regards the guarantee of the human rights of LGBT
people to be founded in the United Nations Universal Declaration of Human Rights
adopted in 1948. Historically in all nations of the world, LGBT people have not enjoyedequal access to basic human rights, protections, resources, and services. As a response tothis discrimination, there have been recent international efforts directed at eradicatingthese inequalities. These efforts have included:
3.2 The submission of a resolution to the United Nations General Assembly in 2008
addressing “Sexual Orientation and Gender Expression.” The resolution, signed by over
60 nations from all continents, affirmed “the principle of non-discrimination [requiring]that human rights apply equally to every human being regardless of sexual orientation orgender identity” and expressed concern about “violations of human rights andfundamental freedoms based on sexual orientation or gender identity.” This resolution,
while not adopted at the General Assembly, was based on a resolution entitled “HumanAdopted IFSW General Meeting 2014 Melbourne
Rights, Sexual Orientation, and Gender Identity” adopted earlier that year by the General
Assembly of the Organization of American States (OAS, 2008). Within the EU theEuropean Parliament has established a road-map to secure the rights and fightdiscrimination against LGBT people (European Parliament, 2012)
3.3 As a follow-up to actions taken at the World Conference on Human Rights in Vienna
in 1993 and in the face of “grave concern at acts of violence and discrimination, in all
regions of the world, committed against individuals because of their sexual orientationand gender identity,” and the EU Charter of Fundamental Rights (EC: Justice, 2009),
which includes protections for LGBTI people.
The United Nations High Commissioner for Human Rights adopted a resolution
expressing concerns about human rights violations affecting LGBT people (UNHCHR,
2011). Later that year (December, 2011) , it issued its first report on “Discriminatory
laws and practices and acts of violence against individuals based on their sexual
orientation and gender identity,” documenting the many areas worldwide in which LGBT
people do not enjoy basic human rights and the many types of persecution,
discrimination, stigmatization and marginalization they suffer. The EU’s FRA (2009,2013) and ILGA-Europe (2010) also reported on violence and discrimination against
LGBTI people in EU member nations.
3.4 In 2013, the Pan American Health Organization (PAHO, 2013) issued a concept
paper entitled “Addressing the Causes of Disparities in Health Service Access andUtilization for Lesbian, Gay, Bisexual and Trans (LGBT) Persons.” It describedsignificant disparities in a range of health indicators that reflect differences in the social
determinants of health, specifically those resulting from stigma, discrimination andmarginalization. The EU Fundamental Rights Agency (FRA, 2013) has published asurvey on the situation of LGBT people in EU nations and in Croatia.
3.5. A number of United Nations entities have integrated issues of sexual orientation andgender expression into their work, including the Office of the United Nations HighCommissioner for Human Rights (OHCHR), the United Nations Development
Programme (UNDP), the United Nations Children’s Fund (UNICEF), the United Nations
Educational, Scientific and Cultural Organization (UNESCO), the Office of the United
Nations High Commissioner for Refugees (UNHCR), the International Labor
Organization (ILO), the United Nations Population Fund (UNFPA), and the Joint United
Nations Programme on HIV/AIDS (UNAIDS).
3.6 In addition to its Universal Declaration of Human Rights, the UN has adopted other
resolutions and conventions (endorsed by many nations) relevant to LGBT people. These
include the Convention on the Elimination of All Forms of Discrimination Against
Women (CEDAW, 1979) which addresses the special risks to lesbian and bisexual
women; the International Covenant on Civil and Political Rights (1966), the International
Covenant on Economic, Social and Cultural Rights (1966), the Convention on the Rightsof the Child (1989), and the Convention and Protocol on the Status of Refugees(1951/1967). In a similar way the EU’s FRA (2014) has published surveys on theseAdopted IFSW General Meeting 2014 Melbourne
themes, addressing violence and discrimination against lesbians and transgender women
specifically and continues to work on this issue (ILGA, 2013)..

4 Areas of critical concern for social work
4.1 The United Nations High Commissioner for Human Rights’ report of December,
2011, documents “discriminatory laws and practices and acts of violence against
individuals based on their sexual orientation and gender identity, in all regions of theworld.” The Pan American Health Organization report of 2013 also documented many
areas in which LGBT people suffer disproportionate burdens of disease and do not enjoy
equal access to affirmative and competent health care. On the other hand, the latter halfof the 20th century saw the emergence of self-help and advocacy efforts on behalf ofLGBT people in many nations of the world. All social workers share an ethicalcommitment to advocacy on behalf of social justice for all oppressed and marginalized
people. In addition, social workers are employed in many sectors and institutions ofsociety that affect the well-being of LGBT people of all ages. Because of their relevanceto social workers worldwide, six areas of critical concern are described below.
4.2 The Right to Life, Liberty and Security. As stated by the OHCHR (2011), “allpeople, including lesbian, gay, bisexual and transgender (LBGT) persons . . .are entitledto enjoy . . .rights to life, security of person, and privacy, the right to be free of torture,arbitrary arrest and detention, the right to be free from discrimination and the right of
freedom of expression, association and peaceful assembly” (p.4). The criminalization ofsame-sex behavior and/or real or perceived LGBT identity by definition is in violation ofthese fundamental rights. In 5 of the 76 nations that criminalize LGBT identity or
behavior, the death penalty can result from consensual adult same-sex activities.
At this time, six nations and some jurisdictions within nations (e.g., states, provinces,cities) afford constitutional guarantees of civil rights protections from discrimination on
the grounds of sexual orientation and gender expression. In addition to providing theseguarantees, governments have an obligation to prevent and punish, to investigate andprosecute all acts of violence that target LGBT people. In addition, refugees who fear for
their lives, safety or basic freedoms in their home countries must not be forced to returnand should be offered asylum as appropriate (UNHCR, 2011).
4.3 Interpersonal Violence. In addition to legal prosecution, homophobic andtransphobic violence, both physical and psychological, occurs throughout the world. Thisphenomenon is understood as gender-based violence motivated by a desire to enforce
dominant gender norms. This violence can be more extreme than that seen in other biasmotivated crimes (OHCHR, 2011, p.8). Rape and other forms of sexual violence against
LBGT people are also widespread globally. There have also been well-documented
instances of torture and abuse, including abuses within prisons and jails.
4.4 Economic Inequality. As compared to providing civil rights guarantees, morenations (54) provide explicitly for non-discrimination in employment based on sexual
orientation and gender expression. In the absence of such protections, LBGT people mayAdopted IFSW General Meeting 2014 Melbourne
be denied employment, may face termination of employment or may be barred fromadvancement in their jobs based on the reality or perception of being an LBGT person. In
addition, employee benefits, including social insurance benefits that are linked to
employment, are often not available to them on an equal basis, making them and theirfamilies vulnerable to economic insecurity even if they are employed. For these andother reasons, the limited data available on the economic wellbeing of LGBT individuals
and households suggests that they are disadvantaged compared to others. Thisdisadvantage is especially pronounced for lesbians and bisexual women, reflecting theadditional disadvantages experienced by all women, and for transgender and othergender-nonconforming people. In addition, many LGBT people report experiencing
verbal harassment and other forms of discrimination in the workplace.
4.5 Health Disparities. All people have the right to enjoy the greatest possible level ofhealth and wellbeing as well as equal access to all systems of health and social care.
However, in all nations LGBT people face excess burdens of ill health and reduced
access to quality health care services because of stigmatization and discrimination in civilsociety and I health service systems themselves. LGBT people often experience
inadequate care due to lack of understanding of their social situations and experiences,denial of care, substandard care, lack of inclusion of family members and significant
others in their care, and avoidance of treatment for these reasons (PAHO, 2013; Cruz,
2014.). Disclosure of an LGBT identity is always an issue in seeking and utilizing healthcare services, making confidentiality on the part of health care providers vital.
Although epidemiological data are limited, there is widespread agreement that specifichealth disparities exist for LGBT people as a whole and for specific subgroups. These
include: (a) higher rates of some mental illnesses, including depression and anxiety
disorders, higher rates of smoking and alcohol use, and higher rates of suicide andsuicidal ideation in all groups; (b) obesity and breast cancer in lesbian and bisexual
women; (c) HIV and other STIs among gay and bisexual men and MSMs; (d)homelessness among LGBT youth, accompanied by many health problems resulting from
that; and (e) isolation and lack of LGBT-inclusive services among elderly LGBT people;and (f) high prevalence of suicide, suicidal ideation and other mental health problems
among transgender people. All are also at increased risk of experiencing violence, hatecrimes, and other forms of victimization, with resulting traumatic effects. Much of thisexcess disease burden is considered to be the result of the social isolation, victimization,and chronic stress that many LBGT people experience (PAHO, 2013).
Finally, it is now well-established that treatments purporting to change a person’s sexual
orientation or gender expression are both ineffective and potentially harmful. Many
health and mental health organizations have condemned such treatments, both for young
people and for adults (e.g., NASW, 2000; APA, 2009); other renowned international andUS-based organizations, including health, mental health and psychotherapeutic
associations, have similar policies.
4.6 HIV/AIDs. Although the shape of the HIV/AIDs epidemic differs across nations, inall parts of the world gay and bisexual men and other MSMs are at elevated risk forAdopted IFSW General Meeting 2014 Melbourne
contracting the HIV virus. In many contexts, these men may be reluctant to seek out
testing and/or medical care because they fear stigmatization or disclosure of theiridentities and/or behavior. Newer HAART treatments can prolong life and maintain or
restore health, but the treatments are costly and the level of adherence needed to maintainhealth and prevent transmission of the virus is demanding. In some parts of the world,
access to the tools needed for safer sex (e.g., condoms) may be limited, and some fear
being “outed” if they seek information about and/or access to these tools. Early andaggressive treatment of HIV infection is considered an important element in reducing
new infections, but not all nations can afford to provide adequate and early-enoughtreatment to prevent further spread of the disease. Efforts to develop and provide sociallyand culturally-accepted HIV/AIDs prevention programs, treatments and care that includes
gay and bisexual men and other MSMs without stigmatization are urgently needed.
4.7 Youth and Education. Children and adolescents who are gender-nonconforming or
who identify as LGBT, instead of loving support, may experience criticism, rejection ortreatments aimed and changing their gender expression or sexual orientation. As a result
LGBT youth are over-represented among homeless and street youth. They are also atelevated risk for suicide compared to their non-LGBTQ peers. In addition the majority
experience teasing, harassment or bullying, sometimes including physical attack, at
schools and in other youth-serving settings, leading them to avoid or withdraw fromschool before completing a planned course of education. These experiences of abuse andrejection from sources normally associated with nurturing and support in turn contributeto the high rates of psychological distress and substance abuse, including suicidality, seenin these young people. However, there is evidence that programs to enhance family
support and to provide “safe spaces” and support groups in schools and other youthserving settings can reduce these stresses substantially.
The usual practice of assigning a gender to intersexed infants and performing surgery tocorrect ambiguous genitalia very early in life is now being questioned (Fausto-Sterling,
1995; reports). Families of these infants need support and information that includes
support for the option to delay any irreversible procedures until the child’s internal senseof gender identity manifests itself or until the child can express an opinion about theirown preferences.

5 Policy statement
5.1 The rights of lesbian, gay, bisexual, transgender and intersex people are human rights.
Therefore, the social work profession’s core commitment to human rights must involve a
commitment to protecting and preserving the rights of LGBT people. LGBT people of all
genders and at all stages of the life cycle deserve protection from discrimination in all
forms, including legal and state-based policies and practices.
5.2 IFSW stresses and affirms the core commitment of the social work profession tohuman rights, human welfare, peace, and the enhancement of the human potential andwell-being of all people. When people whose sexual orientation, sexual identity or gender
expression differs from the norm do not enjoy full and equal rights, their common humanAdopted IFSW General Meeting 2014 Melbourne
needs and those of their families will not be fully met and their human potential will not
be fully realized.
5.3 IFSW and its member organizations will work to advocate for development ofpolicies, implementation of programs, and social action to improve the well-being ofLGBT people of all ages. This work can be effective only if the special needs andcontributions of indigenous, migrant, young, old, and poor LGBT people are emphasized.
For example, current legal obstacles to transnational migration and travel, including theneed for changes in state-issued documents that contain only binary gender designations
and for those who have undergone medical or social gender reassignment, must be
addressed.
5.4 IFSW endorses The United Nations Office of the High Commissioner of Human
Rights (UNHCHR) “Free and Equal” campaign, launched in 2013, to educate the public
on the need for human rights protections for LGBTI2 people in all national and culturalcontexts.
5.5 IFSW recognizes that policies and programs designed to promote the economic wellbeing of all people will not succeed without attention to discrimination against LGBT
people in economic arrangements, in the workplace, in the household, and in social andeconomic policies and programs themselves. Ending workplace discrimination for all
LGBT people, including those with non-conforming gender expression, requires theenhancement of civil rights and other protective legal measures in many national
contexts. Social and economic provisions for the families of workers, including social
insurance systems, must be designed to include the families and couple relationships ofLGBT people.
5.6 IFSW understands that all social workers share a core commitment to be of service tothose from vulnerable, oppressed, and disadvantaged groups. Therefore IFSW and its
member associations will work to improve the health status of LGBT people of all ages
worldwide. Social workers are commonly involved in the delivery of health care,including mental and behavioral health care services, sexual and reproductive health care,and the care and prevention of HIV/AIDS and other sexually transmitted diseases.
Improving the health and well-being of LGBT people requires attention to physical,
mental, emotional, and social well-being and the provision of LGBT-sensitive
prevention, intervention, and long-term care services.
5.7 IFSW endorses the self-determination of LGBT people in all health care decisions as
a core professional value, including all decisions regarding reproductive health, sexual
activity, and reproduction. Social workers understand that transgender people inparticular have the right to receive competent and safe medical care, reproductive healthservices, and sexual health care services free from government, institutional, professional,
religious, familial, or other interpersonal limitation or coercion, including safe and legal
2

Since this public education campaign includes intersex people, that is, those whose external and/orinternal sex characteristics show both male and female biological features, the abbreviation used in thiscontext is LGBTI.

Adopted IFSW General Meeting 2014 Melbourne
medical and/or surgical services related to bringing bodily characteristics into better
conformity with psychological gender identity. Social workers understand that research
to determine the long-term safety and the psychological implications of these treatments
as well as those of electing not to have such treatments is urgently needed.
5.8 IFSW will work to eliminate health disparities affecting LGBT people. These include
but are not limited to differential vulnerability to HIV/AIDs among gay and bisexual men
and other MSMs; higher rates of diagnosed mental illnesses and substance use disorders
attributed minority stress (Meyer, 1995), and higher rates of suicide attempts and suicidein particular; lack of access to safe and legal gender reassignment services especially forthe young and those in controlled environments like jails and prisons; and increased
vulnerability to interpersonal violence within families and communities, including
killings and other hate crimes.
5.9 IFSW supports the ability and right of LGBT people to form intimate relationships
and families in the manner that they choose. IFSW also supports the legal recognition ofthese relationships on a basis equal to what is provided to heterosexual intimate partners,
child-bearing and child-rearing. In addition, policies that do not allow LGBT people tobecome foster parents or to adopt children in need of families or that do not allow forsecond-parent adoptions when marriages are not legally recognized must be changed inorder to provide best for the children involved as well as in fairness to their parents.
5.10 IFSW affirms that social work’s commitment to children and youth and theirfamilies must include attention to the risks associated with being a young person who
identifies as LGBTQ, who is perceived to be LGBTQ, or who is or is otherwise perceived
to be gender-nonconforming. LGBTQ youth are disproportionately represented among
homeless and street youth, often because of rejection in families, schools and/or youth
service systems. Social workers support efforts to enhance family support (Ryan et al.,2010) and, if it is not possible for youth to stay in their families, making child-serving
service systems safe and inclusive for LGBTQ youth (Mallon, 2010; FRA-EU, 2012)5.11 IFSW recognizes that social workers involved in schools must take action to address
the harassment and bullying in school settings, including cyber-bullying, directed atyoung people who are or who are perceived to be LGBTQ. Isolation within or from theclassroom; stress leading to school failure and/or to psychiatric problems including selfharm, suicide attempts and suicide; or school “dropout” disproportionately affect LGBTQ
youth, especially those who have been targeted by their peers and others in the school
setting. Programs and practices that address these problems must be implemented in all
schools in order that LGBTQ youth can fulfill their human potential and benefit equallyfrom educational services. Social workers, social pedagogues and teachers should betrained and given support to raise consciousness about discriminating language andswearwords, finding ways to openly address all sexual and LGBTI, issues.
5.12 IFSW supports the full participation of LGBT people in all decision-making bodies
and processes that affect political, economic, social, educational, and health concerns.

Adopted IFSW General Meeting 2014 Melbourne
This commitment includes full participation in the profession, education for the
profession, social agencies, and other social service delivery systems.
5.13 IFSW supports indigenous, grass-roots, and professional organizations of all kindsthat seek to empower diverse LGBT people in all sectors of society.
5.14 IFSW recognizes the need to expand the social work knowledge base and improve
the skills of professional social workers as they relate to the needs of LGBT people,
especially those from indigenous, poor, migrant, and any other groups also disadvantaged
in their own national, social or cultural contexts. Knowledge about LGBTI people, theimpact of discrimination and criminalization and of hate crimes and bullying in all forms
on individuals must be an obligatory subject in social work education. The work of social
work scholars and activists in advancing knowledge development in these areas must berecognized and celebrated. Social workers are committed to developing, implementing
and enhancing social policies and social services to support LGBTI-people and tosupporting LGBTQI youth who are trying to find ways to identify their gender identity,
to get advice and support in that process, and to secure their human and social rights.
The document was prepared by the National Association of Social Workers, UnitedStates of America, and reviewed by members of the Global Executive Committee of
IFSW.

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