LIMA, Peru. The Second LGBTIQ+ Mental Health Study by Más Igualdad records alarming figures on various types of violence, discrimination, and "conversion therapies" suffered by the community. And, consequently, high rates of mental health conditions. The main victims are trans, non-binary, intersex, and bisexual people.

“This person—the one who sexually abused me—made me look in the mirror and say I was never going to kiss a woman again. I remember I was naked, and he put me in front of the mirror and made me say that I was anatomically made for a man. And that I can't kiss a woman. He told me to cover my mouth and told me he was cleaning me,” Andrea, a 31-year-old cisgender and bisexual woman, told Más Igualdad about the sexual assault she suffered due to machismo and hatred toward her sexual orientation.

Agencia Presentes had access to the final report from the NGO Más Igualdad, which reveals mental health problems among LGBTIQ+ people due to various forms of abuse and the constant stigmatization they face, even from professionals who should protect their emotional well-being.

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Violent practices

The publication of this study takes on even greater relevance in the current climate. 2024 will be remembered as the year in which the Peruvian Ministry of Health issued a Supreme Decree classifying transgender identity as an illness. Yet another year in which the prohibition and sanction of "conversion therapies" has not been included in the Mental Health Law.

Until this last point changes, Peruvian children will continue to be victims of cruel practices, such as the one that occurred a few months ago, when children were tortured with nettle plants for exhibiting "feminine behavior" in the Awajún community in the Amazonas department.

The study obtained a sample of 1,267 LGBTIQ+ people, or those questioning their status, in Lima and the surrounding regions. This group identified as trans (15%), non-binary (13%), and intersex (2%). Regarding sexual orientation, they were bisexual (40%), gay (45%), lesbian (11%), and asexual (10%). The percentages can add up to more than 100% because some people may identify with two labels at the same time. For example, someone may identify as intersex and lesbian, or as non-binary and bisexual.

Sexual harassment and violence

“When I go out, I try to dress up, depending on my mood. So, if they see a woman literally, just like that, the aggression is present, which is something most women experience in their daily lives. But when I go out as trans masculinity, things change. Because it's as if they want to play a little game of seeing whether or not you have boobs,” Demian, a 21-year-old non-binary transmasculine person, shares with Más Igualdad.

Demian's testimony highlights the sexual harassment that 38% of the LGBTIQ+ community frequently experiences. Of this number, the identities with the highest percentage are trans (59%), non-binary (51%), intersex (42%), and bisexual (41%).

Non-Binary Force activist G. Santos tells Presentes that there's a preconceived idea that a non-binary (NB) person "is synonymous with someone who's open to any type of sexual experience. Or who enjoys receiving comments with sexual connotations. That puts us in a vulnerable position in both heterosexual and LGBT spaces," she says.

The study also found that 34% of the community experiences verbal or psychological violence almost always or always. This figure increases among non-binary (59%), trans (53%), and intersex (48%) people. The number of these three identities also increases with respect to physical aggression, threats, and feeling threatened. Additionally, it was reported that 10% of the community frequently experiences sexual violence, with the number increasing among trans (44%), non-binary (39%), and intersex (39%) people. It should be noted that 31% of the sample of LGBTQI+ people reported having experienced sexual assault at least once in their lives.

“Peru is a sexist country. Anything that deviates from the masculine stereotype is socially punished. That's why we who are part of the gender diversity suffer more violence and discrimination,” Leyla Huerta, a trans woman and founder and director of Féminas Perú Presentes . “We aren't accepted as citizens, but we are as objects of pleasure. That's why trans women are in prostitution,” she reports.

For Alex Hernández, the study's researcher, a psychologist and bisexual activist with Más Igualdad (the other researcher is psychologist and gay activist Rodrigo Flores, from the same NGO), sexual violence against the community is often used as a "corrective weapon." She adds that "in the case of trans masculinities, as in the case of lesbians and any person assigned female at birth and who has a diverse identity, there is always the latent risk of being a victim of 'corrective rape.'"

“Minority” stress

The study's researchers measured the respondents' “minority” stress, a “theoretical model that recognizes that there are adverse conditions and events that LGBTQI+ people experience due to being a “minority” group (understood as opposed to the “majority” group in society). This generates specific and additional stress that can affect their long-term mental health.” This type of stress is reflected in the following thoughts and attitudes.

Forty-eight percent of the community frequently reported that their most recurrent thought is having to "mentally prepare themselves for disrespect for being LGBTIQ+." Forty-six percent frequently worry "about what will happen when people find out I'm an LGBTIQ+ person," and 36% almost always or always reported staying "alert and on guard because I've been afraid something bad might happen to me for being an LGBTIQ+ person."

It was also observed that 63% of the sample always or almost always experience anxiety about living in a country that does not recognize their rights, which impacts their life plans. This percentage increases to 80% for the trans population and 71% for the non-binary population.

Percentages skyrocket among trans people

Thirty-eight percent of respondents have received a clinical diagnosis regarding their mental health at some point. These figures increase in the bisexual (45%), trans (54%), and non-binary (55%) communities. Furthermore, it indicates that "anxiety and depression disorders are the most frequently diagnosed (34% and 27%, respectively) in the community." It highlights that "the levels of anxiety disorders identified in the bisexual (91%), trans (91%), and non-binary (90%) sample are concerning."

Más Igualdad also asked respondents questions about their mental health status, based on their own assessment of their emotions and experiences. "Emotional dysregulation is present at high to very high levels. In 66% of the sample, symptoms of depression were high to very high in 44%, and finally, a worrying 26% had suicidal ideation almost always or always," it reads.

Trans people registered higher rates than the general LGBTIQ+ population on all measured indicators, including suicidal ideation. For Leyla Huerta, this situation is due to "the constant bombardment of messages against us, that you're not part of it, that you shouldn't have been born. Violence in every space. This makes these figures so high in a community that is heavily attacked from a very young age," she explains to Presentes .

Nearly 1 in 4 LGBTIQ+ people have undergone conversion therapy.

“A psychiatrist told me the solution was to give me estrogen, so I would stop feeling like a boy. That with female hormones everything would be fixed,” Manolo, a 32-year-old transmasculine and bisexual man, tells Más Igualdad. His testimony highlights one of the perverse techniques—hormone therapy—used in “conversion therapies,” the purpose of which is to seek to “change,” by any means necessary, a sexual orientation, identity, or gender expression that doesn't conform to heteronormativity.

Prestigious international institutions such as the World Health Organization , Pan American Health Organization (PAHO) , the American Psychological Association (APA) , and others have condemned these therapies because they pose "a serious threat to people's health and well-being." The UN also concluded that they use methods considered torture.

The study reveals that nearly 1 in 4 people surveyed (23%) have undergone conversion therapy at some point in their lives, either on their own initiative (11%) or forced (15%). The most common reasons for those who did so of their own free will are that they were “afraid of not being able to be happy” (57%) and “I didn’t want to disappoint my family” (57%). These percentages are higher among trans and non-binary people.

Meanwhile, the 15% of the sample who responded that they had been forced to undergo these therapies said they were mostly forced to undergo them as adolescents (66%), primarily by their parents or primary caregiver (75%). 72% said they received them in a mental health center or by a mental health professional. Forty-seven percent indicated that they received them in a church or by a religious authority. The most common techniques were psychological (84%), religious (16%), hormonal treatments (9%), and electroconvulsive therapy (5%).

Almost all of them reported after-effects after conversion therapy: mental health problems (71%), depression (36%), post-traumatic stress (24%). The study found that "there is an association between having undergone conversion therapy and a higher rate of suicidal ideation and thoughts and problematic substance use." These figures are reflected in the testimony given to Más Igualdad by Majo, a 30-year-old lesbian: "The consequence was that I became extremely depressed and attempted suicide again."

Exclusive health

“It's not possible that LGBTIQ+ people have to hide our identity to receive care. I've had to wear a skirt or a dress. I've had to present myself as feminine to receive care,” Alexander, a 26-year-old transgender man, tells Más Igualdad about a public health center he visited. Alexander's testimony highlights the data collected on the barriers to discrimination-free mental health care. “The biggest obstacle is the cost of care (55%), the lack of training mental health professionals have in an affirmative approach or their lack of preparation and/or experience working with the LGBTIQ+ population (41%), as well as the limited information available to people about professionals who work with an affirmative approach (41%),” it reads.

It was also found that 44% of the sample received their healthcare privately, 23% received it in public health centers, and 28% did not receive mental health care. In the latter case, the figures for trans and non-binary people were 33% and 32%, respectively. Additionally, 19% of those surveyed reported having experienced discrimination. In the case of the trans community, the percentage reached 41%, and in the non-binary community, 32%. The figures refer to both public and private spaces.

No Exit

G Santos shares her opinion on state mental health services in Peru with Presentes . “If a non-binary person wants to go to a public health center, they will have to prepare themselves for the fact that they will be called by their legal name (the name that appears on their ID). For many people, including me, legal names end up causing dysphoria. I know in advance that when I arrive for the appointment, I will have symptoms that are terrible for my health,” she says.

Her words describe the profound sense of anguish and discomfort that non-binary people experience when they go to a state facility for mental health checks. “In many cases, we won't be able to talk about our gender identity or expression because the psychologist may see it as something negative or resort to 'conversion therapy.' The problem is that if the state doesn't protect me and I don't have the means to pay for private therapy, I'm left without treatment. There's no way out,” she questions.

Bisexuality denied

Más Igualdad presented respondents with several stereotypical and discriminatory phrases that LGBTQ+ people often hear in mental health care settings, asking them to select the ones they have experienced most. Biphobic phrases stemming from prejudice were the most frequently heard: “bisexual people hide a latent homosexuality” (53%) and “bisexual people are confused about their sexual orientation and need to define themselves” (47%).

In this regard, Alex Hernández comments that the NGO has a mental health project called El Directorio , a public database composed of affirmative mental health professionals who have been previously vetted to effectively serve the community.

During the selection process, it was observed that the way they worked with gays and lesbians was excellent, but when asked how they would care for a bisexual person, many responded that "they are people who need help discovering their homosexuality." "There is a misconception that sexual orientation can only be oriented toward one gender. Clearly, these people are not part of our board. Biphobia is an issue we must talk about and combat," she told Presentes .

Photo : Courtesy of Féminas Perú taken during the protest in front of the Ministry of Health against the decree that considers trans people as sick.