Venezuelan LGBTI people living with HIV in Colombia: the need for a comprehensive and inclusive humanitarian response

Venezuela is facing a crisis in its health system, including shortages of medicines. The crisis has had differentiated impacts on LGBTI people living with Human Immunodeficiency Virus (HIV). According to Amnesty International, HIV-positive people in the country are at imminent risk to their lives due to the lack of essential antiretroviral drugs Amnesty International (2018) Venezuela: people with HIV from the LGBTI community have never feared as much for their lives as they do now (www.amnesty.org/es/latest/news/2018/07/venezuela-personas-con-vih-de-la-comunidad-lgbti-nunca-han-temido-tanto-por-sus-vidas-como-ahora/). Thousands of people have been forced to migrate to other countries in search of medicines. For them, the options boil down to emigrating or dying. While many have travelled to Peru, Chile and even as far as Spain in search of antiretrovirals, most have gone to Colombia. In Colombia, LGBTI people living with HIV face multiple barriers to accessing antiretroviral treatment (ART). These barriers arise from prejudices related to their diverse sexual orientations, gender identities and gender expressions (SOGIGE), as well as legal barriers linked to their immigration status.

The situation of LGBTI people living with HIV in Venezuela and their journey to Colombia

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 110,000 people in Venezuela were living with HIV in 2020. Of those, 55% were receiving ART. Trans people and men who have sex with men (MSM) had HIV prevalence rates of 35.8% and 22.3% respectively, demonstrating the higher risks they face.

Venezuela’s health system began to deteriorate in 2018, two years after the start of the economic crisis: in that year, just 26% of people with HIV accessed ART, and 90% of people living with HIV who had registered for ART with the government were not receiving it. Lack of funding has caused shortages of drugs and medical supplies and equipment, while large numbers of health professionals have migrated to other countries. Nearly 90% of hospitals reported general drug shortages in 2018, including antiretroviral drugs. Most Venezuelans have resorted to intermittent medication use, partial self-dosing, incomplete treatments (the lack of one or more of the treatment drugs), restricting treatment or using expired medication.

The impact of the crisis on the health system has forced many people to leave the country. For LGBTI people living with HIV, migration to other countries is motivated by shortages of medicines, lack of coverage of comprehensive treatments and inadequate health services.

We left because of all that, because of lack of food, medicine for a friend who has HIV and, above all, because of fear. Discussion group, Cúcuta, Colombia, December 2019, cited in Caribe Afirmativo (2020) Feeling like our lives are slipping away: LGBTI+ refugees and migrants from Venezuela in Colombia, Ecuador and Chile. Barranquilla: Caribe Afirmativo (www.acnur.org/publications/pub_agd/6062ad154/sentir-que-se-nos-va-la-vida-personas-lgbti-refugiadas-y-migrantes-de-venezuela.html).

The risks LGBTI people face are exacerbated by prejudice. Many LGBTI people were already living in precarious situations where they lacked protection and were socially excluded, preventing them from accessing health and support networks.

Access to medicines for the treatment of chronic diseases, including HIV, is a particularly urgent problem in destination countries. For LGBTI people, this implies serious barriers given not only prejudice against their diverse SOGIGE, but also regarding their immigration status. As they face numerous obstacles to accessing healthcare and treatment, humanitarian agencies should prioritise facilitating access to treatment for chronic diseases in their programming, especially for population groups with high HIV prevalence rates. This would create a more comprehensive and inclusive humanitarian response.

The lack of a comprehensive and inclusive humanitarian response in Colombia

In response to the mass migration of Venezuelans to Colombia, the Colombian government has adopted special measures to regularise immigration for Venezuelans and has provided health services regardless of immigration status. However, access to healthcare is limited by Decree 412 of 1992, which established a narrow definition of emergency health services as ‘immediate and effective medical attention aimed at reducing the risks of disability and death’ in the event of an ‘alteration of the physical and/or mental integrity of a person, caused by trauma or by a disease of any etiology’. This definition presents a legal and practical barrier to accessing ART, given that treatment would not constitute immediate medical attention. For LGBTI people in Colombia, access to healthcare is also hampered by prejudice and stigma. For example, health centres require LGBTI people to have blood tests to check for HIV before providing any health service, assuming that, because of their sexual practices, they are living with HIV. Caribe Afirmativo (2020) Feeling like our lives are slipping away.

LGBTI people living with HIV have faced denial of rights, discrimination and violence when seeking healthcare. Many have had to resort to legal action to try to gain access to services that were not considered urgent, but without which they faced an imminent risk to life, including ART. LGBTI individuals living with HIV have pursued legal action in Colombia, arguing that the denial of ART constitutes a violation of the right to life and health. In 2020, the Constitutional Court of Colombia ruled that ART is essential to preserve the life of an HIV-positive patient. Although this did not change the text of Decree 412, it did extend the interpretation of urgent and emergency medical attention to include all means to preserve the life of an LGBTI person living with HIV.

The need for a comprehensive and inclusive humanitarian response

While some LGBTI people living with HIV have managed to access treatment through legal action, the need remains for a humanitarian response that recognises the multiple and complex risks facing LGBTI people living with HIV in Colombia and Venezuela. In particular, in humanitarian crises that indirectly affect the quality of and access to healthcare, a comprehensive and inclusive response is needed that is immediate, focused on particular needs and has the objective of reducing risks to LGBTI people living with HIV. Although HIV treatment requires medium- and long-term measures, this does not exclude an immediate comprehensive humanitarian response, taking into account sexual and gender diversity. Thus, programmes and funds should be designed to provide access to antiretroviral medication, as well as guaranteeing adequate healthcare. HIV is generally invisible in humanitarian responses because the humanitarian system has historically focused on other needs and is not set up to respond to such long-term/chronic health needs. HIV not only puts people in conditions of vulnerability, but also the risks of contagion are heightened in crisis conditions, especially for LGBTI people. Elliott, L. (2003) Gender, HIV/AIDS and emergencies (https://odihpn.org/publication/gender-hivaids-and-emergencies/). For this reason, a humanitarian response that considers components such as prevention and assistance is necessary. This includes training, prevention and care campaigns for LGBTI people living with HIV, and for communities in general.

In the case of Colombia, it is necessary to prioritise measures that allow the detection and prevention of HIV from a sexual and gender diversity perspective, while urgent measures are needed to facilitate immediate access to ART. These humanitarian measures must be accompanied by public health policies and protocols for the care of Venezuelans in the context of human mobility.

Cindy Hawkins Rada is a lawyer and researcher based at Caribe Afirmativo, a Colombian non-governmental organisation that promotes and defends the rights of LGBTI people.