Diego Garcia Rodriguez – Lesbian, gay, bisexual, transgender, and transsexual (LGBT+) individuals in Indonesia have been affected during the COVID-19 pandemic by multi-layered discrimination and intolerance.
Their suffering has increased due to challenges in obtaining national ID cards (KTP), losing their jobs or earning less than before the crisis. They have also faced difficulties securing the same healthcare rights enjoyed by the rest of the population.
My qualitative research, conducted in early 2022 and recently published, shows that LGBT+ people in the archipelago have experienced significant barriers to accessing healthcare, medicines and COVID-19 vaccines during the pandemic.
My study involved four cultural domain analysis (CDA) sessions with Indonesian health experts and LGBT+ activists. CDA is a method based on exploring how people think about lists of things that are linked to each other (such as challenges and facilitators influencing healthcare access). Additionally, I facilitated a focus group discussion (FGD) with the same and additional participants.
Access to healthcare
A major finding from the study relates to how the pandemic has led safe healthcare spaces targeting LGBT+ individuals to either pause their services or disappear entirely. Furthermore, the introduction by the Indonesian government of the Community Activities Restrictions Enforcement (in Indonesian, PPKM) limited citizens' mobility, which made it difficult for gender and sexual minorities to access such healthcare services in the midst of mobility restrictions.
Community health clinics known as Puskesmas were overwhelmed by the number of patients, which disrupted services for sexually transmitted infections (STIs). Some of these clinics, which offered free STI checks pre-COVID, stopped doing so and asked patients to see a doctor only if they presented symptoms.
During a focus group discussion, a participant described how previously offered quick HIV testing, and provision of condoms and lubricants could no longer be delivered at "hotspots" where men who have sex with men (MSM) used to meet in person. As an activist explained, "people were not allowed to gather, and that's been hard for HIV work and to encourage people to have STI checks. Everything has gone online, and our staff have been using gay apps now to reach our clients."
Amid this crisis, we should reflect intersectionally about the class implications of accessing healthcare services too, as LGBT+ individuals from lower socioeconomic backgrounds have been impacted most by the absence of in-person outreach services.
The Indonesian family-based national health system has also impacted LGBT+ people's access to healthcare services. As a health expert said, "there are gatekeepers such as parents, since the national health insurance scheme is family-based, so your insurance card is related to your family, and young queer people have to go through their parents to access healthcare, which leads to problems when explaining why they want to see a doctor".
Access to medicines and COVID-19 vaccines
Access to medicines was a challenge for many LGBT+ people. Activists in Bali, Jakarta and Yogyakarta described how some people living with HIV could not access their antiretroviral drug regimens because of shortages. This meant they were given other combination therapies different from those they were taking before the pandemic.
As an activist said, "people had to change their type of medication into something new, and they went from feeling okay to experiencing side effects".
LGBT+ people have been eligible to receive COVID vaccines, but discrimination, accessibility issues (such as problems with transportation to vaccination centres) and misinformation have emerged as challenges.
In Indonesia, LGBT+ people have also experienced difficulties in accessing vaccines because of transportation issues and because of not having a national ID card (KTP). This has led some charities to support transgender women and homeless people to obtain them.
For example, the charity Kebaya in Yogyakarta supported transgender women to reach the vaccination centres by paying for transportation. Being unable to get the vaccine reduces the mobility of sexual and gender minorities. As an Indonesian activist explained, "if you have no vaccine, you can't go anywhere, you can't enter government buildings; we have an app, and it's a challenge if you have no smartphone".
In Indonesia, the COVID-19 pandemic has disproportionately impacted LGBT+ individuals, specifically those living with HIV, sex workers, transgender individuals, and those living below the poverty line.
This has been especially felt in relation to healthcare services, which those from lower socioeconomic backgrounds struggled to access.
Indonesia has international human rights obligations that apply equally to LGBT+ people and provide guidance to protect and fulfil those rights for all citizens. Indonesia ratified the International Covenant on Civil and Political Rights in 2005 and the International Covenant on Economic, Social and Cultural Rights in 2006, and is a state party to the Convention on the Elimination of All Forms of Discrimination Against Women.
Despite ratifying such conventions, since 2016, moral panics have portrayed LGBT+ people in Indonesia as threatening the moral principles of the nation.
Discriminatory attitudes and difficulties in obtaining national ID cards have made it difficult to receive care. This points to the need to urgently apply a human rights-based approach to understand the needs of the LGBT+ population better and protect their rights as human beings.
[Diego Garcia Rodriguez is a lecturer in global health, Brighton and Sussex Medical School.]