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FEATURE STORY May 17, 2021

LGBTI people in the Western Balkans: Supporting the COVID-19 Recovery



  • The World Bank and the Equal Rights Association (ERA) for Western Balkans and Turkey recently launched a joint report that highlight how COVID-19 disproportionately impacts vulnerable groups more than others—including LGBTI people.
  • Exclusion based on sexual orientation and gender identity (SOGI) is costly to both the individuals concerned as well as a country’s economy.
  • Social inclusion of all vulnerable groups, including of LGBTI people, is a critical issue that is vital to achieving equitable and inclusive policies for all.

Exclusion based on sexual orientation and gender identity (SOGI) is costly – to both the individuals concerned as well as a country’s economy and society as a whole. The COVID-19 pandemic has highlighted the urgent need to address the resulting disparities and the support countries build more inclusive and resilient societies.

According to a joint World Bank and Equal Rights Association (ERA) for Western Balkans and Turkey  report, while COVID-19 can affect anyone, we know it disproportionately impacts vulnerable groups more than others—including LGBTI people. Pre-existing inequalities have been exacerbated by the pandemic, making it more difficult for those from vulnerable groups to access essential services, especially health.

"The assessment revealed convincingly that this pandemic has done nothing but exacerbate and deepen the already huge disparities between the general population and LGBTI people,” said Amarildo Fecanji, Executive Director of ERA. “The most vulnerable members of our community, in particular trans and queer folks, as well as those belonging to more than one minority are again paying the biggest price. This, coupled with the general negative attitudes and the government's focus on combating the pandemic, means that the socio-economic and political situation of LGBTI people could be endangered and potentially far worse in the next few years.”

Access to essential health services  

Since the onset of the pandemic, LGBTI people have faced increased barriers to accessing essential health services.  

A survey of ERA member organizations, Assessing the Impact of COVID-19 Pandemic Response on the LGBTI+ Community in the Western Balkans, found that the measures to combat COVID-19 have resulted in limited access to HIV/AIDS treatment and less testing, with the potential that HIV infections can grow. According to the survey, “as many as 38.7 percent of the member organizations claim that LGBTI people living with HIV/AIDS have faced challenges in receiving their regular health services during this period.” According to qualitative research done in Serbia, 20.8 percent of interviewed LGBTI people have had trouble accessing AIDS medication, other forms of long-term therapy, and/or mental health–related services since the beginning of the pandemic.

Sexual and gender minorities are among the groups most at risk to COVID-19 morbidity and mortality due to underlying conditions such as HIV/AIDS (sexual and gender minorities are among those with highest HIV prevalence in most World Bank client countries), which can contribute to COVID-19 related complications.

"LGBTI people often experience stigma and discrimination while seeking health services, leading to disparities in access to healthcare. This report highlights how COVID-19 has increased the risks for LGBTI people in the Western Balkans and reminds us of the responsibility we have in these challenging times and to call on governments to prioritize social justice for all."
Linda Van Gelder
Country Director for the Western Balkans, Europe and Central Asia, The World Bank

Stigma and discrimination experienced by sexual and gender minorities play a fundamental role in creating these health disparities. Transgender people, particularly, face high levels of prejudice and regular denial of access to health services. As a result, many trans persons have been required to stop hormone therapies and postpone surgeries and other physical health treatments and as a result, have experienced increased anxiety and mental health problems.

Stay-at-home orders and social distance

Many countries have enforced lockdown measures in response to the coronavirus pandemic. These measures result in a day-to-day restriction of movement and have led to significant economic disruption. Based on qualitative research from Serbia, every tenth LGBTI person reported they were unable to pay rent and had to move out of their home. For LGBTI people, especially youth, it may mean being forced to stay with friends or family members who are unsupportive of one’s sexual orientation or gender identity. These situations could increase the risks for sexual and gender minorities of becoming homeless. ERA member organizations across the region reported that COVID-19 measures, including stay-at-home orders and isolation policies, have had a negative impact on the physical and mental well-being of LGBTI people, especially regarding mental health issues, suicide attempts, and increased incidents of domestic violence and abuse.

The persistent discrimination and exclusion that sexual and gender minorities continue to face also comes from governments that negatively target this group—some of which are using pandemic responses to specifically target LGBTI people. In addition to direct targeting, stereotypes and prejudice toward sexual and gender minorities negatively influence the way in which laws and policies are implemented.

Rising to these unique challenges

Now is the time to ensure inclusive recovery and growth. With the robust funding commitments to help countries fight COVID-19, there are opportunities to address the needs of sexual and gender minorities and avoid some of the impacts described above. Although this report was developed for the Western Balkans, the following recommendations are applicable in all countries.

  • Securing existing health needs of sexual and gender minorities, including access to HIV/AIDS treatment and prevention and access to hormonal treatments for transgender people, are met and not suspended during the response to the pandemic;
  • ensuring privacy and patient confidentiality standards are maintained;
  • allowing community organizations to resume their support programs in a safe and responsible manner and where necessary provide additional support, including among other things, access to food and shelter programs, other social protection programs, and economic opportunity for sexual and gender minorities;
  • ensuring relevant information on COVID-19 and vaccines needs are targeted and tailored to marginalized communities, including LGBTI people by working with CSO and grassroots organizations representing these groups;
  • training health workers, including community health workers or volunteers in rural communities, government officials, emergency planners, and other stakeholders on SOGI issues;
  • strengthening SOGI disaggregated data collection to address and mitigate risks to sexual and gender minorities during outbreak situations; and
  • ensuring sexual and gender minorities and CSOs can participate in consultations and citizen engagement of response and economic recovery programs in ways that ensure the safety and privacy of the participants.

As the world faces the uncertainties that accompany this pandemic, social inclusion of all vulnerable groups, including of LGBTI people, is a critical issue that is vital to achieving equitable and inclusive policies that can have direct impacts on health outcomes, safety, wellbeing, and quality of life for all.