\n<\/p>\n
The bulletin<\/a> appeared without much fanfare in an official government newspaper in Peru that publishes new laws and regulations. Peruvian health officials say they had no idea the response it would trigger.<\/p>\n They say they wanted to expand access to privately insured mental health care for transgender Peruvians. So the government decree included language classifying transgender identity as a \u201cmental health problem.\u201d<\/p>\n But as news of the regulation filtered out, it provoked outrage among the country\u2019s L.G.B.T.Q. population and advocates.<\/p>\n Many critics said the rule was another blow in a country where gay marriage and civil unions are illegal; transgender identity is not legally recognized; there is no legislation recognizing hate crimes; and trans Peruvians say they face widespread discrimination and violence.<\/p>\n<\/div>\n<\/div>\n \u201cWhat they\u2019re doing is labeling an entire community as sick,\u201d said Cristian Gonz\u00e1lez Cabrera, who researches L.G.B.T.Q. rights in Latin America for Human Rights Watch.<\/p>\n But health officials said that the anger and backlash was the result of miscommunication and that they had not intended to offend trans people.<\/p>\n<\/div>\n<\/div>\n The Peruvian government this month added seven diagnostic codes from the World Health Organization\u2019s medical classification system to a list of conditions in Peru that must be covered by private and public insurance.<\/p>\n But the law used language from an outdated version of the W.H.O.\u2019s classification system that had listed \u201ctranssexualism\u201d and \u201cgender identity disorder\u201d as \u201cmental and behavioral disorders.\u201d<\/p>\n<\/div>\n<\/div>\n A new version of W.H.O.\u2019s system, put into effect in 2022, replaced those terms with \u201cgender incongruence of adolescence and adulthood\u201d and \u201cgender incongruence of childhood\u201d under a chapter titled, \u201cConditions Related to Sexual Health.\u201d<\/p>\n The change, according to the W.H.O., was meant to reflect<\/a> \u201ccurrent knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.\u201d<\/p>\n Peruvian health officials said in an interview that they were aware of the W.H.O.\u2019s changes but were only now starting the process of adopting them and incorporating a new rule because of bureaucratic obstacles.<\/p>\n \u201cIt is a path that we have already started to walk,\u201d said Henry Horna, the communications director for Peru\u2019s Health Ministry, though officials did not say how long the process would take. So, for now, the current classification remains in place.<\/p>\n In response to the uproar, the ministry clarified in a statement<\/a> that \u201cgender and sexual diversity are not illnesses\u201d and that it rejects discrimination.<\/p>\n<\/div>\n<\/div>\n Dr. Carlos Alvarado, the ministry\u2019s health insurance director, said the regulation was intended to make it easier to bill insurers for treatment related to transgender identity.<\/p>\n \u201cWe did not expect the reaction, honestly,\u201d he said.<\/p>\n<\/div>\n<\/div>\n \u201cThe problem has obviously arisen from a misinterpretation of the meaning of the rule,\u201d Mr. Horna said. \u201cThe rules are written in legal language, in cold language, in technical language.\u201d<\/p>\n But Leyla Huerta, a trans activist, said access to private insurance is irrelevant to most trans Peruvians because of discriminatory hiring practices by many private-sector employers.<\/p>\n She said that any benefits for the trans community were outweighed by the stigmatization from the language used in the government regulation.<\/p>\n<\/div>\n<\/div>\n Classifying transgender people as mentally ill, activists and experts say, could open the door to the promotion by some conservative groups of the widely discredited practice of conversion therapy, intended to change a person\u2019s gender identity or sexual orientation.<\/p>\n But health officials noted previous government guidelines stating that transgender identity was not a mental illness and discouraging conversion therapy.<\/p>\n The current controversy is just one of the many struggles to expand gay and transgender rights and health care across Latin America, a region with high levels of violence against L.G.B.T.Q. people.<\/p>\n Still, even in such an environment, Peru stands out because its system of laws provides almost no rights for gay and transgender people, Mr. Gonz\u00e1lez said.<\/p>\n<\/div>\n<\/div>\n Same-sex marriage has been legal for years in other South American countries, like Brazil, Colombia, Chile, Argentina and Ecuador. \u201cPeru is miles behind its South American neighbors,\u201d Mr. Gonz\u00e1lez said.<\/p>\n<\/div>\n<\/div>\n The head of the Peruvian government\u2019s human rights office, during testimony last year before the country\u2019s Congress, referred to homosexuality<\/a> as \u201cdeformities that must be corrected.\u201d<\/p>\n And last year, a trans woman working as a prostitute was kidnapped and shot<\/a> 30 times on the streets of Lima, a killing that was captured on video. One person has been arrested so far, but there has yet to be a trial.<\/p>\n The Peruvian government does not collect data on acts of bias or violence against transgender people.<\/p>\n