Colonization and the Health of Lesbian, Gay, Bisexual, Transgender, Queer/questioning and Intersex (LGBTQI) Populations: A Narrative Review of Three Case Studies

Background: Colonization by settler nations continues to have an outsized impact on the legal and healthcare landscape in previously colonized nations. Lesbian, gay, bisexual, transgender, queer/questioning, and intersex (LGBTQI) communities were targeted by colonial laws and policies, many of which remain in place today.

Methods: We conducted a narrative literature review with a medical librarian to identify the impact of colonization on LGBTQ health and policy in previously colonized nations and communities. Our initial search included the following concepts and synonyms: colonialism, LGBTQ, health/medicine, and stigma. A wide range of databases, include those outside of the health medicine field, was searched. Preliminary search results revealed a strong literature base describing the impact of colonization on communities in Uganda, India, and indigenous peoples in the United States (U.S.), and our search was subsequently narrowed to focus on these three case studies.

Results: Our narrative review of the impact of colonization on LGBTQI communities identified key ways in which colonial laws and policies continue to negatively impact the health of LGBTQI people in Uganda, India, and indigenous communities in the United States. In both India and Uganda, there were few if any laws prohibiting same-sex relationships or diverse gender identities prior to colonization by settler nations. With colonization, Victorian-era laws were enacted in India and Uganda creating penalties for same-sex relationships and diverse gender expression. These laws have remained in place through the 20th century; India only recently repealed its same-sex marriage prohibition and such a prohibition continues to exist in Uganda, where “aggravated homosexuality” is punishable by life imprisonment. Funding from religious organizations based in the United States have fueled anti-LGBTQI sentiment in Uganda, contributing to a Western culture war that has played out in low- and middle-income nations. In the United States, diverse indigenous communities celebrated Two-Spirit identities prior to colonization. Forced assimilation, including the use of residential boarding schools and compulsory conversion to European religions, forced Two-Spirit communities underground. Powerful resistance allowed Two-Spirit communities to persist until present day. In all three case studies, there are persistent health care disparities in LGBTQI people, including sexual and reproductive, mental, educational, and social health outcomes, many of which are linked to anti-LGBTQI policy and stigma first enacted during colonization. Despite these hardships, LGBTQI communities demonstrate remarkable resilience and have persisted in efforts to achieve equality and acceptance.

Conclusion: Colonization by European and U.S. settlers contributed to anti-LGBTQI policy that persists to this day and continues to adversely affect the health of LGBTQI communities worldwide. Recognition of the impact of colonization, and the role of Western nations, in exacerbating LGBTQI health disparities is necessary in the worldwide effort to promote LGBTQI health and equitable policies.