Latvia: A Government and a Community Disconnected – Max Micallef

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Photograph published in an analysis piece by Brookings Institution Visiting Fellow James Kirchick of recent LGBTQ+ pride parades in the Baltic States PHOTO: Brookings Institution

Latvia is 64,589 sq. kilometers (40,133.7 miles) in area, with a population size of 1,923,559 people as of July, 2018. Though small in number and size when compared to most other countries, the Latvian state has built quite the global reputation in recent years; one that is unfortunate in terms of stagnant progression towards LGBTQ+ equality.

In 2018, the Rainbow Europe Index established by ILGA-Europe revealed that Latvia, along with Poland, Bulgaria, and Lithuania are the worst places in the European Union to be a LGBTQ+ citizen. To be exact, Latvia ranked fortieth out of forty-nine European countries. The first, Malta (also small in number and size), being the best place in Europe to be a LGBTQ+ citizen.

Some progress has occurred socially within the eastern European nation with attempts to destigmatize sexual orientation & gender identity. In 2014, Latvian Foreign Minister Edgars Rinkēvičs publically came-out via Twitter, stating (this the English translation from Latvian), “All hell is likely to break loose, but #proudtobegay.” Additionally, Latvia holds an annual EuroPride march in the capital of Riga. The event however continues to face great backlash as many religious anti-LGTBQ+ groups strongly fight to hold counter-marches in the same time and space EuroPride is held.

Inga Liepina, a Senior Expert with the Latvian Ministry of Health’s Public Health Department provided the following responses to questions regarding the state’s perspective on the standing of the Latvian LGBTQ+ community. The interview also addresses whether or not the state believes they are continuing to uplift and support the health, wellbeing and social standing of the LGBTQ+ community within the country.

The varying amounts of information provided in the following responses truly reveals what the Latvian state chooses to focus on, with what the Latvian LGBTQ+ community’s needs are perceived to be.

Please refer back to the Rainbow Europe Index to compare the below responses to data concluded by ILGA-Europe, with additional reports published by the Human Rights Watch organization.

What would you say are some programs and or services that the Latvian Ministry of Health is providing that aid the health and wellbeing of LGBTQ+ Latvians?

[The] Law on the Rights of Patients prescribes that in ensuring the patient’s rights, difference in treatment depending on the person’s race, ethnic origin, colour, gender, age, disability, state of health, religion, political or other opinion, national or social origin, property or marital status or other circumstances is prohibited. Therefore, the Ministry of Health implements the principle of equal medical treatment for all persons. This without any kind of discrimination like special measures, medical programmes or services for LGBTI [persons].

Does the Ministry of Latvia provide H.I.V./A.I.D.S. prevention and treatment services?

Yes, the Ministry of Health provides several HIV/AIDS prevention and treatment services like in other European countries. Early diagnosis and treatment of HIV are the most important preventive measures to reduce the prevalence of HIV in society. [Additionally,] the Centre for Diseases Prevention and Control (an institution which works under the subordination of the Minister for Health) provides HIV prevention points with methodical support, training and provision of goods. LGBTI persons are amongst those clients who receive services in HIV prevention points.

At national level every year, public awareness campaigns aimed at promoting healthy lifestyle and improving sexual and reproductive health are performed. Local level activities are organized by municipalities, and the Centre for Diseases Prevention and Control. These activities include, for example, educational and practical classes, lectures, healthy nutrition classes, promotion of [balanced] physical activity, substance abuse reduction, promotion of [balanced] mental health, and sexual and reproductive health.

[The] HIV prevention points provide rapid testing, needle and syringe exchange, condoms distribution, as well [as] clients receive the required social and medical aid, consultations about infectious diseases and prophylaxis/prevention measures. These services are free of charge and anonymous for clients. The main target audience of HIV prevention points is injecting drug users (IDU). Other target groups include former prison inmates, sex workers and their clients, homeless people, ethnic minorities, men who have sex with men, pregnant women (drug users) and other. In 2019, there are [currently] 21 HIV prevention points in 17 different municipalities. Local municipalities or non-governmental organisations (NGOs) organize all the work of HIV prevention points and assist with premises, but the Centre for Diseases Prevention and Control provides methodical support, training and provision of goods (syringes, condoms, rapid tests, informative materials, disinfectants).

One of the HIV prevention points (called by the NGO, who provides services there, the Checkpoint) provides low-threshold services specially for men who have sex with men (MSM). From 2015, the Centre for Diseases Prevention and Control has entered into an agreement with the NGO on the provision of services and the necessary materials which are funded from the State budget.

The availability of harm reduction activities is broadened by providing mobile harm reduction services (rapid testing, syringe distribution, condoms distribution, consulting) closer to the gathering places of risk groups involving specially equipped transport and trained personnel. For newly diagnosed patients (possibly infected person) at HIV prevention points using rapid testing, a social worker ensures an appointment with the laboratory and a specialist for confirmation of the diagnosis and initiation of the treatment without the requirement to obtain a referral from a general practitioner (direct access to an infectious disease specialist).

Latvia has speeded up the access to HIV treatment (antiretroviral therapy) from CD4<200 cells/mm3 to the “test and treat” approach which was approved in 1 October 2018. Each HIV-infected person can receive antiretroviral treatment (ART) with no limits for CD4 immune cells in prescribing the ARV therapy.

Now adherence supportive services are implemented for HIV-infected persons, where a qualified support personnel can provide competent advice to the HIV infected patient on the need for ARV therapy, the correct usage of the medicinal product, risks associated with using or not using ARV therapy, to assist in the organisation of re-visits to the doctor. National HIV, Tuberculosis and Sexually Transmitted Infection Prevention Coordination Committee (a governmental advisory committee for the implementation and coordination of the national response to HIV/AIDS) works under the auspices of the Ministry of Health and the membership includes governmental institutions and nongovernmental organizations. Action Plan on Controlling the Spread of HIV, Sexually Transmitted Infections and Hepatitis B and C for 2018–2020 includes comprehensive broad range prevention and control activities for HIV, sexually transmitted infections and viral hepatitis.

Does the Ministry provide any services for transgender individuals? Transitioning or not.

In Latvia, the individual can undergo full or partial gender reassignment surgery, but sexological treatment and gender reassignment are not covered from the State budget.

Are there any programs coming out of the Ministry that aid the Latvian LGBTQ+ community on a more social level, rather than solely physical health concerns?

As described in the answer to the second question, persons (as well LGBTI persons) can attend HIV prevention points and adherence supportive services also for psychological and social support.

What would you say, from the Ministry’s perspective, is the overall standing of the Latvian LGBTQ+ community currently?

The Ministry of Health cannot provide the answer to this question as we have no such kind of information.

What, from the Ministry’s perspective, is the perceived number one need of the Latvian LGBTQ+ community currently?

Ministry of Health always is open for cooperation with all NGOs and persons with no kind of discrimination. The Ministry of Health has cooperated with local LGBTI persons’ NGO, mostly in HIV/AIDS issues.

Do you think the Latvian government is providing adequate advertising and education on LGBTQ+ health matters?

[The] Ministry of Health is providing adequate advertising and education on health issues for all residents of Latvia, and in particular, to people at risk of poverty or social exclusion. Special health promotion and prevention measures for MSM are provided in one HIV prevention point (already described in the answer to the second question).

In order to better plan activities and improve policy-making, in 2020, the Centre for Diseases Prevention and Control will carry out a special study on the use of addictive substances and the prevalence of associated infections in MSM population. This study will provide information on MSM risk behaviour and prevalence of HIV infection. As well, this year, we plan to develop [further] informative material on HIV, sexually transmitted infections, hepatitis B and C prevention and treatment facilities for MSM.

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