A/HRC/22/53 74. By denying effective drug treatment, State drug policies intentionally subject a large group of people to severe physical pain, suffering and humiliation, effectively punishing them for using drugs and trying to coerce them into abstinence, in complete disregard of the chronic nature of dependency and of the scientific evidence pointing to the ineffectiveness of punitive measures. 3. Sex workers 75. A report on sex workers documented negative and obstructive attitudes on the part of medical workers, including denial of necessary health-care services.99 Public health rationales have in some instances led to mandatory HIV testing and exposure of their HIV status, accompanied by punitive measures. 100 Breaches of privacy and confidentiality are a further indignity experienced by sex workers in health settings. 101 Most recently, the Committee against Torture noted “reports of alleged lack of privacy and humiliating circumstances amounting to degrading treatment during medical examinations”.102 The mandate has observed that acts aimed at humiliating the victim, regardless of whether severe pain has been inflicted, may constitute degrading treatment or punishment because of the incumbent mental suffering (E/CN.4/2006/6, para. 35). 4. Lesbian, gay, bisexual, transgender and intersex persons 76. The Pan American Health Organization (PAHO) has concluded that homophobic illtreatment on the part of health professionals is unacceptable and should be proscribed and denounced.103 There is an abundance of accounts and testimonies of persons being denied medical treatment, subjected to verbal abuse and public humiliation, psychiatric evaluation, a variety of forced procedures such as sterilization, State-sponsored forcible anal examinations for the prosecution of suspected homosexual activities, and invasive virginity examinations conducted by health-care providers,104 hormone therapy and genitalnormalizing surgeries under the guise of so called “reparative therapies”.105 These procedures are rarely medically necessary, 106 can cause scarring, loss of sexual sensation, pain, incontinence and lifelong depression and have also been criticized as being unscientific, potentially harmful and contributing to stigma (A/HRC/14/20, para. 23). The Committee on the Elimination of Discrimination against Women expressed concern about lesbian, bisexual, transgender and intersex women as “victims of abuses and mistreatment by health service providers” (A/HRC/19/41, para. 56). 77. Children who are born with atypical sex characteristics are often subject to irreversible sex assignment, involuntary sterilization, involuntary genital normalizing surgery, performed without their informed consent, or that of their parents, “in an attempt to 99 100 101 102 103 104 105 106 18 Campaign to Stop Torture in Health Care, “Torture”, p. 163; see also A/64/272, para. 85. WHO and the Global Coalition on Women and AIDS, “Violence against sex workers and HIV prevention” (WHO, 2005), p. 2. Campaign to Stop Torture in Health Care, “Torture”, p. 163. CAT/C/AUT/CO/4-5, para. 22. PAHO, “ „Cures‟ for an illness that does not exist” (2012), p. 3. See HRW, In a Time of Torture: The Assault on Justice in Egypt’s Crackdown on Homosexual Conduct (2003). PAHO/WHO, “ „Therapies‟ to change sexual orientation lack medical justification and threaten health”, news statement, 17 May 2012; and submission by Advocates for Informed Choice to the Special Rapporteur on the question of torture, 2012. PAHO/WHO, “ „Therapies‟”.