A/HRC/44/53/Add.1 (d) The recent health reform that allows persons to choose their own doctor, which has improved the experience of lesbian, gay, bisexual, trans and gender diverse persons in accessing health-care services by allowing them to select tolerant practitioners. 65. As a result, bias among health professionals affecting access to health care by lesbian, gay, bisexual, trans and gender diverse persons has steadily declined. Much remains to be done, however, and a number of discriminatory legal provisions remain on the books, such as the prohibition against persons having “homosexual relations”35 donating blood and the ban against the adoption of children by persons living with HIV and persons diagnosed as having a gender identity disorder in accordance with the tenth revision of the International Classification of Diseases. During the visit, the Independent Expert heard several accounts of lesbian women, and trans persons in particular, who had to endure patriarchal and discriminatory attitudes from their doctor and gynaecologist. As part of the health reform, patients now have more flexibility to choose their own primary care doctor, but this does not yet extend to specialists who may subject lesbian, gay, bisexual, trans and gender diverse patients to homophobic or transphobic comments and attitudes. In the wake of the health reform, a civil society organization created an online platform of services offered by family doctors who were friendly to the community. The Independent Expert welcomes that initiative, which should be expanded to all regions, as friendly services are mainly available in Kyiv for the time being. In other parts of the country, information about such doctors and tolerant specialists is mainly shared by word of mouth. 66. Since 2016, important measures have been adopted to facilitate access to genderaffirming treatment by trans persons. The approval of a unified clinical protocol of care for gender dysphoria by the Ministry of Health in September 2016, 36 developed with the participation of civil society organizations, has significantly simplified the procedure of gender transition and repealed several abusive requirements, such as mandatory assessment in a psychiatric treatment facility and divorce. Pursuant to the Protocol, the treatment now includes mandatory psychotherapy for at least two years as well as hormone therapy for individuals who want to change their gender identity. 67. Importantly, the protocol states that transsexuals, transgender persons and gender non-conforming persons cannot be considered as sick, and that they have to receive support for the distress caused by gender dysphoria. It also explicitly specifies the inadmissibility of bullying of transgender individuals, as this can result in development of chronic depression, anxiety and suicidal thoughts, and states that patients with gender dysphoria must not be refused the right to use modern reproductive technologies or the right to adopt. 68. The unified clinical protocol has somewhat simplified the procedure to change legal gender and removed abusive requirements such as sterilization, divorce and extensive psychiatric examination. The Independent Expert remains nonetheless concerned that the requirement to undergo medical diagnosis and mandatory medical procedures related to transition, including psychological appraisal and hormonal therapy, violate the principles of bodily autonomy and self-determination of trans persons. These requirements are unnecessary and delay the gender recognition procedure: several trans persons explained that they were not able to find a job, rent an apartment, or were facing obstacles when travelling due to the discrepancy between their appearance and their legal documents during the transition period. Furthermore, the Independent Expert is concerned that the request to undergo “irreversible medical intervention” may be interpreted by some medical experts as a requirement of sterilization. 69. During the visit, the Independent Expert also visited an HIV clinic and learned about the work that it – and others – are doing to reach out to key populations, including men having sex with men. Ukraine remains one of the countries with a high HIV prevalence, and it has the second-largest HIV epidemic in Eastern Europe and Central Asia. In 2018, 240,000 persons were living with HIV and new infections decreased by 11 per cent since 2010. The epidemic is concentrated in key populations, and estimates suggest that there are 35 36 14 Ministry of Health order No. 385 (2005). Ministry of Health order No. 972.