A/HRC/19/41 to health.”98 In Toonen, the Human Rights Committee rejected the claim that laws criminalizing consensual same-sex conduct were a necessary public health measure, noting that such laws risk driving many of those at risk underground.99 Since then, the SecretaryGeneral, special procedures and UNAIDS have drawn attention to the negative health impact of criminalization.100 56. In countries where no criminal sanctions exist, homophobic, sexist and transphobic practices and attitudes on the part of health-care institutions and personnel may nonetheless deter LGBT persons from seeking services, which in turn has a negative impact on efforts to tackle HIV/AIDS and other health concerns.101 Concerns of potential patients include breaches of confidentiality, further stigma and violent reprisals. 102 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”.103 Special procedures have also criticized the practice of so-called “reparative” therapy intended to “cure” individuals of their homosexual attraction, as being unscientific, potentially harmful and contributing to stigma.104 57. In many countries, transgender persons face particular difficulties in their access to health care. Gender reassignment therapy, where available, is often prohibitively expensive and State funding or insurance coverage is rarely available. Health-care professionals are often insensitive to the needs of transgender persons and lack necessary professional training.105 In addition, intersex children, who are born with atypical sex characteristics, are often subjected to discrimination and medically unnecessary surgery, performed without their informed consent, or that of their parents, in an attempt to fix their sex.106 C. Discrimination in education 58. Some education authorities and schools discriminate against young people because of their sexual orientation or gender expression, sometimes leading to their being refused 98 99 100 101 102 103 104 105 106 18 A/HRC/14/20, para. 6. CCPR/C/50/D/488/1992, para. 8.5. See Message of the Secretary-General on World AIDS Day, 1 December 2009, New York; A/HRC/14/20/Add.1, para. 14; A/HRC/14/24/Add.1, para. 1141, and A/HRC/17/27/Add.1, para. 675; UNAIDS, Getting to Zero: 2011-2015 Strategy; UNAIDS, 26th Meeting of the UNAIDS Programme Coordinating Board, 22-24 June 2010, agenda item 5(12). See also A/HRC/10/12/Add.1, paras. 345355. See the concluding observations of the Human Rights Committee on Cameroon (CCPR/C/CMR/CO/4), para. 12. See also A/HRC/14/20, paras. 22-23; Aggleton, P., HIV and AIDSrelated stigmatization, discrimination and denial: research studies from Uganda and India (Geneva, UNAIDS, 2000), pp. 17-18; African Commission on Human and Peoples‟ Rights resolution, 26 May 2010 (ACHPR/Res163(XLVII)2010); “Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people: recommendations for a public health approach”, WHO, 2011, pp. 10- 11; Committee on the Rights of the Child, general comment No. 4 (CRC/GC/2003/4), para. 6. A/HRC/14/20, para. 21. Concluding observations on Costa Rica (CEDAW/C/CRI/CO/5-6), para. 40. See A/HRC/14/20, para. 23, and A/56/156, para. 24. “Human Rights and Gender Identity”, issue paper by the Council of Europe Commissioner for Human Rights, 2009, para. 3.3; WHO, “Prevention and treatment of HIV and other sexually transmitted infections” (see footnote 101), pp. 30-31. Concluding observations of the Committee on the Elimination of Discrimination against Women on Costa Rica (CEDAW/C/CRI/CO/5-6), para. 40.