A/HRC/35/36 B. Awareness of the violence and discrimination issue, and linkage with root causes 34. The cross-cutting scenario of violence and discrimination is described by the World Health Organization (WHO) as follows: Many people in the world are stigmatized and discriminated against because of their actual or perceived sexual orientation or gender identity. Among other disparities, lesbian, gay and transgender people are significantly more likely than the general population to be targeted for violence and harassment, to contract HIV, and to be at risk for mental health concerns such as depression and suicide. In settings where same-sex consensual sexual behaviour is against the law, people may be deterred from seeking health services out of fear of being arrested and prosecuted.24 35. How aware is the general population of the issue of sexual orientation and gender identity and the interface with violence and discrimination? The reality is often embedded in lack of awareness, misunderstanding, misconceptions and/or ambivalence. Violence and discrimination on the basis of sexual orientation and gender identity often starts being experienced in childhood, at home and in school, for example through bullying. The lack of awareness/knowledge might be compounded by stereotyping, homophobia and transphobia, virulent from the bottom to the top of the social, cultural and political ladder, tailed by the immediacy of social networks. Even among those who are educated, there is at times a cloistered mindset that wrongly looks upon lesbian, gay, bisexual and transgender people as being deviants and being mentally ill. Hate crimes, such as killings, rapes, incitement to violence, and cruel treatment on account of one’s sexual orientation or gender identity, might be paralleled by prejudice, intolerance and bigotry from the personal level to the systemic level. 36. What are some of the root causes? While more empirical research is needed on the issue, behind the violence and discrimination there is an environment of negative elements: multiple factors, with longitudinal and intergenerational implications. From the health angle, the message from the following citation rings true: Violence against people from key populations has been shown to be a risk factor for HIV acquisition. Such violence is common. It can take various forms — physical, sexual or psychological. Violence is fuelled by the imbalance in the power dynamics of gender and by prejudice and discrimination against persons perceived to depart from conventional gender and sexuality norms and identities. Also, multiple structural factors influence vulnerability to violence, including discriminatory or harsh laws and policing practices and cultural and social norms that legitimate stigma and discrimination. Homophobic violence, too, is increasing in some countries, as more policies and laws have banned same-sex activity and made it a criminal offence. This is likely to increase HIV risk.25 37. In reality, there are many social, economic, cultural, legal and political factors behind the environment that breeds violence and discrimination. Various underpinnings deserve particular attention to help prevent and overcome the negative elements of that environment. These will be referred to initially below, and in more detail in future reports from the Independent Expert. In particular, the following underpinnings are essential as part of a strategy of preventing and protecting against violence and discrimination on the basis of sexual orientation and gender identity: • Decriminalization of consensual same-sex relations; 24 25 WHO, Sexual Health, Human Rights and the Law (Geneva, 2015), p. 23. WHO, Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (Geneva,2014), p. 101. 11