A/HRC/44/53 exclusively on gay or bisexual men, and only one exclusively on lesbians, a bias that overlooks the impact on lesbian and bisexual women, trans people and gender-diverse persons.53 36. Young people are disproportionally subjected to practices of “conversion therapy”. A recent global survey suggests that 4 out of 5 persons subjected to them were 24 years of age or younger at the time and, of those, roughly half were under 18 years of age. 54 D. Nature of the practices 37. While some of the practices are directly aimed at changing sexual orientation and gender identity, others are aimed at supporting individuals not to act on their same-sex desires. Providers often combine a number of methods and religious interventions with traditional rituals and/or pseudo-medical or mental health consultations, especially when it appears that one type of intervention is not working. In Viet Nam, there are reports of lesbian, gay, bisexual, trans and gender-diverse people being sent to traditional healers, while at the same time receiving psychiatric treatment.55 In the United Republic of Tanzania, reports indicate that medical approaches and traditional approaches are practised, often in conjunction with circumcision rites and religious worship. 56 38. Victims may suffer treatment of heinous physical and psychological violence in institutions and in the context of programmes carrying out practices of “conversion therapy”. Accounts of lesbian women being shackled, beaten, subjected to force-feeding or food deprivation, forced nudity, isolation and solitary confinement, restrained for days and raped in so-called “clinics” in Ecuador were reported by the Inter-American Commission on Human Rights in 2015.57 39. Practices of sexual violence carried out in other contexts have also been linked to alleged intentions of conversion. The evidence base available to the Independent Expert depicts a harrowing picture of pervasive rape – grotesquely called “corrective” – and other forms of sexual violence against lesbian, bisexual and trans women in all regions of the world, including in India,58 Nigeria59 and South Africa,60 and against gay and trans men in settings such as Kenya.61 In a recent global survey, over 870 persons who had experienced such heinous methods provided additional examples for this catalogue of human misery: detention or imprisonment, physical abuse, kidnapping and forced pregnancy. 62 Similarly, coercive anal examinations may be used to punish individuals on the basis of their sexual orientation and to police their sexual orientation. 63 Practices of “conversion” are often combined with other mechanisms of family or community-based coercion. The loss of financial means, dedication to activities seen as gender-specific, excessive exercise and the promotion of same-sex bonding are used in some 20 per cent of recently reported cases, and they can be just as harmful in their impact on lesbian, gay, bisexual, trans and genderdiverse young people: as previously reported by the Independent Expert, they are disproportionately affected by homelessness resulting from religious and cultural 53 54 55 56 57 58 59 60 61 62 63 See www.apa.org/pi/lgbt/resources/therapeutic-response.pdf. See outrightinternational.org/reports/global-reach-so-called-conversion-therapy. See www.undp.org/content/dam/rbap/docs/Research%20&%20Publications/hiv_aids/rbap-hhd-2014blia-viet-nam-country-report.pdf. See outrightinternational.org/reports/global-reach-so-called-conversion-therapy. See www.reuters.com/article/ecuador-lgbt-rights/feature-gays-in-ecuador-raped-and-beaten-in-rehabclinics-to-cure-them-idUSL8N1P03QO; Inter-American Commission on Human Rights, “Violence against Lesbian, Gay, Bisexual, Trans and Intersex Persons in the Americas”, 2015, para. 200; and Submission by Pedro Felipe Rivadeneira Orellana. Submission by Choice for Youth and Sexuality. Ibid. See outrightinternational.org/reports/global-reach-so-called-conversion-therapy. Submission by Choice for Youth and Sexuality. Submission by LGBT Foundation. See https://irct.org/assets/uploads/Vol%2026%20No%202%20Statement %20on%20anal%20by%20Independent%20Forensic.pdf. 9