A/HRC/38/43 to the identity or expression of lesbian, gay, bisexual, trans and gender non-conforming persons, often referred to as “gay propaganda” (A/72/172, para. 29–48).55 In addition, other laws and policies can have a disproportionate impact on the liberty and security of lesbian, gay, bisexual, trans and gender non-conforming persons (A/HRC/38/43/Add.1, paras. 55– 63), such as those based on public decency, public morals, public health and security, and laws that criminalize conduct seen as “indecent” or “provocative”. These laws tend to exacerbate police abuse and harassment, extortion and acts of violence against people based on their perceived or real sexual orientation or gender identity, drawing them into the criminal justice system, sometimes leading to further incidents of discrimination and violence. For example, trans women are often targeted and prosecuted on the basis of laws criminalizing sex work or under laws against “vagrancy”, regardless of whether they are in fact engaged in sex work (A/72/172, para. 34). B. Stigma 57. The combination of social prejudice and criminalization has the effect of marginalizing lesbian, gay, bisexual, trans and gender non-conforming persons and excluding them from essential services, including health, 56 education, 57 employment, 58 housing (A/HRC/29/23, para. 59) 59 and access to justice (ibid., para. 42; A/HRC/35/36, para. 59).60 The spiral of discrimination, marginalization and exclusion may start within the family, extend to the community and have a life-long effect on socioeconomic inclusion. Through this process, stigmatization and exclusion intersect with poverty to the extent that, in many countries, lesbian, gay, bisexual, trans and gender non-conforming persons are disproportionately affected by poverty, homelessness and food insecurity (E/C.12/UGA/CO/1, para. 30). 61 This is often the result of early family and community rejection, compounded by bullying.62 58. These circumstances restrict individuals’ choices and limit their ability to earn a living and participate in all aspects of life, including public and political life. The dynamics of exclusion are exacerbated when it intersects other factors, such as during humanitarian crises, or in the case of persons who face multiple forms of discrimination, for example migrants, ethnic minorities, and persons with disabilities. 59. The violence and exclusion that lesbian, gay, bisexual, trans and gender nonconforming persons endure have a detrimental impact on their health and well-being.63 In many countries, they encounter rejection, humiliation, derision or substandard services when seeking health care. According to some research, certain health concerns that bisexual 55 56 57 58 59 60 61 62 63 See also Carroll and Mendos, State-Sponsored Homophobia (see footnote 27). World Health Organization (WHO), Sexual health, human rights and the law, 2015. United Nations Educational, Scientific and Cultural Organization (UNESCO), Out in the Open: Education sector responses to violence based on sexual orientation or gender identity/expression, 2016. M.V. Lee Badgett, “The Economic Cost of Stigma and the Exclusion of LGBT People: A Case Study of India”, World Bank, 2014. See also Christy Mallory and Brad Sears, “Evidence of Housing Discrimination based on Sexual Orientation and Gender Identity: An Analysis of Complaints filed with State Enforcement Agencies, 2008–2014” Williams Institute, 2016. See also Kaleidoscope Trust, Speaking Out: The rights of LGBTI citizens from across the Commonwealth, 2015. See also Lucas Paoli Itaborahy, “LGBT people living in poverty in Rio de Janeiro”, Micro Rainbow International, 2014; and Taylor N.T. Brown, Adam P. Romero and Gary J. Gates, “Food Insecurity and SNAP Participation in LGBT Community”, Williams Institute, (February 2014). See UNESCO, Good Policy and Practice in HIV and Health Education: Education Sector Responses to Homophobic Bullying, 2012 and Out in the Open (see footnote 57). Ilan H. Meyer, “Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence” Psychological Bulletin, vol. 129, No. 5 (September 2003), pp. 674–697; UNDP, Leave no one behind: Advancing social, economic, cultural, and political inclusion of LGBTI people in Asia and the Pacific, 2016, pp. 36, 50–57 and 102; Blondeel et al., “Violence motivated by perception of sexual orientation” (see footnote 11). 13