The government of Peru signed a Supreme Decree this weekend defining transexuality as a mental disorder as part of an update to the nation’s Essential Health Insurance Plan (PEAS), prompting outrage from the LGBTQIAP2S+ community.
While the definition, according to the Peruvian government, seeks to give access to those identifying as transgender or other gender identities to health insurance coverage, the decree has been met with fierce backlash by local LGBTQIAP2S+ activists and politicians.
The PEAS is a minimum healthcare benefit plan that Peruvian citizens receive when enrolling in the nation’s public, private, or mixed health insurance providers. PEAS provides for the basic medical procedures a citizen needs and contains a detailed list of outpatient medical care, tests, specialized consultations, and other treatments that patients may be entitled to according to their particular health condition.
The controversial decree stated that, following a review of the diagnoses included in the World Health Organization’s (W.H.O.) 10th International Classification of Diseases (ICD-10) that are included in the country’s PEAS health program, the omission of “seven (07) ICD-10 diagnoses” related to mental health problems were found, which, according to the decree, “should be incorporated” into the nation’s healthcare plans taking into account Peru’s mental health laws.
As such, the decree defines transexualism, “dual role transvestism,” child gender identity disorder, “other gender identity disorders,” and “gender identity disorder, unspecified” as mental health problems in accordance with the definitions established by the W.H.O.’s ICD-10 manual.
The decree stated that the inclusion of said diagnoses allows them to be covered according to the list of health benefits of Peru’s PEAS healthcare program.
While the decree utilizes W.H.O.’s ICD-10 as its basis, the World Health Organization has since replaced it with a newer 11th edition that no longer defines transexualism as a mental illness. The ICD-11 was presented to the World Health Assembly in 2019 and went into effect in January 2022.
Shortly after the decree was published, the Peruvian Health Ministry issued a statement on Saturday in which it ratified its position that ”gender and sexual diversity are not diseases” while also expressing “respect for gender identities, as well as our rejection of the stigmatization of sexual diversity in the country.”
“The sexual orientation and gender identity of a person does not constitute in itself a physical or mental health disorder and, therefore, should not be subjected to treatment or medical care or so-called reconversion therapies,” the statement read.
The Ministry explained that, to ensure “complete mental health care coverage,” the PEAS plan was updated “in view of the need to ensure the benefit of comprehensive mental health interventions, as conditions for the full exercise of the right to health and well-being of the individual, the family and the community.”
“ICD-10 remains in effect in our country, as long as the progressive implementation of ICD-11 is initiated, as it happens in other countries of the region,” the statement read.
Local activist Shely Cabrera told the Argentine outlet Infobae on Tuesday that, while the decree does modify the PEAS plan to establish “which diseases are, in some way, covered by insurance,” the decree “posed a threat to members of the LGBTQIA+ community throughout Peru.”
She said:
There is a previous decree, which is from 2021, that makes this update of the Health Insurance Plan and this one, which is 009-2024, modifies it to add these new categories, based on the ICD-10, which is a document that dates back to 1992. The ICD is the international classification of diseases, it is a global diagnostic system that is approved by the World Health Assembly (WHA); however, the ICD-11 is currently in force, from 2019 and came into force in 2022. This does not pathologize, it does not consider disorders or diseases of any kind to sexual and gender diversities.
Cabrera claimed that the decree will “further promote the dissemination of speech that violates the dignity of these people, since discriminatory groups will be able to rely on the law by saying that it is a disease.”
“In the case of trans persons, they will not be respected and will be exposed to be called by their social name, their pronouns will not be considered and one of the most basic rights, which is identity, will not be recognized,” Cabrera asserted.
Similarly, local LGBT activists have denounced the decree as “discriminatory,” claiming that the categorization of transgender identity as a mental illness “contributes to stigma and aggravates the consequences for a minority already subject to discrimination.”
Herberth Cuba, advisor to the Peruvian Health Ministry, told CNN en Español on Tuesday that although the ministry does not consider sexual orientation and gender identity mental health disorders, it is necessary to take the World Health Organization’s ICD-10 — and its definition of transexualism as a mental illness — as basis for the PEAS plan update as ICD-10 is the current medical classification in effect in Peru.
Cuba asserted that, although the update may seem contradictory, it is the only way to ensure the benefit of comprehensive mental health care to the entire population, including Peru’s LGBT population.
Peruvian lawmaker Flor Pablo Medina denounced the decree on Tuesday as “shameful” and issued a formal request to Peruvian President Dina Boluarte and the Peruvian Health Ministry to repeal the decree.
“We cannot allow it to go backwards, denigrate and violate the rights to equality and non-discrimination, as well as the right to health and other rights of LGBTI people in Peru,” Medina’s message read.
Christian K. Caruzo is a Venezuelan writer and documents life under socialism. You can follow him on Twitter here.
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