By Justin Francis Bionat
Abstract: Health issues of non-heterosexual men are not similar across the world. Health issues come with varying consequences to the lives of individuals when studying violations to the right to health. Health disparities exist in societies regardless of their attitudes towards LGBT individuals. The majority of previous studies on gay, bisexual and other men who have sex with men (MSM) identities in Cambodia are focused largely on individualistic risky sexual behaviour. The global HIV epidemic raised the awareness of LGBT communities but has led to the labelling of non-heterosexual men as “at-risk” or “socially deviant” populations. Utilizing the stories of the participants, this study where this study was based challenges the labelling, regulating and controlling of sexuality under categories of “deviance”, “risk” and “illness”. Biomedicine constructed a causal link between homosexuality and HIV/AIDS developing standards wherein queer bodies are seen as diseased and heterosexual bodies as the standard of normality and health. In order to achieve global health justice we have to place prime focus on the dismantling of the hierarchizations and categorization of non-normative sexual identities.
I was a Master’s student with the Institute of Human Rights and Peace Studies of Mahidol University, Thailand under their APMA programme, when I conducted my data gathering in Cambodia for my thesis. There was a conscious effort in the conduct of this study to provide a paradigm where human rights intersect with queer theory. The experience was an interesting one as Cambodia was a familiar country, having travelled there before and been immersed with the LGBTIQ community, however, focusing on the narratives of gay, bisexual, and men who have sex with men (MSM) really put things into a new perspective. It was additionally a great learning experience because I was introduced to a whole movement of Asian queer scholarship. It was further honed during my time with the Asia Research Institute of the National University of Singapore during the Asian Graduate Students Fellowship.
Human rights praxis, particularly in gender rights and sexual rights, is rooted in tradition advised by international mechanisms and instruments, such as the Convention on the Elimination of all Forms of Discrimination against Women (CEDAW). However, this presentation’s contribution to queer Asian studies rethinks how the fulfilment of rights, such as health rights, requires an atypical lens of analysis. Transgression from standard biomedical practices of identification is a necessary (and quite frankly radical) paradigm shift which is needed to be more responsive to the unique needs of sexual and gender minority groups. One can continue to exemplify the queer Asian identity we yearn for, bare of any limiting and restricting categorization.
Sexual Health, Human Rights, and the Biomedicalization of Homosexuality
Coming from a degree program that focused on equipping its students with the fundamental and practical uses of human rights, I came to understand ‘queer’ in a more adroit way. Human rights work must reject binary hierarchical categorization of gender and sexuality as it must take necessary measures to ensure the respect and liberation of sexualities (Miller, 1999 and Gross, 2012). The human rights discourse in non-Western countries involving non-normative sexual identities should critically consider these post-colonial perspectives in order to formulate an effective agenda on sexuality rights using political opportunity structures (Miller, 1999, Kollman and Waites, 2009 & Swiebel, 2009). However, this should not be a template solution as certain political opportunity structures perpetuate the same binaries, hierarchization and risk category classifications which queer theory hopes to dissolve.
If we are to queer existing human rights paradigms, we have to reject divisions between the affluent and the poor, the hetero- and the homo-, the normal and the deviant, as well as, the safe and the risky. We believe that this may indeed be a new concept evidenced by the dearth of literature that queers health human rights. We see various authors who challenge the biomedicalization of homosexuality but never with an effort to situate all components of queer identities in health human rights together. This study aimed at forging a viable nexus between queer identities, human rights and global health.
To address this drawback, we have to fundamentally acknowledge sexualized and gendered subjectivities that are affected by health care practices and systems. We therefore have to focus our attention on the social binaries perpetuating oppression. Medical humanities call this ‘critical healing’, involving a rejection of exclusive territories of defined normalcy by contesting standards and mechanisms of injustice and discrimination (Garden, 2019). Garden points out that biomedical history has been known to define persons as disordered, diseased, and deviant. These definitions that earlier sprung up from public health efforts to curve epidemic transmissions has led to the identification of ‘risk groups’ of sexually transmitted infections (STI) such as HIV/AIDS (Spurlin, 2019).
Sexual health studies looks at risk in lived contexts and queer men are seen to perform risky behaviors in the context of the HIV pandemic. This leads to the hierarchization of identities against health statuses and the categorizing of persons as “ab/normal, us/them, visible symptoms/invisible illness, and risk/non-risk”. Consequently, such studies prompt social and public health policing of the sexual subject’s sexuality and gender performativity, and the development by public health of a label for non-gay-identifying men, ‘men who have sex men’ (MSM) identity (Arguello, 2016; Young & Meyer, 2005).
Biomedicine has, in the early history of the pandemic, constructed a causal link between homosexuality and HIV/AIDS which has developed standards wherein queer bodies are seen as diseased and heterosexual bodies as the standard of normality and health (Spurlin, 2019). Beyond the pathologization of homosexuality and the creation of standards, society’s perceptions of deviance, heteronormative and Western biases, and the enforcement of gender norms may have led to a critical failure in sexual health human rights (Garden, 2019).
Therefore, rejection of the biomedicalization of homosexuality and categorization of ‘risk groups’ would achieve better global sexual health justice by reducing health disparities and improving current human rights strategies. This rejection does not mean the existence of the term ‘risk group’ should be altered (or totally erased) in medical and epidemiological literature, but rather it should consciously avoid homogenizing gay, bisexual and MSM under risk labeling. Re-quoting and expanding the insights of Kole (2007), the author points out that ‘sexual diversity, gender plurality, sexual rights, and freedom must be preserved and upheld in diverse societies in their own way’—in the same way that Khmer sexual identities, like the pro saat and sak lay should be celebrated—devoid of categorizations like ‘deviancy’, ‘health risk’, ‘criminality’ and ‘abnormal’.
Queering the Human Rights Paradigm
As we continue to modernize queer literature in Asia, queer studies have to take into consideration that ‘queering’ should be accompanied with the decolonizing of gender and sexuality, termed ‘decolonial queer praxis’ (Lee, 2019). Queer existence in modernisation processes must acknowledge its pre-colonial roots and celebrate its gendered/sexual heritage. This should strive to work without the same Western framework which brought to Asia the us/them, norm/deviant, and risky/healthy binaries. Sexual health care must catch up and refashion its terminologies to keep up with the times. Beyond this ‘queer paradigm’ lies an effective sexual health care system that operates for communities that need it the most in Cambodia and other parts of Asia.
Expanding on the ‘decolonial queer praxis’ in relation to the ever-evolving human rights agenda (where sexual health rights are lodged within interconnected economic, social and cultural rights), Roland Burke argues for a post-colonial human rights agenda which asserts individual freedom, religious liberty, and democratic governance (2010, p.33), with this concept’s first emergence during the 1955 Asian-African Conference in Bandung, Indonesia. This turned into the political force of decolonization which reframed the United Nations human rights agenda, between the 1950s to the mid-1970s.
More importantly, when we place this alongside queer Asian studies, ‘queering has everything to do with decolonising’ (Lee, 2019). Hence, as Burke posits that the Bandung Conference changed the landscape of human rights agenda, the condemning of colonialism in all its manifestations is essential to the queering of human rights and the challenging of categorizations of sexuality and gender.
To queer is to destabilize any normative references and it seeks to transform assemblages (Lee, 2019). The dismantling of oppressive structures in social activism must, therefore, acknowledge that the universality of rights (such as the fundamental of thought, belief and religion) does not mean the erasure of sexual identities (such as the condemnation of homosexuality based on Islamic scriptures leading to the criminalization of homosexuality in statutory law). The multi-dimensional nature of anti-colonialism and its relationship to individual rights would assist in the argument that there is multiplicity within queer communities (Burke, 2010). To put ‘queer’ and ‘Asia’ together is to operationalize gender equality and sexual rights in non-normative literature. The emerging ‘third-world’ voice that shapes current human rights discourse along with the revolutionary influence of decolonization should be central values to ongoing queer Asian studies.
In sexual health discourse, queer identity is often a subject of concern as it provokes a sense of deviation from health standards. This leaves multiple opportunities to boost policy advocacies and social science scholarship as advocates can lobby to enact laws that provide protection against discrimination not only on the basis of sexual orientation and gender identity, but also on the basis of health status and sexual practices.
This study moves beyond epidemiology and towards human rights, providing an essential argument wherein the disruption of oppressive structures, including terminologies, is in effect a queer process and a new queer human rights paradigm. Through queer theory, we have deduced that these factors exist because of the categorization of gay, bisexual, and ‘men who have sex with men’ (GB-MSM) individuals as ‘sexual anomalies’ and ‘inverts’ of hetero-normative standards. There is a growing need for future studies in contextualizing applications of queer theory to non-Western settings, such as Cambodia. It is recommended for both academia and civil society to utilize non-stigmatizing terminologies, such as ‘key populations’ or ‘sexual identities’, and for an overarching recognition of indigenous sexual identities which also challenge colonial and patriarchal gender ideals, and dichotomized stereotypes. When situated in the post-colonial Cambodian context, this is the ‘decolonial queer praxis’ earlier mentioned, which represents the multiplicity of queerness and Asianness, while being prideful of the localized sexual identity terminologies.
In order to achieve the desired universal accessibility of sexual health care as a human right, we have to place a prime focus on the dismantling of these hierarchizations. Ensuring the propagation of literature that discusses non-normative sexual identities in non-Western countries is also crucial to expand the discourse on health, human rights, and queer theory.
It is therefore recommended to seek ways to study indigenous sexual identity, its intersections with power structures, spatial relations, and queer theoretical underpinnings all under a human-rights based approach. Health disparities should be a subject of interest among researchers especially in countries with weak health infrastructures. This means going beyond sexual identity categories by considering age, physical and mental ability, social class, among other social and economic classifications. This is a challenge to medical and epidemiological researchers to reimagine terminologies and to humanize the experiences of sexual identities devoid of binaries and categorizations. There is resistance in changing and restructuring the terminology, the same way that there is resistance, among the conservative right, to recognize the valiant efforts of the LGBT movement.
 Bionat, J.F., 2018. “A Place To Be Yourself: a safe haven for LGBTI people in Cambodia”. Gay Star News. Accessed at: https://www.gaystarnews.com/article/a-place-to-be-yourself-a-safe-haven-for-lgbti-people-in-cambodia/ (Date Accessed: April 7, 2020)
 See full manuscript of the author’s thesis:
Bionat, J.F., 2019. Narratives from over the rainbow: Health disparities, sexual health care, and being gay, bisexual, and ‘MSM’ (men who have sex with men) in Cambodia (Thesis). Institute of Human Right and Peace Studies, Mahidol University. Accessed at: https://apma-humanrights.org/2019/11/14/narratives-from-over-the-rainbow-health-disparities-sexual-health-care-and-being-gay-bisexual-and-msm-men-who-have-sex-with-men-in-cambodia/
Arguello, T.M., 2016. Fetishizing the health sciences: Queer theory as an intervention. Journal of Gay & Lesbian Social Services, 28:3, pp.231-244.
Burke, R., 2010. Decolonization and the Evolution of International Human Rights Agenda. Philidelphia: University of Pennsylvania Press.
Garden, R., 2019. Critical Healing: Queering Diagnosis and Public Health through the Health Humanities. Journal of Medical Humanities. 40(1). pp.1-5.
Gross, A., 2013. Post/Colonial Queer Globalisation and International Human Rights: Images of LGBT Rights. Jindal Global Law Review. 4:2. 98-130
Kole, S.K., 2007. Globalizing queer? AIDS, homophobia and the politics of sexual identity in India. Globalization and Health.3(1).8
Kollman, K., and Waites, M., 2009. The global politics of lesbian, gay, bisexual and transgender human rights: an introduction. Contemporary Politics. 15:1. pp.1-17.
Lee, P.H., 2019. Queer Asia’s Body without Organs. In: Luther, J.D. and Ung Loh, J., ed. 2019. ‘Queer Asia’: Decolonising and Reimagining Sexuality and Gender. Zed Books. London, United Kingdom., pp. 219-242.
Miller, A.M., 1999. Human Rights and Sexuality: First Steps Toward Articulating A Human Rights Framework for Claims to Sexual Rights and Freedoms. Proceedings of the ASIL Annual Meeting. 93, pp. 288-303.
Spurlin, W.J., 2019. Queer Theory and Biomedical Practice: The Biomedicalization of Sexuality/The Cultural Politics of Biomedicine. Journal of Medical Humanities. 40. pp. 7-20.
Swiebel, J., 2009. Lesbian, gay, bisexual and transgender human rights: the search for an international strategy. Contemporary Politics. 15:1, pp.19-35.
Young, R.M. and Meyer, I.H., 2005. The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health. 95:7. pp.1144-1149.
Bio: Justin is a graduate of the APMA program, Master of Arts in Human Rights and Democratisation, of the Institute of Human Rights and Peace Studies, Mahidol University, Thailand. He also completed the Asian Graduate Students Fellowship with the Asia Research Institute of the National University of Singapore. Presently, Justin works as the Executive Director of Youth Voices Count, a regional organization working with LGBTIQ youth in the Asia-Pacific region.
You can reach him through Twitter and Instagram: @rainbowgrindsp.
Academia: https://mahidol.academia.edu/JBionat (contact: firstname.lastname@example.org)