The health access and health vulnerabilities experienced by the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA) community in South Korea are influenced by the state's continuous failure to pass anti-discrimination laws that prohibit discrimination based on sexual orientation and gender identity. The construction and reinforcement of the South Korean national subject, "kungmin," and the basis of Confucianism and Christian churches perpetuates heteronormativity, homophobia, discrimination, and harassment towards the LGBTQI community. The minority stress model can be used to explain the consequences of daily social stressors, like prejudice and discrimination, that sexual minorities face that result in a hostile social environment. Exposure to a hostile environment can lead to health disparities within the LGBTQI community, like higher rates of depression, suicide, suicide ideation, and health risk behavior. Korean public opinion and acceptance of the LGBTQI community have improved over the past two decades, but change has been slow, considering the increased opposition from Christian activist groups. In South Korea, obstacles to LGBTQI healthcare are characterized by discrimination, a lack of medical professionals and medical facilities trained to care for LGBTQI individuals, a lack of legal protection and regulation from governmental entities, and the lack of medical care coverage to provide for the health care needs of LGBTQI individuals. The presence of Korean LGBTQI organizations is a response to the lack of access to healthcare and human rights protection in South Korea. It is also important to note that research that focuses on Korean LGBTQI health access and vulnerabilities is limited in quantity and quality as pushback from the public and government continues.
Access to healthcare International organizations like the United Nations and the World Health Organization call for equity and access to medical health services free of discrimination based on sexual orientation or gender identity, ensuring the dignity and the human rights of LGBTQI individuals.World Health Organization (2016). FAQ on Health and Sexual Diversity An Introduction to Key Concepts. Gender, Equity & Human Rights (GER). World Health Organization. Where the state fails to provide care and resources, Korean LGBTQI organizations push for change and provide the necessary care.
Transition-related healthcare Access to transition-related healthcare is a crucial determinant of the quality life of transgender individuals, in which access can mean alleviating gender dysphoria and improving their physical and mental health. A South Korean nationwide cross-sectional survey found that transgender adults face barriers to transition-related healthcare. These include the cost of procedures, lack of access to healthcare needs, and discrimination by healthcare professionals.
The primary barrier to transitional-related healthcare is the cost of procedures like hormone therapy and sex reassignment surgery, as the national health insurance does not cover it. For instance, participants reported spending 250,000-490,000 KRW for a Gender Identity Disorder diagnosis or 15,148,000 KRW for transfeminine and 20,571,000 KRW for transmasculine individuals and genital reconstruction surgery. Transgender Koreans also face a financial burden resulting from the hardship of finding and maintaining a career due to societal stigma revolving around medical transition. Similarly, some face opposition to their medical transition from family and friends.
There are few healthcare professionals with education and transition-related healthcare training as Korean medical schools do not have a medical transition in their curriculum. As of early 2022, the only general hospital with an LGBTQ+ Center openly displaying their services and doctors supporting the LGBTQ+ is Kangdong Sacred Heart Hospital. Limited access to healthcare resources complicates transgender individual's process of changing their legal gender identity. Transgender or non-conforming individuals' physical appearance must conform to the norm of their preferred gender, following South Korean binarism to change their legal gender identity.Na, T. Y. J., Han, J. H. J., & Koo, S. W. (2014). The South Korean gender system: LGBTI in the contexts of family, legal identity, and the military. Journal of Korean Studies, 19(2), 357-377. There are also instances where sterilization is required for legal gender change.Byrne, J. (2014). License to Be Yourself: Law and Advocacy for Legal Gender Recognition of Trans People. Open Society Foundations. Not conforming to the gender binary by undergoing GID diagnosis, hormonal therapy, and sex reassignment surgery means losing citizen rights. Without legal gender change, a trans woman cannot be exempt from military service, and a transgender man cannot participate in military service.
Prejudice and discrimination of healthcare professionals is a significant factor of why transgender people did not seek transition-related healthcare. Transgender or non-conforming participants in the study also reported having been denied healthcare services. The lack of legal protection also affects LGBTQI individual's ability to "raise objection even in cases of medical malpractice, and especially in cases of female to male genital reconstruction surgery, can expect nothing but entirely unsatisfactory results."
These obstacles threaten transgender individual's access to healthcare. Implementing programs that provide transition-related healthcare services training to Korean healthcare providers, and providing national health insurance coverage of transition-related procedures will directly improve the health access of transgender people. Increasing research on the experiences and health barriers transgender people face can also potentially improve health access conditions.
Mental healthcare Coupled with South Korean stigma surrounding mental healthcare, LGBTQI individuals in South Korea must also account for the lack of anti-discrimination laws that prevent discrimination from psychologists and medical professionals. LGBTQI Koreans risk being recommended or forced to undergo conversion therapy as a proposed way to cure their homosexuality.Kim, J., Kim, H., & Ryu, M. (2018). Human Rights Situation of LGBTI in South Korea 2017. Seoul, South Korea: SOGILAW. The government established counseling hotlines like Youth Hotline 1388 for sexual minority youth, which resulted in failure considering counseling professionals in the hotline used heteronormative rhetoric and encouragement to pursue conversion therapy rather than choosing to live as a sexual minority. The following organizations are responsible for the creation of centers and programming that concerns LGBTQI mental health and wellness in response to the lack of government-sponsored resources for LGBTQI mental health care despite limits and constraints due to a lack of economic resources. These organizations provide an inclusive, safe environment to LGBTQI Koreans that face mental health needs like depression and suicide.
Chingusai (친구사이) Korean Gay Men's Human Rights Group Chingusai ("Between Friends") is an organization mobilizes to ensure LGBTQI human rights and protect LGBTQI individuals from discrimination. Chingusai also provides counseling programming to promote acceptance within families and teachers. Chingusai established "마음연결" (Heart Connection), a suicide prevention helpline in response to the high rate of suicide and suicide ideation within LGBTQI youth. The use of the forum is open to all ages, and individuals can reach out anonymously. Heart Connection guarantees professional counselor response within 48 hours. Dr. Park Jae-wan, a night volunteer for the Heart Connection helpline, states that those who reach out "usually talk about feeling alienated, isolated, feeling like they are a burden to someone."
Dding Dong (띵동) Dding Dong, an LGBTQ Youth Crisis Support Center, provides LGBTQI youth with support and protection to "confront crisis circumstances and guide them to live an independent life guaranteed of physical and mental well-being and self-esteem on one's sexual orientation and gender identity." Dding Dong provides emergency living expenses, living goods support (underwear, socks, condoms, sanitary napkins, hygiene products, and toiletries), shelter connection, and a place to live. The center is prepared to provide support for LGBTQI individuals with psychological trauma, family trauma, and suicide crisis.
Korean Lesbian Counseling Center (한국레즈비언상담소) The Korea Lesbian Counseling Center caters to the needs of the Korean lesbian community. It rejects the prescribed notions of what a woman is or should be including the dichotomy of femininity and masculinity. The Korean Lesbian Counseling Center provides telephone and online counseling. The center focuses on cultivating self-esteem and provide victims of violence and discrimination a space to heal.
HIV/AIDS healthcare South Korea took an aggressive response to high HIV/AIDS cases in the late 1980s through the implementation of the Aids Prevention Act, which investigated and tested individuals suspected to be "high risk," gay men and sex workers. The government used more than 60% of its HIV/AIDS budget on testing.Cho, B. (2008). HIV/AIDS policy in South Korea. International Studies in Education, 9, 37-39. In 1996, only 1 for every 58,000 individuals tested resulted in HIV/AIDS positive, showing the failure of the high volume of testing. The failure was due to the change in transmission pattern, most HIV/AIDS transmission was previously through contact with foreigners, and transmission after that 1990s is attributed to domestic sexual contacts. HIV/AIDS within the gay community increased after the 1990s. Despite the shift in transmission patterns, the South Korean government continued with HIV policy that implemented medical consideration through high volume testing and aggressive supervision of individuals that tested positive. The KCDCP's reported that from the years 1985 to 2011, 80.9% of HIV infections were transmitted through sex, and 32% were transmitted through "homosexual contact." Regardless, the South Korean government remained reluctant to implement policies that considered sexuality and "sexual health promotion, empowerment and self-reliance, and community-oriented HIV/AIDS."
Individuals living with HIV/AIDS experience prejudice, discrimination, and human rights violations when they seek medical care. One way is through South Korea's continued HIV testing of individuals suspected of being "high risk" enabled by the AIDS Prevention Act. Findings from "The People Living with HIV Stigma Index In South Korea 2016-2017" found that 61.5% of participants were unknowingly tested, most during non-related medical procedures. The HIV Stigma Index also found that learning about one's positive HIV status abruptly is a traumatic experience. Only 11.5% received "pre- and post-HIV test counseling," and 42.3% did not receive counseling. Human rights activists have called for the end of the AIDS Prevention Act and its replacement with the HIV/AIDS Victims Human Rights Act. The HIV/AIDS Victims Human Rights Act would "prohibit HIV testing without proper consent, punish offenders of discrimination and those who disclose the identity of those living with HIV/AIDS, and require firms, schools, and medical professionals to have human rights education." However, no change was enacted by the government, which the government justified by stating that the public feared people living with HIV/AIDS.