World
USAID seeks to bolster LGBTQ rights efforts in Colombia
LGBTQ-inclusive peace agreement took effect in 2016
BOGOTÁ, Colombia — The director of the U.S. Agency for International Development’s Colombia mission says he and his colleagues remain committed to the implementation of the country’s LGBTQ-inclusive peace agreement.
“The entire portfolio that we have and all of our work here in Colombia is really to support a durable and an inclusive piece,” Larry Sacks told the Washington Blade on Sept. 21 during an interview in Bogotá, the Colombian capital. “The core principles of what we do are based on equality, inclusion, rights and justice.”
The agreement then-President Juan Manuel Santos and the Revolutionary Armed Forces of Colombia Commander Rodrigo “Timochenko” Londoño signed in Cartagena on Sept. 26, 2016, specifically acknowledged LGBTQ Colombians as victims of the decades-long conflict that killed more than 200,000 people. The accord also called for their participation in the country’s political process.
Wilson Castañeda, director of Caribe Afirmativo, an LGBTQ group in northern Colombia with which USAID works, is one of three activists who participated in the peace talks that took place in Havana.
Colombian voters on Oct. 2, 2016, narrowly rejected the agreement in a referendum that took place against the backdrop of anti-LGBTQ rhetoric from religious and conservative groups. Santos and Londoño less than two months later signed a second peace agreement — which also contains LGBTQ-specific references — in Bogotá.
“That was a very progressive move,” said Sacks in describing the inclusion of LGBTQ Colombians in the agreement.
President Iván Duque, who campaigned against the agreement ahead of his 2018 election, spoke to the U.N. General Assembly hours before the Blade interviewed Sacks. Duque described it as “fragile.”
“Peace accords worldwide tend to be made or broken within the first five years of implementation, and Colombia is right at that point,” Sacks told the Blade when asked about Duque’s comments. “There are certain people deep in the territories and others and high governments who are really helping and making sure that it’s successful, and that there’s continuity, and that the gains that have been made are irreversible. And there’s others who may question, but at the end of the day, I think that from our analysis, it’s on pace with what we’ve seen of the implementation of other peace accords worldwide.”
“At least from USAID’s perspective, we’re doing everything that we can to help support the implementation on multiple chapters of the peace accord,” he added.
USAID specifically supports the implementation of rural development programs through the agreement, efforts to reintegrate former child soldiers into Colombian society and expand the government’s presence into “violence-affected areas.” USAID also works with the Truth Commission, the Unit for the Search of Disappeared Persons, the Special Jurisdiction for Peace, the government’s Victims’ Unit and NGOs that support the conflict’s victims.
USAID’s fiscal year 2021 budget for Colombia is $212.9 million. Upwards of $50 million of this money is earmarked for human rights work that specifically focuses on indigenous Colombians and Colombians of African descent, security, access to the country’s justice system and victims of the conflict.
More than 200 LGBTQ Colombians reported murdered in 2020
Sacks said USAID’s LGBTQ-specific work in Colombia focuses on four specific areas.
“The first is really to kind of shine a light on, raise the visibility, raise the profile on issues of discrimination and violence and stigma and all the issues that this population is facing,” he said.
Colombia Diversa, a Colombian LGBTQ rights group, on Sept. 15 issued a report that notes 226 LGBTQ people were reported murdered in the country in 2020. This figure is more than twice the number of LGBTQ Colombians — 107 — who Colombia Diversa said were known to have been killed in 2019.
Sacks acknowledged anti-LGBTQ violence is increasing in Colombia.
He said the mission works with Ombudsman’s Office of Colombia, an independent agency within the Colombian government that oversees human rights protections in the country, to provide additional support to LGBTQ rights groups. Sacks noted USAID also works with the Interior Ministry to “support the development of their LGBTQI-plus policies” and the country’s attorney general “to hold those accountable.”
Sacks told the Blade that USAID also works to provide “technical and legal support to help” LGBTQ Colombians and other vulnerable groups “access public goods, services and justice.”
USAID-supported groups assist Venezuelan migrants
The Colombian government earlier this year said there were more than 1.7 million Venezuelan migrants in the country, although activists and HIV/AIDS service providers with whom the Blade has spoken say this figure is likely much higher. Duque in February announced it would legally recognize Venezuelan migrants who are registered with the country’s government.
The Coordination Platform for Migrants and Refugees from Venezuela notes upwards of 5.4 million Venezuelans have left the country as of November 2020 as its economic and political crisis grows worse. The majority of them have sought refuge in Colombia, Brazil, Ecuador, Peru and Chile.
Venezuelan migrants are among the upwards of 570,000 people who have benefitted from a USAID program that provides direct cash assistance — between $49-$95 per family — for six months in order to purchase food and other basic needs. USAID also supports Americares, a Connecticut-based NGO that operates several clinics along the Colombia-Venezuelan border and in northern Colombia that specifically serve Venezuelan migrants with the support of the Colombian Health Ministry.
Sacks noted USAID has an “agreement with” Aid for AIDS International, a New York-based group that serves Venezuelans with HIV/AIDS. Aid for AIDS International has used this support to conduct a survey of 300 sex workers in Maicao, Medellín and Cali.
USAID is also working with the Health Ministry to provide health care to Venezuelan migrants with HIV/AIDS, among others, who are now legally recognized in Colombia.
Caribe Afirmativo has opened three “Casas Afirmativos” in Maicao, Barranquilla and Medellín that provide access to health care and other services to Venezuelan migrants who are LGBTQ and/or living with HIV/AIDS. Medellín officials have also invited Caribe Afirmativo staffers to speak with LGBTQ migrants in the city’s public schools.
“Colombia has shown a generosity that you don’t see in many other countries with regard to migrant populations,” Sacks told the Blade. “They really open their borders, their homes, their hearts, to migrants, including the LGBTI community.”
Biden global LGBTQ rights memo is ‘tremendous benefit’
The White House earlier this year released a memorandum that committed the U.S. to promoting LGBTQ rights abroad. State Department spokesperson Ned Price in May told the Blade the protection of LGBTQ migrants and asylum seekers is one of the Biden administration’s priorities on this front.
Sacks said the memo “gives us the political framework with which to operate and obviously sends a message from the highest levels of the U.S. government about LGBTQI-plus rights and equality and inclusion.”
“So for us, it’s a tremendous benefit,” he told the Blade.
USAID Administrator Samantha Power — a vocal champion of LGBTQ rights — has yet to visit Colombia, but Sacks said she has spoken with Vice President Marta Lucía Ramírez.
“We hope to get her down,” said Sacks.
Editor’s note: Michael K. Lavers was on assignment in Colombia from Sept. 11-22.
Colombia
Colombia anunció la inclusión de las categorías ‘trans’ y ‘no binario’ en los documentos de identidad
Registraduría Nacional anunció el cambio el 28 de noviembre
Ahora los ciudadanos colombianos podrán seleccionar las categorías ‘trans’ y ‘no binario’ en los documentos de identidad del país.
Este viernes la Registraduría Nacional del Estado Civil anunció que añadió las categorías ‘no binario’ y ‘trans’ en los distintos documentos de identidad con el fin de garantizar los derechos de las personas con identidad diversa.
El registrador nacional, Hernán Penagos, informó que hizo la inclusión de estas dos categorías en los documentos de: registro civil, tarjeta de identidad y cédula de ciudadanía.
Según la registraduría: “La inclusión de estas categorías representa un importante avance en materia de garantía de derechos de las personas con identidad de género diversa”.
Estas categorías estarán en el campo de ‘sexo’ en el que están normalmente las clasificaciones de ‘femenino’ y ‘masculino’ en los documentos de identidad.
En 2024 se inició la ejecución de diferentes acciones orientadas implementar componentes “‘NB’ y ‘T’ en el campo ‘sexo’ de los registros civiles y los documentos de identidad”.
Las personas trans existen y su identidad de género es un aspecto fundamental de su humanidad, reconocido por la Corte Constitucional de Colombia en sentencias como T-236/2023 y T-188/2024, que protegen sus derechos a la identidad y no discriminación. La actualización de la Registraduría implementa estos fallos que ya habían ordenado esos cambios en documentos de identidad.
Por su parte, el registrador nacional, Penagos, comentó que: “se trata del cumplimiento de unas órdenes por parte de la Corte Constitucional y, en segundo lugar, de una iniciativa en la que la Registraduría ha estado absolutamente comprometida”. Y explicó que en cada “una de las estaciones integradas de servicio de las más de 1.200 oficinas que tiene la Registraduría Nacional se va a incluir todo este proceso”.
Japan
Tokyo court upholds Japan’s same-sex marriage ban
Country is only G7 nation without legal recognition of same-sex couples
The Tokyo High Court on Nov. 28 ruled the lack of marriage rights for same-sex couples in Japan is constitutional.
The Associated Press notes Judge Ayumi Higashi upheld the legal definition of a family in Japan as a man and a woman and their children. The court also dismissed the eight plaintiffs’ demand for 1 million yen ($6,406.85) in damages.
Hiromi Hatogai, one of the plaintiffs, told reporters after the court ruled that she is “so disappointed.”
“Rather than sorrow, I’m outraged and appalled by the decision,” said Hatogai, according to the AP. “Were the judges listening to us?”
Japan remains the only G7 country without legal recognition of same-sex couples, even though several courts in recent years have ruled in favor of it.
The Sapporo District Court in 2021 ruled the denial of marriage benefits to same-sex couples violates the constitution’s equality clause. The Nagoya District Court in 2023 issued a similar ruling. The Fukuoka District Court in a separate decision said Japan’s current legal framework is unconstitutional. The Tokyo High Court in 2024 came to the same conclusion.
The Washington Blade last month noted Prime Minister Sanae Takaichi, who is Japan’s first female head of government, opposes marriage equality and has reiterated the constitution’s assertion the family is an institution based around “the equal rights of husband and wife.”
India
India’s Jharkhand state works to improve trans people’s access to health care
People for Change working with local officials to address disparities
The transgender community has been part of India’s social fabric for centuries, but decades of policy neglect pushed many into poverty and inadequate health care.
The Supreme Court formally recognized trans people as a third gender in 2014, yet state-level services developed slowly. Telangana opened India’s first dedicated trans clinic, the Mitr Clinic, in 2021 with support from the U.S. Agency for International Development and Johns Hopkins University. Jharkhand State has now ordered all government hospitals and medical colleges to establish dedicated outpatient units for transgender patients.
People for Change, an LGBTQ organization, spent the past year mapping gaps in trans health care across Jharkhand. Its surveys of 100 trans residents in five districts found limited access to gender-affirming care, hormone therapy, dermatology, and mental-health services. The group followed this survey with a May 2025 consultation in Jamshedpur, an industrial town in Jharkhand, that brought together clinicians and community leaders to outline a feasible outpatient model.
Those findings were presented to Health Minister Irfan Ansari in June, backed by input from allied organizations and more than 50 trans leaders. The process helped inform the state’s decision to introduce dedicated trans outpatient departments in all government hospitals and medical colleges.
People for Change, which played a central role in shaping the policy, noted that government hospitals in Jharkhand still face infrastructure and resource gaps. Even so, the group said the order reflects a clear policy commitment to creating dedicated trans health services.
If Jharkhand’s trans outpatient departments system functions as planned, it could become a regional model for states with comparable gaps in public health access.
Government data from the 2011 Census — the latest official count to identify an “other” gender category — lists 13,463 trans residents in Jharkhand, alongside sizable populations in neighboring states: 40,827 in Bihar, 30,349 in West Bengal, 22,364 in Odisha, 18,489 in Chhattisgarh, and 137,465 in Uttar Pradesh. Though likely underreported, these figures underscore the scale of need across eastern and central India.
“The decision to start dedicated transgender OPDs (outpatient departments) is not just an administrative step — it is a statement of inclusion, a recognition that the transgender community deserves discrimination-free, dignified, and responsive healthcare. When the government takes such a deliberate step, it sets a tone for systemic change,” said Souvik Saha, founder of People for Change. “It creates an official entry point for transgender healthcare.”
“For the first time, transgender persons will have a recognized and respectful space within the public health system,” added Saha. “That itself is a major shift. It signals to doctors, nurses, and administrators that transgender health is a priority. This leads to sensitization, accountability, and the gradual improvement of attitudes within hospitals.”
Saha told the Washington Blade the policy is likely to trigger broader improvements, noting that once a service is formally notified, budget allocations, training, infrastructure, and staffing typically follow. He said the move could strengthen the system gradually, “step by step.”
“We are realistic: we know improvements won’t happen overnight. But we are also optimistic because the state has already shown genuine leadership and empathy by issuing this order,” said Saha. “And since Jharkhand is celebrating its 25th year of formation, this decision reflects the state’s intention to move towards greater equality and social justice.”
“For the transgender community, this is not just a service — it is dignity. It is visibility. It is inclusion,” he added. “And with the government, civil society, and community working together, we believe this will lead to meaningful and lasting change in the years ahead.”
Saha told the Blade that the dedicated transgender outpatient will operate within existing government medical colleges and hospitals in Jharkhand and will be staffed by current medical and paramedical teams, with no separate funding required at this stage. He said the policy does not call for separate wards or beds, but for clearly designated outpatient spaces for trans patients. The service, he added, will be run by existing staff who will receive training and orientation as needed.
“At this moment, the specific operational details are still being discussed with the government of Jharkhand. However, what is clear is: the OPD will function as a dedicated space within the hospital, not limited to a specific day,” said Saha. “Transgender individuals will have access to focused, discrimination-free services through this dedicated space. The clinic will run through existing hospital systems, with linkages to psychiatry, dermatology, endocrinology, and other departments when required.”
“This structure allows the government to start services immediately without needing new construction, new staff positions, or separate budget lines,” he added. “It is a practical and efficient first step, making the service accessible while keeping the doors open for: future budget allocations, specialized staffing, expansions into gender-affirming services, and strengthened infrastructure. The government’s intent is very clear: to ensure dignified, equitable, and discrimination-free healthcare for the transgender community. This order is a strong beginning, and operational details will continue to evolve through collaborative discussions between the government, hospitals, and People for Change.”
Saha acknowledged that taboos, misinformation, and stereotypes about the trans community persist in Jharkhand and in many other states. However, Saha said there are encouraging models at which to look.
He pointed to Kerala and Chhattisgarh, which have introduced sensitization programs and begun integrating trans-inclusive practices into their public health systems. These examples, he noted, show that when health departments invest in training and awareness, attitudes shift and services become more respectful and accessible.
“In Jharkhand, People for Change has proposed a similar approach. We have formally recommended to the government that civil surgeons, chief medical officer, doctors, nurses, and other hospital staff be trained on gender sensitization and transgender health challenges. This includes understanding gender identity, psychological needs, respectful communication, medical protocols, and ways to ensure discrimination-free services,” said Saha. “The encouraging part is that these proposals are already being discussed in detail with the government of Jharkhand. The government has shown strong intent through the issuance of the transgender OPD order, and training health professionals is naturally the next crucial step.”
Saha noted that it remains unclear whether trans people will be recruited into government health roles, saying it is too early to make any definitive statement. He explained that recruitment requires separate processes, policies, and approvals, and the current order does not address new staffing or the creation of government positions.
A recent performance audit by the Comptroller and Auditor General of India, the constitutional authority responsible for auditing government spending and administration, outlined severe human-resource and medicine shortages across Jharkhand’s public health system.
Tabled in the state assembly in February, the report found that about 61 percent of sanctioned posts for medical officers and specialists were vacant, along with more than half of all staff-nurse positions and roughly four-fifths of paramedic posts. The audit also documented acute shortages of essential drugs in the hospitals it reviewed, with stock gaps ranging from 65 to 95 percent during the 2020-2022 period. The findings highlight the systemic constraints that the new trans outpatients will have to navigate.
Saha acknowledged that drug shortages remain a serious issue in government hospitals and said the concern is valid. Even so, he added that he is approaching the new outpatient policy with hope and confidence.
“The government of Jharkhand has made a historic and intentional decision by opening dedicated transgender OPDs,” said Saha. “When a government takes such a strong step of recognition and inclusion, it also shows the readiness to understand the specific health challenges and medication needs of the transgender community.”
“As more transgender persons start coming to the OPDs and their health requirements become clearer through proper documentation and reporting, we are confident that the state will make every effort to ensure that essential medicines are available for them,” he added.
Saha said People for Change is also seeking support outside the public system. The organization has begun briefing civic service groups — including Lions Club, Rotary Club and Inner Wheel, international volunteer organizations that run local welfare and health projects — on the outpatient order and the community’s needs. According to Saha, several of these groups have indicated they may help trans patients with medicines and other essentials when prescribed by a doctor.
“So the effort is two-fold: the government is creating an inclusive health system and will be informed of the community’s specific medicinal needs through the OPDs. People for Change and partners are strengthening the safety net to ensure that transgender persons are never left unsupported,” said Saha. “We truly believe that this collaborative approach will ensure that transgender individuals receive the medication and care they deserve — with dignity, consistency, and compassion.”
“Every hospital may take a slightly different amount of time depending on internal readiness, but overall: The foundational work is already underway, Hospitals have started preparing their designated OPD spaces, And coordination is happening at the level of civil surgeons, medical superintendents, and hospital management teams,” he added.
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India’s Jharkhand state works to improve trans people’s access to health care
