Globally, sexual and gender identity minority individuals are marginalized along multiple intersecting identities, making them vulnerable to extreme biopsychosocial stressors, including heterosexism, known to impact longevity, mental health, and physical health (1, 2). These disparities are likely heightened in Guyana, where cultural biases and laws continue to contribute to the marginalization of the sexual and gender identity minority community. Moreover, other disparities within Guyana’s larger society, including one of the world’s highest suicide rates, a high prevalence of inter-partner violence, and relatively high rates of mental health disorders (3, 4, 5, 6), underscore the importance of examining factors associated with the health and wellbeing of gender identity minority individuals in Guyana—the primary objective of this qualitative research.
History of Sexual and Gender Identity Minority Exclusion in Guyana
Intolerance of sexual and gender identity minorities in Guyana, and the Caribbean more generally, can be traced to European and British cultural norms that were enforced through colonialism (7). Guyana remains a largely religious society, with 64% of Guyanese reported to belong to a Christian denomination, 25% identifying as Hindu, and 7% identifying as Muslim (8). According to the Institute on Religion and Public Policy (IRPP), the British colonial establishment supported Anglicanism as the state religion, and after independence, the Anglican Church and the Catholic Church cooperated to maintain influence in the society (9). As a result of this colonial era religious influence, the cultural norms of British colonial rule remain largely intact, both in cultural biases and law. The Constitution of Guyana includes a clause that is a barrier to revising laws that were inherited from the British Empire, even when they undermine human rights. As a result, the so-called “buggery and gross indecency laws,” Criminal Law (Offences) Act 1893, Section 353 Buggery Under Section 353, “anyone who commits ‘buggery’ is liable to life imprisonment,” continues to empower acts of discrimination (10).
Recent Findings on Sexual and Gender Identity Minority Life in Guyana
Despite significantly improved social circumstances for sexual and gender identity minority Guyanese (11), recent studies on the state of the Guyanese sexual and gender identity minority population have revealed a persistent lack of positive media and public messaging, as well as inertia in repealing colonial-era laws that enforce Old Testament (Levitical)-derived sexual behavior codes. A 2013 survey found that women and younger adults tend to be more tolerant of homosexuality, whereas the Evangelical Christian community and those with lower education levels are less tolerant (12). When examining the attitudes and knowledge of sexual and gender identity minority needs within the medical community, Rambarran and colleagues (13) found that medical personnel lacked community-centric knowledge and a significant reluctance to learn more about the unique needs of sexual and gender identity minorities.
However, limited research has examined the experiences of sexual and gender identity minority individuals in Guyana, indicating a significant gap in our understanding of this community’s challenges and needs. One recent study by Guybow (14) found that a substantial portion of sexual and gender identity minority individuals, approximately 54%, reported struggling to meet their financial obligations. This highlights potential economic vulnerabilities within this group, suggesting that disparities may exist, which could negatively impact their overall well-being and quality of life. Additionally, the study revealed that very few individuals in this community had sought support from law enforcement (14). This reluctance to seek help implies a potential lack of trust in or fear of discrimination or mistreatment when dealing with authorities, with potential consequences for access to justice and protection from discrimination or violence for the gender and sexual identity minority community in Guyana.
Moreover, research conducted by the Georgetown University Law Center Human Rights Institute (15) found that sexual and gender identity minority individuals in Guyana face verbal and physical threats when in public. These experiences indicate significant safety concerns within this community and suggest that individuals may be at risk of harassment and violence. In light of these findings, it is clear that there are pressing issues facing sexual and gender identity minority individuals in Guyana. The limited research, economic struggles, reluctance to seek help from law enforcement, and experiences of threats in public spaces underscore the need for further research, as well as the development of policies and support systems to address these challenges and promote the well-being and safety of the community.
Conceptual Approach
To gain a comprehensive understanding of the experiences among sexual and gender identity minorities in Guyana, we use a theoretical framework that integrates the Social Determinants of Health (SDH), Well-being Domains Theory (16), and Intersectional Minority Stress Theory (17). We use this integrated theoretical framework with the goal of providing a holistic understanding of the experiences and challenges faced by sexual and gender identity minorities in Guyana by examining the interplay of social determinants of health, well-being domains, and intersectional minority stress. We believe that this integrated framework offers a more comprehensive perspective on the factors influencing well-being and health, paving the way for targeted interventions and policy initiatives to address the unique needs and challenges of sexual and gender identity minorities in Guyana.
The Social Determinants of Health
The Social Determinants of Health (SDH) framework acknowledges that non-medical factors profoundly impact the physical and psychological health of individuals (18, 19). SDH operates through three key mechanisms: (1) the social context during an individual’s development, (2) social stratification in adulthood affecting exposure to stressors, and (3) the differential consequences affecting mental and physical health. The World Health Organization’s (WHO) commission on social determinants of health has identified two major categories of social determinants of health that affect health equity and well-being. Structural determinants of health such as public policy, cultural and socioeconomic factors, and intermediary factors such as living circumstances and biopsychosocial factors (19). These determinants encompass structural factors, including public policy, cultural and socioeconomic conditions, and intermediary factors such as living circumstances and biopsychosocial elements. Through the lens of human rights, recognizing SDH is a means to empower governments to address health disparities among social groups. The ultimate goal is to provide marginalized communities, including sexual and gender minority individuals, with the resources to control the factors influencing their health, contingent on fair resource allocation and informed communities. Understanding well-being is central to this process.
Well-being Domains Theory
At the individual level, SDH is better understood through objective well-being, linked to community factors that promote wellness. For sexual and gender identity minority communities facing ongoing social inequities across numerous life domains, this objective well-being perspective is essential. The Well-being Domains Theory focuses on identifying and understanding various domains or areas of life that contribute to an individual’s overall well-being and quality of life. This theory recognizes that a person’s well-being is influenced by a combination of factors and experiences in different aspects of their life (20, 21). By identifying the proximal factors affecting their well-being, we can better understand the contexts that shape their decisions and experiences.
Well-being measures provide a balanced approach to identify common domains influencing quality of life for populations worldwide (22, 23, 24, 25). Some domains of wellbeing found in multiple measures include social connectedness, mental health, physical health, and productivity (20, 21). For the sexual and gender identity minority community in Guyana, we selected nine domains that we believe to be most appropriate: social, interpersonal, vocational, healthcare, housing, public spaces, socio-political, significant experiences, and successes. Stressors within each of these domains can collectively impact the wellness of individuals, depending on their intersections.
Intersectional Minority Stress Theory
Multiple socially and self-stigmatized minority identities result in cumulative psychological stress that impacts wellbeing through various means such as social alienation, discrimination and self-medication (26). The intersectional ecology model of marginalized minority stress is a crucial framework to comprehend the unique stressors faced by marginalized communities, such as sexual and gender minority Guyanese individuals (17). Sexual and gender minority Guyanese experiences are situated at the crossroads of multiple identities and communities within which they reside. Factors like gender expression, sexual behavior, socioeconomic status, race, region of residence, and religious beliefs intersect to create compounding stressors that result in a unique experience for these individuals. These stressors can significantly impact both physical and psychological health. The exclusion of sexual and gender minority individuals in Guyana is deeply rooted in history, further compounding the intersectional nature of the stressors they face.