LGBTQ+ Georgians say health crisis looms as new laws hit services

• HIV, mental health services disrupted by anti-LGBTQ+ laws
• Medics cancelling gender-affirming treatments
• Activists hope election will lead to legislation rollback

BUCHAREST- Georgia could be on the verge of a health crisis if recent legislation targeting the LGBTQ+ community is not rolled back, activists say, adding that they are pinning their hopes for change on this month's parliamentary election.

Two laws passed this year have already curbed LGBTQ+ rights and activists fear that if the ruling Georgian Dream party wins an unprecedented fourth term on Oct. 26, there could be more crackdowns, with serious consequences for healthcare.

"These kinds of laws perpetuate pandemics. They harm the public health approach and then harm the whole community because HIV will spread more effectively - or any disease will," Eamonn Murphy, UNAIDS director for Eastern Europe and Central Asia regions, told Context in a telephone interview.

"If people are afraid of being identified, or something else happening other than the treatment they're seeking, they're not going to come forward."

During the election campaign, Georgian Dream has pledged to protect "traditional values" and strengthen anti-LGBTQ+ legislation if the party secures a constitutional majority.

Already, the Law on Transparency of Foreign Influence, passed in May, forces internationally-funded organisations to share internal data, while the Law on Protection of Family Values and Minors, signed in October, blocks access to gender-affirming care, so-called LGBTQ+ propaganda, and freedom of assembly.

The "family values" law will not come into effect until December.

Activists hope the laws could be overturned if Georgian Dream loses the vote, but even if that were to happen - and polls have the ruling party in the lead - healthcare professionals say treatments for HIV and mental health, and transgender healthcare services are already being affected.

Trust shattered

Last year, Georgia, a country of around 3.8 million people, had the highest prevalence rate of HIV among men who have sex with men in Eastern Europe, of countries that reported to UNAIDS. The region has seen infections rise by 20% since 2010, according the 2024 Global AIDS report. 

AIDS-related deaths have also increased in the region by 34%, the same report showed.

The Global Fund to Fight AIDS, Tuberculosis and Malaria contributes more than $12 million to HIV and AIDS prevention in Georgia, with funds allocated to NGOs by the country's National Centre for Disease Control.

But the future of such services could be jeopardised by the "foreign agents" law, which stipulates that such groups would be forced to declare confidential information about those who use their services, shattering the trust they've established.

The "family values" law will also make it harder to reach those most at risk of contracting HIV, activists said.

This is because articles in the law ban the promotion, "popularisation" or advertisement of LGBTQ+ issues, making outreach work difficult, they say.

"It will be impossible to work with men who have sex with men or the trans community. Everything we do will be propaganda," Iason Shishniashvili, from the Georgian NGO Equality Movement, told Context during an LGBTQ+ conference in Bucharest, Romania in October.

"It's already hard for them to go the AIDS centre for PrEP (HIV pre-exposure prophylaxis) - people have fears that someone will see them, about confidentiality."

'Already very afraid'

Georgia is already deeply conservative on LGBTQ+ issues and ranks 36th out of 48 European nations in advocacy group ILGA-Europe's annual Rainbow Map, which examines countries based on their legal policies towards the community.

The country did not mark Pride with physical events this year, after Tbilisi Pride was targeted by anti-LGBTQ+ protesters in 2023.

Tbilisi Pride's offices have been vandalised twice in the last few months, director Tamar Jakeli said, adding that she had also faced personal attacks.   

"I am in a pre-election political advert (for) Georgian Dream," Jakeli said on the sidelines of the conference in Bucharest.

"The script says, 'Say no to moral degeneracy, say yes to family values', and it includes my face. It's running on TV every day, all day."

Increased incidents of harassment have contributed to a climate of fear that is already causing frontline health workers to be hesitant about continuing their work with the LGBTQ+ community, activists said.

"There will be problems for psychologists, social workers and doctors," said Keti Bakhtadze, from the Women's Initiatives Supporting Group, noting that a number of social workers had ended their contracts with the organisation.

"They have already demonstrated they are very afraid. They are not ready to face this type of aggression against their professions."

Higher levels of social stress, including stigma, discrimination and prejudice, can lead to increased prevalence of mental health issues experienced by LGBTQ+ people, according to a study published in the Clinical Psychology Review last year.

"The mental health crisis is right now and it will be more. One-third of our budget is going to the mental health programme," said Beka Gabadadze, chairperson of trans community organisation Temida, explaining that these funds could be affected by the "foreign agents" legislation.

"It was hard to find psychologists at first. Right now we have a good system but it is paid for by NGOs, who are supported by international donors."

Gender-affirming treatment

The "family values" legislative package bans both changing legal gender and undergoing gender-affirming treatment or surgery, with those found guilty of offering such services facing up to four years in prison.

The inclusion of LGBTQ+ topics, such as trans issues or same-sex relations, is also banned in vocational education programmes for healthcare professionals, with fines of up to 1,500 lari (424 pounds) for individual breaches.

But while the legislation doesn't come into effect until December, LGBTQ+ organisations say trans Georgians are already being refused access to gender-affirming care.

"Two weeks ago one of the only clinics we have in Georgia ... was performing vaginoplasty, a gender-affirming surgical procedure for trans women, and the doctor cancelled this operation," Bakhtadze said.

"We are trying to provide (doctors) with all the information that the law is not enforced right now, but they are very afraid."

Temida's Gabadadze said their organisation's gender-affirming care programme would have to be closed once the "family values" law is enforced.

Some organisations are exploring alternative ways to provide support, but with the future uncertain, many activists' hopes hinge on the election and a change in government.

"We still have a chance to stop the ("family values") law in the election. The ("foreign agents" law) is also not being used, there is kind of silence right now," Gabadadze said.

"If there is not a good outcome for us in this election, (the government) will start monitoring everything."

(Reporting by Lucy Middleton; Editing by Clar Ni Chonghaile.)