scoring guide

Blood donation eligibility has historically been used as a site of legal and institutional discrimination against LGBTQIA+ people, most notably against men who have sex with men, who faced permanent lifetime bans in many countries from the 1980s onwards in response to the HIV epidemic. While scientific understanding and testing technology have advanced considerably since that era, many jurisdictions have been slow to update their policies to reflect contemporary evidence, and some retain deferral periods or permanent bans that are not applied to any other demographic group on comparable grounds.

This subcategory assesses whether LGBTQIA+ people are subject to deferral periods, permanent bans, or other eligibility restrictions that do not apply equally to their heterosexual or cisgender peers. The gold standard is a system of equal access based on individual behavioural risk assessment rather than categorical exclusion based on identity or relationship type. Discriminatory blood donation policies, even when framed in public health terms, communicate a stigmatising message and have a real deterrent effect on LGBTQIA+ people's willingness to engage with healthcare systems more broadly.

Gender-affirming care encompasses the range of medical and psychological services that support trans and non-binary people in aligning their bodies and social presentation with their gender identity. This may include hormonal therapies, surgical procedures, voice therapy, fertility preservation, and access to mental health support from practitioners with expertise in gender diversity. Access to gender-affirming care is recognised by major international medical bodies as medically necessary for many trans and non-binary people, and its availability has been directly linked to significant improvements in mental health outcomes, including reductions in depression, anxiety, and suicidality.

This subcategory measures whether a legal or administrative framework exists to ensure trans and non-binary people can access gender-affirming care, and the strength and scope of that framework. At the positive end, a comprehensive legal framework provides a clear statutory right to access care with appropriate funding and oversight. At the negative end, some jurisdictions have enacted statutory or constitutional bans on gender-affirming care, including for adults, representing a direct state intervention against the wellbeing of trans and non-binary people. The accessibility and quality of gender-affirming care is one of the most significant determinants of health and quality of life for many people in these communities.

The right to serve in the armed forces on equal terms is both a practical matter and a symbolic one, reflecting whether the state regards LGBTQIA+ citizens as full and equal members of the national community. Historically, many countries excluded LGBTQIA+ people from military service entirely, and some continue to do so through explicit statutory bans or through practical conditions that make open service impossible. In countries without a standing military or compulsory service obligations, this subcategory is treated as not applicable rather than penalised.

This subcategory examines whether LGBTQIA+ people can serve openly without conditions, whether conditional or restricted service is permitted, or whether a statutory or constitutional ban is in effect. Equal service means that a person's sexual orientation or gender identity is neither a barrier to enlistment nor a ground for dismissal or differential treatment during service. Limited equal service reflects jurisdictions where formal equality exists but implementation is incomplete or informal barriers remain. Conditional service captures situations where LGBTQIA+ people may serve but face requirements, such as concealment of their identity, that do not apply to others.

Access to public bathroom facilities that correspond to a person's gender identity is a practical daily necessity that has become a flashpoint in many jurisdictions' legal and political debates about trans and non-binary rights. For trans and non-binary people, being forced to use facilities that do not align with their gender identity can be distressing, expose them to harassment or violence, and in many cases cause them to avoid using public facilities altogether, which has knock-on effects on their ability to participate in work, education, and public life. The framing of bathroom access as a safety issue has been used in some jurisdictions to justify restrictive legislation, despite evidence suggesting that such restrictions actually increase risk for trans people.

This subcategory assesses whether legal or administrative frameworks exist to protect trans and non-binary people's access to appropriate facilities, whether protections have been inferred through broader equality or anti-discrimination legislation, or whether restrictive or punitive frameworks have been enacted. The most positive outcomes involve explicit legal protection for trans and non-binary bathroom access, while the most negative involve statutory or constitutional bans that expose people to legal penalty for using facilities consistent with their gender identity.