The inclusion of sexual and gender minorities (SOGI minorities) in humanitarian action has until quite recently been a neglected topic within the humanitarian sector. This paper zeroes in on the growing discussion surrounding this issue by analyzing and problematizing ”non-local” humanitarian actors' advocacy for SOGI inclusive humanitarian efforts in ”SOGI hostile” states. The thesis can be divided into three parts. I firstly account for how four ”non-local” humanitarian actors’ have advocated for SOGI inclusion in humanitarian action in ”SOGI hostile” settings. After this, I problematize the discussed advocacy using postcolonial concepts. I lastly come with suggestions regarding how the identified problems can be remedied. The study has shown that humanitarian actors engage in advocacy for SOGI inclusion in various ways. Some of the actors seem comfortable with directly pushing the idea of SOGI inclusivity onto humanitarian workers in ”SOGI hostile” states, while others take a more relaxed approach. Regarding the problems with the advocacy discussed in the paper I have argued that the advocacy does not take postcolonial concerns into a sufficient account, and that it often seems to be rooted in western understandings of sexuality. One of the actors also appears to undermine the risks that can come with advocating for SOGI inclusion in certain settings. To remedy the mentioned problems I suggest that aspects of a Culturally specific advocacy approach should be implemented when ”non-local” humanitarian actors advocate for SOGI inclusion in ”SOGI hostile” states, since such an approach would consider the impacts of colonialism. I also implore the discussed humanitarian actors to look beyond ”identity-centric” and ”LGBTI-centric” understandings of gender and sexuality. I lastly assert that the advocacy should recognize that inclusion may be unsafe in some contexts.

Purpose LGBTQ patients experience marginalization and discrimination when seeking healthcare in the Southern Region of the United States. As a result, they experience negative healthcare outcomes. Collecting sexual orientation/gender identity (SOGI data) is vital in decreasing health disparities and improving hospitalized LGBTQ patients’ quality of care. Providers cannot adequately assess health risk factors or deliver culturally competent care without SOGI data knowledge. Aims The aim is to collect SOGI data during intake to implement a standard of care to promote LGBTQ health outcomes and decrease marginalization. Processes To understand how to provide high-quality care to LGBTQ patients, providers receive instruction on the importance of collecting SOGI data and cultural competency training using the Gay and Lesbian Medical Association (GLMA) guideline. After IRB determined the project as not research involving human subjects, SOGI data questions (your current gender identity is and describe your sexual orientation) were added to the EHR demographic health history section. Provider adoption of collecting SOGI data is measured by extracting data from the EHR. Results Results will determine the providers’ responsiveness to implementing SOGI data questions into the EHR. Limitations Provider having a choice of collecting SOGI data, the small sample size of providers, and the project’s location are limitations. Conclusions LGBTQ individuals have more health inequities and face marginalization when accessing healthcare. SOGI data collection is essential for assessing health risk factors, improving health outcomes, and creating a safe and inclusive healthcare environment for LGBTQ patients.

Cotutelle avec l'Université libre de Bruxelles / Depuis l’adoption de la Directive Qualification en 2004 et de sa refonte en 2011, l’Union européenne reconnaît explicitement les persécutions du fait de l’orientation sexuelle et de l’identité de genre en tant que motif d’octroi du statut de réfugié∙e, selon le critère de l’appartenance à un certain groupe social. Cependant, il existe toujours des différences considérables dans la manière dont les États européens examinent les demandes des personnes invoquant ce type de persécutions, ce qui contrevient à la volonté marquée de l’UE d’atteindre un Régime d’asile européen commun. Dans cette thèse je propose de suivre le processus de fabrique de la nouvelle catégorie de « réfugié∙e LGBTI » en Belgique, en France et au Royaume-Uni afin d’apporter une explication au fait que malgré les pressions d’harmonisation de l’Union européenne, les contours de cette catégorie de réfugié∙es diffèrent d’un État européen à l’autre. M’inscrivant dans la suite des travaux qui proposent d’aborder le processus d’action publique à partir de l’interdépendance entre les institutions et les idées, je suggère d’appréhender la fabrique de la catégorie de « réfugié∙e LGBTI » en tant que processus de traduction multi-niveaux engendré par les logiques positionnelles (institutions) et les logiques interprétatives (idées) d’acteurs en interactions. Pour ce faire, je développe les notions de « configuration des arènes de traduction » et de « paradigme de traduction » qui me permettent de capturer et de suivre les logiques positionnelles et interprétatives des acteurs tout au long du processus de traduction (genèse, stabilisation et verrouillage). La configuration des arènes de traduction correspond à la somme des institutions formelles et informelles qui contraignent les acteurs dans les trois arènes où s’opère la traduction de la catégorie de « réfugié∙e LGBTI » : l’arène administrative, l’arène associative et l’arène judiciaire. Le paradigme de traduction correspond à l’espace de sens à travers lequel les acteurs impliqués dans le processus de traduction interprètent la catégorie de « réfugié∙e LGBTI ». Il est composé de trois éléments : la définition du problème, la solution politique et l’univers de discours. La démarche proposée permet quatre principaux apports, à la fois d’ordre empirique et analytique. D’une part, pour ce qui est des apports empiriques, mon approche permet d’articuler plusieurs niveaux de gouvernement (international, européen et national). Elle permet également d’apporter une profondeur historique à l’analyse. D’autre part, pour ce qui est des apports analytiques, ma démarche permet d’articuler plusieurs niveaux d’analyse (institutions et idées). Elle permet également d’articuler plusieurs temporalités du changement de l’action publique (moyenne et longue). La présente recherche fait deux principales contributions : à la littérature en politiques publiques sur le changement et à celle en études migratoires queer sur l’homonationalisme. D’une part, en proposant de saisir le changement en tant que processus de traduction, ma démarche permet de dépasser les dichotomies latentes entre changements lents et marginaux versus changements radicaux et rapides. Elle permet également de dépasser la dichotomie entre pressions exogènes et pressions endogènes du changement. D’autre part, en prenant au sérieux l’interdépendance entre les institutions et les idées dans la constitution d’une communauté nationale qui intègre les minorités sexuelles, elle suggère de regarder au-delà de l’homonationalisme tel que conceptualisé aujourd’hui pour comprendre la manière dont la frontière entre « nous » et « eux » s’érige. Cette frontière n’est pas la même d’un État à l’autre et se révèle être peu stable, évoluant d’une phase à l’autre du processus d’action publique. Une telle perspective propose ainsi une troisième voie analytique qui se distingue d’une part des tenants du discours de la libération sexuelle et d’autre part de ceux de l’impérialisme sexuel. / Since the adoption of the Qualification Directive in 2004 and its recast in 2011, the European Union has explicitly recognized persecutions on the basis of sexual orientation and gender identity as a ground for granting refugee status, according to the criterion of membership of a particular social group. However, there are still considerable differences in the way European states deal with applications from those who claim this kind of persecution, which goes against the EU’s strong desire to achieve a Common European Asylum System. This dissertation follows the “fabrique” of the new category of “LGBTI refugee” in Belgium, France, and the United Kingdom. It provides an explanation for the fact that in spite of pressures to harmonize the European Union, the contours of this category of refugees differ from one European state to another. Following an approach that focuses on the public policy process with an emphasis on the interdependence between institutions and ideas, I suggest apprehending the “fabrique” of the category of “LGBTI refugee” as a multi-level translation process, generated by the logics-of-positions (institutions) and the logics-of interpretations (ideas) of actors in interactions. To this aim, I develop the notions of “configuration of translation arenas” and of “translation paradigm” which allow me to capture and follow the positional and interpretative logics of actors throughout the translation process (genesis, stabilization and lock-in). The configuration of the translation arenas corresponds to the sum of the formal and informal institutions that constrain actors in the three arenas where the translation of the category of “LGBTI refugee” takes place: the administrative arena, the associative arena and the judicial arena. The translation paradigm corresponds to the space of meaning through which the actors involved in the translation process interpret the category of “LGBTI refugee”. It is composed of three elements: the problem definition, the political solution, and the discursive universe. The proposed approach gives rise to four main contributions, both empirical and analytical. On the one hand, in terms of empirical contributions, this approach allows for the articulation of several levels of government (international, European, and national). It also provides historical depth to the analysis. On the other hand, with regard to the analytical inputs, this approach facilitates the articulation of several analytical levels (institutions and ideas). It also makes possible the articulation of several temporalities of public action change. Overall, this research makes an important contribution to two literatures, namely the literature on public policy and the literature on queer migration studies. First, by proposing to capture change as a translation process, my approach overcomes the latent dichotomies between slow and marginal changes versus radical and rapid changes. It also overcomes the dichotomy between exogenous pressures and endogenous pressures that explain change in public policy. Second, considering the interdependence between institutions and ideas in the constitution of a national community inclusive of sexual minorities, it suggests looking beyond homonationalism, as it is conceptualized today, for understanding the construction of “us” and “them”. This construction is not the same from one state to another and does not appear to be very stable, as it evolves from one phase to another during the entire public action process. Such a perspective thus offers a third analytical path which differs from the discourse on sexual liberation and the discourse on sexual imperialism.

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