The bulletin appeared without much fanfare in an official government newspaper in Peru that publishes new laws and regulations. Peruvian health officials say they had no idea the response it would trigger.
They say they wanted to expand access to privately insured mental health care for transgender Peruvians. So the government decree included language classifying transgender identity as a “mental health problem.”
But as news of the regulation filtered out, it provoked outrage among the country’s L.G.B.T.Q. population and advocates.
Many critics said the rule was another blow in a country where gay marriage and civil unions are illegal; transgender identity is not legally recognized; there is no legislation recognizing hate crimes; and trans Peruvians say they face widespread discrimination and violence.
“What they’re doing is labeling an entire community as sick,” said Cristian González Cabrera, who researches L.G.B.T.Q. rights in Latin America for Human Rights Watch.
But health officials said that the anger and backlash was the result of miscommunication and that they had not intended to offend trans people.
The Peruvian government this month added seven diagnostic codes from the World Health Organization’s medical classification system to a list of conditions in Peru that must be covered by private and public insurance.
But the law used language from an outdated version of the W.H.O.’s classification system that had listed “transsexualism” and “gender identity disorder” as “mental and behavioral disorders.”
A new version of W.H.O.’s system, put into effect in 2022, replaced those terms with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” under a chapter titled, “Conditions Related to Sexual Health.”
The change, according to the W.H.O., was meant to reflect “current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.”
Peruvian health officials said in an interview that they were aware of the W.H.O.’s changes but were only now starting the process of adopting them and incorporating a new rule because of bureaucratic obstacles.
“It is a path that we have already started to walk,” said Henry Horna, the communications director for Peru’s Health Ministry, though officials did not say how long the process would take. So, for now, the current classification remains in place.
In response to the uproar, the ministry clarified in a statement that “gender and sexual diversity are not illnesses” and that it rejects discrimination.
Dr. Carlos Alvarado, the ministry’s health insurance director, said the regulation was intended to make it easier to bill insurers for treatment related to transgender identity.
“We did not expect the reaction, honestly,” he said.
“The problem has obviously arisen from a misinterpretation of the meaning of the rule,” Mr. Horna said. “The rules are written in legal language, in cold language, in technical language.”
But Leyla Huerta, a trans activist, said access to private insurance is irrelevant to most trans Peruvians because of discriminatory hiring practices by many private-sector employers.
She said that any benefits for the trans community were outweighed by the stigmatization from the language used in the government regulation.
Classifying transgender people as mentally ill, activists and experts say, could open the door to the promotion by some conservative groups of the widely discredited practice of conversion therapy, intended to change a person’s gender identity or sexual orientation.
But health officials noted previous government guidelines stating that transgender identity was not a mental illness and discouraging conversion therapy.
The current controversy is just one of the many struggles to expand gay and transgender rights and health care across Latin America, a region with high levels of violence against L.G.B.T.Q. people.
Still, even in such an environment, Peru stands out because its system of laws provides almost no rights for gay and transgender people, Mr. González said.
Same-sex marriage has been legal for years in other South American countries, like Brazil, Colombia, Chile, Argentina and Ecuador. “Peru is miles behind its South American neighbors,” Mr. González said.
The head of the Peruvian government’s human rights office, during testimony last year before the country’s Congress, referred to homosexuality as “deformities that must be corrected.”
And last year, a trans woman working as a prostitute was kidnapped and shot 30 times on the streets of Lima, a killing that was captured on video. One person has been arrested so far, but there has yet to be a trial.
The Peruvian government does not collect data on acts of bias or violence against transgender people.
But a study published in 2021 by a Peruvian human rights group, More Equality, found that among a sample of 323 L.G.B.T.Q. Peruvians, 83 percent said they had experienced some kind of verbal or physical abuse and 75 percent said they had been subject to discrimination.
The president of More Equality, Alexandra Hernández, a psychologist, said she believed that some Health Ministry officials had good intentions in issuing this rule, but failed to consult with experts on L.G.B.T.Q. mental health.
“They say it was beneficial for us,” said Gianna Camacho García, a trans activist and journalist. “Actually, it was a minimal benefit compared to how much we have to lose in other areas or aspects of life by calling us people with mental disorders.”
