The Uncertain Path to Legal Recognition and Health Equity for Sexual Minorities in Hong Kong

FIGHT FOR RIGHTS VIEWPOINT

Patrick Tang

On September 5, 2023, Hong Kong’s Court of Final Appeal delivered a landmark victory for LGBTQ rights in the semi-autonomous city state. In Sham Tsz Kit v. Secretary for Justice, the de facto supreme court stopped short of extending full marriage rights to same-sex couples but mandated that within two years, Hong Kong’s legislature must establish an “alternative framework” that grants “core rights” to allow same-sex couples to manage their civil affairs.[1] As the court-imposed deadline approaches, the Hong Kong government recently introduced a bill that has reignited the debate over marriage equality both in its conservative legislature and across society.[2]

A brief history of conservatism and discrimination

Hong Kong has historically had a conservative stance toward legal protections for sexual minorities. Under British colonial rule, same-sex conduct between men remained criminalized until 1991, when the colonial government—in the aftermath of Tiananmen Square and in response to the ensuing international concerns over the human rights promises—amended the Crimes Ordinance to permit consensual same‑sex relations above the age of 21.[3] Yet this reactive legal progress did little to dismantle deeper cultural conservatism shaped by both colonial rule and traditional Chinese values.[4] The Hong Kong Bill of Rights Ordinance—which enjoys constitutional status after Hong Kong’s handover to China in 1997— retains explicitly heterosexual language in its marriage clause, which has effectively thwarted any constitutional arguments to justify marriage equality.[5] Since the handover, the conservative-leaning executive and legislative branches have shown no interest in recognizing or protecting LGBTQ rights, and Hong Kong still lacks any laws prohibiting discrimination on the grounds of sexual orientation or gender identity.[6]

The mental health effects of discrimination against LGBTQ populations are also experienced in Hong Kong.[7] A 2024 population-based study of over 8023 adolescents in Hong Kong found that those holding marginalized sexual identities exhibited the highest prevalence of suicidal ideation and suicide attempts among all subgroups surveyed.[8] Likewise, a 2022 longitudinal study on men who have sex with men in Hong Kong showed that internalized self‑stigma significantly increases the risk of developing generalized anxiety disorder over time, while an earlier study exposed the high suicide rate among transgender people.[9]

In health care settings, LGBTQ people often face systematic barriers (such as “unfriendly attitudes of general society and healthcare providers”), and social workers lack sufficient training on sexual and gender diversity.[10] At the structural level, policy and legal obstacles compound these challenges. For example, pre‑exposure prophylaxis is not available through the public health system; voluntary organ transplant rights are restricted to married couples; and until 2019, civil servants could not extend medical or dental benefits to a same‑sex spouse.[11] Moreover, essential medical matters such as hospital visitation and powers of attorney depend mostly on private instruments like an enduring power of attorney because same‑sex partners are not recognized as next‑of‑kin under existing law.

The fight for LGBTQ rights

The LGBTQ rights movement in Hong Kong has evolved through a confluence of forces unique to the city’s complex history, culture, and geopolitical position. One major driver of progress has been the influence of international corporations and the global workforce they attract. Hong Kong’s financial services sector contributes approximately 21.3% of the city’s GDP, and multinational firms and foreign staff have brought with them workplace norms and social values that have shaped public discourse around LGBTQ rights.[12] A notable example is the QT v. Director of Immigration case, in which a British lesbian woman challenged the government’s refusal to grant her a dependent visa.[13] Twelve leading financial institutions—including Goldman Sachs and Morgan Stanley—intervened as supporting appellants, arguing that discrimination against same-sex couples undermined Hong Kong’s competitiveness and ability to attract a global workforce.[14] Outside the courtroom, international corporations do not shy away from backing LGBTQ causes.[15]

LGBTQ advocacy has also become intertwined with broader democratic movements.[16] Many gay rights leaders, such as former legislator Raymond Chan and activist Sham Tsz Kit, were also active in the 2014 Umbrella Movement and the 2019 anti-extradition protests.

Another key arena for progress has been the judiciary. Unlike many jurisdictions in Asia, Hong Kong operates under a common law system, allowing its courts to draw on legal precedents from other common law jurisdictions. The Court of Final Appeal includes overseas non-permanent judges, typically senior jurists from the UK, Australia, and Canada. This legal architecture has enabled rights-based claims to gain traction. In past rulings, the judiciary has granted piecemeal victories to sexual minorities, from recognizing same-sex spousal benefits for civil servants to granting dependent visas for foreign partners.

Yet Hong Kong’s judicial independence is now under increasing strain. The National Security Law imposed by China in 2020 allows Beijing to bypass Hong Kong’s high court entirely in politically sensitive cases. In this new climate, scholars have observed a pattern of judicial self-restraint, where the Court of Final Appeal often puts on a “conservative performance” to preserve judicial independence under perceived pressures from Beijing.[17] The Sham ruling exemplifies this shift, as the appellant Sham himself was simultaneously pro-democracy activist facing prosecution under the National Security Law.

Small steps toward new norms

After sitting on the Sham decision for nearly two years, the Hong Kong government finally introduced the Registration of Same‑Sex Partnerships Ordinance to the Legislative Council on July 16, 2025. Rather than establishing a straightforward civil registration system, the bill creates a local registry that same‑sex couples can enter into only if they have a legal marriage or civil partnership from overseas.[18]

Despite its symbolic significance, the proposed ordinance has apparent shortcomings. By requiring couples to first register overseas, it imposes administrative and financial hurdles, effectively creating a “two‑tier system” that privileges those who can afford the entire legal process.[19] Second, the ordinance leaves major gaps in substantive rights, such as housing entitlements, adoption, and joint property ownership, and thus barely narrows the broad disparities created by the various differential treatments identified by the Equal Opportunities Commission.[20] But the bill offers some long-denied rights by allowing members of same-sex couples to make funeral arrangements, donate a partner’s body for medical research, consent to organ transplants involving a partner, and access a partner’s personal data in life-threatening situations.

Unfortunately, even this limited reform has drawn fierce opposition from conservative legislators.[21] The chief executive, John Lee, has sought to steady the political waters by publicly backing the bill and affirming respect for the Court of Final Appeal’s ruling, while reassuring opponents that the ordinance does not amount to legalizing same‑sex marriage.[22]

The broader political climate complicates the bill’s prospects. Since the implementation of the National Security Law, issues touching on rights and identity have become politically sensitive. In response, LGBTQ advocates have shifted away from overt equality-based demands and instead frame their appeals around legal compliance and alignment with official discourse. Days after the bill was introduced, a coalition of nongovernmental organizations submitted a joint petition urging the government to implement the court’s ruling simply on the basis that failure to comply would undermine public confidence in the rule of law.[23]

The fight for LGBTQ rights in Hong Kong is likely to continue on cautious, incremental terms: through litigation, policy reinterpretation, and strategic appeals to rule-of-law principles rather than open calls for equality. Meanwhile, the ordinance itself, if passed, could generate new legal precedents and bureaucratic norms that serve as stepping stones. In today’s political climate, quiet gains may be the most realistic path forward.

Patrick Tang is a policy researcher and a graduate student at Harvard T.H. Chan School of Public Health, United States.

Please address correspondence to Patrick Tang. Email: zhengtang@hsph.harvard.edu.

Competing interests: None declared.

Copyright © 2025 Tang. This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

References

[1] Sham Tsz Kit v. Secretary for Justice, Hong Kong Court of Final Appeal, 2023.

[2] M. Fung, “HK’s Same-Sex Union Bill Marks First Big Split Between Govt and Legislature,” Straits Times (July 18, 2025).

[3] C. J. Peterson, “International Law and the Rights of Gay Men in Former British Colonies: Comparing Hong Kong and Singapore,” Hong Kong Law Journal 46 (2016).

[4] E. Han and J. O’Mahoney, “British Colonialism and the Criminalization of Homosexuality,” Cambridge Review of International Affairs 27/2 (2014); K. K. Chan, “Family and Homosexuality in Chinese Culture: Rights Claims by Non-Heterosexuals in Hong Kong,” Sexuality and Culture 21/3 (2017).

[5] Hong Kong Bill of Rights Ordinance (1991).

[6] A. Barrow, “Sexual Orientation, Gender Identity, and Equality in Hong Kong: Rights, Resistance, and Possibilities for Reform,” Asian Journal of Comparative Law 15/1 (2020).

[7] C. P. Hoy-Ellis, “Minority Stress and Mental Health: A Review of the Literature,” Journal of Homosexuality 70/5 (2023).

[8] Z. Li and P. S. F. Yip, “Suicidality at the Intersection of Sex, Sexual Orientation, and Gender Expression Among Secondary School Students in Hong Kong: A Population-Based Study,” Lancet Regional Health–Western Pacific 53 (2024).

[9] H. Hu, P. K. H. Mo, M. Ip, and Z. Wang, “How Is Self-Stigma Associated with Generalized Anxiety Disorder Symptoms in Men Who Have Sex with Men? Roles of Perceived Stress and Negative Affect in a Longitudinal Study,” Sexuality Research and Social Policy 19/4 (2022); Y. T. Suen, R. C. H. Chan, and E. M. Y. Wong, “Mental Health of Transgender People in Hong Kong: A Community-Driven, Large-Scale Quantitative Study Documenting Demographics and Correlates of Quality of Life and Suicidality,” Journal of Homosexuality 65/8 (2018).

[10] E. M. Y. Wong, Y. T. Suen, R. C. H. Chan, et al., “Inclusion of LGBTQ+ Individuals in Hong Kong: A Scoping Review,” Sexuality Research and Social Policy (2025).

[11] Allen & Overy, The Recognition and Treatment of Relationships Under Hong Kong Law (2019), https://www.eoc.org.hk/EOC/upload/ResearchReport/2019626142922933384.PDF.

[12] US Department of Commerce, “Hong Kong – Financial Services and Fintech,” https://www.trade.gov/country-commercial-guides/hong-kong-financial-services-fintech.

[13] QT v. Director of Immigration, Hong Kong Court of Final Appeal, 2018.

[14] Ibid.

[15] HKPride, https://hkpride.net/sponsor/.

[16] N. H. Madson, Reaching the Ordinary Citizen: Variations in Hong Kong’s LGBT Activism after the Umbrella Movement, PhD dissertation (New York University, 2021).

[17] W. Wang, “From Liberal to Conservative? The Role of Hong Kong Court of Final Appeal in Safeguarding Fundamental Rights Under China’s One Country Two Systems Policy,” International Journal of Human Rights 27/8 (2023).

[18] Registration of Same Sex Partnerships Ordinance (2025).

[19] H. Davidson, “‘Creating Inequality’: Hong Kong’s Same-Sex Marriage Registration Proposal Criticised,” Guardian (July 9, 2025).

[20] Allen & Overy (see note 11).

[21] Fung (see note 2).

[22] Ibid.

[23] “Appeal to Lawmakers for Favourable Consideration of the Registration of Same-Sex Partnerships Bill” (2025), https://docs.google.com/forms/d/e/1FAIpQLSdrXyE-d5QzUjl5rftWg1bogVP0KNxIVHUyPMVOhpal6HTTdg/viewform?fbclid=IwY2xjawL24WRleHRuA2FlbQIxMABicmlkETF4ZDdyT1lXclFNa2ZiYzdVAR5QApZtxUANtB0Sv47UaOw-1tLEhpVeRMukS5-cHspXOjBx_FxFAGhBRub4ug_aem_FjxlFDxSRSFRL4kt9nnfaA.