A new report paints a chilling picture of how ‘conversion therapy’ – attempts to change someone’s sexual orientation or gender identity – occurs in at least 80 countries worldwide.

The first global study of its kind, published on Thursday, shows how these practices are prevalent beyond well-documented US cases – and range from mental health services to prayer and ‘self-help’ groups.

Far from an outdated activity, conversion therapy is “a very current global problem”, said Maria Sjödin, deputy director at LGBTIQ rights group OutRight International that published the study.

Speaking to openDemocracy, Sjödin warned that these practices could become even more widespread as "the world becomes generally more aware of LGBTIQ identities" and people promote ‘therapy’ in response.

Sjödin called this backlash a “huge risk” to the rights of LGBTIQ people and said it’s urgent to raise awareness about these practices and the “irreparable damage” they can cause, “before it’s too late”.

These practices don’t work, “it’s not conversion. And it’s not therapy”, she said. Among the most disturbing testimonies in the report are those of physical violence, forced fasting and exorcism.

The 81-page study reviews existing laws and research and contains the findings of a new survey of more than 500 LGBTIQ people in 80 countries along with a series of in-depth interviews and testimonies.

Amie Bishop, the researcher who wrote the report, told openDemocracy that many of the LGBTIQ people she interviewed found recalling their experiences extremely painful, but “they wanted their stories published” to expose the practice as “physical, sexual, and psychological abuse”.

Only four countries in the world have completely banned conversion therapy – Taiwan (in 2018), Malta (2015), Ecuador (2014) and Brazil (where such a law was introduced in 1999, repealed in 2017, then reintroduced last year) – though some partial bans exist in other places.

The report notes that these practices have been described as “unethical, unscientific, and ineffective and, in some instances, tantamount to torture" by the United Nations High Commissioner for Human Rights, and says they have been “condemned” by major medical and mental health associations in the US, Canada, Australia and Europe.

Bishop and Sjödin called on the World Health Organisation to join other international bodies in condemning ‘conversion therapy’. But Bishop noted that enforcing bans on these practices is challenging as “there is not one definitive form of conversion therapy”.

While approximately two-thirds of survey respondents who had experienced conversion therapy said they had been ‘coerced’ into these activities, about one-third said they had voluntarily sought it out themselves. For Bishop, this finding reflects the profound effects of internalised homophobia and transphobia “when your family, your faith, and your community are all condemning you”.

“I keep thinking of one interviewee from Algeria who had tried various approaches to change”, she said, recalling how this person had told her several times: “I just want to be acceptable”.

“Laws are important and can certainly help”, Bishop continued, yet these practices can take a wide range of forms and are ultimately fueled by “societal and internalised homophobia and transphobia” and the idea “that being LGBTIQ is pathological, disordered, and unacceptable”.

The report traces these practices back to mid-19th century “early sexuality science”, Freudian concepts, and theories attributing homosexuality to “arrested pschosexual development”.

In the 1970s, as sexuality was declassified as “mental disorder” by medical associations in several countries, organised “ex-gay” movements emerged in the US, Canada, and Australia.

At this time new organisations were set up like Love in Action, Exodus International, and Restoration Ministries that promoted conversion therapy. By 2002, Exodus International had 250 ‘local ministries’ in North America, and more than 150 affiliates around the world.

Today many conversion therapy groups have rebranded their activities, notes the report, using scientific and human rights language in their public materials for example. New technology including social media apps have made it easier to target young LGBTIQ people, it adds.

One example is a group called 3:16 Church that promotes conversion therapy online. Its TrueLove.Is website is “bathed in rainbow colors and soothing language" inviting browsers to “come out and come home”.

In Africa, Bishop points to the role of European colonisation in the 19th and 20th centuries in fostering anti-LGBTIQ attitudes – and legislation.

More recently, she said that “as the religious right loses ground” in fights against LGBTIQ people in Europe, North America and Australia, including on same-sex marriage equality, they “have turned increasingly to countries where they believe their agenda will resonate”.

Zambian scholar and Anglican priest Kapya Kaoma has identified a 1998 conference hosted by the Archbishop of Canterbury in the UK – where he said “African bishops and other leaders were told that homosexuality could be cured” – as a key moment in the spread of these practices.

Sjödin says “there are definitely elements of US presence” in conversion therapy across the world. However, she says, these activities “require further investigation” and are “not entirely driven by American churches”.

The White Garment churches in Nigeria, for example, appear to be expanding and exporting conversion therapy tactics to the rest of Africa, says Bishop. The report also reflects seemingly widespread conversion therapy in China, unconnected to US influence and religious groups.

In China, these practices have occurred in at least 134 places, including hospitals, clinics, psychiatric wards and public health facilities, according to a study by LGBT Rights Advocacy Group China earlier this year. Meanwhile researchers expect true figures to be much higher.

Outright’s report says all Chinese respondents to its survey attributed their “treatment” to family and social pressure, rather than religion.

It suggests that the country’s one-child policy, combined with parents’ intense pressure for their children to marry, fuel these practices – along with sexual orientation’s continued classification as a “disorder” in the clinical guide used by doctors to diagnose mental health issues.

While Taiwan’s legislators passed a bill in May that endorsed same-sex marriage, this week a Chinese parliamentary spokesperson said the law only allowed for marriage between a man and a woman, which “suits our country’s national condition and historical and cultural traditions”.