to straight people, "the intent, at least historically, was to address a clinical situation in which individuals express a desire to develop heterosexual attractions they do not feel or to relieve distress about an unwanted homosexual orientation." The working group named that lesbian, gay, and bisexual people often report higher levels of distress than straight people, but research has shown that this distress is due to higher levels of social rejection and discrimination, and distress that stems from societal stigma cannot be considered a mental disorder. It named that stigma around physical illness and poverty is also likely to cause distress, but this distress is not considered a mental disorder under the ICD. Echoing sentiments voiced 30 years before by Robert Cabaj, the working group also noted that "social and political disapproval has at times resulted in the abuse of diagnoses—especially psychiatric diagnoses—to harass, silence or imprison people whose behaviour violates social norms or challenges existing authority structures." It concluded, "It is not justifiable from a clinical, public health or research perspective for a diagnostic classification to be based on sexual orientation" and that the needs of lesbian, gay, and bisexual people can be addressed under other diagnostic categories, "in a manner consistent with good clinical practice, existing human rights principles and the mission of WHO." Following the publication of the working group's report in 2014, it was peer reviewed by a variety of other experts from countries around the world, including some that criminalize homosexuality, and none of them argued against the working group's recommendations. The draft ICD-11 was then extensively field tested in countries including Brazil, India, Lebanon, Mexico, and South Africa, and voted on by ministers of health from more than 170 WHO member countries. Ultimately, the WHO accepted the working group's recommendations and deleted section F66, including ego-dystonic sexual orientation. The ICD-11, which was approved in 2019 and went into effect in January 2022, does not include any diagnostic categories that can be applied to people on the basis of sexual orientation, bringing the ICD in line with the DSM-5. Inclusion in the CCMD-3 The current Chinese Classification of Mental Disorders (CCMD-3), which is styled after the DSM-IV and ICD-10, includes ego-dystonic sexual orientation, with the note that "a person could be conflicted or suffering from mental illness because of their sexuality, and that condition could be treated." Homosexuality and bisexuality were eliminated from the CCMD