Trans Visibility Day: access to healthcare is a human right, not a privilege

Trans Visibility Day: access to healthcare is a human right, not a privilege

Washington D.C., 31 March 2024.- On International Transgender Day of Visibility, the Institute on Race, Equality and Human Rights (Race and Equality) recognizes that trans people, trans non-binary people, and gender diverse people continue to face strong institutional, social, and economic barriers in the exercise of their right to healthcare, while even more people who are racialized, impoverished, migrants or sex workers.

According to the thematic report on trans people and people of diverse gender identitiy and their economic, social, cultural, and environmental rights from the Inter-American Comission on Human Rights (IACHR) and the Special Rappertour on Economic, Social, Cultural, and Environmental Rights (SRESCER), the lack of legal and social recognition of the gender identity of trans people, non-binary trans people, and gender diverse people vulnerabilizes their human rights, and much of time puts them in risky situtations.

Even in Latin American countries that enjoy gender identity recognition legislation, the lack of comprehensive implementation, investment, awareness and training of authorities and health officials continue to produce situations of discrimination and violence. In Brazil, for example, “we have the Comprehensive National LGBTQIA+ Health Policy which is a fundamental document and we have the Gender Modficiation Process which is very necessary for the specific demands of trans people. However, it is crucial that the government allocates more investments so that the service really reaches all the people who need it”, says Yara Cavalcante, from ANTRA.

Some of the prejudices against the right to healthcare of trans, trans non-binary and gender-diverse people have to do with the impossibility of accessing health services due to their gender identity and the exposure to unsafe, unsupervised, and even clandestine methods of body modification (hormonal processes, surgical interventions). “In Peru, transmasculine people do not have access to specialized services such as hormone therapy, treatment follow-up or gender affirming surgeries; and many must choose to seek alternatives in the private sector, which is expensive and not accessible to all, so many end up self-medicating with inappropriate medications and putting their health at risk”, says Bruno Montenegro, trans man, founder of Fraternidad Trans Masculina Perú.

Likewise, the lack of knowledge of health workers about the specific health needs of transgender people, mistreatment and pathologization in health services linked to prejudice and stigma -also related to HIV cases- generate anxiety, fear and lack of motivation to return to the health centers. On the other hand, medical personnel who are neither trained nor sensitized to attend to the needs of transgender people can lead to misdiagnosis and mistreatment. In the worst cases, they may incur in negligence, often committing torture, as in the case of so-called “conversion therapies” in mental health centers, as pointed out by the testimonies in the report: Bodies and resistances that transgress the pandemic: transmasculinities and AFAB non-binary people in Peru (2020).

Other factors that impacts the access trans people have to healthcare services is a lack of resources. In countries like Cuba, for example, shortages of hormonal products is one problem the population faces. “Testosterone is sometimes in short supply. At times we have to go one to five months without treatment,” stressed Carlos Hernández, a Cuban trans man that coordinates the independent social project Por Siempre Trans.

In addition to all this, which has its origins in the hegemonic cisgender model, no major medical advance has considered trans people as an objective and specific population. As Mateo Rodrigo of Hombres Trans Diversos de Bolivia points out, “hormonal treatments and other medical procedures to which trans people have access were not originally created for trans people. Nor is there sufficient academic production that studies the long-term repercussions of these treatments on the health of trans people.”

Faced with these situations of violation and concerns of trans counterparts around the right to healthcare, Mi Salud Transmasculina Importa was born, which is a project with a regional scope managed by Fraternidad Trans Masculina de Perú, Fraternidad Trans Masculina de Ecuador, Rosa Rabiosa de Perú, Hombres Trans Diversos de Bolivia, and the Instituto Brasilero de Transmasculinidades – IBRAT of Brazil, with the support from Race and Equality. This space also has the objective to support the integral wellbeing of the transmasculine population of Latin America through information and communication.

For all of the above reasons, Race and Equality recalls that States have the obligation to ensure access to health care for all people without discrimination. In this regard, it highlights the following recommendations on the right to access to healthcare for trans, non-binary trans and gender-diverse people, which were set forth by the IACHR in the Report on Trans and Gender-Diverse People and their Economic, Social, Cultural and Environmental Rights (2020):

  • Promote the training of medical personnel on the needs of transgender people.
  • Combat prejudice and binary male and female stereotypes in access to health services.
  • Establish directives or protocols for the care of trans patients.
  • Guarantee health protocols for gender affirming care, including psychological, endocrinological, and surgical care.
  • Gender affirming care should be based on free, prior and informed consent and move towards being free of charge.
  • Prohibit and sanction activities that offer “therapies” to “modify,” “re-orient,” or “cure” people’s gender identity.

Trans Remembrance: Colonialism and Trans Resistance

Washington D.C., November 20, 2022 – Today, on Trans Remembrance Day, it is important to reflect on the memory of transgender and gender-diverse persons, their memory-building process, and the struggle to recover their stories and memories that were erased by colonialism. Therefore, the Institute on Race, Equality, and Human Rights (Race and Equality) joins in commemorating this date and asks various transgender and gender-diverse activists in Latin America about what colonialism represents in trans memory and how they reclaim their history.

The Independent Expert, Victor Madrigal-Borloz, recently presented the final report of his mandate focused on the impact of colonialism as one of the fundamental causes of violence and discrimination based on sexual orientation and gender identity (A/78/227), and how this has led to the creation of a stigmatized and binary memory of transgender populations in Latin America.

Latin American history is full of examples of how the region always preserves its memories and seeks new ways of remembering. In recent years, transgender and LGBTI+ persons, in general, have been fighting to recover, redefine, and remember their history. Furthermore, after armed conflicts and dictatorships that resulted in the erasure of human rights violations against the LGBTI+ persons, fulfilling this task of reclaiming memory takes us back to the beginning of the violent processes that stripped identities from many peoples during colonial occupation.

As the report indicates, colonization was a process of imposing systems of differentiation, hierarchy, and domination by a colonizing power over indigenous peoples. It also suggests that, after the decolonization process, a kind of continuation of the colonial project persists, which continues to discriminate against and harm transgender people. Before colonization, many communities did not use a binary gender approach or correlate anatomy with gender identity. Social hierarchies were not gender-dependent, and in certain communities, people had fluid gender identities, alternating between masculine and feminine roles. There were various sexual behaviors and gender expression fluidity, including homosexual relationships, transgender identities, and cross-dressing.[1]

As a result of colonialism spreading strict binary standards, gender identity-based violence plagues the region. Today, we see alarming figures from the Transgender Murder Monitoring (TMM) of Transgender Europe (TGEU), which indicates that between October 1, 2022, and September 30, 2023, there were 320 murders worldwide, of which 235 occurred in Latin America and the Caribbean.[2]

Bicky Bohórquez, from her experience as a Black transgender woman and activist for the Afro-descendant Foundation for Social and Sexual Diversities – Somos Identidad, mentions that the imposition of cis-heteronormative religiosity is one of the colonial manifestations that persist in Colombia.

“Religious conversion, the imposition of rigid gender binaries on colonized peoples, and the criminalization of sexual and gender diversity were strategies of colonial oppression,” as stated in the report, in line with Athiany Larios, a transgender feminist woman and human rights activist from Nicaragua, who says, “Colonialism is as relevant as ever. Many so-called experts and psychologists disqualify our feelings and label us as aberrant madmen with almost demonic ideas. We have been educated and taught under a misogynistic, macho, patriarchal scheme of what it means to be a man or a woman.”

In the case of Peru, although the artistry of the Moche and Chimu cultures depicted homosexual and affective behaviors as part of their daily lives, today, same-gender relationships in Peru are discriminated against.

One revealing aspect is that part of the repercussions left by colonialism—as stated in the Independent Expert’s report—is the acronym LGBTI, which cannot fully capture the diversity of sexualities and genders experienced by people in the sexual diversity community. Additionally, in some countries, laws like those used by colonial powers to impose binary gender norms are still in effect.

“We are nothing; they always censor us. When we look for jobs, they tell us there are none. And if they accept us, we have to dress as they say, as if God had brought us into this world. Personally, I disagree with the laws and the things that happen in this country regarding transgender persons. We, like everyone else, are human beings. We think, we have dreams, and desires to be heard,” says Carlos Hernández, a Cuban transgender man who coordinates the independent social project Por Siempre Trans.

In this regard, Race and Equality makes the following recommendations to States to respect and guarantee the rights of all transgender people:

  • Adopt the necessary laws and policies to change the name and gender on official identification documents to ensure the recognition, respect, and inclusion of transgender and gender-diverse persons in line with the standards of Advisory Opinion 24/17.
  • Systematically collect data on acts of violence and murders against transgender and gender-diverse persons, disaggregated by gender identity, sexual orientation, ethnic-racial identity, and age.
  • Implement a public policy with a gender perspective in investigations into violence and murders against transgender and gender-diverse persons, respecting the individual’s chosen name, gender identity, and establishing guarantees of non-recurrence.
  • Monitor and publicly penalize transphobic discourses reproduced in public and private institutions and in the media that promote discrimination and violence against transgender and gender-diverse populations.

[1] UN (2023). Report A/78/227. Available at:

[2] Transgender Europe’s Trans Murder Monitoring (TMM) 2023. Available at:

LGBTI+ Rights in Brazil: Impressions After the Visit of Roberta Clarke, IACHR Rapporteur

Brazil, October 9th, 2023 – In a promotional visit to Brazil facilitated by the Institute on Race, Equality and Human Rights (Race and Equality), Roberta Clarke, Rapporteur on the Rights of LGBTI People of the Inter-American Commission on Human Rights (IACHR), had the opportunity to dialogue with civil society organizations and LGBTI+ activists from Brasília, Fortaleza, and Rio de Janeiro. During the visit, which took place from September 18th to 22nd, the IACHR Rapporteur was able to closely monitor the reality of the Brazilian LGBTI+ population, which, between advances and setbacks, remains united as a social movement and in the struggle for the preservation of the rights achieved thus far.

The trajectory of Roberta Clarke’s visit beyond the Rio-São Paulo axis was a strategy adopted by Race and Equality after several hearings with civil society, which constantly demanded attention to the different realities of the LGBTI+ population in other parts of the country. Thus, together with the support of the Ministry of Human Rights, through the National Secretary for the Rights of LGBTQIA+ People, Symmy Larrat, the city of Brasília was crucial for meetings with ministerial offices and meetings with the LGBTI+ movement in the Federal District. It is worth mentioning that the state of Ceará, with one of the highest rates of murders of LGBTI+ people, especially trans people, according to the dossier released by the National Association of Travestis and Transgenders (ANTRA), was also part of the script for active listening with activists from the northeast region, and for having the ‘Sister Imelda Lima Pontes Prison Unit’,  aimed exclusively at the LGBTI+ prison population.

Acknowledging that it is still too early to draw opinions and conclusions on the LGBTI+ Rapporteur’s visit to the country, Race and Equality brings to its audience an overview of the impressions shared by Roberta Clarke after talking to more than 15 organizations of the LGBTI+ movement in the visited cities. The Rapporteur’s impressions about the LGBTI+ population in the country were also reported during the public event held in Rio de Janeiro; “Building Bridges: LGBTI+ People’s Rights in an Intersectional Perspective”, hosted by Race and Equality.

During the week in which the Commissioner was in Brazil, two issues concerning LGBTI+ rights – which have already been achieved – were under discussion at the national level. One of them refers to equal civil marriage, which, due to the advance of extreme right-wing politicians in the Brazilian Congress, has once again been questioned as to its validity. Since 2011 and 2013, the Supreme Court (STF) and the National Council of Justice (CNJ) have equalized same-sex civil unions with heterosexual civil unions; however, Bill No. 5,167/2009 aims to annul this right. Although it has been postponed twice due to pressure from LGBTI+ deputies, and the vote remains suspended, it may return to the agenda in Congress. The other agenda that was under discussion refers to a manipulation also orchestrated by the growing anti-trans ideology that created a movement to attack the use of unisex bathrooms. The fomentation of intolerance on the part of conservative political actors has created a false idea that this was an urgent agenda item to be voted on.

These facts, for the Commissioner, reflected another Brazilian reality, since among the countries in the region, Brazil stands out among those that have made the most progress on LGBTI+ rights. In this regard, Roberta Clarke expressed concern about what is happening in the country and, particularly, about the issue of gender-based political violence, a topic that has been repeatedly denounced before the IACHR. For her, the spread of hate speech and the growth of the anti-trans movement has led to the need for reflection and the need to work together between social movements and LGBTI+ leaders. That is, to organize strategically to understand when it is worth expending efforts to the attacks of conservatives who aim only to spread fake news to dismantle civil society and interrupt the progress of the LGBTI+ political agenda.

In the face of these setbacks, the Commissioner demonstrated her solidarity and highlighted that the opportunity of having experienced different perspectives from across the country made her understand, in an intersectional way, the various types of violence that differentially affect the LGBTI+ community. While acknowledging the progress achieved through the historic struggle for visibility and rights, listening carefully to activists revealed that there is still much to be done. The country’s current situation has shown that there is strong pressure from the far right to destroy the progress made through gender equality policies and the recognition of LGBTI+ rights, and how through the spread of hate speech, trans people feel increasingly threatened and forced to live without access to basic rights.

Thus, Roberta affirmed the IACHR’s commitment to pay close attention to what happens in the country in the coming months, given that Brazil is a country of continental dimension and what happens in its territory has political influence on the entire region.

In her dialogue with the LGBTI+ social movement, the Rapporteur expressed concern about the difficulties reported in the documentation required for the process of civil rectification of name and gender; the various forms of violence against lesbian women; and the gap in the provision of public policies that meet their specificities, from the lack of data collection to the absence of health policies. In addition, lesbian women strongly emphasized the social exclusion they experience when they show affection in public, corrective rape practices, and conversion therapies, in addition to being expelled from their homes when they openly embrace their sexual orientation.

From the conversation with transmasculine people, the Commissioner was able to perceive how the violence they face is crossed mainly by issues of race, class, and territory, especially with regard to police violence. In Ceará, the theme of education was a major motto among LGBTI+ activists, highlighting the need for school inclusion policies since many LGBTI+ students abandon their educational institutions, either due to LGBTIphobia, bullying, disrespect for gender identity, among other forms of discrimination, and some do not even complete elementary school. In this context, on September 19th, the National Council for the Rights of the LGBTQIA+ Population published a resolution establishing guidelines to ensure inclusion and respect for gender identity in educational institutions.

In Brasilia, in addition to meetings with ministerial offices, Roberta Clarke met with the board of directors of the National LGBTQIA+ Council and had the opportunity to learn about the current demands of the LGBTI+ political agenda, in view of the democratic resumption in the country. The meeting with activists from the region took place in the Drag District with a round table that discussed topics such as the need for social assistance policies for the LGBTI+ population, such as the promotion of shelters and access to healthcare for the trans population.

During her visit to Rio de Janeiro, the Commissioner received a report from the Brazilian Lesbian Articulation (ABL) about lesbian women in the country; and received the ‘Dossier on Lesbocide’, after talking to one of the authors. In addition, she was given the dossiers on murder and violence against Brazilian travestis and transgender people in 2022; and the ‘Trans Brasil’ dossier, on their situation in the prison system, both documents being produced by ANTRA.

Finally, Race and Equality is deeply grateful to the Brazilian LGBTI+ movement that mobilized activists from different regions of the country so that they could convey to the IACHR Rapporteur their life experiences and their trajectories of struggles for rights in a country where being and existing as an LGBTI+ person is an act of courage. We also thank the IACHR for accepting our invitation and engaging in dialogue with the Brazilian LGBTI+ civil society movement. In view of our mission, encouraging visits by rapporteurs and experts from international mechanisms is another step in ensuring visibility, non-discrimination, and the full realization of human rights. Therefore, we ask the IACHR to consider the following recommendations for the Brazilian State:

1 – Creation of a National Council to confront hate speech and the dissemination of fake news with an intersectional perspective, in view of the violence and attacks suffered by the LGBTI+ population in the country.

2 – Establishment of policies and bills that constitutionally guarantee same-sex equal marriage, in addition to guaranteeing the safety of trans people in public bathrooms according to their gender identities and the plurality of unisex bathrooms.

3 – Collection of disaggregated data regarding the LGBTI+ population, either through the National Census or through surveys that foster the creation of specific public policies for this population.

4 – Training and education policies aimed at public security forces so that they can ensure the safety of Brazilian LGBTI+ people.

5 – Construction of a policy to confront gender-based political violence, with the provision of measures to protect LGBTI+ members of Congress.


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