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: https://www.ohchr.org/en/documents/thematic-reports/a78227-protection-against-violence-and-discrimination-based-sexual

[2] Transgender Europe’s Trans Murder Monitoring (TMM) 2023. Available at: https://transrespect.org/es/trans-murder-monitoring-2023/